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Psychotropic and Prescription Medications
From the US DHHS/Administration for Children & Families, Children’s Bureau, and T&TA Network

Resources & Publications

  • NSCAW, No. 17: Psychotropic Medication Use by Children in Child Welfare
    This brief from the Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (DHHS), uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to examine the use of psychotropic medications by children involved with the child welfare system (CWS).  This research brief examines psychotropic medication use across in-home and a variety of foster care placements for children involved with the child welfare system. (May 2012)
  • ACYF-CB-IM-12-03: Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Care
    The Children’s Bureau issued this Information Memorandum (IM) to serve as a resource to State and Tribal title IV-B agencies as they comply with requirements to develop protocols for the appropriate use and monitoring of psychotropic medications in the title IV-B plan. This IM defines the issues surrounding psychotropic medication use by children in foster care, highlights available resources for States to consider when developing their Annual Progress and Services Report (APSR), and encourages increasing access to clinically appropriate screening, assessment, and evidence-based interventions for foster children with mental health and trauma-related needs. (April 2012)
  • Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care 
    This guide from the Children’s Bureau can be read directly by youth or serve as a discussion tool for child welfare workers, health care providers, mentors, and others working with youth in foster care. This guide provides valuable information and worksheets to assist youth in recognizing when they need help, weigh options for medication use, ask questions about their diagnosis and treatment, and take medication safely. This guide was developed by ACF staff in collaboration with youth, and other federal agencies and national organizations, including physicians and psychiatrists. It was tested in the field by youth, nurses, and physicians; their feedback was incorporated into the final version of the guide. The guide is available in English and Spanish through the National Resource Center for Youth Development website. (2012)

    Two flyers about the guide are also available that can be distributed to youth and professionals working with youth. 
  • Activity on Psychotropic Medications for Children in Foster Care
    Commissioner Samuels testified on December 1, 2011 at a Senate Subcommittee hearing on the use of psychotropic medications among children in foster care. ACYF staff have been working extensively with representatives across several HHS agencies to develop a plan to help States address this issue within the context of improving social and emotional well-being for children who have experienced maltreatment. ACYF will be working to: Improve oversight and monitoring of psychotropic medication for children in foster care; build the knowledge base about best practices for treatment, both pharmaceutical and psychosocial, for children with social-emotional problems in child welfare; and, increase States’ access to and capacity to deliver evidence-based behavioral interventions to these children. Click here to access the complete written testimony delivered by Commissioner Samuels.

    A letter co-signed by ACF Acting Assistant Secretary George Sheldon, CMS Administrator Donald Berwick, and SAMHSA Administrator Pam Hyde outlining the issue and the Department’s plan to address it was recently delivered to directors of child welfare, Medicaid, and mental health authorities in all 50 States plus DC and Puerto Rico. Click here to access the letter on the Child Welfare Information Gateway website. (November 23, 2011)

Webinars, Webcasts, and Videos

  • Psychotropic Medication Use Among Children and Youth in Care
    In this free National Resource Center for Permanency and Family Connections (NRCPFC) webcast, Dr. Gerald Mallon, NRCPFC Executive Director, talked with Dr. Christopher Bellonci about psychotropic medication use among children and youth in care.  This webcast complimented past NRCPFC and National Technical Assistance Center for Children’s Mental Health events, and discussed best practices regarding use, and oversight and monitoring of use, of psychotropic medications by children/youth in foster care, as well as the impact of the Fostering Connections Act. This webcast focused primarily on the role of child welfare staff in working with prescribers of medications, foster parents, birth parents, and children/youth in care. (March 28, 2012)
  • Getting Practical: Developing Your State Plan for Psychotropic Medication Management
    This web series of three Q&A discussion sessions from the National Technical Assistance Center for Children’s Mental Health Center (TA Center) was primarily targeted toward State leaders who would be working together on plans to enhance oversight and monitoring.  Experts in the field provided ideas and feedback designed to support States in their planning efforts.  The first two sessions offered a discussion of major content areas to be addressed in State plans and the third session featured representatives of ACYF.  Archived webinar playback and PowerPoint presentations are available:
  • Use of Psychotropics Among Children in Foster Care Webinar Series
    The National Technical Assistance Center for Children’s Mental Health (TA Center), in partnership with ACYF, SAMHSA, Georgetown University, and AIR, hosted this webinar series designed to provide an overview of the topic, to describe the issues and challenges, and highlight two approaches to medication monitoring.  Complete audio recordings and PowerPoint presentations are available (scroll down to section titled “Past Webinar Series on Psychotropics).
    • Part 1: Mental Health, Psychotropic Use, and Evidence-Based Interventions (January 9, 2012)
    • Part 2: Clinical Management and Monitoring of Psychotropic Medications (February 13, 2012)
    • Part 3: Collaborative Oversight and Monitoring Approaches: State Examples (February 28, 2012)
  • Psychotropic Medication
    This teleconference for state foster care and adoption managers and for others working, involved, or interested in the field of child welfare, was hosted by the National Resource Center for Permanency and Family Connections (NRCPFC).  An analysis of state medication usage rates in foster care programs; State perspectives on medication usage, challenges, and solutions; and personal experiences from foster care alumni were presented. (February 10, 2010)
  • NRCPFC Teleconference Series: Use of Psychotropic Medication for Children in the Child Welfare System
    The NRCPFC and Child Welfare League of America (CWLA) hosted this two-part teleconference series for State foster care and adoption managers on the use of psychotropic medications for children in the child welfare system. 
Evidence-Based Practice, Research, and Reports
  • Multi-State Study on Psychotropic Medication Oversight in Foster Care 
    In this report published by Tufts Clinical and Translational Science Institute, an overview of the status of policies and guidelines for psychotropic medication oversight across 47 states and the District of Columbia in 2009-2010 are provided. The report also includes descriptions of challenges and innovative solutions implemented by states and links to specific tools developed by states. (September 2010)
  • Antipsychotic Medication Use in Medicaid Children and Adolescents: Report and Resource Guide From a 16-State Study
    This report was the product of a collaboration of 16 States, the Medicaid Medical Directors Learning Network (MMDLN) and the Rutgers CERTs (Center for Education and Research on Mental Health Therapeutics).  It includes a description of how 16 States produced antipsychotic and mental health drug utilization data using their pharmacy claims systems; a data dictionary and methodology that can be adapted by States to develop similar analyses/reports; an overview of the utilization of antipsychotic medications in the 16 States; and a compendium of 36 practices related to utilization, categorized by the States as mature, promising, or emerging. (June 2010)

Resources and Publications

  • Issue Brief No. 59: Psychotropic Medication Use among Children in the Child Welfare System
    This issue brief from The Carsey Institute, at the University of New Hampshire, highlights usage of psychotropic medications among children in the child welfare system.  It includes discussion of the following issues: psychotropic medication use, need for psychotropic medication, characteristics of children receiving medication, and understanding psychotropic medication use in rural and urban places.  This resource was authored by Wendy A. Walsh and Marybeth Mattingly. (Fall 2012)
  • CMCS Informational Bulletin: Collaborative Efforts and Technical Assistance Resources to Strengthen the Management of Psychotropic Medications for Vulnerable Populations 
    The Center for Medicaid and CHIP Services (CMCS) issued this Informational Bulletin to inform states about additional opportunities and resources to address the use of psychotropic drugs in vulnerable populations. The collaborative efforts and technical assistance resources highlighted in this bulletin provide states with additional tools and mechanisms to promote the appropriate use, and enhance oversight of, psychotropic medications for children in foster care and individuals living in nursing facilities. The Centers for Medicare and Medicaid Services (CMS), the Administration for Children and Families (ACF) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have been working collaboratively to expand opportunities for states, territories and Tribes to strengthen their systems of prescribing and monitoring use of psychotropic medication among children in foster care. This Informational Bulletin continues this tri-agency coordinated effort to explore, identify, and support effective strategies for states in overseeing and monitoring the use of psychotropic medications with youth in the foster care system. (August 2012)
  • Psychotropic Medication and Children in Foster Care: Tips for Advocates and Judges
    This practice and policy brief from the American Bar Association (ABA) Center on Children and the Law provides information for judges and advocates on psychotropic medications for children in foster care and mental health diagnoses.  It also includes recommendations for best practice and a list of questions that should be asked when considering the best interests of, or advocating for, a child/teen in care. (October 2011)
  • Psychotropic Medication Use among Children in Foster Care
    In this resource from PolicyLab, two interactive maps are accessible that feature national and state-level trends in psychotropic medication use among children in foster care from 2002 to 2009, including prevalence of polypharmacy and antipsychotic use.
Webinars, Webcasts, and Videos
From the States
  • Arizona:  Psychotropic Medication Use in the Foster Care Population in Arizona
    Published by the Arizona Department of Health Services (ADHS), Department of Economic Security, and Arizona Health Care Cost Containment System (AHCCCS), this resource provides background information on the issue of psychotropic medication usage in Arizona’s foster care population.  The publication includes the following sections: Physical and Behavioral Health Services for Children in Foster Care; Overall Utilization of Behavioral Health Services for CMDP vs. Non-CMDP; Arizona Study on Psychotropic Medication Use; and, Comparing Arizona Practice to AACAP Best Practice Guidelines. (August 2012)
  • Florida:  Psychotropic Medication Resources
    The Center for Child Welfare is a resource guide for child welfare professionals provided by the University of South Florida’s College of Behavioral and Community Sciences, Department of Child and Family Studies in collaboration with the Florida Department of Children and Families.  This section of their website provides forms and staff resources (including DCF Memoranda and training resources), and medication information and guides, as well as reports and publications pertaining to psychotropic medications.
  • Georgia
    • Georgia Psychotropic Medication Monitoring Project 
      Published by the Barton Child Law and Policy Center of the Emory University School of Law in collaboration with Casey Family Programs and the Child Welfare Collaborative, this report presents findings from the Georgia Psychotropic Medication Monitoring Project, a year-long project examining the state’s capacity for oversight of the administration of psychotropic medications to children in foster care.  Recommendations for improvement of oversight of psychotropic medication administration also provided. This resource was prepared by Melissa D. Carter. (January 2012)
    • Psychotropic Meds for Georgia Youth in Foster Care: Who Decides? 
      This publication prepared for the Georgia Supreme Court Committee on Justice for Children discusses issues surrounding the administration of psychotropic medications to youth in foster care and specifically focuses on the need for the State of Georgia to address such issues. This resource was written by Karen Worthington. (January 2011)
  • Michigan:  Michigan Foster Care Review Board 2012 Annual Report—Focus: Psychotropic Medications and Children in Foster Care
    This annual report issued by the Michigan Supreme Court, State Court Administrative Office, details the efforts of the Foster Care Review Board (FCRB) during the past year and some of the systemic issues that have been identified by citizen volunteers while reviewing foster care cases throughout the state.  The report focuses on the utilization of psychotropic medication with children in foster care who display emotional and behavioral disorders and the impact this may have on a child’s safety, well-being, and achievement of timely permanency.  The mission of the Foster Care Review Board is to utilize citizen volunteers to review and evaluate permanency planning processes and outcomes for children and families in the Michigan foster care system.  Based on the data collected through case review, the Foster Care Review Board advocates for systemic improvements in areas of child safety, timely permanency, and family and child well-being. (2012)
  • New Jersey: New Jersey Psychotropic Medication Policy
    This comprehensive resource from the New Jersey Department of Children and Families Office of Child Health Services outlines basic principles for good practice for the treatment and monitoring of children with psychiatric illnesses who may require psychopharmacologic therapy within an out-of-home care setting.  (January 2010; Revised May 2011)
  • North Carolina: 
    • Fostering Perspectives Articles
      Fostering Perspectives is a publication sponsored by the North Carolina Division of Social Services and the Family and Children’s Resource Program for resource parents and child welfare professionals.  The following articles from Fostering Perspectives focus on psychotropic medications:
      • Caring for a Child Who Takes Psychotropic Medication
        This article provides a brief overview of psychotropic medications and children in the child welfare system, as well as suggestions for how foster parents and caregivers can make sure that children taking psychotropic medications get the care and oversight they need.   (November 2013)
      • Young People’s Thoughts about Psychotropic Medication
        This article shares the responses to a prior issue of Fostering Perspectives in which young people were asked their thoughts on how psychotropic medications may help or cause problems for children in foster care. (November 2013)
    • FCRP Webinar: “Monitoring and Oversight of Psychotropic Medications for Children in Foster Care in North Carolina
      This webinar from the Family & Children’s Resource Program (FCRP) features experts in this area of child welfare practice in North Carolina.  Topics discussed in this webinar included: basic information about psychotropic medications; North Carolina’s state registry for prescribers of antipsychotic medications to children, A+KIDS; partnering with Community Care of North Carolina (CCNC); informed consent; and working with birth parents and prescribers. (January 29, 2013)
    • North Carolina Division of Social Services Multiple Response System (MRS) Newsletter- Vol. 8, No. 1
      MRS! is a newsletter published quarterly by the NC DSS and the Jordan Institute for Families at the University of North Carolina at Chapel Hill School of Social Work. It provides information in support of North Carolina’s Multiple Response System.  This issue of MRS! highlights the need to focus on management and oversight of psychotropic medications for children in DSS custody. (November 2012)
  • Tennessee:  Use of Psychotropic Medications in Child Welfare: the needs and challenges of informed consent, ordering, and tracking of psychiatric medications for children in state custody 
    This presentation was prepared by Christopher Bellonci, M.D., Walker Home and School and Tricia Henwood, Ph.D., Tennessee Department of Children's Services for a teleconference sponsored by the NRCPFC and the Child Welfare League of America. 

  • Texas: 
    • Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care 
      In February 2005, the Texas Department of Family and Protective Services (DFPS), the Department of State Health Services (DSHS), and the Health and Human Services Commission (HHSC) released a best practices guide to ensure the proper use of psychotropic medications for the children in foster care.  This updated guide serves as a resource for physicians and clinicians who care for children diagnosed with mental health disorders, and provides recommendations for the appropriate use of psychotropic medications for children in foster care.  It includes nine criteria indicating need for review of the child's clinical status.  Since April 2008, STAR Health has conducted Psychotropic Medication Utilization Reviews (PMURs) on the children whose medication regimens fall outside of the expectations of the Parameters.  The STAR Health PMUR Frequently Asked Questions document explains this process and how to request a review.  As a result of the wide use of the Parameters, the prescription patterns of psychotropic medications for Texas children in foster care have improved significantly since 2004. (September 2013)
    • Update on the Use of Psychoactive Medications in Texas Foster Children Fiscal Years 2002 - 2011
      This report from the Texas Health and Human Services Commission (HHSC), the Department of Family and Protective Services (DFPS) and the Department of State Health Services (DSHS) provides an update on the use of psychotropic medications in Texas children in foster care following the state-wide distribution of best practice Parameters.  This update focuses and reports specifically on four of eight criteria from the Parameters for fiscal years 2002-2011 with data provided by Medicaid prescription and medical claims. (2011)
  • Washington: Children’s Administration Practices and Procedure Guide
    Section 4541 of the Washington State Children’s Administration Practices and Procedure Guide provides guidelines to follow when considering the administration of psychotropic medication for a child in the custody of the department who is placed in out-of-home care.