25-45% of youth in foster care take psychotropic medications. 4% of youth in the general population take psychotropic medications. What is the significance of these numbers?

Lawyers, doctors, social workers, judges, researchers and policy makers are increasingly asking this question because of concerns that are unique to youth in foster care:
  • Youth in foster care have greater mental health needs than most other youth populations;
  • Youth in foster care are unlikely to have a consistent caregiver or involved parent who manages the child’s health care and makes informed decisions about medications and treatment;
  • Youth in foster care often experience multiple placement moves and see different doctors with each placement change;
  • These youth often do not receive complete physical and psychiatric exams at recommended intervals;
  • Youth in foster care often do not have proper follow-up when medications or other therapies are prescribed;
  • Youth in foster care who take psychotropic medications often take multiple medications;
  • Most psychotropic medications do not have FDA approval for use in children;
  • Studies do not exist that detail the long-term health impact of psychotropic medications on children;
  • Youth in foster care often do not have a coordinated mental health plan that considers nonpharmacological treatments instead of or in addition to psychotropic medications.
Given their unique vulnerabilities, what do youth in foster care need to improve their mental and physical health? Many experts have responded to this question in the last three years:
  • Mental health experts and adults who grew up in foster care testified before Congress in 2008 and 2010;
  • the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Child Welfare League of America issued policy statements and recommendations;
  • Several universities and the federal government published new findings and examples of promising state practices related to mental health services for youth in foster care.
Georgia is currently addressing this issue. Pending legislation would require state agencies to create an independent review system for psychotropic drugs for youth in foster care. The bill’s sponsor, Representative Mary Margaret Oliver, wrote an op-ed explaining the need for the bill.

The bill is supported by research and recommendations from the Georgia Court Improvement Project (the Georgia Supreme Court Committee on Justice for Children) policy paper,
Psychotropic Meds for Georgia Youth in Foster Care: Who Decides? The paper, which came out of the Committee's Cold Case Project, provides an overview of psychotropic medications and youth in foster care, summarizes the national studies and reports on the topic, describes what states are doing to address the issue, and makes recommendations for Georgia. The paper includes a lengthy reference section with links to helpful resources.

Several states have created specific protections for children who are prescribed psychotropic medications. Information on these practices and how they are helping youth receive appropriate and necessary mental health services can be found in the resources listed below.

Recent studies

Tufts Clinical and Translational Science Institute, September 2010, Multi-State Study on Psychotropic Medication Oversight in Foster Care (describes 47 states’ policies and guidelines for psychotropic medication oversight).

Rutgers University Center for Education and Research on Mental Health Therapeutics and the Medicaid Medical Directors Learning Network, June 2010, Antipsychotic Medication Use in Medicaid Children and Adolescents: Report and Resource Guide From a 16-State Study and State Practices: 36 State Practices to Improve AP Medication Safety and Quality.

Government Accountability Office, February 2009, Foster Care: State Practices for Assessing Health Needs, Facilitating Service Delivery, and Monitoring Children’s Care (examines 10 states’ approaches to improving health care services for youth in foster care).

Selected Policy Statements and Recommendations

American Academy of Pediatrics

American Academy of Child and Adolescent Psychiatry

Child Welfare League of America
  • 2003: Best-Practice Framework for Addressing the Mental Health and Substance Abuse Needs of Children and their Families
  • 2006: Integrating Systems of Care: Improving Quality of Care for the Most Vulnerable Children and Families (with the Robert Wood Johnson Foundation)
  • 2007: revised Standards of Excellence for Health Care Services for Children in Out-of-Home Care (with the American Academy of Child and Adolescent Psychiatry)

Sample state policies and guidelines

Arizona Division of Children Youth and Families, Psychotropic Medication: A Guide for CPS Specialists and Licensed Caregivers (November 2009)

Arizona Department of Health Services Practice Protocol: Informed Consent for Psychotropic Medication Treatment (November 2007)

Florida Medicaid Drug Therapy Management Program for Behavioral Health

Illinois collaboration between the Division of Guardian and Advocacy and the University of Illinois at Chicago College of Medicine Department of Psychiatry

Massachusetts Department of Mental Health Psychoactive Medication for Children and Adolescents: Orientation for Parents, Guardians, and Others (January 2005)

Texas Department of Family and Protective Services Psychotropic Medication Parameters for Foster Children (December 2010)

Texas Department of Family and Protective Services STAR Health and Other Medical Services Project


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