Interstate variations in psychotropic medication use among a national sample of children in the child welfare system
Ramesh Raghavan1, Gyanesh Lama, Patricia Kohl
1Brown School, Washington University, St. Louis, MO 63130, USA. raghavan@wustl.edu
Insights
Interstate variations in psychotropic medication use among children in child welfare are linked to child characteristics, not just mental health needs. California children had significantly lower medication use than Texas children.
Area of Science:
- Child and Adolescent Psychiatry
- Health Services Research
- Social Work
Background:
- Geographic variations in service utilization signal care quality issues.
- Psychotropic medication use in children within the child welfare system is a significant concern.
Purpose of the Study:
- To examine interstate variations in psychotropic medication use among children interacting with child welfare agencies.
- To identify factors contributing to these observed geographic disparities in medication prescribing.
Main Methods:
- Utilized data from the National Survey of Child and Adolescent Well-Being (NSCAW), Kaiser Family Foundation, and Area Resource File.
- Conducted regression analyses to compare psychotropic medication use probabilities between states, controlling for child characteristics.
Main Results:
- Significant interstate variations in psychotropic medication use were found, with California (7.1%) showing lower rates than Texas (20.1%).
- Children in California had substantially lower odds of psychotropic medication use compared to those in Texas.
- Differences in evaluating child characteristics (age, gender, foster care, mental health need) between states appeared to drive these variations.
Conclusions:
- Interstate disparities in psychotropic medication use among child welfare-involved youth are primarily influenced by how child characteristics are assessed, not solely by mental health needs.
- Further research into clinical contexts is crucial for ensuring equitable and high-quality psychotropic medication management for vulnerable children.
Abstract:
Geographic variations in service utilization have emerged as sentinels of quality of care. We used data from the National Survey of Child and Adolescent Well-Being (NSCAW), the Kaiser Family Foundation, and the Area Resource File to examine interstate variations in psychotropic medication use among children coming into contact with child welfare agencies. Mean probabilities of medication use differed by 13% between California (7.1%) and Texas (20.1%). On regression analyses, children in California had a fifth of the odds of medication use compared to children in Texas, principally, because child characteristics of age, gender, foster care placement, and mental health need seem to be evaluated differently in Texas compared to in other states. These findings suggest that interstate variations in psychotropic medication use are driven by child characteristics, rather than by mental health need. Understanding the clinical contexts of psychotropic medication use is necessary to assure high-quality care for these children.
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