A Mistreated Epidemic: State and Federal Failure to Adequately Regulate Psychotropic Medications Prescribed to Children in Foster Care

Abstract

Foster children are prescribed psychotropic medications at alarmingly high rates. Some studies indicate that up to fifty percent of all children in foster care are prescribed one or more psychotropic medications at a given time. These rates indicate that epidemic numbers of children in state care are on mind- or mood-altering medications. Given that available mental health care for children in state custody is woefully inadequate, these rates also suggest that psychotropic medications are being used to manage — not treat — children in care. Yet, many states and the federal government have been exceedingly slow to implement policies that meaningfully regulate how psychotropic medications are prescribed to children in foster care. The result is a serious risk of harm to children from the medications’ side effects, and a high likelihood that the child's underlying mental health, behavioral, or emotional issues will not be treated beyond the “quick fix” that psychotropics offer.

This Article explores the psychotropic medication epidemic in the child welfare system and how broad failures by states to attend to the mental health needs of dependent children, along with existing child welfare policies, have contributed to this epidemic. The Article reviews the role federal legislation has had on the psychotropic epidemic and what role the Fostering Connections Act may have on how psychotropics are prescribed. It concludes by reviewing specific action states have taken to regulate psychotropic medications, and offers best practices to help ensure that psychotropics are legally prescribed in therapeutically appropriate ways.

Keywords: psychotropic medications, foster children, child welfare, Fostering Connections to Success Act, reasonable efforts, state regulation, mental health systems, foster parents, ASFA, Adoption and Safe Families Act

JEL Classification: K19, K32, K29, K39, K49, I31, I18, J13