Alabama Psychiatric Medication Review Team (APMRT): Advocating for Foster Children

Abstract

Foster care children who engage in challenging behavior are likely to receive psychotropic medication as the primary intervention to reduce their behavior. These children are more likely to receive multiple psychotropic medications from the same class or three or more medications to treat a given behavioral condition, a practice called polypharmacy. In response to this practice, federal legislation mandated states to monitor psychotropic medication prescriptions to foster care children. Consequently, the Deputy Director of the Alabama Department of Human Resources proposed the development of a behavioral health professional team, collectively known as the Alabama Psychiatric Medication Review Team (APMRT). The APMRT was tasked with developing application and safety guidelines for prescribers and determining the extent to which behavioral interventions are a cost-effective alternative for managing problem behavior. This paper briefly outlines APMRT's general strategies, describes the team members' roles, and discusses future directions. KEYWORDS: behavioral interventions, foster care, psychotropic medications, problem behavior Due to familial trauma, abuse, and neglect, over 400,000 youth in 2016 were placed in foster care in the U.S. (United States Department of Health and Human Services, 2017). When compared to children who reside with their biological parents, foster children are more likely to display disruptive behavior (Bronsard et al., 2016) and to be prescribed psychotropic medications to treat their behavior problems (Zima, Bussing, Crecelius, Kaufman, & Belin, 1999; United States Government Accounting Office, 2012). Although estimates range geographically and placement (community-based foster care, therapeutic foster home, or group homes), studies suggest 13-40% of foster youth receive one or more psychotropic medications in community settings (Leslie, Raghavan, Zhang, & Aarons, 2010; Raghavan & McMillen, 2008; Raghavan, Brown, Allaire, Garfield, & Ross, 2014). In general, foster care children are more likely to receive (a) multiple medications concurrently to treat a single condition, (b) dosages of one or more psychotropic medications that exceed maximum recommended values, or (c) off-label application of medication