Psychotropic medication patterns for American indian children in foster care

Objective: This study assesses the effects of race, age, sex, and time spent in foster care on rates of psychotropic medication use for children in foster care in 2012. Methods: Using existing electronic records through county Social Service and Minnesota Medical Assistance databases, 626 children were identified using the inclusion criteria of having been in foster care for at least 30 days during 2012 in St. Louis County, Minnesota. All prescriptions for dispensed psychotropic medications were identified into the following classes: antidepressants, attention-deficit/hyperactivity disorder (ADHD) medications, antipsychotics, alpha-agonists, and other (including anticonvulsants/mood stabilizers, lithium, benzodiazepines, and sedative hypnotics). Results: Overall, 26% of children were dispensed at least one psychotropic medication during the year with the percentage of children on medication for each race as follows: American Indian (AI) 23.3%, European American (EA) 29.2%, and African American (AA) 18.3%. AI children were significantly less likely to be dispensed any psychotropic medication and ADHD medication. EA children, males, and older children received psychotropic medications from significantly more classes than AI or AA children, females, and younger children. Males were significantly more likely to be dispensed alpha-agonists, antipsychotics, and ADHD medications. Increased time since placement into foster care was also significantly associated with increased dispensing rates of antidepressants, ADHD medication, and multiple medication classes. Conclusions: The results of this study show that non-EA children, in particular AI children, were dispensed psychotropics both overall and across different medication classes less often compared to other racial groups. While the reasons for this difference are not known, future studies are needed to address whether mental health needs of all children in foster care are being appropriately addressed, accounting for need and patient preference.