Psychiatric Services Preceding Initiation of Antipsychotic Medication Among Youth in Foster Care

Spence, O’Mareen; Castillo, Wendy Camelo; Reeves, Gloria; dosReis, Susan

doi:10.1089/cap.2018.0109

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Concerns over the overutilization of psychotropic medications in children in foster care has led to the development of federal and state policies to promote greater oversight of psychotropic medication use in children and youth and now almost all states employ some mechanism to monitor psychotropic medication use in children in foster care [ 9 , 10 , 18 , 45 , 46 ]. In addition, many states have programs that prospectively or retrospectively monitor psychotropic medications for all children on Medicaid [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

et al. 2021

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Background The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. Methods A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. Results High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. Conclusions Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

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Section: Discussionmentioning

confidence: 99%

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

et al. 2021

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“…Prevalence comparisons across studies should be interpreted carefully given that some definitions of DBD used in the literature include ADHD (e.g., Spence et al, 2019; Vanderwerker et al, 2014). Others include certain mood disorders (e.g., disruptive mood dysregulation disorder) and broader externalizing disorders in children (Ghosh et al, 2017; Keil & Price, 2006; Spence et al, 2019). A meta-analysis of mental disorders among children in the child welfare system, using a definition that included nonspecific disruptive disorders, reported a DBD prevalence rate between 15% and 39% with an average of 27% (Bronsard et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…DBD co-occurs with many other disorders, including attention deficit hyperactivity disorder (ADHD), and is often related to these disorders through etiology (Ghosh et al, 2017). Prevalence comparisons across studies should be interpreted carefully given that some definitions of DBD used in the literature include ADHD (e.g., Spence et al, 2019; Vanderwerker et al, 2014). Others include certain mood disorders (e.g., disruptive mood dysregulation disorder) and broader externalizing disorders in children (Ghosh et al, 2017; Keil & Price, 2006; Spence et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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

Rose¹,

Lanier²,

dosReis³

2022

American Journal of Orthopsychiatry

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Many youth in foster care are diagnosed with disruptive behavior disorder (DBD), a diagnosis indicative of aggression and behavior problems. These youth, who are at high risk for being placed in psychiatric residential treatment facilities (PRTF), are commonly prescribed antipsychotic (AP) medications off-label. However, treating children in the community is an important goal, and although AP medications can have severe side effects, these prescriptions may help to achieve this goal. In this study, we used Medicaid data to determine whether AP medications reduce the risk of admission to PRTF among two groups of children with DBD: those with DBD only and those who were diagnosed with DBD in addition to at least one of two conditions indicated for AP prescribing (psychosis and bipolar disorder.) Event history models show that AP medications are associated with a high rate of admission, which are likely due to the higher mental and behavioral health needs of youth who are prescribed. However, youth diagnosed with both DBD and indications who are prescribed an AP medication have one-tenth the rate of admission of similar youth who are not prescribed. For youth with DBD only, the findings are inconclusive. Given these mixed results, practitioners should follow clinical guidelines; ensuring youth are treated with psychosocial interventions and other psychotropic medications prior to AP prescribing. Agencies should attempt to address systemic factors such as shortages of foster homes, increased availability of therapeutic foster care, and implementation of in-home prevention services. Public Policy Relevance StatementThis study suggests that some youth in foster care diagnosed with disruptive behavior disorder may benefit from antipsychotic medications, helping to keep them in the community and out of psychiatric residential treatment. In the context of the health risks associated with these medications in youth, however, these youth should be provided appropriate psychosocial and preventive treatments. aaa Y outh in foster care have high rates of behavioral disorder diagnoses, including disruptive behavior disorders (DBD), relative to youth not in foster care. If untreated, many youth with DBDs may require care in settings such as psychiatric residential treatment facilities (PRTFs), a restrictive and medically supervised form of residential placement for youth under 21. Although medical necessity is a prerequisite for admission, experiences with child protective services and out-of-home placements independently predict admission: most CPS investigations do not result in removal; some youth placed in foster care come from the juvenile justice system or voluntary placement; and both of these characteristics may proxy for other unobserved characteristics (Lanier & Rose, 2017). Further, a systematic review argues that PRTF placements are a costly residential setting (more than $55,000 per year per resident) in which This document is copyrighted by the American Psychological Association or one of its allied publishers.This...

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Psychiatric Services Preceding Initiation of Antipsychotic Medication Among Youth in Foster Care

Cited by 2 publications

References 23 publications

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

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

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