Psychotropic Medication and Placement Outcomes in a Child Welfare Medication Oversight Program

This study aimed to investigate the demographic, clinical, and placement factors associated with psychotropic medication prescribed to youth in foster care presenting with a request for a psychotropic medication. Additionally, this study explored placement instability after the initial prescription of psychotropic medication since entering foster care. Insight into specific factors that may influence the number of placement changes of youth in care prescribed psychotropic medication within a medication oversight program can help provide proactive support and timely mental health interventions. Psychotropic medication data were obtained for youth in the oversight program ages 0 to 18 who entered foster care from 2015 to 2021 ( N = 480) and merged with placement data from an integrated administrative database. Regression analyses examined demographics, clinical factors, and placement instability predicting antipsychotic or polypharmacy prescription following an initial psychotropic medication review. The number of placements and hospitalizations in the following two years was analyzed by medication types. After controlling for covariates, entering care on no medication predicted the prescription of an antipsychotic, and polypharmacy of youth in care prescribed at least one psychotropic medication. Additionally, among youth with a psychotropic referral, being initially prescribed an antidepressant or an antipsychotic and a disruptive behavior diagnosis predicted the number of subsequent placements and hospitalizations. These factors can help identify youth at high risk for placement instability and psychiatric hospitalization at the point of referral for psychotropic medication, allowing for targeted intensive mental health treatment and casework.