Report: Foster System Should Offer More Therapy, Less Medication

May 6, 2012 Updated: September 29, 2015

Children in state custody use psychotropic medications at 2-3 times the rate of other children, according to a new study. States could help foster children more effectively by diverting some of their medication money into trauma-based therapy, says lead author David Rubin, MD.

“There needs to be a much stronger investment in the therapeutic options that provide alternatives to medication for children in foster care, especially,” said Rubin. Use of second-generation antipsychotic (SGA) drugs for children has increased, while use of other kinds of drugs, and administering several drugs in combination(polypharmacy)has declined, according to the study.

Medicaid should and can pay for trauma-based therapies, according to Rubin. He does not intend to blame providers who are forced to give medications to troubled children because they have no other tools. Because medication is one of the greatest expenses in the Medicaid program, it should be affordable to reduce drug use and increase other kinds of interventions.

“It’s a matter of shifting resources, and Medicaid programs do have the capacity to provide the interventions we’re talking about,” said Rubin.

For example, young children benefit from parent-child interaction therapy. “When you start to get to the older children you talk about programs like trauma-focused cognitive therapy,” said Rubin.

The majority of children who enter state custody and foster care do so because their parents or other caregivers neglect, abuse or abandon them. A minority are orphans. These children all share traumatic histories.

“There are a lot of people around the country especially interested in this issue,” said Rubin. The Obama administration is trying to develop grants to states to improve the availability of trauma-focused resources for children, he said.

Advances have been made in therapeutic alternatives—effective mental health care for depression, anxiety, post-traumatic stress disorder and other mental health issues associated with traumatic experiences. But according to Rubin, they just aren’t widely used.

“There are areas in this country where we see pockets of really terrific work but it’s been a difficult process in terms of seeing widespread dissemination of these programs,” said Rubin. “This was the largest study of such children ever done”—686,000 foster-care children enrolled in Medicaid annually in 48 states from 2002-2007.

Medications have a role to play, but they do have side effects, said Rubin. “The thing about psychotropic medications is they’ve not been well studied in children. There are much higher rates of adverse effects especially metabolic effects like weight gain. Also we don’t know what the long-term effects on the developing brain are.”

Rubin is an associate professor of pediatrics in the Perelman School of Medicine at the University of Pennsylvania. The study is “Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care.” It was published in the “Children and Youth Services Review” in April. An interactive web-based tool with state data will be made available later this year.

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