Antipsychotic Treatment Among Youth in Foster Care

Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2011; 128(6):e1459-66. DOI: 10.1542/peds.2010-2970
Source: PubMed


Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth.
The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had ≥1 claim with a psychiatric diagnosis and ≥1 antipsychotic claim in 2003. Antipsychotic treatment was characterized by days of any use and concomitant use with ≥2 overlapping antipsychotics for >30 days. Medicaid program categories were foster care, disabled (Supplemental Security Income), and Temporary Assistance for Needy Families (TANF). Multicategory involvement for youths in foster care was classified as foster care/Supplemental Security Income, foster care/TANF, and foster care/adoption. We used multivariate analyses, adjusting for demographics, psychiatric comorbidities, and other psychotropic use, to assess associations between Medicaid program category and concomitant antipsychotic use.
Average antipsychotic use ranged from 222 ± 110 days in foster care to only 135 ± 101 days in TANF (P < .001). Concomitant use for ≥180 days was 19% in foster care only and 24% in foster care/adoption compared with <15% in the other categories. Conduct disorder and antidepressant or mood-stabilizer use was associated with a higher likelihood of concomitant antipsychotic use (P < .0001).
Additional study is needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youths in the foster care system.

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Available from: Susan Dosreis
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    • "About 1 in 7 children in foster care receives a psychotropic drug at a given point in time (Zima, Bussing, Yang, & Belin, 2000), a rate that rises to nearly 1 in 4 when these children are followed over time (Leslie, Raghavan, Zhang, & Aarons, 2010). Approximately 40% of children in foster care reportedly received multiple psychotropic medications simultaneously (Zito et al., 2008) and used them for significantly longer than other children in the Medicaid program (dosReis et al., 2011). Cumulatively, children in the child welfare system are the largest consumers of psychotropic drugs among all child populations in the United States today. "
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    • "Between 1993 and 2002, office visits involving the prescription of SGAs to children and youth increased five-fold (Cooper et al., 2006; Olfson et al., 2006). By 2003, greater than 1 in 10 foster youth were receiving an SGA, and of those, 1 in 5 were receiving duplication of this class (dosReis et al., 2011). "
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