New Study Examines Antipsychotic Treatment in Foster Care

A new study, Antipsychotic Treatment Among Youth in Foster Care, examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth. The study looked at a sample of roughly 17,000 youth who were continuously enrolled in Medicaid program and had at least one psychiatric diagnosis and one antipsychotic prescription. Most of the children in the study were in foster care, some also had a disability, and the others were adopted out of foster care during the study period. For comparison, the researchers also looked at kids on Medicaid who had disabilities or were receiving Temporary Assistance for Needy Families, but were not in foster care.

They found that more than a third of the kids in foster care without disabilities had multiple antipsychotic prescriptions lasting longer than 90 days. The children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care. In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

The findings suggest that children in foster care are being prescribed antipsychotic drugs just as frequently as some of the most disabled children on Medicaid. The authors recommend that additional studies are needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youth in the foster care system.

While statistics suggest that up to 80% of all children in foster care have serious emotional problems, approximately half of them have chronic medical problems, and the youngest, those ages 0-5, have developmental delays, experts believe that doctors are this population with the same powerful drugs given to people with schizophrenia and severe bipolar disorder, even though there is no evidence to support this kind of use in young children, and despite the fact that these disorders are rare in young children.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the utilization of psychotropic medication for children in foster care.  In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.

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