More than 1 in 4 kids in U.S. child welfare system prescribed psychotropic medication, study finds

Sustainable Development Goals and the U.S. Child Welfare System

A recent study has shed light on a concerning issue within the U.S. child welfare system, emphasizing the importance of addressing the Sustainable Development Goals (SDGs) in this context.

What the Study Reveals

According to a research letter published in August, children in the U.S. child welfare system, including those in adoption assistance, foster care, or guardianship care, are more likely to receive psychotropic medication without receiving psychotherapy or behavioral intervention. Psychotropic medication is used to treat behavior or mood disorders such as anxiety, depression, or bipolar disorder.

Key Findings of the Study

1. 26.25% of children and adolescents in the child welfare system had a psychotropic medication prescription.
2. 13.27% of children and adolescents in the child welfare system had two or more psychotropic medication prescriptions.
3. 9.06% of other Medicaid-enrolled youths had a psychotropic medication prescription.
4. 3.11% of other Medicaid-enrolled youths had two or more psychotropic medication prescriptions.

The most common medications in the child welfare group were stimulants (15.95%), followed by antidepressants (9.88%) and antipsychotics (7.87%). Additionally, 42.85% of children and adolescents in child welfare had a diagnosed mental health condition, with trauma or stressor-related disorder (22.93%), attention-deficit/hyperactivity disorder (21.49%), and behavior or conduct disorder (11.67%) being the most prevalent diagnoses.

Expert Opinions

Dr. Louis Kraus, division director of child and adolescent psychiatry at Rush University Medical Center in Chicago, states that the study’s findings are not surprising. He explains that children in foster care are at a higher risk for developmental and psychiatric disorders, making them more likely to be prescribed psychotropic medication. The challenges within the foster care system, such as multiple home placements and difficulties in accessing specialized care, contribute to the increased use of multiple medications.

Dr. Rachael J. Keefe, a pediatrician on the executive committee for the American Academy of Pediatrics Council on Foster Care, Adoption, and Kinship Care, also expresses her lack of surprise regarding the study’s results. Her own research conducted in 2021 confirmed the overprescription of psychotropic medications to children in foster care. She highlights the need for uniform guidelines and oversight rules across states to ensure the safety and effectiveness of these medications.

The Significance of the Issue

The overprescription of psychotropic medications to children in foster care raises concerns about their safety and effectiveness. Inconsistent monitoring and lack of uniform guidelines contribute to this issue. Dr. Kraus emphasizes the importance of specialized care for young people in the child welfare system. He suggests that children should receive treatment from child psychiatrists rather than multiple general practitioners, which can lead to multiple diagnoses and prescriptions. Regular follow-up appointments are crucial to monitor the effectiveness of treatment and explore alternative psychiatric services.

While medication can play a role in treatment, it should not be the sole solution. Dr. Kraus emphasizes the need to consider other interventions and support services, such as programming through the school system, to address behavioral difficulties. Close monitoring and careful evaluation of medication effectiveness are essential to ensure the well-being of children in the child welfare system.

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease.
   • Indicator 3.4.2: Suicide mortality rate.

2. SDG 4: Quality Education

   • Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including among others through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.
   • Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessment.

3. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
   • Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities.

Table: SDGs, Targets, and Indicators

Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The issues highlighted in the article are connected to SDG 3: Good Health and Well-being, SDG 4: Quality Education, and SDG 10: Reduced Inequalities.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the specific targets that can be identified are:

– Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

– Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including among others through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.

– Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, there are indicators mentioned or implied in the article that can be used to measure progress towards the identified targets:

– Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease.

– Indicator 3.4.2: Suicide mortality rate.

– Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessment.

– Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities.

These indicators can be used to measure progress towards the targets related to health and well-being, quality education, and reduced inequalities.

Table: SDGs, Targets, and Indicators