USE OF PSYCHOTROPIC MEDICATION IN FOSTER CARE AND RELATED OUTCOMES
Public Deposited- Last Modified
- March 20, 2019
- Creator
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Gwaltney, Angela
- Affiliation: School of Social Work
- Abstract
- Children who enter foster care have experienced some of the most severe cases of abuse, neglect, and/or dependency. Because of these adverse experiences, their prevalence of mental health disorders is predictably higher than in the general population. Children in foster care also have high rates of psychotropic medication use, which has become a national concern. The literature in this area has also found the occurrence of risky medication practices such as polypharmacy, concomitant pharmacy, and prescribing to very young children (i.e., under 4 years of age). However, studies have yet to explore the social effects of medicating children in foster care such as stabilizing foster care placements or supporting reunification with families. The following three-paper dissertation not only examines how children in foster care are receiving psychotropic medication but also the effects, both positive and negative, that using psychotropic medications has on the child’s foster care outcomes. Paper I is a literature review to synthesize the existing research on the factors related to the prescription of psychotropic medications among youth in foster care. An explicit strategy is specified to conduct a thorough and replicable search including dates, terms, search engines and databases used, and inclusion/exclusion criteria. A sensitivity analysis was also used to assess risk of publication bias. The PRISMA guideline was followed to conduct the literature review and to report the prevalence rate of psychotropic medication use among foster children in the United States as well as characteristics of foster children who use psychotropic medication. Articles published between 1990 and 2016 were included in the search. After a two-step inclusion/exclusion process, 39 articles were identified to have met the inclusion criteria. Results of the meta-analysis found that the overall prevalence rate of psychotropic medication use for children in foster care was 32.9%. The paper also found that males, older youth, children with internalizing/externalizing behavior problems, children living in rural areas, as well as children placed in out-of-home placements were more likely to receive psychotropic medication. The odds of receiving psychotropic medication also varied by abuse type. Paper II is a descriptive study of children in foster care in North Carolina who received psychotropic medication. Foster care and Medicaid data were linked to create the sample of foster children from the state of North Carolina who entered into care between March 2006 and June 2012 (N = 30,657). Univariate analysis was performed for frequency distributions and measures of central tendency and variation. Chi-square tests were used to test linear trends over the study period and generalized linear modeling (GLM) was used to assess association of individual and contextual factors and medication use. About one in five foster children (20.9%) received a psychotropic medication during their time in care. Males, Whites, older children, and those with a mental health diagnosis were more likely to receive psychotropic medication. Those placed in kinship care were less likely to receive psychotropic medication. Among those who were medicated, disruptive disorder was the most commonly diagnosed mental illness and its prevalence grew throughout the study period. Stimulants were the most prescribed medication and taken by 59.0% of those who received medication. Paper III examines the impact of psychotropic medication on children’s foster care experiences such as their placement stability, length of time in care, and permanency outcomes. Using the same linked administrative dataset, inverse probability of treatment weighting was calculated and applied to mimic a randomized study. The Cox proportional hazards model., Poisson count regression, and multinomial logit regression and were used to examine the effects of medication use on length of time in care, placement stability, and permanency outcomes (i.e., reunification, guardianship, adoption, or others). Results revealed that children on medication stayed in care longer, less likely to experience placement disruption, and more likely to exit to adoption. As a whole, the three papers synthesize findings from previous literature on what has been established in the research regarding psychotropic medication use and foster care; offer a deeper understanding on what characteristics are associated with psychotropic medication use among children in foster care; and extend the scope of existing research to the effects of medication on more proximal outcomes such as placement stability, length of time in care, and permanency outcomes. Furthermore, the innovative statistical analysis used demonstrates a novel approach to conduct causal analysis on large, administrative datasets.
- Date of publication
- May 2018
- Keyword
- DOI
- Resource type
- Rights statement
- In Copyright
- Advisor
- Smith, Jean
- Duncan, Dean
- Shaw, Terry
- Chen, Din-Geng
- Zimmerman, Sheryl
- Degree
- Doctor of Philosophy
- Degree granting institution
- University of North Carolina at Chapel Hill Graduate School
- Graduation year
- 2018
- Language
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- Parents:
This work has no parents.
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