A Longitudinal Analysis of Concerning Psychotropic Medication Regimens Among Adolescents in Foster Care

Abstract

Purpose: To provide a population-based examination of psychotropic medication use before and after entry into foster care (FC), with special attention on the use of concerning medication regimens: polypharmacy, stimulants, and antipsychotics.

Methods: Using linked administrative Medicaid and child protective service data from Wisconsin, we follow a cohort of early adolescents ages 10-13 years who entered FC between June 2009 and December 2016 (N = 2,998). Descriptive statistics and Kaplan Meyer survival curves illustrate the timing of medication. Cox proportional hazard models identify hazard of outcomes (new medication, polypharmacy, antipsychotic, and stimulant medication) during FC. Separate models were run for adolescents with and without a psychotropic medication claim in the six months before FC.

Results: Overall 34% of the cohort entered with a pre-existing psychotropic medication, accounting for 69% of adolescents with any psychotropic medication claim during FC. Similarly, the majority of adolescents with polypharmacy, antipsychotics or stimulants during FC entered with those prescriptions. Among youth with pre-entry medication, rates of polypharmacy (56%), antipsychotic (50%) and stimulants (64%) were high. Among adolescents who entered FC with no prior medication, placement disruptions (30 days before or after) predicted new medication.

Discussion: Although a great deal of attention - and policies - have focused on youth in care, there is high reliance on psychotropic medications within the broader population of maltreated adolescents, indicating a need for timely and accurate re-assessment of current and past medications upon entry. Adolescents should also be actively involved in their own health care.

Keywords: Child maltreatment; Foster care; Linked administrative data; Psychotropic medication.

Figure 1.

Kaplan Meier Survival Curves: Onset of Psychotropic Medication Regimens During Foster Care by Pre-Entry Medication Status Figure Note: Graph 1. Full sample: N =2,998; 931 failures. Graph 2. Adolescents without past 6 months polypharmacy: n=2,465; 309 failures. Graph 3. Adolescents without past 6 months antipsychotic med: n=2,558; 195 failures. Graph 4. Adolescents without past 6 months stimulant med: n=2,278; 248 failures.