{ "id": "R43466", "type": "CRS Report", "typeId": "REPORTS", "number": "R43466", "active": true, "source": "EveryCRSReport.com", "versions": [ { "source": "EveryCRSReport.com", "id": 586985, "date": "2017-02-17", "retrieved": "2020-01-02T14:49:30.686822", "title": "Child Welfare: Oversight of Psychotropic Medication for Children in Foster Care ", "summary": "Children in foster care are children that the state has removed from their homes and placed in another setting designed to provide round-the-clock care (e.g., foster family home, group home, child care institution). The large majority of children enter foster care because of neglect or abuse at the hands of their parents. Maltreatment by a caregiver is often traumatic for children, and may lead to children having challenges regulating their emotions and interpreting cues and communication from others, among other problem behaviors. Children in foster care are more likely to have mental health care needs than children generally. \nChildren in foster care who have mental health needs may receive psychosocial services such as individual or group counseling and case management to improve their health. Alternatively, or in addition, a medical professional may prescribe psychotropic medications. These are prescribed drugs that affect the brain chemicals related to mood and behavior. They are used to treat a variety of mental health conditions including attention disorders, depression, anxiety, conduct disorders, and others. While psychotropic medication alone is not necessarily advised, children in foster care may more readily receive psychotropics to treat their mental health needs due to the complexity of their symptoms and the lack of appropriate screening and assessment and/or the limited availability of health care professionals trained to provide effective therapies (e.g., cognitive behavioral therapy). \nBetween 16% and 33% of children in out-of-home care may be using psychotropic medication on any given day, although the rate of use varies significantly based on certain factors, including the child\u2019s age, placement setting, and length of involvement with the child welfare agency. Among children generally, about 6% are taking psychotropic medications at some point during a given year. Some of the difference in prevalence of use may be explained by the higher levels of mental health risk factors among children in foster care. \nThe use of psychotropics by children in foster care has come under increased scrutiny by policymakers and stakeholders in the child welfare field. Little research has been conducted to show whether psychotropics are effective and safe for children who need mental health services. Despite these concerns, some children may benefit from specific psychotropic medication for managing mental and behavioral symptoms associated with their exposure to traumatic events. President Obama\u2019s FY2017 budget proposed a five-year initiative to reduce reliance on psychotropic medications for children in foster care by encouraging the use of evidence-based screening, assessment, and treatment of trauma and mental health disorders. Congress has also taken a strong interest in oversight of prescription medications used by children in care, addressing the issue in oversight hearings and other fact-finding forums. \nFurther, federal law (Title IV-B, Subpart 1 of the Social Security Act) requires states and other jurisdictions to describe their oversight of prescription medications for children in foster care, including specific protocols used with regard to psychotropic medication. The Department of Health and Human Services (HHS) has issued guidance about these provisions and requires jurisdictions to submit annual reports to the department that describe this oversight.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R43466", "sha1": "815fa5170b08e54f5d59edd150437c717e7eb44f", "filename": "files/20170217_R43466_815fa5170b08e54f5d59edd150437c717e7eb44f.html", "images": { "/products/Getimages/?directory=R/html/R43466_files&id=/0.png": "files/20170217_R43466_images_4566a664b9280b33bf72d7248c02c862d75b3451.png", "/products/Getimages/?directory=R/html/R43466_files&id=/1.png": "files/20170217_R43466_images_f71a9ac36e7e38e2764f18a4c2a9e7a507307101.png", "/products/Getimages/?directory=R/html/R43466_files&id=/3.png": "files/20170217_R43466_images_7e0abb1474d99bb82d8cec70255cb0f0bda262da.png", "/products/Getimages/?directory=R/html/R43466_files&id=/2.png": "files/20170217_R43466_images_036a3e86bfc282041af27c5b44f3717c7af7225e.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R43466", "sha1": "62d2a80968fb095760b70f326e1932be457cee0d", "filename": "files/20170217_R43466_62d2a80968fb095760b70f326e1932be457cee0d.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4761, "name": "Child Welfare" } ] }, { "source": "EveryCRSReport.com", "id": 443410, "date": "2015-07-28", "retrieved": "2016-04-06T18:43:18.502649", "title": "Child Welfare: Oversight of Psychotropic Medication for Children in Foster Care", "summary": "Children in foster care are children that the state has removed from their homes and placed in another setting designed to provide round-the-clock care (e.g., foster family home, group home, child care institution). The large majority of children enter foster care because of neglect or abuse at the hands of their parents. Maltreatment by a caregiver is often traumatic for children, and may lead to children having challenges regulating their emotions and interpreting cues and communication from others, among other problem behaviors. Children in foster care are more likely to have mental health care needs than children generally. \nChildren in foster care who have mental health needs may receive psychosocial services such as individual or group counseling and case management to improve their health. Alternatively, or in addition, a medical professional may prescribe psychotropic medications. These are prescribed drugs that affect the brain chemicals related to mood and behavior. They are used to treat a variety of mental health conditions including attention disorders, depression, anxiety, conduct disorders, and others. While psychotropic medication alone is not necessarily advised, children in foster care may more readily receive psychotropics to treat their mental health needs due to the complexity of their symptoms and the lack of appropriate screening and assessment and/or the limited availability of health care professionals trained to provide effective therapies (e.g., cognitive behavioral therapy). \nBetween 16% and 33% of children in out-of-home care may be using psychotropic medication on any given day, although the rate of use varies significantly based on certain factors, including the child\u2019s age, placement setting, and length of involvement with the child welfare agency. Among children generally, about 6% are taking psychotropic medications (at some point during a given year). Some of the difference in prevalence of use may be explained by the higher levels of mental health risk factors among children in foster care. \nThe use of psychotropics by children in foster care has come under increased scrutiny by policymakers and stakeholders in the child welfare field. Little research has been conducted to show whether psychotropics are effective and safe for children who need mental health services. Despite these concerns, some children may benefit from specific psychotropic medication for managing mental and behavioral symptoms associated with their exposure to traumatic events. The President\u2019s FY2016 budget proposes a five-year initiative to reduce reliance on psychotropic medications for children in foster care by encouraging the use of evidence-based screening, assessment, and treatment of trauma and mental health disorders. Congress has also taken a strong interest in oversight of prescription medications used by children in care, addressing the issue in oversight hearings and other fact-finding forums. Further, federal law (Title IV-B, Subpart 1 of the Social Security Act) requires states to describe their oversight of prescription medications for children in foster care, including specific protocols used with regard to psychotropic medication.\nThe Congressional Research Service (CRS) reviewed state plans submitted to HHS in 2012 that described state protocols in five areas identified by HHS as important to monitoring and appropriate use of psychotropic medication. States\u2019 responses were wide ranging, and oversight efforts are nascent in some states and fairly robust in others. With regard to screening for mental health need and planning treatment: Mental health evaluations appear to be available for children generally who are entering care, though some states limit this kind of evaluation to children of a minimum age (e.g., age three or older). States most frequently indicated that evaluations are conducted, within 30 days of removal from the home, by a primary care physician or a mental health professional such as a psychiatrist. With regard to consent and assent for the use of psychotropic medications by children in care, and methods for ongoing communication between stakeholders involved in the child\u2019s health care: Over half of states that responded reported that a parent or legal guardian is involved in providing consent. With regard to effective medication monitoring at both the client and agency level: States reported that monitoring at the child (i.e., client) level is primarily focused on determining how the medication is affecting the child and may be carried out by a foster caregiver, caseworker, and or clinician. Agency monitoring, which tracks use of psychotropics at a system level, may be conducted by the child welfare agency, an overall health program for children in foster care, or special committees or review boards. \nThe findings from the state plans suggest policy issues that may be relevant to Congress as it considers the next steps in oversight of psychotropic use among children in foster care. These issues include possible broader use of medical homes and electronic health records to improve oversight of psychotropic medications, the role of Medicaid in improving screenings and services for children in care with mental health needs, the involvement of youth in choosing their mental health care, and the extent to which states should report to HHS on their oversight policies.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43466", "sha1": "dab170ceb76ca6557e9ad489c0409119ed731316", "filename": "files/20150728_R43466_dab170ceb76ca6557e9ad489c0409119ed731316.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43466", "sha1": "5c63888068e06e7bcd67d67ac0dfb94551ce81aa", "filename": "files/20150728_R43466_5c63888068e06e7bcd67d67ac0dfb94551ce81aa.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2651, "name": "Child Well-Being" } ] } ], "topics": [ "Domestic Social Policy", "Health Policy", "Intelligence and National Security" ] }