Appropriate Use of Psychiatric Medication for Youth in Foster Care

Approved by Council October 2018

Background

Foster youth are more likely than their non-foster peers to be prescribed psychiatric medications.[i] Determining whether a medication regimen is appropriate is an important yet challenging task. While much attention has appropriately been devoted to high prescribing rates, foster youth are also at risk for unidentified and untreated behavioral health concerns.[ii],[iii],[iv] Determining the appropriateness of prescribing patterns entails more than comparing utilization rates of foster youth with non-foster youth. Some degree of higher prescribing may be appropriate given the increased mental health needs of foster youth.

Recommendations

The American Academy of Child and Adolescent Psychiatry (AACAP)

  • Advocates for the judicious use of psychiatric medication, as part of a comprehensive treatment plan, for foster youth diagnosed with a psychiatric illness. Caution should be exercised to ensure that medications are not being used in place of effective psychosocial interventions to support foster youth in addressing their emotional and behavioral problems.
  • Recommends consulting with a child and adolescent psychiatrist when foster youth psychiatric prescription concerns arise.
  • Supports more research into how best to treat the behavioral conditions most common to foster youth, training on those interventions, and advocacy to better address the complex behavioral health needs of foster youth.

Practical and Concrete Implications of the Policy

Child and adolescent psychiatrists should support child welfare agencies' responsibility to develop evidence-based mental health resources for foster youth. Specificially, where possible, they should ensure that foster care youth are receiving appropriate behavioral health services in general including psychotropic medication where indicated. Child and adolescent psychiatrists may also serve as consultants to child welfare agencies when concerns arise over the appropriate use of psychiatric medications.

[i] Lee T, Fouras G, Brown R. Practice parameter for the assessment and management of youth involved with the child welfare system. Journal of the American Academy of Child and Adolescent Psychiatry. 2015;54:502-517.
[ii] Stein REK, Hurlburt MS, Heneghan AM, et al. For better or worse? Change in service use by children investigated by child welfare over a decade. Acad Pediatr. 2016;16:240-246.
[iii] Zima BT, Bussing R, Crecelius GM, Kaufman A, Belin TR. Psychotropic medication use among children in foster care: Relationship to severe psychiatric disorders. Am J Public Health. 1999;89:1732-1735.
[iv] Leslie LK, Raghavan R, Zhang J, et al. Rate of psychotropic medication use over time among youth in child welfare/child protective services. J Child Adolesc Psychopharmacol. 2010;20:135-143.
[1] Alavi Z, Calleja NG. Understanding the use of psychotropic medications in the child welfare system: Causes, consequences, and proposed solutions. Child Welfare. 2012,91: 77-94.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.