American Academy of Pediatrics National Conference and Exhibition

American Academy of Pediatrics National Conference and Exhibition

October 12, 2021
2 min read

'Increased oversight' needed: One in three kids in foster care prescribed psychotropics

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More than one-third of children on Medicaid in the foster care system were prescribed psychotropic medications, a higher amount than children on Medicaid outside the system, according to an AAP National Conference & Exhibition presentation.

Presenting author Rachael J. Keefe, MD, MPH, FAAP, assistant professor of pediatrics at Baylor College of Medicine and pediatrician at Texas Children’s Hospital, said in an interview with Healio that the inspiration for the study came from working with children in foster and kinship care in her clinical practice.

More than one-third of children on Medicaid in the foster care system are prescribed psychotropic drugs, more than four times more than their peers outside of the system. Source: Adobe Stock

“We don't typically do research in kids in foster care, but Medicaid claims data was a nice way to see what was actually going on within the population that we're serving,” Keefe said.

In the study, Keefe and colleagues analyzed claims data from two Medicaid managed care organizations in southeast Texas. The largest provided Medicaid to children in the region, and the second provided Medicaid exclusively to children in the foster care system.

The researchers then examined Medicaid claim files for six different classes of drugs: alpha agonists, anxiolytics, antidepressants, antipsychotics, mood stabilizers and stimulants.

Overall, 388,914 children (mean age, 8.2 years) on Medicaid and 8,426 children (mean age, 7.7 years) in foster care were included in the study. In considering both age group and drug class, the researchers found prescriptions for psychotropic medications were more prevalent among children in foster care compared with children on Medicaid.

Prescriptions were filled for a mean of 2.8 distinct drug classes for children in foster care compared with 1.4 distinct drug classes for children not in the system.

The researchers also found that 35% of children on Medicaid and in foster care were prescribed psychotropic drugs to alter their behavior or mood, more than four times the 8% of children on Medicaid outside the system who are prescribed psychotropic drugs.

“I feel like I see it every day in my clinical practice, but it's another thing to see it on paper,” Keefe said.

Keefe added that the answer was not to cease giving all psychotropic drugs to children.

“I think you need increased oversight, increased awareness of this overmedication,” Keefe. “This is really a unique study because there aren't others that compare Medicaid populations that have the same geographic region. So, theoretically you would expect kids on Medicaid to be the same rates across the board, not such a stark difference between kids in and out of the foster care system.”


Children in foster care much more likely to be prescribed psychotropic medications compared with non-foster children in Medicaid program. Published Oct. 8, 2021. Accessed Oct. 10, 2021.