According to the Department of Children and Family Services, in Illinois, 19, 863 children were in foster care in 2023. Of those children 7,964 were placed in non-familial placement, 654 were in group homes, 559 were placed in what the department calls “other” placement and 10,686 children lived with relatives. In the United States the numbers are just as jarring with the most recent report from the U.S. Department of Health and Human Services indicating that almost 400,000 children where in foster care. In Illinois in 2022 there were 24 foster children residing in the Department of Corrections, 109 of them were in psychiatric hospitals. According to the American Academy of Child and Adolescent Psychiatry (AACAP), there are current concerns about psychotropic prescribing practices for children and adolescents, especially involving those in foster care. Keefe (2021) indicated that over one third (35%) of children in foster care filled a prescription for psychotropic medications compared to 8% of children who were on Medicaid. These concerning statistics and should be at the forefront of policy makers, healthcare professionals, foster care agencies and researchers alike to identify interventions and find ways to solve these problems.
The question remains as to if medication is being used as a substitute for more comprehensive mental health needs in these children. An additional concern is the potential long-term impact of psychotropic medication on developing brains and bodies. Psychotropic medications have significant side effects from metabolic changes to suicidal thoughts in some cases. Healthcare professionals should be conducting mental health assessments to accurately diagnose underlying conditions and determine which treatment approaches are the most appropriate. Foster children are prescribed medications that often not even approved for them (Downard, 2022). This assessment should include multiple professionals such as psychologists, psychiatrists, and social workers and consider the child’s history, trauma experiences, and needs. There should be expanded alternative treatment options that are covered for foster and adoptive children including psychotherapy, counseling, and behavioral interventions tailored to the unique needs of the individual child. We need to address the barriers such as the limited mental health services available and stigma of mental illness.Hapé
Trauma informed care practices should be implemented in all healthcare practices, schools, foster, and adoptive homes. This will help to address the underlying trauma experienced by many children. Trauma informed practices recognize the impact that experiences have on a child’s development, behavior, and well-being. By understanding and acknowledging trauma history it can provide a more empathetic and effective support. Trauma informed practices also seek to minimize re-traumatization by prioritizing safety, choice, and collaboration with the child. Trauma has long lasting, profound effects on mental health and well-being, by addressing trauma in a sensitive, holistic way healing from past experiences can occur and the development of healthy coping mechanisms can lead to improved outcomes.
Policy reform needs to occur at all levels to address the over prescription of psychotropic medications in foster care. The OIG indicated that up to 80% of children who enter foster care do so with significant mental health needs (Downard, 2022). There simply isn’t enough resources to bear that weight. Oversight mechanisms should be implemented to monitor the prescription and use of psychotropic medications among foster children. It may include regular reviews of medication regimens, multi-disciplinary teams, and adherence to prescribing psychotropic medications in pediatric population. It also will require more funding for mental health services, more services in more areas, and support systems for foster and adoptive children and families. Research should be conducted to better understand the factors that contribute to this overuse of medication and evaluate interventions that may reduce the usage. Collaboration with policy makers and practitioners to make those findings actionable strategies for improving the mental health care for foster and adoptive children could minimize the overuse of psychotropic medications.