A landmark report from a multi-state study on psychotropic medication oversight in foster care has been issued by the Tufts Clinical and Translational Science Institute (CTSI).
Led by Laurel K. Leslie, MD, MPH at Tufts CTSI, Christopher Bellonci, MD at Tufts Medical Center and Justeen Hyde, PhD at Cambridge Health Alliance, the study examined state policies and practices in 47 states, including Massachusetts, and the District of Columbia regarding the use of medication for treating behavioral and mental health problems in foster care children and adolescents ages 2 to 21 years.
Over the past decade, psychotropic medication use in the general youth population has more than doubled. Estimated rates of psychotropic medication use in foster care youth, however, are much higher (ranging from 13-52%) than those in the general youth population (4%).
The majority of states in the multi-state study reported an increasing trend in the use of psychotropic medications among youth in foster care, specifically regarding: Increased use of antipsychotics, antidepressants, and attention-deficit hyperactivity disorder (ADHD) medications;Increased polypharmacy (the use of more than one psychotropic medication at the same time); Increased medication use among young children; and Increased reliance on giving medications "as needed" and "blanket authorizations" for such drug use in residential facilities.
Officials in some states felt that this increase partially reflected demand by foster parents, schools, and other stakeholders. Others felt that reimbursement and time pressures in the healthcare system encouraged medication use. A few states, however, indicated a decrease in medication use in their states and thought that these changes reflected policy and practices implemented over the last several years.
Many child welfare officials understood that medication plays an important role in addressing mental health problems. However, officials were concerned that medications were being used to manage problems that might respond as well, or better, to psychosocial treatments.Funded by the Charles H. Hood Foundation and the National Institute of Mental Health-funded Child and Adolescent Services Research Center in San Diego, the study involved interviews with state child welfare agency key staff as well as a review of existing policies and guidelines available on state public websites or provided by staff. The Study Report and specific tools developed by states are available online at http://www.tuftsctsi.org/About-Us/CTSI Components/Community-Engagement.aspx. The Study Report was funded by the William T. Grant Foundation and Tufts CTSI.
States that participated in the study include: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.