Journal of Child and Family Studies

, Volume 23, Issue 4, pp 666–674 | Cite as

Use of Psychotropic Medications Among Youth in Treatment Foster Care

  • Sharon L. Brenner
  • Dannia G. Southerland
  • Barbara J. Burns
  • H. Ryan Wagner
  • Elizabeth M. Z. Farmer
Original Paper

Abstract

We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of “questionable polypharmacy.” Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past 2 months. Of the youth taking psychotropics, 61 % took two or more and 22 % met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with “questionable polypharmacy” were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.

Keywords

Mental health services Psychotropic medication Polypharmacy Treatment foster care Children 

References

  1. Ascher, B. H., Farmer, E. M. Z., Burns, B. J., & Angold, A. (1996). The child and adolescent services assessment (CASA): Description and psychometrics. Journal of Emotional and Behavioral Disorders, 4, 12–20.CrossRefGoogle Scholar
  2. Bentley, K. J., & Collins, K. S. (2013). Psychopharmacological treatment for child and adolescent mental disorders. In C. Franklin, M. S. Harris, & P. A. Mears (Eds.), The school services sourcebook (2nd ed.). NY: Oxford.Google Scholar
  3. Bourdon, K. H., Goodman, R., Rae, D. S., Simpson, G., & Koretz, D. S. (2005). The Strengths and Difficulties Questionnaire: US normative data and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 557–564.PubMedCrossRefGoogle Scholar
  4. Boyer, E. W., & Shannon, M. (2005). The serotonin syndrome. New England Journal of Medicine, 352, 1112–1120.PubMedCrossRefGoogle Scholar
  5. 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, 706–708.PubMedCrossRefGoogle Scholar
  6. Breland-Noble, A. M., Farmer, E. M. Z., Dubs, M. S., Potter, E., & Burns, B. J. (2005). Mental health and other service use by youth in therapeutic foster care and group homes. Journal of Child and Family Studies, 14, 167–180.CrossRefGoogle Scholar
  7. Brown, R., & Sammons, M. T. (2002). Pediatric psychopharmacology: A review of new developments and recent research. Professional Psychology—Research and Practice, 33, 135–147.CrossRefGoogle Scholar
  8. Burns, B. J., Hoagwood, K., & Mrazek, P. J. (1999). Effective treatment for mental disorders in children and adolescents. Clinical Child and Family Psychology Review, 2, 199–253.PubMedCrossRefGoogle Scholar
  9. Bussing, R., Mason, D. M., Leon, C. E., & Sinha, K. (2003). Agreement between CASA parent reports and provider records of children’s ADHD services. Journal of Behavioral Health Services and Research, 30, 462–469.PubMedCrossRefGoogle Scholar
  10. Chen, H., Reeves, J. H., Fincham, J. E., Kennedy, W. K., Dorfman, J. H., & Martin, B. C. (2006). Off-label use of antidepressant, anticonvulsant, and antipsychotic medications among Georgia Medicaid enrollees in 2001. Journal of Clinical Psychiatry, 67, 972–982.PubMedCrossRefGoogle Scholar
  11. Comer, J. S., Olfson, M., & Mojtabai, R. (2010). National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996–2007. American Academy of Child and Adolescent Psychiatry, 49, 1001–1010.CrossRefGoogle Scholar
  12. Connor, D. F., Ozbayrak, K. R., Harrison, R. J., & Melloni, R. H. (1998). Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology, 8, 27–38.PubMedCrossRefGoogle Scholar
  13. Constantine, R. J., Boaz, T., & Tandon, R. (2010). Antipsychotic polypharmacy in the treatment of children and adolescents in the fee-for-service component of a large state Medicaid program. Clinical Therapeutics, 32, 949–959.PubMedCrossRefGoogle Scholar
  14. Crismon, M. L., & Argo, T. (2009). The use of psychotropic medication for children in foster care. Child Welfare, 88, 71–100.PubMedGoogle Scholar
  15. Dean, A. J., McDermott, B. M., & Marshall, R. T. (2006). Psychotropic medication utilization in a child and adolescent mental health service. Journal of Child and Adolescent Psychopharmacology, 16, 273–285.PubMedCrossRefGoogle Scholar
  16. dosReis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005). Multiple psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent Psychopharmacology, 15, 68–77.PubMedCrossRefGoogle Scholar
  17. Essock, S. M., Covell, N. H., Leckman-Westin, E., Lieberman, J. A., Sederer, L. I., Kealyey, E., et al. (2009). Identifying questionable psychotropic prescribing practices for Medicaid recipients in New York State. Psychiatric Services, 60, 1595–1602.PubMedCrossRefGoogle Scholar
  18. Farmer, E. M. Z., Angold, A., Burns, B. J., & Costello, E. J. (1994). Reliability of self-reported service use: Test–retest consistency of children’s responses to the child and adolescent services assessment. Journal of Child and Family Studies, 3, 307–325.CrossRefGoogle Scholar
  19. Farmer, E. M. Z., Burns, B. J., Dubs, M. S., & Thompson, S. (2002). Assessing conformity to standards for treatment foster care. Journal of Emotional and Behavioral Disorders, 10, 213–222.Google Scholar
  20. Farmer, E. M. Z., Burns, B. J., Wagner, H. R., Murray, M., & Southerland, D. G. (2010a). Enhancing “usual practice” treatment foster care: Findings from a randomized trial on improving youths’ outcomes. Psychiatric Services, 61, 555–561.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Farmer, E. M. Z., Mustillo, S. A., Wagner, H. R., Burns, B. J., Kolko, D. J., Barth, R. P., et al. (2010b). Service use and multi-sector use for mental health problems by youth in contact with child welfare. Children and Youth Services Review, 32, 815–821.CrossRefGoogle Scholar
  22. Ferguson, D. G., Glesener, D. C., & Raschick, M. (2006). Psychotropic drug use with European American and American Indian children in foster care. Journal of Child and Adolescent Psychopharmacology, 16, 474–481.PubMedCrossRefGoogle Scholar
  23. Findling, R. L., Johnson, J. L., McClellan, J., Frazier, J. A., Vitiello, B., Hamer, R. M., et al. (2010). Double-blind maintenance safety and effectiveness findings from the treatment of early-onset schizophrenia spectrum (TEOSS) study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 583–594.PubMedCentralPubMedGoogle Scholar
  24. Fontanella, C. A., Bridge, J. A., & Campo, J. V. (2009). Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. Annals of Pharmacotherapy, 43, 1939–1947.PubMedCrossRefGoogle Scholar
  25. Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345.PubMedCrossRefGoogle Scholar
  26. Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry, 177, 534–539.PubMedCrossRefGoogle Scholar
  27. Huefner, J. C., Griffith, A. K., Smith, G. L., Vollmer, D. G., & Leslie, L. K. (2012). Reducing psychotropic medications in an intensive residential treatment center. Journal of Child and Family Studies, 1–11.Google Scholar
  28. Jensen, P. S., Bhatara, V. S., Vitiello, B., Hoagwood, K., Feil, M., & Burke, L. B. (1999). Psychoactive medication prescribing practices for U.S. children: Gaps between research and clinical practice. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 557–565.PubMedCrossRefGoogle Scholar
  29. Jerrell, J. M. (2009). Neurological and cardiovascular adverse events associated with antimanic treatment in children and adolescents. CNS Neuroscience and Therapeutics, 16, 25–31.PubMedCrossRefGoogle Scholar
  30. Jerrell, J. M., & McIntyre, R. S. (2008). Adverse events in children and adolescents treated with antipsychotic medications. Human Psychopharmacology Clinical and Experimental, 23, 283–290.PubMedCrossRefGoogle Scholar
  31. Leslie, L. K., Mackie, T., Dawson, E. H., Bellonci, C., Schoonover, D. R., Rodday, A. M., et al. (2010). Multi-state study on psychotropic medication oversight in foster care. Boston, MA: Clinical and Translational Sciences Institute, Tufts University Medical Center.Google Scholar
  32. Malone, R. P., Sheikh, R., & Zito, J. M. (1999). Novel antipsychotic medications in the treatment of children and adolescents. Psychiatric Services, 50, 171–174.PubMedGoogle Scholar
  33. Mark, T. L., Levit, K. R., & Buck, J. A. (2009). Psychotropic drug prescriptions by medical specialty. Psychiatric Services, 60, 1167.PubMedCrossRefGoogle Scholar
  34. Mojtabai, R., & Olson, M. (2010). National trends in psychotropic medication polypharmacy in office-based psychiatry. Archives of General Psychiatry, 67, 26–36.PubMedCrossRefGoogle Scholar
  35. Morrato, E. H., Nicol, G. E., Maahs, D., Druss, B. G., Hartung, D. M., Valuck, R. J., et al. (2010). Metabolic screening in children receiving antipsychotic drug treatment. Archives of Pediatrics and Adolescent Medicine, 164, 344–351.PubMedCrossRefGoogle Scholar
  36. Murray, M. M., Southerland, D., Farmer, E. M., & Ballentine, K. (2010). Enhancing and adapting treatment foster care: Lessons learned in trying to change practice. Journal of Child and Family Studies, 19, 393–403.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Olfson, M., Blanco, C., Liu, L., Moreno, C., & Laje, G. (2006). National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Archives of General Psychiatry, 63, 679–685.PubMedCrossRefGoogle Scholar
  38. Olfson, M., Crystal, S., Huang, C., & Gerhard, T. (2010). Trends in antipsychotic drug use by very young, privately insured children. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 13–23.PubMedGoogle Scholar
  39. Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167, 1456–1463.PubMedCrossRefGoogle Scholar
  40. Olfson, M., Marcus, S. C., Weissman, M. M., & Jensen, P. S. (2002). National trends in the use of psychotropic medications by children. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 514–521.PubMedCrossRefGoogle Scholar
  41. Riddle, M. A., Kastelic, E. A., & Frosch, E. (2001). Pediatric psychopharmacology. Journal of Child Psychology and Psychiatry, 42, 73–90.PubMedCrossRefGoogle Scholar
  42. Rushton, J. L., & Whitmire, J. T. (2001). Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends, 1992 to 1998. Archives of Pediatrics and Adolescent Medicine, 155, 560–565.PubMedCrossRefGoogle Scholar
  43. Ryan, J. B., Reid, R., Gallagher, K., & Ellis, C. (2008). Prevalence rates of psychotropic medications for students placed in residential facilities. Behavioral Disorders, 33, 99–107.Google Scholar
  44. Safer, D. J., Zito, J. M., & dosReis, S. (2003). Concomitant psychotropic medication for youths. American Journal of Psychiatry, 160, 438–449.PubMedCrossRefGoogle Scholar
  45. StataCorp. (2009). Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.Google Scholar
  46. Swanson, J., Arnold, L. E., Kraemer, H., Hechtman, L., Molina, B., Hinshaw, S., et al. (2008). Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment Study of Children with ADHD (MTA)—Part II: Supporting details. Journal of Attention Disorders, 12, 15–43.PubMedCrossRefGoogle Scholar
  47. Treatment for Adolescents with Depression Study (TADS) Team. (2007). The Treatment for Adolescents with Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132–1144.CrossRefGoogle Scholar
  48. Walkup, J. T., Albano, A. M., Piacentini, J., Bimaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766.PubMedCentralPubMedCrossRefGoogle Scholar
  49. Walkup, J., & The AACAP Work Group on Quality Issues. (2009). Practice parameter on the use of psychotropic medication in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 961–973.CrossRefGoogle Scholar
  50. Zima, B. T., Bussing, R., Crecelius, G. M., Kaufman, A., & Belin, T. R. (1999). Psychotropic medication treatment patterns among school-aged children in foster care. Journal of Child and Adolescent Psychopharmacology, 9, 135–147.PubMedCrossRefGoogle Scholar
  51. Zito, J. M., Safer, D. J., dosReis, S., Gardner, J. F., Magder, L., Soeken, K., et al. (2003). Psychotropic patterns for youth: A 10-year perspective. Archives of Pediatrics and Adolescent Medicine, 157, 17–25.PubMedCrossRefGoogle Scholar
  52. Zito, J. M., Safer, D. J., Sai, D., Gardner, J. F., Thomas, D., Coombes, P., et al. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics, 121, e157–e163.PubMedCrossRefGoogle Scholar
  53. Zito, J. M., Safer, D. J., Valluri, S., Gardner, J. F., Korelitz, J. J., & Mattison, D. R. (2007). Psychotherapeutic medication prevalence in Medicaid-insured preschoolers. Journal of Child and Adolescent Psychopharmacology, 17, 195–203.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sharon L. Brenner
    • 1
  • Dannia G. Southerland
    • 1
  • Barbara J. Burns
    • 1
  • H. Ryan Wagner
    • 1
  • Elizabeth M. Z. Farmer
    • 2
  1. 1.Services Effectiveness Research Program, Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamUSA
  2. 2.School of Social WorkVirginia Commonwealth UniversityRichmondUSA

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