Combining stimulants with antipsychotics for foster children and adolescents: Do prescribers adhere to guidelines?

Objective: Consistent with federal requirements for states to monitor psychotropic medication use in foster children and adolescents, we assessed prescribers' adherence to best practice guidelines. Specifically, we identified the prevalence and patterns of combined use of stimulants and antipsychotics among a sample of foster children and adolescents that received additional non-pharmacological interventions from a state-funded team. A secondary purpose of this paper was to demonstrate a method for monitoring psychotropic medication use for this vulnerable population. Methods: Using data from a state Medicaid database and a state-funded team, we tracked medication use among a sample of 128 foster children and adolescents aged 5-19 years with varying diagnoses who received behavioral and medication review services. We extracted data for children and adolescents who received the combination of stimulants and antipsychotics, and then we visually depicted the data to show changes in medication use before, during, and after our services. Results: Out of the larger sample, twenty-one foster children and adolescents (16%) simultaneously received stimulants and antipsychotics. Visual depictions of data show that less than 50% received stimulants alone before combined use. In addition, participants experienced limited changes in medication regimens even after receiving non-pharmacological services. Conclusions: These findings suggest that prescribers may not adhere to practice guidelines for use of stimulants and antipsychotics, even for clients who receive other services, and highlight the need for relevant stakeholders to monitor unsafe prescribing practices.