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Krystal Goolsby
Ms. Amanda Amstutz
English 219
18 April 2016
Overuse of Psychotropic Medication on Children in Foster Care
Introduction
The overuse of psychotropic medication for children on foster care is a problem that I
have watched happen among my peers. It is something that would have happened to me if I
would not have spoken up for myself. According to research, it is not just a problem that is
happening to and around me. It is happening in many other places. My question, going into this
was, is there any other treatment methods of treatment that are effective for children without
reverting to medication? However, after thinking about it and receiving feedback from my peers
in the discussion board, I have decided to take a small step back as far as the question goes. It
didnt change what I was doing, just the question. My new question is this. Why is the overuse of
psychotropic medications in foster children a problem? Im not saying that medication is bad in
any sense when it is needed, but it can be dangerous when misused or overused. My goal for this
report is to first lay out some data that shows psychotropic medication use in foster children, then
I will talk about how that can be a problem using more data and a personal interview. Finally, I
will give some recommendations as to what can be done to prevent this problem in the future and
ultimately help children in foster care have the best experience that they can have.

Research

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First, I will lay out some data that talks about the use of psychotropic medication in foster
care. Two of my sources I found on the UNM libraries website when I searched for peer
reviewed articles. I also did a personal interview. The other two sources were documents I had as
a result from meetings I went to as part of youth advocacy. One study that was done in Texas
showed that youth who were in foster care that were covered by Medicaid received psychotropic
medication at a rate more than three times higher than youth on Medicaid who qualified because
of family income. Some people would say that it makes sense that foster kids would have more
medications because they are at a higher risk for psychiatric disorders. In the study in Texas, a
random sample of data from 472 medicated youth in foster care from ages 0 to 19 was reviewed.
The data was broken up into categories first by age, race, and gender. Table 1 (pictured below)
shows how many of those that were prescribed medication were in each age group, what gender
they were, and what race they were. The table shows us that males were prescribed more
medications (54.7%) than females (45.3%). It also shows that there were proportionately more
10-14 year olds (39%) who received medication. A lot of times young people in foster care are
prescribed multiple medications in different classes and subclasses at the same time. Table 2
(pictured below) shows that data. Of the 472 people in this sample, 10 of them were on
medications from five or more different classes. This doesnt speak to the number of individual
medications each one of those children were on, but only the number of classes. 120 of the youth
were on medications from three or more classes (Zito et al). Another similar study focuses only
on children in foster care who are six years old or younger. Those running the study wanted to
know if taking psychotropic medications at a younger age would predict prolonged use of
psychotropic medication. They found that the earlier these children started the use of
psychotropic medications, the longer, in general, that they would be on them (DosReis et al).

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The Problem
Looking at all the data that has been presented so far, one might gasp, or one may not
even think twice about it. However, this definitely is a problem. The Administration for Children
and Families (ACF) put out an information memorandum about this issue in 2012. The ACF says
that they do not deny that children in foster care are often at higher risk for trauma and mental
health issues. They do not deny that psychotropic medication is sometimes a necessity. It is a
great thing when used in the right way. However, according to the Administration for Children
and Families there are three main reasons why psychotropic medications become problematic.
Those reasons are that children are prescribed too many medications, too much and at too young
of an age.
The first reason is that children are prescribed too many medications. Figure 3 (pictured
below) shows psychotropic medication use and polypharmacy by age group. Polypharmacy is
the term used to describe the use of multiple psychotropic medications at one time. There is little
evidence supporting this and no research supporting the use of five or more medications.
However, even despite the lack of evidence supporting it, a study done in 2008 found that 41.3%
of youth in foster care in this study were taking three or more classes of psychotropic
medication, and 2.1% were taking five or more classes of psychotropic medication (ACF pg. 8).
As a part of this section, I conducted a personal interview with one of my peers, Marisol Garcia
who experienced this problem first hand. She was born in Mexico to a drug addicted mother and
a father who didnt stick around. She was placed in the custody of her great-grandmother;
however this was not exactly a healthy situation for her either. From the time that my friend was
four years old, she was in and out of the foster care system. She was in and out of different foster

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homes and treatment centers. I was just so angry, and I remember when I was eleven I didnt
want to take my meds, but they told me I had to or I would get moved again. I was tired of that,
so they held me down and forced the pills down my throat. I dont even know what they were
giving me or why, but I didnt have a choice. My friend told me this when thinking about her
early childhood. When she aged out of foster care at age eighteen, she told me that she was
taking seventeen different medications. I was like a zombie. I had no personality, and I was fat.
It was like the medications made me a completely different person, but not in a good way. I still
had no idea what I was taking or why, so I just stopped. I was fine for the most part, and I went
back to being my old selfthe personality I mean. I used this, because, yes, this might be an
extreme case, but it does happen. I am by no means condoning the discontinuance of medication
without a doctors approval. This was just one persons experience.
The second reason that psychotropic medications can become problematic for foster
youth is that too much can be prescribed. Only a few psychotropic medications have actually
been approved by the Food and Drug Administration for use on children under the age of
eighteen. With that being said, most psychotropic medication use in children is off-label. This
does not make it illegal, it has just not been specifically been tested for that specific age group or
isnt specifically labeled for use in children for another reason. This means that there are no clear
doses for most of these medications for children. Psychiatrists and doctors are forced to use their
wisdom and give it their best guess (ACF pg. 9)
The last reason that the ACF mentions can be a problem with prescribing psychotropic
medication in foster youth is that it happens too young. There was a 50% increase in the use of
psychotropic medication in two to four year olds between 1991 and 1995 in the general
population. A 2011 study done by the Government Accountability Office revealed that anywhere

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from 0.3 to 2.1 percent of foster children under the age of one were prescribed medication that is
potentially psycho-active. They were usually antihistamines and benzodiazepines. Only 0.1 to
1.2 percent of children not in foster care were prescribed the potentially psycho-active drugs. In
all children, but the youngest especially, it is crucially important to pay attention to the side
effects of medications as they can be different than in adults (ACF pg. 10).

Recommendations
As I mentioned before, I am not saying that psychotropic medication is bad, however it
does need to be used in the right way. Some ways that could help the growing problem of
overuse of psychotropic medication in foster care are to always implement better screening,
assessment and treatment planning tools, to practice shared decision making and informed
consent, and to utilize medication monitoring on a client level as well as overall.
The first recommendation is to implement better screening, assessment and treatment
planning tools. Upon coming into state custody, children should be given an initial health
screening within twenty-four hours to seventy-two hours. They should also have a more
comprehensive assessment done no more than thirty to sixty days after being in the states
custody. At that point, children should be assessed for primary and secondary trauma that may
not have been noticed during an initial health screening. As far as treatment goes, all methods
should be trauma informed and evidence based (Mackie 39, 41).
The second recommendation for helping the overuse of psychotropic medication in foster
care is for all parties to be involved in the decision making, and for the young person to have
informed consent when being placed on psychotropic medication. Shared decision making means
that the prescriber, the guardian, the child, and possibly the social worker are involved in making

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the decision to use psychotropic medication. Informed consent is when the child understands and
agrees with, to the best of his or her developmental ability, the course of treatment (Mackie 26,
27). Often times, young people will go to the doctor and be placed on new medications or higher
doses without any explanation. In a collaboration meeting I attended about the overuse of
psychotropic medication for foster children, it was also reported by a foster parent who wished to
remain anonymous that he felt the psychiatrist did not have time to listen to him about the
concerns he had with the four different medications his five year old foster son was on.
Unfortunately, there is less time spent with patients due to higher numbers and fewer providers
(2014 Psychiatric Summit).
The last recommendation I have to help with the overuse of psychotropic medication is
medication monitoring. This happens in two ways; both on the individual level between child
and doctor, and on the population level. Children who are on psychotropic medications need to
meet with their prescriber to check how the medications are working as well as to make sure
there are no adverse effects (Mackie) On a population level, there needs to be a system in place
to monitor the number of medications that each child is on, as well as the classes that those
medications are in. There should be a limit to how many classes of medications and how many
psychotropic medications in general that children should be on.

Conclusion
In closing, my focused question was why is the overuse of psychotropic medication for
foster youth a problem? My simple answer is that it isnt a problem when it is done in the right
way, but it becomes a problem when too many medications are prescribed, doses are too high,
and/or children are too young. I recommended that better screening and training, shared decision

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making and informed consent, and better medication monitoring will help with this problem.
Hopefully, with time, state regulations will be put into place to alleviate this problem.

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Works Cited
DosReis, Susan, Ming-Hui Tai, David Goffman, Sean E. Lynch, Gloria Reeves, and Terry Shaw.
Age-Related Trends in Psychotropic Medication Use among Very Young Children in
Foster Care. Psychiatric Services 65.12 (2014): 1452-1457. Web. 16 April 2016.
Garcia, Marisol. Personal Interview. 18 April 2016.
Mackie, Thomas I. Psychotropic Medication Oversight among Youth in Custody of State Child
Welfare Systems. 2014 New Mexico Psychiatric Summit. Los Lunas, NM. 21 October
2014. Oral presentation with ppt.
United States. Department of Health and Human Services. Administration on Children, Youth
and Families. Childrens Bureau. Information Memorandum ACYF-CB-IM-12-03. GPO,
2012. Print.
Zito, Julie M, Daniel J. Safer, Devadatta Sal, James F. Gardner, Diane Thomas, Phyllis Coombes,
Melissa Dubowski, and Maria Mendez-Lewis. Psychotropic Medication Patterns among
Youth in Foster Care. Pediatrics 121.1 (2008): e157-e163. Web. 16 April 2016.
2014 Psychiatric Summit. Los Lunas, NM. 21 October 2014. Roundtable discussion.