Many of these children and youth experienced trauma before and because of removal from their homes. As a result, they are likely to need behavioral health services — but, not necessarily psychotropic medications, or specifically, antipsychotics. A number of factors contribute to the potential for inappropriate psychotropic prescribing practices:
A lack of access to effective non-pharmacological interventions and a reliance on medications to quickly control difficult behaviors;
An inadequate supply of child behavioral health specialists with training in evidence-based, trauma-informed practices;
Limited clinical knowledge among child welfare case workers about appropriate psychotropic medication use;
A lack of coordination across providers and child-serving agencies; and
Aggressive, effective pharmaceutical marketing and financial incentives that drive prescribing.
Recognizing this issue, a joint November 2011 letter from the Centers for Medicare and Medicaid Services (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Administration for Children and Families (ACF), encouraged states to strengthen oversight of psychotropic medication use among this high-risk population