Psychotropic Medication Patterns for American Indian Children in Foster Care

Abstract

The results of this study show that non-EA children, in particular AI children, were dispensed psychotropics both overall and across different medication classes less often compared to other racial groups. While the reasons for this difference are not known, future studies are needed to address whether mental health needs of all children in foster care are being appropriately addressed, accounting for need and patient preference.

Predisposing, Enabling, and Need Factors Associated with Psychotropic Medication and Mental Health Service Use among Children in Out-of-Home Care in the United States: A Scoping Review

“…Among the 22 included studies, 8 studies examined predictors associated with psychotropic medications [ 10 , 37 , 38 , 39 , 40 , 43 , 47 , 48 ], whereas 16 studies examined factors associated with the use of mental health services [ 9 , 10 , 38 , 42 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. Of note, two studies examined both outcomes in the same article (i.e., [ 10 , 47 ]).…”

“…Regarding predisposing factors associated with the use of psychotropic medications, race was a significant predictor, and the directions of the associations were mixed (positive for White and youth of color: [ 38 , 47 ]; and negative for African American, American Indian, and youth of color: [ 10 , 43 ]). McMillen and Raghavan (2009) suggested that youth of color were more likely to discontinue the use of medication, which explained why they had a different direction for this association.…”

“…Results across studies suggest that White children were more likely to use psychotropic medications than children of color. In addition, we identified that child age (negative for younger than 13 compared to older than 13, ages 5–9 compared to ages 15–17, and based on age at the entrance to foster care: [ 38 , 43 , 47 ]; positive for ages 6–12 compared to ages 13–21 and continuous age: [ 40 , 41 ]); gender (positive for male: [ 43 ]; negative for male: [ 47 ]); history of penetrative sexual abuse (no sexual abuse history as reference: [ 47 ]); history of physical neglect (no physical neglect history as reference: [ 47 ]); and beliefs in the usefulness of medication (positive: [ 48 ]) as significant factors. Brenner et al’s (2014) finding on the relationship between age and use of medication differed from the other studies in that younger children were less likely to use medications than older children.…”

Stranded on Antipsychotics: Role of the Pediatric Clinician

“…4,5 Off-label use of antipsychotic medications in pediatric patients increased rapidly through the 2000s, leveling off in 2008. 6 Off-label use occurs more frequently in vulnerable populations, including children in foster care, 7,8 children with Medicaid, 9,10 minority children, 11 and children with intellectual disabilities. 12 Some states have implemented stringent oversight programs to reduce and monitor prescriptions for psychotropic medications in general and antipsychotic medications in particular.…”

Reasons why Prescribers Decrease Psychotropic Medication for Foster Youth

“…Some youth in state custody are at higher risk for being prescribed psychotropic medication, including older youth and youth with a history of physical or sexual abuse (Raghavan & McMillen, 2008). Additionally, rates of psychotropic medication use in foster care have been shown to differ across race and increase with time spent in foster care ( Glesener et al, 2018 ).…”