A recent study sheds more light on a known medical anomaly in the US child welfare system.
What the study says
According to a research letter published in August, children in the U.S. child welfare system, which includes youth in foster care or foster care, are more likely than other Medicaid children to receive psychotropic medications (ie, medication that helps with behavior or mood disorders such as anxiety, depression, or bipolar disorder) without receiving psychotherapy or behavioral intervention.
The study, which was conducted from July 7 to September 29, 2022, used data from 2019 from a national database that included all Medicaid Children’s Health Insurance Program (CHIP) beneficiaries ages 3 to 17 who were enrolled for at least six consecutive months that year.
It found that 26.25% of children and adolescents in the child welfare system had a prescription for psychotropic medication and 13.27% had two or more prescriptions for psychotropic medication compared to 9.06% and 3.11%, respectively, to other youth who were enrolled in Medicaid.
Stimulants (used to treat disorders such as attention deficit hyperactivity disorder) were the most common drugs in the child protection group (15.95%), followed by antidepressants (9.88%) and antipsychotics (7, 87%).
Furthermore, 42.85% of children and adolescents in child protection had a diagnosed mental health condition, with trauma or stress-related disorder (22.93%), attention deficit/hyperactivity disorder (21.49%) and conduct disorder or behavior (11.67%) are the most common diagnoses.
What do the experts think?
Dr. Louis Krauss, director of the division of child and adolescent psychiatry at Rush University Medical Center in Chicago, who was not involved in the study, told Yahoo Life that he was not at all surprised by the study’s findings.
Children in foster care are at greater risk for developmental and psychiatric disorders, [and] as a result, they are more likely than the general population to be on psychotropic medications, Kraus says. And because of the foster care process, multiple foster home placements, noncompliance with medical follow-up, and difficulties in obtaining child psychiatrists, these children will be at greater risk of taking multiple medications.
Dr. Rachel J. Her own 2021 research, which looked at psychotropic medication use among children in foster care in southeast Texas, confirmed the results of these studies and revealed alarming statistics.
Across six drug classes, the prevalence of psychotropic medication use was 2 to 27 times higher among children in foster care compared to non-foster children covered by Medicaid, and these differences persisted across age groups, she told Yahoo Life about her research. The overprescribing of psychotropic medications to children in foster care is a daily concern in my clinical practice, but it becomes even more poignant when I see it on paper.
Why is it important?
Keefe points out that while it is common for children in foster care to take two or more psychotropic medications, there is limited data on whether they are safe and effective. Prescription guidelines and supervision rules for children in foster care are also not uniform across states and are often not well followed.
Kraus says this recent study highlights the importance of young people in the child welfare system seeing a specialist when needed. Often, says Krauss, children in foster care are treated by multiple general practitioners and physicians rather than a child psychiatrist, which can lead to multiple diagnoses and prescriptions.
If you have an eye problem, you probably won’t see your pediatrician; you’re going to see an ophthalmologist,” he says. “It shouldn’t be any different when a child has problems; they should see a child psychiatrist.
After being prescribed medication, many youth in foster care may not have a follow-up appointment for months, but Krauss says regular visits are key to making sure the treatment is working. He adds that while medications can play an important role, they should not be an automatic solution and cannot replace other psychiatric services.
If a child has behavioral problems, is another medication the best answer? Or is it helpful to try to figure out programming to help them try to get additional services through their school system, he asks. Psychotropic medications are very important for children who need them, but you must watch and monitor these children carefully. If you start a drug and it’s not helpful, you’ll take them off of it. You are not adding another.
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