Does a Child's Race, Sex, and Age Matter in Prescription of Psychotropic Medication While in Foster Care?

Background and Purpose: Children in foster care are prescribed psychotropic medications at high rates (dosReis, et al., 2011), possibly due to incidence of mental health issues (Littrell, 2012). Research has found that greater psychotropic medication use is associated with specific characteristics of children in care beyond mental health diagnoses such as being of European American origin (Leslie, et al., 2003), older, and male (Raghavan, et al., 2005).  However, studies have rarely focused on differences across psychotropic medication categories, especially for American Indian children (Ferguson, Glesener, & Raschick, 2006).  The purpose of this research was to examine recent trends in psychotropic medication prescriptions among children in foster care, focusing on differences across medication categories relative to child demographics and time in care. It was hypothesized that children who identified as European American, males, older children, and those in foster care longer would be more likely to receive psychotropic medications and that there would be significant differences across medication types as well as in the overall number of drugs prescribed at once. 

Methods:  Using secondary data analysis, this cross-sectional study utilized a convenience sample of 694 existing records from children in foster care during 2012.  De-identified data was culled from Medical Assistance records within a rural upper Midwest county Public Health and Human Services department.  Variables included the child's age, sex, race, total time in foster care, whether psychotropic medications were prescribed, the categories of medication, and the overall number of medications prescribed at once. Data analyses were based on descriptive statistics, linear regression, and logistic regression. 

Results:  Controlling for significant child demographic variables, results revealed that American Indian children were less likely to be prescribed any psychotropic medications (OR=0.6, CI=0.37-0.97, p<0.05), including anti-ADD medication (OR=0.4, CI=0.22-0.75, p<0.01) and antipsychotics (OR=0.4, CI=0.14-0.96, p<0.05).  Males were more likely to be prescribed medication from two categories:  ADHD medication (OR=2.2, CI=1.33-3.86, p<0.05 and antihypertensives (OR=2.5, CI=1.30-4.97, p<0.05), and were also more likely to be on multiple medications at once (t = 0.14, p<0.05).  Older children were more likely to be prescribed any medication (OR=1.3, CI=1.25-1.37, p<0.001) as well as to receive medication from the following categories: ADHD medication (OR=1.2, CI=1.15-1.29, p<0.001), antidepressants (OR=1.4, CI=1.24-1.48, p<0.001), antihypertensives (OR=1.2, CI=1.11-1.27, p<0.001), and antipsychotics (OR=1.3, CI=1.18-1.44, p<0.001).  Children in foster care longer were more likely to be on anti-ADD medication (OR=1.0, CI=1.00-1.02, p<0.05) and less likely to be on antidepressants (atypical) (OR=0.9, CI=0.96-0.99, p<0.05).

Implications: Our results show that a child’s race, sex, age, and overall length of time in care significantly predicted not only whether psychotropic medication was prescribed, but also the category and number of medications utilized.  The outcomes of this study suggest a need for further research on factors potentially contributing to observed differences in psychotropic medication use for children in foster care.  Implications for social work practice include an examination of the availability of other services offered to children in care, who may need assistance beyond medication through a strengths-based, culturally responsive framework of practice.