Reducing Psychotropic Medication Use in Foster-Care Children with a Personalized Medication Review

Objectives: Investigators and government agencies have expressed concern about the high percentage of foster youth who receive psychotropic medication, the number of psychotropic medications prescribed, and the extended duration for which many foster youth receive psychotropic medication. One contributor to the duration of medication use is the absence of clear guidelines for de-prescribing in pediatric psychiatry. The present study evaluated whether medication review letters crafted by medical professionals and sent to caregivers prompted a reduction in psychotropic medication in foster youth. Methods: The caretaker or caseworker of 52 foster children, 38 males, under 16 years of age, who received medication through Medicaid, was sent a letter assessing the use of psychotropic medication and identifying areas of concern. Recipients were encouraged to discuss the letter with the child's prescriber. These children had been referred to a university-affiliated organization that provided behavioral interventions to other children, but the children in the present study did not receive behavioral interventions from the organization. The use of psychotropic medication was assessed for 18 months before and 24 months after the letter was sent. The control group had comparable demographics and medication-use parameters. The trajectories of medication count before and after a letter (for cases) or a "phantom" letter (for controls) was sent were compared. Results: The medication review letter precipitated a decrease in medication count over the year after the letter was sent for 9- to 12-year-olds. For 13- to 16-year-olds, an increasing trend in medication use was halted. No effect was seen for 5- to 8-year-olds. No such changes occurred in the control groups. Conclusions: A single personalized letter, tailored to a child's medication list, was provided to caregivers to share with prescribers. This decreased or halted an increase in the use of psychotropic medications for children in foster care who were 9 years old or older.