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Brief Reports   |    
Foster Care, Externalizing Disorders, and Antipsychotic Use Among Medicaid-Enrolled Youths
Lauren Vanderwerker, Ph.D.; Ayse Akincigil, Ph.D.; Mark Olfson, M.D., M.P.H.; Tobias Gerhard, Ph.D.; Sheree Neese-Todd, M.A.; Stephen Crystal, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300455
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When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: lvanderwerker@hilltop.umbc.edu).

Copyright © 2014 by the American Psychiatric Association


Objectives  The authors investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths.

Methods  Medicaid claims data from 44 states for 2009 for youths in foster care (N=301,894) and those not in foster care (N=5,092,574) were analyzed, excluding those with schizophrenia, bipolar disorder, autism, and major depressive disorder. Logistic regressions assessed the relationship between foster care, externalizing disorders, and antipsychotic use.

Results  Foster care youths had higher rates of externalizing disorders than the comparison group (attention-deficit hyperactivity disorder, 17.3% versus 6.5%; disruptive behavior disorder, 7.2% versus 2.5%; conduct disorder, 2.3% versus .5%) and greater antipsychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54–2.63).

Conclusions  High rates of externalizing disorder diagnoses only partially explained elevated levels of antipsychotic use in this vulnerable population.

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Table 1Multivariate associations between antipsychotic use, foster care status, and characteristics of 5,394,468 Medicaid-enrolled youths


Crystal  S;  Olfson  M;  Huang  C  et al:  Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges.  Health Affairs 28:w770–w781, 2009
[CrossRef] | [PubMed]
Christian  R;  Saavedra  L;  Gaynes  BN  et al:  Future Research Needs for First- and Second-Generation Antipsychotics for Children and Young Adults. Future Research Needs Paper, no 13 .  Rockville, Md,  Agency for Healthcare Research and Quality, 2012
Matone  M;  Localio  R;  Huang  YS  et al:  The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: a national study of US Medicaid-enrolled children.  Health Services Research 47:1836–1860, 2012
[CrossRef] | [PubMed]
Correll  CU;  Manu  P;  Olshanskiy  V  et al:  Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents.  JAMA 302:1765–1773, 2009
[CrossRef] | [PubMed]
Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions. Washington, DC, Government Accountability Office, 2011. Available at www.gao.gov/assets/590/586570.pdf
dosReis  S;  Yoon  Y;  Rubin  DM  et al:  Antipsychotic treatment among youth in foster care.  Pediatrics 128:e1459–e1466, 2011
[CrossRef] | [PubMed]
Zito  JM;  Safer  DJ;  Sai  D  et al:  Psychotropic medication patterns among youth in foster care.  Pediatrics 121:e157–e163, 2008
[CrossRef] | [PubMed]
Pilowsky  D:  Psychopathology among children placed in family foster care.  Psychiatric Services 46:906–910, 1995
Stahmer  AC;  Leslie  LK;  Hurlburt  M  et al:  Developmental and behavioral needs and service use for young children in child welfare.  Pediatrics 116:891–900, 2005
[CrossRef] | [PubMed]
Greeson  JK;  Briggs  EC;  Kisiel  CL  et al:  Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network.  Child Welfare 90:91–108, 2011
dosReis  S;  Zito  JM;  Safer  DJ  et al:  Mental health services for youths in foster care and disabled youths.  American Journal of Public Health 91:1094–1099, 2001
[CrossRef] | [PubMed]
Aarons  GA;  Palinkas  LA:  Implementation of evidence-based practice in child welfare: service provider perspectives.  Administration and Policy in Mental Health and Mental Health Services Research 34:411–419, 2007
[CrossRef] | [PubMed]
Burns  BJ;  Phillips  SD;  Wagner  HR  et al:  Mental health need and access to mental health services by youths involved with child welfare: a national survey.  Journal of the American Academy of Child and Adolescent Psychiatry 43:960–970, 2004
[CrossRef] | [PubMed]
Lapan T: Legislation aims to curb overmedicated odyssey many foster children face. Las Vegas Sun, June 18, 2012
Harris  E;  Sorbero  M;  Kogan  JN  et al:  Concurrent mental health therapy among Medicaid-enrolled youths starting antipsychotic medications.  Psychiatric Services 63:351–356, 2012
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