Reasons why Prescribers Decrease Psychotropic Medication for Foster Youth

Abstract

Although prescribers frequently use psychotropic medication to treat emotional and behavioral problems for children in foster care, and states are required to monitor psychotropic medication usage with foster youth, few studies have evaluated the extent to which prescribers decrease psychotropic medication. We developed a system to track medication decreases for foster youth to ascertain why deprescriptions occurred. Researchers reviewed case files for 223 children and adolescents in a child welfare system who had received services via a state-funded project from October 2016 through January 2021. We found 99 individuals who had (a) prescriptions for one or more psychotropic medications at intake and (b) received both behavioral and medication review services. Results show only 32 (32%) of individuals in this sample experienced a deprescription of psychotropic medication while receiving services from the project. Analyses for these 32 individuals revealed four key findings. First, the most frequently deprescribed medications were stimulants and antipsychotics. Second, the most common reasons for decreasing any psychotropic medication were (a) medication advocacy and (b) adverse side effects. Notably, only foster youth aged 12 years or younger experienced medication reductions due to adverse side effects. Third, stimulants and antipsychotics accounted for the highest percentage of undesirable side effects. Fourth, practitioners deprescribed stimulants and antipsychotics for adverse side effects two times more often than for behavior or symptom improvement. These findings may contribute to the development of deprescribing guidelines for children in state welfare systems.