Youth in the foster care system are more likely to be prescribed two or more psychiatric medications than other youth covered by Medicaid, according to a report published this week in JAMA Pediatrics.
“High rates of psychotropic prescription are concerning because of the limited safety and efficacy data for individuals younger than 18 years,” wrote Sarah Lieff, Ph.D., M.P.H., of Mathematica and colleagues at the U.S. Department of Health and Human Services. Mathematica is a research and data analytics consulting firm.
The researchers analyzed data from the 2019 Centers for Medicare & Medicaid Services’ Transformed Medicaid Statistical Information System Analytic Files, which contained information on Medicaid Children’s Health Insurance Program (CHIP) beneficiaries aged 3 to 17 years from all 50 U.S. states as well as Washington, D.C., Puerto Rico, and the U.S. Virgin Islands. To be included in the analysis, the youth had to have been covered by Medicaid for at least six consecutive months in the year.
The final study sample included 719,908 youth in foster care and 31,473,608 youth covered by Medicaid who were not in foster care. The researchers compared the rates of psychotropic medication and psychotropic polypharmacy (defined as prescription of two or more classes of psychiatric medications) between these two groups of youth, as well as diagnoses of mental health conditions.
Among youth in the foster care group, 26.25% had been prescribed a psychotropic medication and 13.27% were prescribed two or more psychotropic medications compared with 9.06% and 3.11%, respectively, among other Medicaid-enrolled youth.
The most common class of psychotropic medication prescribed to youth in the foster care group was stimulants (15.95%), followed by antidepressants (9.88%), and antipsychotics (7.87%). The most common medications prescribed to the other Medicaid-enrolled youth were stimulants (4.41%), antidepressants (2.75%), and antipsychotics (1.74%).
In the foster care group, 42.85% had a diagnosed mental health condition compared with 13.53% in the other group. Trauma or stressor-related disorder, attention-deficit/hyperactivity disorder, and behavior or conduct disorder were the most common mental health diagnoses in the foster care group.
“Given safety concerns and uncertainties about these medications’ long-term effects on brain development and metabolic adverse effects, judicious prescribing of psychotropic medications for child welfare–involved children remains a policy challenge,” Lieff and colleagues wrote. “Guidance on safe prescribing and oversight of psychotropic medication use in the child welfare system has been issued at the federal level; however, implementation at the state level varies and may benefit from further policy initiatives.”
For related information, see the Psychiatric News article “Antipsychotic Use in Children Declining, But Concerning Trends Remain.”
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