| Description |
- Background:
Deterioration of children's mental health during the pandemic resulted in the declaration of a national emergency. High rates of psychotropic prescribing among children within the foster care system has been a target of federal and state policies over the last two decades. This study evaluates psychotropic medication use for children in foster care with mental health diagnoses facing significant barriers to placement through a collaboration with state-level, cross-divisional case-review team.
Methods:
This is a retrospective descriptive analysis of cases referred for a cross-disciplinary review from July to December 2022. This analysis includes cases identified by county child welfare (DSS) offices as having significant barriers to placement and delivery of mental health services. Rurality was determined by the United States Department of Agriculture's rural-urban commuting area (RUCA) classification.
Results:
Of 108 cases presented, the median age of the children reviewed was 15. Fifty percent identified as White, 41% as Black/African American, 6% as Multiracial, and 3% as Hispanic. Most common mental health diagnoses were PTSD (37%), ADHD (32%) and DMDD (26%). Seven percent were prescribed two antipsychotics, 4% were prescribed a combination of two mood stabilizers and 22% were prescribed a combination of at least one mood stabilizer and one antipsychotic; which were defined as high-risk medication regimens. Prevalence of autism was 5%, bipolar disorder was 7% and psychotic disorders were 2%.
Forty-nine percent of children in rural counties received high risk prescribing compared to 44% in non-rural counties. Over half of children (56%) who identified as Black/American, Multiracial or Hispanic received high-risk prescribing compared to those who identified as White (37%).
Conclusions:
Medication oversight has focused on antipsychotics. Results suggest that use of mood stabilizers more broadly needs further evaluation. Racial and rural disparities exist in the prescribing of psychotropic medications among children with mental health needs within the foster care. Further evaluation is needed to understand the causes, as well as diagnostic indications for antipsychotics and mood stabilizers.
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