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Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care

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Abstract

This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables. Data were retrieved from electronic health records for 3,067 patients seen at integrated pediatric primary care clinics serving individuals in care. Descriptive and bivariate statistics for presence of MH diagnoses and psychotropic medication prescription were calculated. Multivariable zero-inflated negative binomial regressions were used to assess relationships. Half (50.0%) of patients had at least one MH diagnosis; trauma and stressor-related (31.5%) and attention deficit hyperactivity (22.6%) disorders were most common. 27.8% of patients were prescribed at least 1 psychotropic medication. Complex chronic physical health, having 1 and 2 or more maltreatment exposures, and being 6–11 and 12–20 years of age had significantly higher rates of having a MH diagnosis while being female, Black, Hispanic, and other race were significantly associated with lower rates. Patients with at least 1 MH diagnosis that had complex chronic physical health status, experienced sexual abuse, and were 6–11 and 12–20 years of age had significantly higher rates of psychotropic medication prescription while shelter and kinship placement and female gender were significantly associated with lower rates. Findings suggest that initial and ongoing MH screening is vital for individuals in care so that appropriate interventions can be offered. Results support implementing strategies designed to increase access to MH services for this population, such as integrated care and child psychiatry consult programs.

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References

  • Aarons, G. A., Monn, A. R., Leslie, L. K., Garland, A. F., Lugo, L., Hough, R. L., & Brown, S. A. (2008). Association between mental and physical health problems in high-risk adolescents: A longitudinal study. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 43(3), 260–267. https://doi.org/10.1016/j.jadohealth.2008.01.013

    Article  PubMed  Google Scholar 

  • Beal, S. J., Nause, K., Crosby, I., & Greiner, M. V. (2018). Understanding health risks for adolescents in protective custody. Journal of Applied Research on Children: Informing Policy for Children at Risk, 9(1), 2.

    PubMed  Google Scholar 

  • Bramlett, M. D., Radel, L. F., & Chow, K. (2017). Health and well-being of children in kinship care: Findings from the National Survey of Children in Nonparental Care. Child Welfare, 95(3), 41–60.

    PubMed  PubMed Central  Google Scholar 

  • Breland-Noble, A. M., Elbogen, E. B., Farmer, E. M. Z., Dubs, M. S., Wagner, H. R., & Burns, B. J. (2004). Use of psychotropic medications by youths in therapeutic foster care and group homes. Psychiatric Services, 55(6), 706–708.

    Article  PubMed  Google Scholar 

  • Burcu, M., Zito, J. M., Safer, D. J., & Ibe, A. (2014). Psychotropic medication patterns in Medicaid-insured youth based on clinician-reported maltreatment status. Journal of Child & Family Studies, 23, 632–640. https://doi.org/10.1007/s10826-013-9713-6

    Article  Google Scholar 

  • Cecil, C. A., Viding, E., Fearon, P., Glaser, D., & McCrory, E. J. (2017). Disentangling the mental health impact of childhood abuse and neglect. Child Abuse & Neglect, 63, 106–119. https://doi.org/10.1016/j.chiabu.2016.11.024

    Article  Google Scholar 

  • Child and Family Services Improvement and Innovation Act. H.R.2883. (2011). 12th Congress.

  • Cyr, K., Clément, M. È., & Chamberland, C. (2014). Lifetime prevalence of multiple victimizations and its impact on children’s mental health. Journal of Interpersonal Violence, 29(4), 616–634. https://doi.org/10.1177/0886260513505220

    Article  PubMed  Google Scholar 

  • Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860

    Article  PubMed  PubMed Central  Google Scholar 

  • Doherty, A. M., & Gaughran, F. (2014). The interface of physical and mental health. Social Psychiatry and Psychiatric Epidemiology, 49(5), 673–682. https://doi.org/10.1007/s00127-014-0847-7

    Article  PubMed  Google Scholar 

  • Engler, A. D., Sarpong, K. O., Van Horne, B. S., Greeley, C. S., & Keefe, R. J. (2022). A systematic review of mental health disorders of children in foster care. Trauma, Violence & Abuse, 23(1), 255–264. https://doi.org/10.1177/1524838020941197

    Article  Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31(1), 7–26. https://doi.org/10.1016/j.chiabu.2006.06.008

    Article  Google Scholar 

  • Fontanella, C. A., Warner, L. A., Phillips, G. S., Bridge, J. A., & Campo, J. V. (2014). Trends in psychotropic polypharmacy among youths enrolled in Ohio Medicaid, 2002–2008. Psychiatric Services, 65(11), 1332–1340. https://doi.org/10.1176/appi.ps.201300410

    Article  PubMed  Google Scholar 

  • Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. Journal of Pediatrics, 206, 256-267.e3. https://doi.org/10.1016/j.jpeds.2018.09.021

    Article  PubMed  Google Scholar 

  • Griffin, G., McClelland, G., Holzberg, M., Stolbach, B., Maj, N., & Kisiel, C. (2011). Addressing the impact of trauma before diagnosing mental illness in child welfare. Child Welfare, 90(6), 69–89.

    PubMed  Google Scholar 

  • Guerra, C., Pereda, N., Guilera, G., & Abad, J. (2016). Internalizing symptoms and polyvictimization in a clinical sample of adolescents: The roles of social support and non-productive coping strategies. Child Abuse & Neglect, 54, 57–65. https://doi.org/10.1016/j.chiabu.2016.03.004

    Article  Google Scholar 

  • Haahr-Pedersen, I., Ershadi, A. E., Hyland, P., Hansen, M., Perera, C., Sheaf, G., Bramsen, R. H., Spitz, P., & Vallières, F. (2020). Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire. Child Abuse & Neglect, 107, 104589. https://doi.org/10.1016/j.chiabu.2020.104589

    Article  Google Scholar 

  • Herrenkohl, E. C., Herrenkohl, R. C., & Egolf, B. P. (2003). The psychosocial consequences of living environment instability on maltreated children. American Journal of Orthopsychiatry, 73(4), 367–380.

    Article  PubMed  Google Scholar 

  • Hodgdon, H. B., Spinazzola, J., Briggs, E. C., Liang, L.-J., Steinberg, A. M., & Layne, C. M. (2018). Maltreatment type, exposure characteristics, and mental health outcomes among clinic referred trauma-exposed youth. Child Abuse & Neglect, 82, 12–22. https://doi.org/10.1016/j.chiabu.2018.05.021

    Article  Google Scholar 

  • Hoffmann, M. L., Powlishta, K. K., & White, K. J. (2004). An Examination of gender differences in adolescent adjustment: The effect of competence on gender role differences in symptoms of psychopathology. Sex Roles: A Journal of Research, 50(11–12), 795–810. https://doi.org/10.1023/B:SERS.0000029098.38706.b1

    Article  Google Scholar 

  • Horwitz, S. M., Owens, P., & Simms, M. D. (2000). Specialized assessments for children in foster care. Pediatrics, 106(1 Pt 1), 59–66. https://doi.org/10.1542/peds.106.1.59

    Article  PubMed  Google Scholar 

  • Humphreys, K. L., LeMoult, J., Wear, J. G., Piersiak, H. A., Lee, A., & Gotlib, I. H. (2020). Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse & Neglect, 102, 104361. https://doi.org/10.1016/j.chiabu.2020.104361

    Article  Google Scholar 

  • John, S. G., Brandt, T. W., Secrist, M. E., Mesman, G. R., Sigel, B. A., & Kramer, T. L. (2019). Empirically-guided assessment of complex trauma for children in foster care: A focus on appropriate diagnosis of attachment concerns. Psychological Services, 16(1), 120–133. https://doi.org/10.1037/ser0000263

    Article  PubMed  Google Scholar 

  • Jonas, B. S., Gu, Q., & Albertorio-Diaz, J. R. (2013). Psychotropic medication use among adolescents: United States, 2005–2010. NCHS Data Brief, 135, 1–8.

    Google Scholar 

  • Keast, S. L., Tidmore, L. M., Shropshire, D., Nesser, N., & Lambert, T. L. (2019). Characterization of chronic multiclass psychotropic polypharmacy and psychotherapy in foster care youth in a state medicaid population. Journal of Managed Care & Specialty Pharmacy, 25(12), 1340–1348. https://doi.org/10.18553/jmcp.2019.25.12.1340

    Article  Google Scholar 

  • Keeshin, B. R., Strawn, J. R., Luebbe, A. M., Saldana, S. N., Wehry, A. M., et al. (2014). Hospitalized youth and child abuse: A systematic examination of psychiatric morbidity and clinical severity. Child Abuse & Neglect, 38, 76–83. https://doi.org/10.1016/j.chiabu.2013.08.013

    Article  Google Scholar 

  • Konijn, C., Admiraal, S., Baart, J., van Rooij, F., Stams, G. J., Colonnesi, C., ... & Assink, M. (2019). Foster care placement instability: A meta-analytic review. Children and Youth Services Review, 96, 483–499.

  • Kutz, G. D. (2011). Foster children: HHS guidance could help states improve oversight of psychotropic prescriptions (GAO-12–270T). Retrieved December 2021, from https://www.gao.gov/products/gao-12-270t

  • Lee, T., Fouras, G., Brown, R., American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). (2015). Practice parameter for the assessment and management of youth involved with the child welfare system. Journal of the American Academy of Child and Adolescent Psychiatry, 54(6), 502–517. https://doi.org/10.1016/j.jaac.2015.03.005

    Article  PubMed  Google Scholar 

  • Leslie, L., Raghavan, R., Hurley, M., Zhang, J., Landsverk, J., & Aarons, G. (2011). Investigating geographic variation in use of psychotropic medications among youth in child welfare. Child Abuse & Neglect, 35, 333–342. https://doi.org/10.1016/j.chiabu.2011.01.012

    Article  Google Scholar 

  • Lippard, E., & Nemeroff, C. B. (2020). The devastating clinical consequences of child abuse and neglect: increased disease vulnerability and poor treatment response in mood disorders. The American Journal of Psychiatry, 177(1), 20–36. https://doi.org/10.1176/appi.ajp.2019.19010020

    Article  PubMed  Google Scholar 

  • Maniglio, R. (2010). Child sexual abuse in the etiology of depression: A systematic review of reviews. Depression and Anxiety, 27, 631–642.

    Article  PubMed  Google Scholar 

  • Massachusetts Department of Mental Health. (2014). About Massachusetts Child Psychiatry Access Program (MCPAP). Mcpap.com. Retrieved March 2022, from https://www.mcpap.com/About/OverviewVisionHistory.aspx

  • McGuire, A., Cho, B., Huffhines, L., Gusler, S., Brown, S., & Jackson, Y. (2018). The relation between dimensions of maltreatment, placement instability, and mental health among youth in foster care. Child Abuse & Neglect, 86, 10–21.

    Article  Google Scholar 

  • McMillen, J. C., Zima, B. T., Scott, L. D., Jr., Auslander, W. F., Munson, M. R., Ollie, M. T., & Spitznagel, E. L. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44(1), 88–95. https://doi.org/10.1097/01.chi.0000145806.24274.d2

    Article  PubMed  Google Scholar 

  • Miller, E. A., Hee, P. J., Bonner, B. L., & Cherry, A. S. (2020). Training Psychologists in Integrated Primary Care and Child Maltreatment: Trainee and Supervisor Perspectives on Lessons Learned. Journal of Clinical Psychology in Medical Settings, 27(3), 541–552. https://doi.org/10.1007/s10880-019-09648-w

  • Nabi, H., Kivimaki, M., De Vogli, R., Marmot, M. G., Singh-Manoux, A., Whitehall II Prospective Cohort Study. (2008). Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study. British Medical Journal (Clinical Research Edition), 337(7660), a118. https://doi.org/10.1136/bmj.a118

    Article  Google Scholar 

  • Okpych, N. J., & Courtney, M. E. (2018). Characteristics of foster care history as risk factors for psychiatric disorders among youth in care. The American Journal of Orthopsychiatry, 88(3), 269–281. https://doi.org/10.1037/ort0000259

    Article  PubMed  Google Scholar 

  • Oswald, S. H., Heil, K., & Goldbeck, L. (2010). History of maltreatment and mental health problems in foster children: A review of the literature. Journal of Pediatric Psychology, 35(5), 462–472.

    Article  PubMed  Google Scholar 

  • Park, K., Okpych, N. J., & Courtney, M. E. (2019). Psychotropic medication use and perceptions of medication effects among transition-age foster youth. Child and Adolescent Social Work Journal, 36, 583–597. https://doi.org/10.1007/s10560-019-00605-y

    Article  Google Scholar 

  • Raghavan, R., Brown, D. S., Allaire, B. T., Ross, R. E., & Landsverk, J. (2016). Associations between magnitude of child maltreatment and Medicaid expenditures for psychotropic medications. Psychiatric Services, 67, 916–919.

    Article  PubMed  Google Scholar 

  • Raghavan, R., Zima, B. T., Andersen, R. M., Leibowitz, A. A., Schuster, M. A., & Landsverk, J. (2005). Psychotropic medication use in a national probability sample of children in the child welfare system. Journal of Child and Adolescent Psychopharmacology, 15(1), 97–106.

    Article  PubMed  Google Scholar 

  • Romero, S., Birmaher, B., Axelson, D., Goldstein, T., Goldstein, B. I., Gill, M. K., ... Keller, M. (2009). Prevalence and correlates of phsyical and sexual abuse in children and adolescents with bipolar disorder. Journal of Affective Disorders, 112, 144–150.

  • Sakai, C., Lin, H., & Flores, G. (2011). Health outcomes and family services in kinship care. Archives of Pediatric and Adolescent Medicine, 165, 159–165.

    Article  Google Scholar 

  • Simon, T. D., Cawthon, M. L., Popalisky, J., Mangione-Smith, R., Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN). (2017). Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0. Hospital Pediatrics, 7(7), 373–377. https://doi.org/10.1542/hpeds.2016-0173

    Article  PubMed  PubMed Central  Google Scholar 

  • Spinazzola, J., Hodgdon, H., Liang, L.-J., Ford, J. D., Layne, C. M., Pynoos, R., & Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S18–S28. https://doi.org/10.1037/a0037766

    Article  Google Scholar 

  • StataCorp. (2019). Stata Statistical Software: Release 16. StataCorp LLC.

    Google Scholar 

  • Surtees, P. G., Wainwright, N. W., Luben, R. N., Wareham, N. J., Bingham, S. A., & Khaw, K. T. (2008). Psychological distress, major depressive disorder, and risk of stroke. Neurology, 70(10), 788–794. https://doi.org/10.1212/01.wnl.0000304109.18563.81

    Article  PubMed  Google Scholar 

  • Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S., Council on Foster Care and Adoption and Kinship Care, Committee on Adolescence & Council on Early Childhood. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142–e1166. https://doi.org/10.1542/peds.2015-2656

    Article  PubMed  Google Scholar 

  • Texas Health and Human Services. (2021). Psychotropic medications for children in Texas foster care: State fiscal years 2002–2019 data report. Texas Health and Human Services. https://www.hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2021/psychotropic-meds-tx-foster-care-fy2002-2019.pdf

  • Trivedi, S. (2019). The harm of child removal. NYU Review of Law & Social Change, 43, 523.

    Google Scholar 

  • Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, https://doi.org/10.1016/j.amepre.2009.11.012

  • Turney, K., & Wildeman, C. (2016). Mental and Physical Health of Children in Foster Care. Pediatrics, 138(5), e20161118. https://doi.org/10.1542/peds.2016-1118

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2022). The AFCARS report (#29). https://www.acf.hhs.gov/sites/default/files/documents/cb/afcars-report-29.pdf

  • U.S. Government Accountability Office. (2017). Foster Care: HHS has taken steps to support states' oversight of psychotropic medications, but additional assistance could further collaboration. Retrieved December 2021, from https://www.gao.gov/assets/gao-17-129.pdf

  • Woods, S. B., Farineau, H. M., & McWey, L. M. (2013). Physical health, mental health, and behaviour problems among early adolescents in foster care. Child: Care, Health and Development, 39(2), 220–227. https://doi.org/10.1111/j.1365-2214.2011.01357.x

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Acknowledgements

The authors wish to thank Rong Huang, MS, for his statistical support for this research and the Rees-Jones Foundation for its commitment to improving health care for children in foster care. Research reported in this publication was supported by Children’s Medical Center Dallas. The content is solely the responsibility of the authors and does not necessarily represent the official views of Children’s Medical Center Dallas.

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Authors and Affiliations

  1. Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX, 75235, USA

    Jill D. McLeigh & Mohsin Khan

  2. Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA

    Jill D. McLeigh

  3. University of Texas Health Science Center School of Public Health, Dallas, TX, USA

    Lauren Q. Malthaner

  4. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Madeline C. Tovar & Mohsin Khan

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  1. Jill D. McLeigh
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McLeigh, J.D., Malthaner, L.Q., Tovar, M.C. et al. Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care. Journ Child Adol Trauma 16, 745–757 (2023). https://doi.org/10.1007/s40653-023-00547-9

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