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Treatment Planning and Medication Monitoring Were Lacking for Children in Foster Care Receiving Psychotropic Medication


Up to 80 percent of children enter foster care with significant mental health needs. For children with mental health needs, psychotropic medications (i.e., medication used to treat clinical psychiatric symptoms or mental disorders such as depression, bipolar disorder, schizophrenia, and anxiety disorders) may be effective treatments. However, these medications can have serious side effects and, as ACF suggests, should be used in conjunction with treatment planning mechanisms and effective medication monitoring.

A 2015 OIG report found-based on review of medical records-serious quality-of-care concerns in the treatment of children with psychotropic medications.


We selected a sample of 625 children in foster care from the 5 States that had the highest utilization of psychotropic medications in their foster care populations. On the basis of foster care case file documentation and Medicaid claims data, we determined the extent to which the children in our sample were treated with psychotropic medications in a manner consistent with their respective States' requirements. Additionally, we compared the five States' requirements for psychotropic medication oversight with treatment planning and medication monitoring practice guidelines from the American Academy of Child and Adolescent Psychiatry (AACAP).


In five States, one in three children in foster care who were treated with psychotropic medications did not receive treatment planning or medication monitoring as required by States. Additionally, ACF has suggested that States consider practice guidelines from professional organizations, including the AACAP, related to treatment planning and medication monitoring. We found that State requirements for oversight of psychotropic medication did not always incorporate these professional practice guidelines.

Treatment planning is critical to enhancing continuity of care; improving coordination of services between health and child welfare professionals; and reducing the risk of harmful side effects. Effective medication monitoring can reduce the risk of inappropriate dosing and inappropriate medication combinations.


To ensure coordinated care for children in foster care who receive psychotropic medications, we recommend that ACF develop a comprehensive strategy to improve States' compliance with requirements related to treatment planning and medication monitoring for psychotropic medications. ACF should assist States in strengthening their requirements for oversight of psychotropic medications by incorporating suggested professional practice guidelines for monitoring children at the individual level. ACF stated that it concurred with some of our recommendations but not others; it did not specify which of the two formal recommendations it agreed with, and which it did not.