Psychotropic Medications

Oversight of the Administration of Psychotropic Medications to Youth in Foster Care

The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub. L. No. 110-351), required state child welfare agencies to develop a plan for the ongoing oversight and coordination of health care services for children in foster care. Subsequently, the Child and Family Services Improvement and Innovation Act (Pub. L. No. 112-34) amended the law by adding requirements specifying that the plan must include an outline of protocols for the appropriate use and monitoring of psychotropic medications.

With that charge, the Barton Center formed a collaboration with Casey Family Programs, the national's largest operating foundation focused entirely on foster care and improving the child welfare system, the Supreme Court of Georgia Committee on Justice for Children, the Georgia Division of Family and Children Services, and other child advocacy partners, including the Child Welfare Collaborative, and Georgia EmpowerMEnt, to examine and improve upon this systemic issue in Georgia.

“Tommy’s” story, first featured in a November 2010 Atlanta Journal Constitution editorial by Representative Mary Margaret Oliver, inspired the Barton Center’s efforts.

Georgia Psychotropic Medication Monitoring Project

Psychotropic medications act upon the central nervous system to affect brain function, resulting in changes to a child’s mood, behavior, consciousness, perception, and cognitive function.  Largely due to early childhood trauma, children in foster care are at higher risk for emotional and behavioral challenges.  The effect of this trauma is compounded by the family disruption and lack of support experienced as the child enters foster care.  While in foster care, multiple placement changes, overreliance on emergency room care, lack of proper psychiatric assessment and reassessment, and gaps in the system of care impede longitudinal health care coordination and further increase the risk of poor health outcomes for this vulnerable population.  Consequently, youth in foster care often accumulate multiple psychiatric diagnoses and are prescribed psychotropic medications more often, in higher doses, and in greater combinations than other youth populations.  Recently published national studies report that the use of psychotropic medications is 3-4 times higher in the foster care population than in a comparable population of low-income, Medicaid-eligible youth.

In 2011, the Barton Center and its partners took a closer look at this issue in Georgia through a year-long project to examine the state’s capacity for oversight of the administration of psychotropic medications to children in foster care.  The Georgia Psychotropic Medication Monitoring Project included comprehensive medical and legal research; review of agency policies; clinical review of select foster care cases and consultation by an independent child psychiatrist; and training for caseworkers, foster parents, attorneys, judges, and Court Appointed Special Advocates.

The Project found that approximately one-third of the children in Georgia’s foster care system were prescribed at least one psychotropic medication, and almost 5% were prescribed at least 4 different psychotropic medications during the course of the year.  Many factors contribute to this complex problem, which requires a multi-agency response.

Read the Barton Center's final report and recommendations.

Many of these recommendations have been adopted or are in the process of being implemented, resulting in the hiring of the first DHS Medical Director, policy clarifications, uniform procedures, automation of health records, routine data collection and analysis, and clinical support to caseworkers.  Despite these early efforts, however, utilization of psychotropic medications remains high.  A recent analysis conducted by DFCS using Medicaid Claims Data shows that 27% of children currently in foster care are prescribed at least one psychotropic medication.  However, the use of antipsychotic medications seems to have declined.

Review a sample of presentations and publications on this important and complex issue by clicking on the titles below.

Evaluating the Use of Psychotropic Drugs in Georgia's Foster Care System
Georgia's Psychotropic Medication Monitoring Project
Medical Welfare is Child Welfare: A Trauma-Informed Approach to Children in Foster Care
Medicating Trauma
Psychotropic Medication of Our Clients: What's to Be Done?
Psychotropic Medications for Youth in Foster Care: Who Decides?
Youth in Foster Care and Psychotropic Medications: Strategies to Improve Health Outcomes

Examine press coverage by clicking on the name of the article below. Additional articles will be forthcoming.

"New Thinking on Brain-Science Therapies Could Help Foster Kids" - The Denver Post, April 15, 2014

Youth Advocacy Toolkit

The initial collaboration between the Barton Center and Casey Family Programs led to a second effort designed to empower youth in foster care to advocate for their own mental health care, particularly regarding psychotropic medications.  The Barton Center, in partnership with the Georgia Division of Family and Children Services and Georgia EmpowerMEnt, developed a written guide to help youth with decision-making about medications.  Additionally, the Barton Center worked with VOX Teen Communications and Georgia EmpowerMEnt to videotape testimonials of young adults speaking about their experiences with psychotropic medications while in foster care.

Access the guide "Making the Healthy Choice."

Watch youth journalist interviews of EmpowerMEnt advocates. Click on the images below to launch the video.

Barton Center Barton Center Barton Center
Meet Antoinette Meet Deadrick Meet Chance

The Georgia guide was inspired by Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care, a resource published by the Administration for Children and Families (ACF). Click on cover memo for the introduction to the guide. Click on guide to read the full document. Click on youth or professionals to view fliers published by the Children's Bureau.

External Resources

The Supreme Court of Georgia Committee on Justice for Children 2010 Cold Case Project Report in 2010 included as of of its 15 recommendations the need to "provide independent oversight for children receiving mental health treatment."

Out of this recommendation, the Committee on Justice for Children commissioned a research paper, Psychotropic Medications for Youth in Foster Care: Who Decides?, to further examine the issue and recommend action steps for Georgia.

The National Resource Center for Permanency and Family Connections (NRCPFC) has developed a new webpage on Psychotropic and Prescription Medications as part of the Fostering Connections micro-website.  This webpage offers resources from ACF, the Children’s Bureau, and the T/TA Network, as well as resources from collaborating organizations.  It includes evidence-base practice, research, and reports; publications and other resources; webinars, webcasts, and videos; and links to related websites. It also offers a variety of resources developed by states, including guides, reports, policies and procedures, and training materials addressing psychotropic medications for children in foster care. The webpage will be updated regularly as new information and resources become available.

The U.S. Department of Health and Human Services Administration for Children and Families (ACF) issued an Information Memorandum to assist state agencies to comply with federal requirements regarding the appropriate use and monitoring of psychotropic medications.