Study Questions Child Welfare Systems’ Drug Policies

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More than two-thirds of state child welfare systems employ health professionals that handle the use of psychotropic drugs, but far fewer have mental health or medical directors to review usage, according to a study released today.

The Boston-based Tufts Clinical and Translational Science Institute received information from child welfare departments in 47 states and the District of Columbia for Multi-State Study on Psychotropic Medication Oversight in Foster Care. The purpose was to find out how the use of psychotropic medications such as anti-psychotics and anti-depressants was monitored by agencies in charge of foster youth.

Of the responding states, 68 percent said there is “specialized mental health staff” on staff. But only 24 states had a mental health director, and only 16 reported having a medical director.

The lack of top-down oversight was reflected in how few states endorsed certain “red-flags” as indicators that psychotropic drugs were inappropriately administered.

Tufts asked child welfare officials to acknowledge whether they checked for 10 particular “red flags.” The list includes psychotropic use by very young children, use of medications that were not approved by the Food and Drug Administration, and use of multiple drugs simultaneously.

The only circumstance on the list that close to half of officials regarded as a red flag was use in very young children; 22 states reported watching for that. Less than 40 percent of states reported watching for any others.

The use of psychotropic medications with adolescents has exploded over the decade, and foster youth may receive them more frequently than any single youth population. Estimated rates of psychotropic medication usage by foster children range from 13 percent to as high as 52 percent, according to the Tufts report.

The report comes at a time when one Congressional committee is taking interest in the explosion of psychotropic prescriptions for foster youth. The Senate Subcommittee on Federal Financial Management, chaired by Sen. Tom Carper (D-Del.), has asked the Government Accountability Office to look into the drugging of foster care children.