Antipsychotic Medication Use in Foster and Medicaid-Insured Children

High rates of foster and Medicaid-insured children are receiving antipsychotics, but providers are not following the recommended guidelines.

A recent study found that children in foster care and children with Medicaid insurance are still facing many different challenges with antipsychotic medications.

Researchers also found that guidelines, such as nonpharmacological mental health services, are the first-line treatment, while monitoring blood sugar and cholesterol for side effects of the medication are not followed, according to the study published by Health Affairs.

In the study, researchers collected data from national and state-level Medicaid programs, as well as from private insurers.

Approximately one-third of foster children and more than two-thirds of Medicaid children did not have psychosocial mental health interventions during 3 months before and 1 month after starting antipsychotic medication, according to the study.

"Only 28% of foster children, and 18% of other children, received metabolic monitoring for both blood glucose and serum cholesterol," said lead author Stephen Crystal, PhD.

In 2010, 8.92% of children (0 to 17-years old) in foster care and 1.51% of Medicaid-insured children received treatment with antipsychotics. "Levels of use of antipsychotics among children in foster care were almost six times higher than in nonfoster care children in 2010,” Dr Crystal said. “The state serves in loco parentis for these children. Therefore, we have additional responsibility to ensure they are receiving the most appropriate treatment.”

The use of antipsychotics has been increasing since 2000 and peaked in 2008 for Medicaid children and 2009 for children with private insurance, according to the study.

"The 'new normal' levels of prescribing represent a substantially higher rate than was seen prior to the sharp expansion of the early 2000s," Dr Crystal said. "Given safety concerns and uncertainties about long-term effects on brain development, encouraging judicious prescribing of antipsychotic medications for children remains a policy challenge and a priority."

Researchers also found that antipsychotics are being prescribed off-label for certain conditions. In 2010, 34% of antipsychotics prescribed for foster children were for attention deficit disorder, anxiety, or depression.

However, researchers discovered that children in foster care have a higher rate of psychosocial interventions and metabolic monitoring compared with Medicaid-insured children.

"While these findings do suggest more careful monitoring of children in foster care who are prescribed antipsychotic medication, challenges remain in increasing safety monitoring and access to psychosocial treatment," Dr Crystal said.

Researchers said that specialized managed care plans should be put into place for children in foster care and national quality measures for safe prescribing for antipsychotics should be created.

"Progress in a number of states that have implemented programs for oversight and quality improvement in children's psychotropic medication use is encouraging. However, persistently high rates of antipsychotic treatment, particularly among foster children, alongside gaps in metabolic monitoring, over-reliance on use of multiple concurrent antipsychotic medications and underuse of psychosocial interventions, underscore enduring behavioral health care challenges,” Dr Crystal concluded.

"State and federal health care policymakers have opportunities to promote meaningful improvements that bear directly on the symptoms, social function and quality of life of foster children with mental health problems, by seizing opportunities such as emerging managed care models and new treatment guidelines.”