Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Abstract

Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

Psychopathology and mental health service use among youth in foster care admitted to a psychiatric inpatient unit: a 4-year retrospective controlled study

“…Another notable finding was the high rate of prescription of psychotropic medications among the FC sample, with 98.9% of these subjects taking one or more of these medications; this is consistent with findings from other studies on out-of-home care [ 49 , 54 ]. These findings indicate that psychotropic medication may be prescribed at particularly elevated rates to youth in FC with a history of hospitalisation.…”

“…Given the recognition of existing deficits in mental health services and the barriers to receiving community-based treatment, the increased use of acute health services is of particular concern as it suggests that the existing mental health service model is not appropriate and that the needs of this specific population are not being fully met. Addressing these disparities in service use is an important step toward building a more evidence-based and specialist community-based mental health system, as generic services do not do justice to the complexity of these children [ 49 ]. Additionally, improving the adequacy and quality of care of current services, both in the inpatient unit and in the emergency department, should be a priority.…”

“…The study also points out the difficulty of institutions in facilitating the provision of mental health care and treatment to these children under the same conditions as those living in the household. All stakeholders should invest in evidence-based psychosocial interventions to address behavioural needs and potentially lessen psychotropic medication use and hospitalisation rates [ 49 ].…”

Antipsychotic medications and admission to psychiatric residential treatment facilities among youth in foster care diagnosed with disruptive behavior disorders.

“…These may constitute a safer and underutilized opportunity for reducing the risk of PRTF admission. Although many youth with externalizing disorders receive some form of psychotherapy, a recent study indicated that psychotherapy models typically used were not evidence-based, nor did these services tend to include caregiver training (Leathers et al, 2021). For youth in foster care, several practices and programs for treating aggressive behavior have been found to be effective, including multisystemic therapy, cognitive behavioral therapy, dialectical behavior therapy, and parental management training (e.g., Triple P; Ghosh et al, 2017; Miller et al, 2013).…”

“…Clinical guidelines call for the treatment of DBDs with APs adjunctively only after psychosocial and non-AP psychotropic medications have been applied (American Academy of Child and Adolescent Psychiatry [AACAP], 2009[AACAP], , 2011. Although several psychosocial interventions, including Triple-P and cognitive behavioral therapy have been shown to be effective at treating forms of DBD, the clinical guidelines calling for these therapies prior to prescribing are not universally followed (Aitken et al, 2018;Daviss et al, 2016;Ghosh et al, 2017;Leathers et al, 2021;Patel et al, 2006).…”