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Mental health is a key component in a child’s healthy development. Children in foster care are an especially vulnerable group, and often have mental health needs. In order for them to grow to become healthy adults, the right mental and behavioral health treatments at the right time are critically important.

For some children, psychotropic drugs can be especially helpful in treating mental illness. But for many others, therapeutic treatments are much more successful in treating the underlying problems. Without careful policies set in place to ensure psychotropic drugs are only being prescribed to children who need them, we increase the risk to prescribe dangerous drugs to minors who do not need them.

This task force can play a vital role in protecting the safety and well being of Nebraska’s foster children, while also ensuring Nebraska fulfills new federal requirements for policies for prescribing psychotropics to foster children.

Psychotropic interventions
Many of Nebraska’s children are put into foster care due to abuse or neglect, which can result in trauma. The consequences of neglect and abuse include severe interpersonal trust issues, conflict, anger, very poor coping mechanisms, lack of self-worth, and a lack of sense of belonging, safety, and security.¹  All these factors can make children frightened, anxious, can affect sleep, appetite, motor activity (hyperactivity), ability to relate to peers, authority figures, and poor academic performance. Medications do not solve these underlying issues.²

However, when properly provided, medications can still be an important aspect to a child’s treatment plan. Medications can be helpful to regulate motor activity, which can lead to improved behavior, relationships and school performance. Children with strong symptoms of mental illness can control their emotions through psychotropic medications and with therapy are able to process thought patterns and gain control.³

Dangers of psychotropic drugs
Almost all psychotropic medications are not supposed to be prescribed for children below age 10. Risks are greatly increased when children are taking multiple psychotropics, not only because of each individual drug’s risks, but because we often do not know how different drugs will interact together.⁴

Also, since a majority of children in foster care are being medicated for trauma-related symptoms, their response to medications is poor or unsatisfactory. Unfortunately, this often results in increasing the dosages or adding new psychotropic medications.⁵

National trends
A recent study found that, compared with youths who qualify for Medicaid because of a disability or low income, youths in foster care are more likely to receive psychotropic drugs concomitantly (taken at the same time) and for longer periods of time despite the lack of evidence to support such regimens.⁶

Another study found that it is common for youth in foster care to be prescribed patent-protected, expensive psychotropic medications, which lack clinical testing in children. For example, 74% of SSRIs (a class of drugs that are used to treat depression and anxiety) used were sertraline and escitalopram, although neither drug has a labeled indication for treating depression in children and adolescents.⁷

GAO Report
On December 1, 2011, the US Government Accounting Office (GAO) published their findings on the use of psychotropics in foster care. An audit was performed on five states: Florida, Massachusetts, Michigan, Oregon, and Texas from February 2010 to October 2011.

The GAO study found that:

• Foster children below the age of one year were prescribed psychotropic medications. These medications are not meant for infants or children and have no psychiatric guidelines.
• Foster children were routinely prescribed five or more psychiatric medications.
• Dosages of medications exceeded the maximum allowable FDA guidelines.

Federal Legislation
The GAO study recommended the Federal Government Health and Human Services (HHS) to provide oversight to the states. In September 2011, Congress signed into law (with almost unanimous support from both sides) the Child and Family Services Improvement and Innovation Act (P.L. 112-34) which mandates that each state creates specific protocols regarding the use of psychotropic drugs for children in foster care.

Solutions

In order to ensure the right services at the right time are provided for children in foster care with behavioral and mental health problems, careful policies should be put in place to oversee the process of prescribing psychotropic drugs to children in foster care.

A task force would be an ideal first step for Nebraska to come into compliance with federal law, as well as address the difficulties in prescribing psychotropics to state wards.

 

 

References
[1] Gopal, K. (2011) Ask a pro with Dr. Kaylani Gopal. Foster Focus, 1(8), 14-15.
²Ibid
³Aman, M.G. (1980) Psychotropic drugs and learning problems—A selective review. Journal of Learning Disabilities, 13(2), 87-98.
⁴Martin, A., Van Hoof, T., Stubbe, D., Sherwin, T., & Scahill, L. (2003) Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid managed care. Psychiatric Services, 54(1): 72-77.
⁵Cohen, J.A., Mannarino, A.P., Murray, L.K., & Igelman, R. (2006) Psychosocial interventions for maltreated and violence-exposed children. Journal of Social Issues, 62(4), 737-766.
⁶dosReis, S., Yoon, Y., Rubin, D.M., Riddle, M.A., Noll, E., & Rothbard, A. (2011) Antipsychotic treatment among youth in foster care. Pediatrics, 128(6), 1459-1466.
7Zito, J.M. et al (2008) Psychotropic medication patterns among youth in foster care. Pediatrics, 121(1), 157-163.

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