By Darcy Gruttadaro, NAMI Director of Child & Adolescent Action Center
NAMI recently prepared a statement for a Senate hearing examining the use of psychotropic medication for children in foster care. NAMI is pleased that the Senate is looking closely at this issue and that the U.S. Government Accountability Office (GAO) recently released a report on the issue. The GAO report calls for states to more closely monitor the prescribing of psychotropic medications for children in foster care. This is a critical first step, but is not enough.
Expert prescribing guidelines for psychotropic medications should be developed and distributed by states to agencies and mental health professionals that serve children in foster care. Training, support and technical assistance are needed on an ongoing basis to help ensure that the guidelines are being used and followed.
Given the high prevalence of children in foster care with mental health care needs, these children should be screened and for those who screen positive, provided with a comprehensive psychiatric evaluation and a physical examination to rule out other physical health conditions that the child may be experiencing. All of this must be paid for by Medicaid and private insurers.
Our nation has a critical shortage of child mental health professionals, making access to care extremely difficult for all families, including those involved in the foster care system. States need to support access to scarce psychiatric care for children by supporting collaborative care and integrated care models that encourage the development of partnerships between families, primary care and mental health providers. NAMI recently released a family guide on integrated care that outlines the effective collaborative care and integrated care models that exist around the country and that benefit children and families.
Our nation must get serious about providing effective and evidence-based psychosocial interventions to all children with mental illness, including those in foster care. Many psychosocial interventions have been shown through research to work for children with mental illness, some as part of a comprehensive treatment plan along with medications and some on their own. These include cognitive behavioral therapy, parent-child interaction therapy, functional family therapy and more. Sadly, these interventions are often not available because providers are not trained in them and/or they are not paid for by private insurers or through Medicaid. The provider community, state Medicaid Directors, private insurers, federal agencies and others should work to ensure that there is a trained work force that understands how to deliver these effective interventions to children both within and outside of foster care. The availability of psychosocial interventions will impact the rate of psychotropic medications prescribed for children in foster care.
Finally, more research is needed to better understand the long-term safety and effectiveness of psychotropic medications for children, especially very young children. With the exception of stimulant medications for children with ADHD, there is very limited research. Although medications, when prescribed appropriately, can be lifesaving for children, more must be learned about their long-term impact on children’s health.
If we want to get serious about protecting the health and well-being of children in foster care, then we must look at all of these variables that directly impact the care provided to these children. These issues transcend the foster care system and pertain to all children and youth living with mental illness.