Recently in Psychotropic Medication Category

Attorneys who represent youths, parents, and foster parents have reason to be concerned about a pamphlet recently published by the federal government’s Children’s Bureau. The pamphlet, “Making Healthy Choices,” is intended to advise youth in foster care about psychotropic medications and is being distributed nationwide in English and Spanish.

Unfortunately, the pamphlet encourages youths to fill out a checklist/questionnaire of crimes they may have committed and to list deficits in their personalities and character. The youths are encouraged to share the checklist/questionnaire information with people who have authority over them. We believe that the result will be stigmatization of youths and in some cases even arrests and convictions flowing from youths’ confessions to criminal acts.

We intend to ask the Children’s Bureau to withdraw or revise its pamphlet/questionnaire. Attorneys who may be interested in joining in this recall effort may request further information by sending an e-mail with the text “subscribe—Children’s Bureau pamphlet:” to eopton@youthlaw.org.

Guest commentary by:

Edward Opton
PsychDrugs Action Campaign
National Center for Youth Law
405 14th St.
Oakland, CA 94612
www.youthlaw.org

Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care looks like a graphic novel, but its photo-heavy format and cartoon speech balloons carry a serious message. Designed to appeal to youth, the booklet walks the reader through the decisions that have to be made when mental health problems—short- or long-term—need to be addressed.

Often, the quick solution to dealing with behavior issues of youth in foster care has been to prescribe psychotropic medications. Recent publicity about the high numbers of medicated children and youth in foster care has caused policymakers and agencies to revisit this issue and to consider alternative ways of helping children and youth—many of whom have experienced trauma because of abuse or neglect and removal from their parents.

Making Healthy Choices was developed by a collaborative committee of individuals from the Children's Bureau and other Federal and State agencies and private organizations. Youth in foster care were part of the committee and contributed to the content and review of the final publication.

The booklet discusses medication, but it also discusses alternatives to medication, and it includes vignettes that describe teens' mental health dilemmas. It includes worksheets and lists of questions that youth or their caregivers can ask doctors or other health-care professionals.

The booklet is posted on the website of the National Resource Center on Youth Development, which offers a number of resources for youth in foster care:

http://www.nrcyd.ou.edu/psych-med-youth-guide

The booklet is currently available in English, and a Spanish version is in development.

A research brief released by the Administration for Children and Families (ACF) Office of Planning, Research and Evaluation (OPRE) examines the use of psychotropic medications by children in child welfare. What makes this brief unique is its exploration of and distinction among the use of psychotropics across placement types (in-home and out-of-home settings), mental health needs, and usage in tandem with other mental health treatments or services.

Authors used data from the second National Survey of Child and Adolescent Well-Being (NSCAW II). The NSCAW II study included 5,873 children who had contact with the child welfare system during a 14-month period beginning in February 2008. This brief used data, collected between 2008 and 2010, on children involved in allegations of maltreatment, both substantiated and unsubstantiated, and children and families who did not receive services. The brief set out to answer the following questions:

• What are the rates of psychotropic medication use by age among children living in-home and in foster care settings following a report of child abuse or neglect?
• What are the rates of antipsychotic medication use by preschoolers, school-aged children, and adolescents involved with child welfare?
• What types of behavioral services do children involved with child welfare receive, including but not limited to psychotropic medications?

Findings included the following:

• Children living in-home (e.g., with one or more biological parent, an adoptive family, or informally with kin) were significantly less likely to use psychotropic medications than children living in out-of-home care (e.g., foster care, formal kinship care, residential care) 11 percent compared to 17.7 percent. Rates of medication use among children in care, however, were higher than those among the general population.
• The rates of medication use by preschoolers (aged 4–5 years) were 3.5 percent, school-aged children (aged 6–11 years), 18.8 percent, and adolescents (aged 12–17 years), 16 percent and higher. The rates of use of three or more medications were less than 1 percent for preschoolers, nearly 5 percent for school-aged children, and 5 percent for adolescents.
• The rate of children living in-home care who used psychotropic medications without simultaneous mental health treatments was less than 2 percent, compared to more than 9 percent of children living in out-of-home care.

The National Survey of Child and Adolescent Well-Being No. 17: Psychotropic Medication Use by Children in Child Welfare is available on the OPRE website:

http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/psychotropic-meds/NSCAW-Psychotropic-Meds-Brief-No-17.pdf  (232 KB)