Children in foster care much more likely to be prescribed psychotropic medications

One in every three children in foster care are on psychotropic medications designed to alter their mental status or mood, a significantly higher percentage than children who are not in foster care within the Medicaid program.

That is one of the findings of a study abstract, "Psychotropic Medication Usage Among Foster and Non-Foster Youth on Medicaid," that will be presented during the virtual American Academy of Pediatrics 2021 National Conference and Exhibition.

About 8% of children on Medicaid who are not in foster care are prescribed psychotropic medications, in comparison to the 35% of those in foster care, according to an analysis of Medicaid managed care organizations in southeast Texas. The dramatic differences in the prevalence of psychotropic medication use persist across all age groups, the research found. 

"The overprescribing of psychotropic medications to children in foster care is something I feel every day in my clinical practice, but it's different to see it on paper," said the author, Rachael J. Keefe, MD, MPH, FAAP, medical director for Foster Care Clinical Service at Texas Children's Hospital and assistant professor of pediatrics—public health at Baylor College of Medicine.

"It's especially shocking to see these dramatic differences in children of preschool and elementary age," Dr. Keefe said.

The study included 388,914 children in Medicaid and 8,426 children in foster care, ages 18 and younger.

Children in foster care were younger than children in Medicaid (mean age 7.7 years vs. 8.2 years (p<0.000), respectively).

The author analyzed records of those who had at least one healthcare visit generating a Medicaid claim from July 1, 2014 to June 30, 2016. Prescription medications were categorized into six classes: alpha agonists, anxiolytics, antidepressants, antipsychotics, mood stabilizers, and stimulants. Drug classifications were based on the primary indication as approved by the Federal Drug Administration or their primary use in child psychiatry.

Among children prescribed psychotropic medication, children in foster care are on medications in more distinct drug classes than non-foster children in Medicaid.  Across six drug classes, the prevalence of psychotropic medication use is 2-27 times higher among children in foster care as compared to non-foster children in Medicaid,

Dr. Keefe will present the study abstract at 4:15 pm Monday, October 11, 2021.