Psychotropic Medication Use Patterns in Older Foster Youth

Purpose: Use of psychotropic medications among foster youth has received growing national attention due to the high rates of use and concerns about the appropriateness of prescribing.  Understanding medication use in older foster youth is of heightened concern as these youth are preparing to take over the management of their own mental health care.  While it has been established that rates of medication use are high among this population, we know little about the nature of this medication treatment over time and whether meaningful subgroups with different medication use patterns exist.  This study examined psychotropic medication use patterns by month between ages 17-18 for a group of older foster youth preparing to exit state care.

Methods: Data come from the Voyages study of youth leaving foster care conducted in 8 counties of Missouri between 2001-2005.  Participants were recruited and continuously enrolled as they turned 17.  Structured initial interviews were conducted in person, then by phone every 3 months using history calendars to collect information on medication use by month.  This study used data from youth that remained in state custody between ages 17-18 (n=294).  Data were extracted from history calendars in order to create medication use variables by month.  Descriptive analyses examined: rates of use across the study period overall and by medication class, length of medication treatment, medication changes over the year, and number of medications each month.  Latent growth mixture modeling was used to identify subgroups of medication users by the number of medications used each month and multinomial logistic regression was used to examine the characteristics of these classes. 

Results: Rates of medication use began at 34.7% and declined to 27.9% in the final month of the year.  Gradual declines were observed in all types of medications with the exception of stimulants where use remained constant.  Over 80% of youths who were on medications had at least one medication change over the study year. Four medication use subgroups emerged: low/no use (74%), medium stable use (14%), declining use (4%), and high stable use (9%).  Youth of color were less likely to be in the medium and high use groups.  Those in the medication using groups were characterized by higher rates of congregate care, mental health diagnoses and symptoms, and histories of psychiatric hospitalization.  Youths in the high use group were more likely to meet criteria for behavioral disorders than youth in the medium use group and more likely to be taking anti-psychotic and stimulant medications.

Conclusion and Implications: Most youths demonstrated patterns of relative stability in the number of medications used over the study year, though changes within the medication regimen were common.  Interventions to support youth taking medications should recognize that the process of treatment often involves medication changes.  Meaningful subgroups of medication users did emerge.  Practitioners can use this information to guide transition planning specific to medication treatment to differentially target the types of medications and mental health needs each group presents.