The Government Accountability Office (GAO) has released a new report on foster care and oversight of prescription drug medication. The report, HHS Has Taken Steps to Support States’ Oversight of Psychotropic Medications, but Additional Assistance Could Further Collaboration, as the title suggests indicates more needs to be done in terms of the overuse and prescribing of psychotropic medications.  The report looked at seven states specifically.  The states examined used a range of practices from requiring initial mental health screenings to monitoring children after they are prescribed psychotropic drugs.  All had some form of initial screen.  Common actions included consultation with health professionals, permission from parents or caretaker, and coordination between various agencies including Medicaid and mental health agencies.

The GAO determined that between 2011 through 2015 of the seven states, four of the states—California, Illinois, New Jersey, and Washington— reduced the percentage of children in foster care on psychotropic medications while two other selected states— Arizona and Maryland—had steady rates of medication use and Ohio did not have data for the period reviewed.

The GAO indicated that it is difficult to fully determine which factors are most significant in reducing medication use but Washington child welfare and Medicaid officials said their second opinion program, which requires physicians to consult a child psychiatrist when prescribing certain medications, has likely prevented inappropriate prescribing. New Jersey also made significant progress.  In that state’s case, for children entering foster care, each child health status is reviewed by a nurse.

The GAO said that child welfare and Medicaid officials and most national professional and research organizations said reducing medications may not be appropriate for every child.  All seven states said a child’s mental health can be affected by many factors, including psychotropic medications, psychosocial services, and other situational and environmental factors. They also said that rather than focusing on reducing medications overall, officials in these states said their goal is to ensure the child receives appropriate treatment, which may involve efforts related to all the factors mentioned.

The report outlined several actions taken by various agencies within HHS to assist states but some states interviewed indicated that ongoing challenges that HHS could help with include 1) obtaining best practices in medication use concurrent with other treatments; 2) overcoming siloes across child welfare, Medicaid, and mental health systems serving the foster care population; and 3) enhancing access to child and adolescent psychiatric resources. In addition, officials in selected states transitioning their foster care populations into managed care expressed concern about the transition, and the need to manage the transition to ensure optimal care coordination.