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Dec/Jan 2011Vol. 11, No. 10Psychotropic Medication Oversight in Foster Care

According to the Tufts Clinical and Translational Science Institute, psychotropic medication use in youth has increased significantly over the past decade, with the rates of use much higher for youth in foster care (estimated between 13 and 52 percent) than for youth in the general population (4 percent). In an effort to address this trend, Tufts researchers surveyed key staff in State child welfare and affiliated agencies between March 2009 and January 2010 to gather current policies and guidelines on psychotropic medication use in foster care and examine challenges and innovative solutions implemented by States. The results are published in a new report, Multi-State Study on Psychotropic Medication Oversight in Foster Care.

Of the 48 States that participated in the survey, 26 had written policy or guidelines on psychotropic medication use, and 13 were developing policy or guidelines. While most guidelines addressed all psychotropic medications and all youth in foster care, some focused on specific medications or certain age groups. The study examined the "red flags" States use to identify safety or quality of care concerns around psychotropic medication use and to initiate case reviews or additional oversight when necessary. The most common "red flags" were medication use in young children (up to 3-6 years of age), polypharmacy (multiple medications), and medication use and/or dosage levels inconsistent with recommendations.

Based on States' survey responses, the report summarizes the components of a successful psychotropic medication oversight system:

  • Mechanisms to identify children needing psychotropic medication, including screening procedures, tools, and appropriate evaluator training
  • A specified decision-maker who renders an informed decision using active youth participation
  • Forms and procedures for documenting medication, rationale, informed consent, dose, response, and emerging side effects
  • A monitoring system for medication use of individual youth as well as population trends
  • Collaboration with youth-serving agencies and stakeholders

The full report, by Laurel K. Leslie et al., is available on the Tufts website: (283 KB)

The Study Appendix lists State tools, related websites, and additional research and is also available online: (254 KB)