Psychotropic Medications and Children in Out-of-Home Care: Why does this matter to me?

• Caregivers have a lot of responsibility in the safe use of psychotropic medications for the children in their care.

• We hope that the information included here will help answer questions you have about psychotropic medication safety and support best practices at home!

​​What are psychotropic medications?

• Some children in out-of-home care (like foster care or kinship care) are prescribed psychotropic medications by their psychiatrist, pediatrician, or other licensed provider.

• Psychotropic medications (sometimes called “psych meds”) are used to treat a person’s thinking, mood or behavior.

• Children may be prescribed psychotropic medications to treat mental health disorders related to mood or behavior, or attention issues or impulsivity related to conditions like Attention Deficit Hyperactivity Disorder (ADHD).

​​Why children and adolescents in out of home care are prescribed psychotropic medications?

• Many children in out of home care have had hard life experiences, or traumatic events, which have caused them to be moved from their families and relocated to foster or kinship care. Moving away from family is very stressful for children.

• Children that experience trauma may develop behavioral symptoms related to traumatic events or due to underlying mental health conditions that affect their behavior or emotions. Your child’s licensed treatment provider should get to know your child so that they can understand what is behind your child’s symptoms. This will help make sure that the provider treats your child safely.

• Psychotropic medications may be the right treatment for your child, but psychotropic medication should probably not be the only treatment for children with behavioral and emotional symptoms or mental health conditions.

• Experts from North Carolina recommend that providers start a child on therapy that don’t involve medications. If medication is needed, the provider should consider both medication and non-medication therapies.

​​Why do we need to be careful about psychotropic medication prescription to children in foster care?​​

• The 2011 Government Accountability Office (GAO) Report on Youth in Foster Care showed that youth in foster care in the United States are prescribed psychotropic medications a lot more often than kids that are not in foster care. According to the American Association of Children and Adolescent Psychiatrists (AACAP), some practices can be risky for kids’ health, and must be watched closely. These practices are:

1. Polypharmacy: More than five psychotropic medications are the same time or more than two to treat a specific disorder/ symptom (AACAP; Fostering Health).

   • A prescription for more than one medication for a single symptom might be the best thing for a child in foster care! AACAP says it's best to keep an eye on medication effects on the child.

2. Off-label prescriptions: Prescribing psychotropic medication in a way that the drug maker has not identified is safe (AACAP; Fostering Health).

   • This can be a different dose than the drug maker says is safe, or prescribing medications to a child younger than the drug maker suggests.

   • An off-label prescription might be the best thing for a child in foster care! AACAP says it's best to keep an eye on medication effects on the child.

Questions to Ask

Below are 12 questions you can ask your child's doctor or prescriber when a new medication is added to your child's plan or if a prescription is changed. These questions are from Fostering Health's Best Practices for Medication Management for Children & Adolescents in Foster Care.

1. Are there non medication options that might be tried before medication? If there isn't, are there non-medication options that I can use along side medication?

2. How do we know that this medication is OK for a child that is my child’s age and with similar needs? Has it been studied by researchers?

3. How does medication fit with my child's treatment plan?

4. Is the prescribed medication more, less, or as effective / helpful as other non-medicine options?

5. What should we be looking for in changes in behavior, changes in symptoms? If I see something change in my child's behavior, who should we contact with questions about these changes and the medication?

6. How after we start this medication will it take before we should begin seeing behavioral changes? Can you tell me what will the changes look like?

7. What are the possible risks or dangers of the medication and other treatment options? What are possible side effects? How might the medication help?

8. If a medication dose is missed or stopped, are there possible side effects? What are those?

9. How will our family, our child, and the doctor/ prescriber monitor progress, behavior changes, symptoms, and safety concerns? (keeping an eye on these things is important with with all medications at all times, however, it is really important when medication is started and when dosages are changed.)

10. How will we know when it is time to talk about stopping medication? What steps need to be taken before the medication is stopped?

11. How can we develop a plan to talk about medication issues between our family and the treating providers (therapist and psychiatrist) to ensure open lines of communication?

12. What if my child has a crisis and is hospitalized? Who can we contact in your office, especially if someone wants to change medications?

Adapted from NAMI, “Choosing the Right Treatment: What Families Need to Know about Evidence-Based Practices, 2007.”