Psychotropic medication oversight for youth in foster care: A national perspective on state child welfare policy and practice guidelines

This study uses data collected from multi-state interviews, document review, and the U.S. Census to provide a national perspective on the policies and practice guidelines for mental health evaluation and psychotropic medication oversight among youth in foster care within 47 states and the District of Columbia. This study specifically employs descriptive statistics and logistic regression models to examine various components of these policies/guidelines and the state characteristics and organizational structure associated with the presence of a policy/guideline for mental health evaluation and psychotropic medication oversight. Almost half of states (47.9%) endorsed a mental health evaluation in policies/guidelines; policies/guidelines varied with respect to specific sub-populations targeted and the components of the evaluation. Over half of states (52.7%) held policies/guidelines for psychotropic medication oversight with substantial variation in populations and medications covered, and in the mechanism for psychotropic medication oversight (e.g., informed consent, child- and population-level monitoring). Organizational structure, specifically staffing both a medical and mental health director, and percentage of urban land area (i.e., Metropolitan Statistical Area) were associated with presence of policies/guidelines. Implications for federal and state implementation of the Fostering Connections to Success and Increasing Adoptions Act (Public Law 110–351) and future research on child welfare policy are discussed.

► We examine mental health policies for youth in foster care in 47 states and D.C.
► Policies for mental health evaluation and psychotropic oversight vary across states.
► Percentage of urban land area in a state is associated with policy endorsement.
► Medical expertise in state agency leadership is associated with policy endorsement.
► State variation in mental health policy can inform implementation of PL 110–351.