Psychotropic Medication Practices for Youth in Systems of Care

Concerns have been raised about the quality and appropriateness of psychiatric medication treatment for youth treated in the child welfare or juvenile justice systems. Unfortunately there is a lack of empirical research to indicate whether there are indeed widespread problems related to psychopharmacologic treatment for youth served by public sector systems. This exploratory study utilized data from a national survey of social workers to examine differences in reports on medication type, processes, and perceived outcomes for adolescent clients in the juvenile justice and/or child welfare system (n = 90) versus non-systems clients (n = 305). Relevant clinical and demographic factors were controlled in hierarchical binary logistic and linear regression analyses. The results indicated that social workers referring to systems cases were more likely to report the use of highly potent medication (antipsychotics, mood-stabilizers, and poly-pharmacy), less likely to report that clients were receptive to or involved in the decision to utilize medication, and less likely to report beneficial medication outcomes. However, these reported differences, suggesting that medication treatment for systems youth tends to be less participatory and beneficial, were largely accounted for by differences in clients’ level of functional impairment and rate of disruptive behavior disorders. Implications for further research are discussed.