The Inappropriate Prescribing of Psychotropic Medication to Foster Children: An Integrative Review

Abstract Background: The prescribing rates of psychotropic medication for foster children far exceed the prescribing rates of psychotropic medications for other children, ages 0-18. Many psychotropic medications have not been researched for children and have not been proven safe or effective for this age group, and do not adhere to AACAP safety guidelines. Objectives: The purpose of this integrative literature review is to identify the factors that contribute to the high prescribing rates of psychotropic medication among foster children, as well as identifying the risks associated with prescribing habits that do not follow AACAP guidelines. Additionally, safer alternatives to psychotropic medications will be assessed. Methods: An integrative literature review was conducted following the Whittemore & Knafl guideline. Databases searched included: CINAHL, ProQuest Nursing, PubMed, ProQuest Sociology, and PsycINFO. Included articles were related to foster children, ages 0-18, and were published between 2008-2018. Eighteen articles were selected for review. Results: Trends that are correlated with high prescribing rates were based on demographics, diagnosis, prescriber and medication type, and fragmented care. Additionally, the risks associated with prescribing habits that do not follow AACAP guidelines were: polypharmacy, exorbitant and off label antipsychotic use, receiving a treatment plan that does not follow evidence-based practice, and receiving medication before proper mental health screenings were completed. Furthermore, alternative options that can limit the amount of psychotropic medications prescribed and better ensure medication safety are: psychosocial treatment, treatment foster care, and the “Fostering Healthy Futures” program. Conclusion: Psychotropic medications are being prescribed without utilizing the AACAP protocols effectively. Additionally, safer first line treatments, such as psychological therapy, could be used in place of medications to increase safety and decrease negative long-term effects for foster children who are prescribed psychotropic medication. Key Words: foster children, overmedication, polypharmacy, psychotropi