Psychotropic Medication Use by Children in Foster Care

In December 2012, the U.S. Government Accountability Office (GAO) issued Children’s Mental Health: Concerns Remain About Appropriate Services for Children in Medicaid and Foster Care.  The report noted that “HHS’s Administration for Children and Families (ACF) reported that 18 percent of foster children were taking psychotropic medications at the time they were surveyed, although utilization varied widely by the child’s living arrangements.  ACF also reported that 30 precent of foster children who may have needed mental health services did not receive them in the previous 12 months.”  In contrast, “an annual average of 6.2 percent of noninstitutionalized children in Medicaid nationwide and 4.8 percent of privately insured children took one or more psychotropic medications…”  Statistics for Indiana children were not readily available.

According to the Indiana Department of Child Services (DCS), Child Welfare Manual, Section 8.30 related to psychotropic medication, DCS requires “that informed consent be obtained from the parent, guardian, or custodian and for the appropriate DCS Local Office Director or designee before a child in out-of-home care is placed on psychotropic medication.”  There are exceptions if the child’s parent, guardian, or custodian cannot be located; the parental rights have been terminated; the parent, guardian, or custodian is unable to make a decision due to physical or mental impairment; a court order has been obtained; or an emergency exists and the child is a danger to himself or others.  DCS defines the term “psychotropic drugs” as “prescription drugs used to control and/or stabilize mood, mental status,  behavior, or mental health,” including antidepressant medications, anti-anxiety medications, antipsychotics, psychostimulants, and mood stabilizers.

The DCS manual also notes that the family case manager should discuss the use of psychotropic medications at family team meetings.  “In particular, the option of alternative therapies and behavioral approaches should be explored before psychotropic medication is considered.”

Pursuant to 465 IAC 2-1.5-19(g), foster parents administering psychotropic medication must have received: (1) any consents required by DCS prior to giving the medication; and (2) instructions regarding the administering of the medication and its possible side effects, in writing, from either the prescribing physician or the pharmacist.

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