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. 2026 Aug 3;16(4):185–191. doi: 10.9740/mhc.2026.08.185

The role of board-certified psychiatric pharmacists in United States foster care: Opportunities to optimize psychotropic medication use

Danielle L Stutzman 1, Andreea Temelie 2, Mary Accomando 3, Carol A Ott 4, Matthew Dick 5, Gregory H Payne 6
PMCID: PMC13449229  PMID: 42569208

Abstract

Polypharmacy, gaps in transitions of care, and inconsistent medication monitoring contribute to inappropriate psychotropic prescribing among youth in foster care. Additionally, foster care psychotropic prescribing regulations are complex and insufficient. Acknowledging these concerns, pharmacists have been identified as essential advocates for youth in foster care given their expertise in medication therapy management, medication reconciliation, patient/caregiver education, and interprofessional collaboration. Specifically, inclusion of board-certified psychiatric pharmacists (BCPPs) on the foster care team could allow for the implementation of best practices, including psychotropic stewardship, collaborative telemedicine services, telemedicine teaching initiatives, comprehensive medication management, and procurement of accurate medical and medication histories, amongst others. It is critical that child welfare administrators, health system administrators, and the foster care team consider inclusion of a BCPP to better support prescribing practices of psychotropic medications among youth in foster care.

Keywords: child and adolescent psychiatry, foster care, psychotropic stewardship

Introduction

It is estimated that 30% to 40% of youth in foster care are diagnosed with a psychiatric disorder, most commonly depressive, anxiety, attention deficit/hyperactivity, disruptive behavioral, and/or trauma and stressor related disorders.1-3 Rates of psychotropic prescribing are 2 to 6.5 times higher in foster care youth compared with the general US youth population.1,4-6 Whereas this difference may be partially explained by high rates of psychiatric disorders, concerns regarding inappropriate psychotropic prescribing exist. These concerns include polypharmacy, inconsistent monitoring, and gaps in transitions of care, amongst others.2,5-9

Board-certified psychiatric pharmacists (BCPPs) are educators and advocates for the evidence-based use of psychotropics through comprehensive medication management, medication therapy management, and psychotropic stewardship programs (PSPs).10-13 BCPPs have expertise in medication treatment of psychiatric disorders, including substance use disorders, and work with a variety of patient populations. Although many BCPPs work with youth in foster care, literature describing their effect is lacking.7,10,11,14,15 Whereas other pharmacists play important roles treating patients living with psychiatric disorders, BCPP is the gold standard and allows administrators to easily confirm appropriate training and expertise.13 The American Association of Psychiatric Pharmacists, the community of practice for BCPPs, initiated this exploration of the role of BCPPs in foster care in the United States. A general literature search was performed to identify relevant studies pertaining to this topic.

This manuscript aims to (1) identify medication management challenges among youth in foster care, (2) describe the current role of BCPPs in foster care, and (3) propose strategies for integration of BCPPs to support evidence-based practices. Whereas this manuscript focuses on psychotropic medication management, the authors acknowledge the critical role of trauma-informed mental health evaluations and psychotherapy, routine physical health evaluations, and other nonpharmacologic interventions.

Psychotropic Medication Prescribing Challenges

Risk Factors Unique to Foster Care Youth

Care provided by multiple providers, placement changes, and caregiver unfamiliarity with psychotropic medications interfere with ongoing safety monitoring and optimal prescribing among youth in foster care.10,11 Consent for psychotropics in foster care often relies on multiple caregivers, child welfare case workers, and/or the court system, introducing risk for delays, discrepancies, and overprescribing.9 Informed consent and assent prior to psychotropic medication initiation is essential though often omitted among youth in foster care.9 These characteristics of foster care stress every aspect of the patient-centered care process (Figure).

FIGURE.

FIGURE

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The failure of the patient-centered care process for foster care youth

Note: Adapted from Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014. Available at: https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf

Polypharmacy

Youth in foster care are at risk of being overprescribed psychotropics, most commonly atypical antipsychotics, alpha-2 agonists, and stimulants.5,16 Polypharmacy introduces significant risk in this patient population, importantly metabolic (eg, type II diabetes, dyslipidemia), endocrine (eg, hyperprolactinemia), and extrapyramidal side effects (eg, tardive dyskinesia) among youth prescribed ≥1 antipsychotic.17 According to 2018 Medicaid HMO data, 2.4% of youth prescribed an antipsychotic were prescribed ≥2 concurrent antipsychotics for ≥3 months.18

Use of psychotropic medications prior to foster care entry, a diagnosis of a trauma-based mental health condition, living in a group home setting, infrequent use of appropriate deprescribing, and frequent medication changes increases the risk of polypharmacy.5,16,19,20 Frequent changes in medications and overuse of medications may indicate a lack of understanding among prescribers/caregivers regarding the expected medication onset of effect, anticipated symptom improvement, and the potential adverse effects of medication optimization (eg, withdrawal effects or initial side effects).16,19,20

Inconsistent Monitoring

Inconsistent monitoring, in combination with high rates of polypharmacy, contributes to significant risk among foster care youth.5,16 It is estimated that 30% to 80% of youth enter foster care with at least 1 medical problem and that 33% have a chronic medical condition.21 Federal and state initiatives to optimize psychotropic monitoring in this patient population have been created to improve monitoring in this vulnerable population.6,8,22,23

There has been extensive growth in national, state, and system-wide antipsychotic interventions, including antipsychotic monitoring programs (eg, prior authorizations, drug utilization review [DUR]), provider prescribing supports (eg, learning collaboratives, primary care consultation), and delivery system enhancements (eg, trauma-informed care coordination).6,8,24 Despite these efforts, only ∼30% of children and adolescents enrolled in Medicaid prescribed an antipsychotic receive the recommended metabolic monitoring.18

Additionally, regulatory standards aim to support routine monitoring among youth prescribed stimulants with a focus on long-term cardiovascular risk.18 In 2021, only 40% of Medicaid HMO–enrolled 6- to 12-year-olds had follow-up within 1 month after initiation of attention deficit/hyperactivity disorder medication, and 50% had 2 follow-up visits in 9 months.18 Because stimulants are schedule II controlled substances, prescription drug monitoring programs (PDMPs) attempt to identify individuals at risk for stimulant misuse and/or diversion. Whereas most PDMPs communicate across state lines, this monitoring strategy may not be as effective for youth in foster care who move frequently.

Gaps in Transitions of Care

Youth in foster care often move between different foster/kinship homes, levels of mental health care (eg, partial hospitalization, residential, inpatient), child welfare programs (eg, different state counties), and/or birth family home with reunification efforts.6,8,25 Based on author experience, these changes introduce significant vulnerability for foster care youth, including inaccurate or incomplete medication histories. As a result, foster care youth may experience medication discontinuation effects, medication adverse effects, worsening of psychiatric symptoms, and/or hospital readmission.6,8,10

Complex medication regimens, inconsistent outpatient follow-up, and frequent rehospitalizations are additional factors that may complicate transitions of care. Whereas efforts to enhance medication education, accuracy of medication histories, and follow-up post–hospital discharge have been reported, significant gaps continue to exist.8,16,19,26

Finally, emancipation out of the foster care system as a young adult is a care transition that is often overlooked.27 Given increased rates of disrupted health insurance coverage and poor access to health care following emancipation, there is a need for targeted wraparound support and educational materials.

Complex and Insufficient Regulations

The Child and Family Services Improvement and Innovation Act of 2011 requires states to develop protocols for appropriate use and monitoring of psychotropic medications among youth in foster care.6,9,24 As a result, most states have developed prescribing guidelines to optimize psychotropic prescribing and monitoring though recommendations vary and are often process-driven rather than outcomes-driven.8 In addition to defining high-risk psychotropic medication criteria, many state Medicaid programs require prior authorizations for certain psychotropic medications (eg, atypical antipsychotics) prescribed to youth in foster care. Though well-intentioned, prior authorizations may delay treatment without a guarantee of improving quality of care. This delay in treatment, for some, may lead to hospital readmission.28

Ongoing federal concern for “too much, too many, too young” acknowledges the lack of oversight for prescribing in many states.29 Congressional inquiries, class action lawsuits, and oversight requirements are the result of concerns regarding overuse of psychotropic medications among youth in foster care and that prescribing practices do not comply with practice guidelines.16 In response to class action lawsuits, many states have focused efforts on improved medication records systems, creation of informed consent processes, and psychiatric clinical review of medications.

Foster care guidelines vary significantly by state as analyzed elsewhere.30 Many state-based foster care guidelines summarize psychotropic prescribing criteria that warrant an external review by an interprofessional psychiatry team (Table). Examples of these criteria include (1) absence of a thorough mental health assessment; (2) concomitant medication prescribing; (3) prescribing of more than 1 medication in a specific psychotropic class (eg, >1 concomitant alpha-2 agonist, >1 concomitant antipsychotic); (4) high doses; (5) medication prescribing in preschoolers; and (6) prescribing of more than 1 medication per mental health condition.

TABLE.

Psychotropic prescribing risk stratification

Parameter Risk Level
Psychotropic Polypharmacy

  1. ≥4 psychotropics prescribed concomitantly

  2. ≥2 psychotropics within the same class prescribed concomitantly

  3. ≥2 psychotropics for a given mental health condition before using psychotropic monotherapy

 High
Diagnoses/Symptoms

  1. Lack of DSM-5-TR diagnosis

  2. Lack of clearly defined target symptoms and treatment goals

  3. ≥3 DSM-5-TR diagnoses

  4. Comorbid substance use disorder

 High
Psychotropic Age-Based Prescribing

  1. <5 years of age: antipsychotic use

  2. <4 years of age: mood stabilizer, antidepressant, alpha-2 agonist

  3. <3 years of age: stimulant use

 High
Incomplete Monitoring

  1. Lack of metabolic labs in the last year with second generation antipsychotic

  2. Lack of provider visit in the last 90 days

 Moderate
Inappropriate Psychotropic Dosing

  1. Dose exceeds the maximum recommended dose

 Moderate
Psychotropic Choice Associated with Higher Risk

  1. First generation antipsychotic

  2. Long-acting injectable antipsychotic

  3. Therapeutic drug monitoring (ie, lithium, valproate)

  4. Off-label psychotropic use

 Moderate
Low-Risk Psychotropic Choice

  1. Antidepressants for moderate-to-severe depression or anxiety

  2. Prazosin for trauma-related nightmares

  3. 6 + years of age: stimulant to treat ADHD +/− co-occurring disruptive behaviors

  4. 13 + years of age: NRT for nicotine use disorder

 Low
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ADHD = attention deficit/hyperactivity disorder; DSM-5-TR = Diagnostic and Statistical Manual 5th Edition, Text Revision; NRT = nicotine replacement therapy.

Parameters adapted from Texas HHS Psychotropic Medication Utilization Parameters 2019,31 Mackie et al,8 Crystal et al,22 American Academy of Pediatrics,21 Heise and Qureshi.10

Integration of BCPPs in Foster Care

Current Efforts

BCPPs are well positioned to improve several key elements in the patient-centered care process for foster youth (Figure). Pharmacists have been identified as essential advocates for this patient population by members of the foster care team given their expertise in medication therapy management, medication reconciliation, patient/caregiver education, and interprofessional collaboration.7,11,14,15 In a series of focus groups, foster care stakeholders (eg, social workers, legal professionals, health care professionals) highlighted pharmacists as a necessary resource and expressed a desire to work on collaborative teams with pharmacists for the care of foster care youth.14 Likewise, caregivers requested inclusion of a medication expert on collaborative teams although they did not explicitly specify pharmacists.14

Models for pharmacist integration into foster care health care teams exist. A state program that partnered with an academic medical center employed clinical pharmacists as the first phase in a peer-review process for new and refill antipsychotic prescriptions using clinical criteria for approval; any denials could pursue approval through a secondary review by a child and adolescent psychiatrist. This peer-review process resulted in a significant decrease in the prevalence of off-label antipsychotic use in youth of all ages.32

BCPPs have been included as team members in peer-review processes and state Medicaid and Department of Child Services advisory committees responsible for the development and dissemination of psychotropic prescribing guidelines for youth in foster care.6,32,33 BCPPs who work in child and adolescent psychiatry serve in a variety of roles, including as consultants reviewing medical records, provision of first audit for preauthorization for medication use, and experts in psychiatric medication use for youth in guideline development.32,33

When embedded in a department of psychiatry-, school of medicine, and state child services department–based psychotropic review team, BCPPs provide comprehensive review of current medications and medication recommendations (Figure). An initial evaluation of this program demonstrated a significant reduction in psychotropic polypharmacy, off-label medication use, and health care expenditures related to emergency department visits and inpatient psychiatry admissions.33

Medications can be court ordered; judges often rely on staff who may not have a medical background when making decisions related to treatment and medication. Whereas BCPPs have not been integrated specifically into foster care court systems, pharmacists have been included in local drug and problem-solving court teams across the country. In these settings, pharmacists attend precourt team meetings; review participant progress; attend provider appointments; and provide medication education, medication regimen review, and status reports to the courts.34 BCPPs can use this model to integrate with Department of Child Services family case managers to advocate for appropriate medication use in the court system.

BCPP consultation is also currently provided via collaborative telemedicine models (eg, Extension for Community Health Outcomes [ECHO], The REsource for Advancing Children’s Mental Health [REACH] Institute) to pediatricians, child and adolescent psychiatrists, and other members of the foster care team. Inclusion of a BCPP within a Child Psychiatry Project ECHO has been shown to increase pediatrician knowledge of psychotropic medications, increase implementation of evidence-based interventions, and decrease psychotropic polypharmacy (2.8% to 2.2% of patients prescribed ≥3 psychotropic medications).35,36 Project ECHO is a practical way in which BCPPs can partner with child and adolescent psychiatrists and other members of the foster care team to support medication education and consultation.

Given the established prevalence of mental health needs in foster care youth, BCPPs are well-positioned to meet this need. As experts in the evidence-based use of psychotropics in youth for a variety of mental health conditions, BCPPs improve patient outcomes (eg, reduced hospital stays and reduced emergency department visits)11-13,37 and patient satisfaction scores (eg, improved patient engagement/adherence)11,12 and resolve drug therapy problems (eg, prevented adverse events).11-13,37

Emerging Practice Models

Transitions of Care/Care Coordinators

National expansion and standardization of BCPP integration within foster care teams offers the opportunity for another specialized health care provider to increase care continuity and access to nonemergent ambulatory care. Notably, pharmacist transition of care programs have successfully resulted in improved patient satisfaction, decreased hospital readmissions, and decreased medication errors.38-43 Pharmacists have been identified as effective care coordinators who decrease rates of medication errors at hospital discharge, transitions between foster families, and at emancipation from the foster care system.7,25

Additionally, as youth transition out of foster care, there is a call for youth to prepare for their own health care autonomy.27 Implementing shared decision making that empowers the youth voice in appointments with mental health providers has been suggested as a strategy to improve medication management, especially related to antipsychotics and side effect education.44 Minimizing treatment fragmentation during time in foster care is 1 strategy to enhance preparation, but further medication education is often still needed for successful treatment self-management. Trusted institutional agents, including care providers such as BCPPs, who have supported continuity of care during the youth’s time in foster care, can also serve as a trusted educational resource, providing needed medication education, adherence support, and overall continued connection to care.45

Psychotropic Stewardship

PSPs promote safe, evidence-based, and patient-specific use of psychotropic medications (Figure).12 At the heart of psychotropic stewardship are regulatory standards that promote best practices for psychotropic prescribing, monitoring, and follow-up.11,12 Implementation of PSPs among specialty populations, including youth in foster care, has been proposed as a strategy to optimize psychotropic prescribing.10,11

BCPPs often take on roles as medication stewards. For foster care youth, this may involve extensive medication history reviews in the electronic health record serving as “medication passports”. This strategy may combat challenges with treatment fragmentation, incomplete health history files, and child welfare staff reporting limited knowledge of psychotropic medication use.2 These medication passports can provide critical information about treatment directions and prevent substandard care involving retrials of medications that were not effective or not tolerated. When a BCPP cannot be deployed, BCPPs can support larger groups of child welfare staff through interdisciplinary education and training.7

Additional roles as medication stewards may include identification of high-risk psychotropic medication regimens with recommendations for thoughtful deprescribing, proposing strategies to reduce antipsychotic polypharmacy and identify youth who are not up-to-date on antipsychotic metabolic monitoring. Therapeutic drug monitoring, pharmacogenomic test results, and increased access to medications for substance use disorders and harm reduction strategies may serve as other important roles for the BCPP (Table).11,12

Recommendations

Health care systems should implement PSPs, especially for foster care youth. Inclusion of BCPPs on the foster care team could allow continuous evaluation of new psychotropic medication prescriptions, optimize evidence-based use of psychotropic medications, and ensure regulatory standard compliance and medication reconciliation at each transition the child faces in addition to psychotropic medication education for other team members.7 Foster care teams are currently in need of an accountable leader for psychotropic use. As psychotropic medication experts, BCPPs could serve in this role as critical collaborators with child psychiatrists, social workers, pediatricians, and caregivers; collectively, they become the psychotropic stewardship team. Child welfare administrators, health system administrators, and the foster care team should consider these best practices:

  • 1)

    Everyone should utilize shared decision making, including patient/caregiver informed consent and assent prior to psychotropic medication prescribing in alignment with state regulations.

  • 2)

    BCPPs should be involved in developing criteria that identify high-risk psychotropic regimens. This process should be repeated periodically to identify new trends in prescribing and should be used to inform regulatory oversight for prescribing/monitoring in this patient population.

  • 3)

    Youth prescribed high-risk psychotropic medication regimens should be referred to a BCPP who can complete comprehensive medication management with an emphasis on rational deprescribing.

  • 4)

    Accurate medical and medication histories should be maintained for foster youth via medical passports or other strategies to optimize transitions of care and to minimize medication errors.

  • 5)

    All DUR committees should include BCPPs to inform best practices regarding psychotropic medication prescribing. BCPPs can conduct secondary reviews before and after psychotropic medications are prescribed, identify and address outlier prescribing practices, offer consultation on psychotropic medication decisions, and provide second opinions to prescribers upon request.

  • 6)

    The foster care team should participate in telemedicine teaching initiatives (eg, ECHO) that can leverage the medication expertise of BCPPs. Through use of didactic teaching and case examples, Project ECHO is a successful model that connects psychotropic experts with primary care physicians.

  • 7)

    Collaborative telemedicine services should increase access for foster care team members to BCPPs and other specialists in child and adolescent psychiatry. Many states have these psychiatric consult services, and they would benefit from including a BCPP.

It is important to acknowledge limitations to these proposed strategies. There are not enough BCPPs to directly partner with all interprofessional teams that care for youth in the foster care system, and this emphasizes the importance of the DUR, Project ECHO, and consult service best practices. Whereas the strategies have demonstrated success, the extreme heterogeneity of foster care systems preclude efforts to establish the generalizability of these recommendations. Additionally, it is essential for BCPPs to acknowledge the complex role of trauma in effective treatment and support for youth in foster care. Finally, not all BCPPs have direct and practical access to foster care teams such that the feasibility and effort of implementing the best practices could vary significantly by location.

Notwithstanding these limitations, further integration of BCPPs into the foster care workforce is essential. With increases in psychotropic medication prescribing in this patient population, BCPPs are essential to provide evidence-based medication oversight.

Conclusions

Pharmacists have been identified as essential advocates for youth in foster care with successful integration supporting transitions of care, quality of care, and prescribing guideline creation. National expansion and standardization of BCPP integration within foster care youth teams offers the opportunity for another specialized health care provider to increase care continuity and access to nonemergent ambulatory care.

Acknowledgment

The authors thank the board of directors of the American Association of Psychiatric Pharmacists for their support in researching and developing this paper.

References

  • 1.McLeigh JD, Malthaner LQ, Tovar MC, Khan M. Mental health disorders and psychotropic medication: prevalence and related characteristics among individuals in foster care. J Child Adolesc Trauma. 2023;16(3):745-57. 10.1007/s40653-023-00547-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Bertram J, McKanry J. Minding the complexities of psychotropic medication management for children and youth in the foster care system. Paper 1: the facilitators and barriers to learning about trauma-informed medication management. 2022. [DOI] [PubMed]
  • 3.Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A systematic review of mental health disorders of children in foster care. trauma violence abuse. 2022;23(1):255-64. 10.1177/1524838020941197 [DOI] [PubMed] [Google Scholar]
  • 4.Keefe RJ, Cummings ADL, Smith AE, Greeley CS, Van Horne BS. Psychotropic medication prescribing: youth in foster care compared with other medicaid enrollees. J Child Adolesc Psychopharmacol. 2023;33(4):149-55. 10.1089/cap.2022.0092 [DOI] [PubMed] [Google Scholar]
  • 5.Davis DW, Lohr WD, Feygin Y, Creel L, Jawad K, Jones VF, et al. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry. 2021;21(1):303. 10.1186/s12888-021-03309-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Mackie TI, Cook S, Crystal S, Olfson M, Akincigil A. Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention. J Am Acad Child Adolesc Psychiatry. 2020;59(1):166-76.e3. 10.1016/j.jaac.2019.04.022 [DOI] [PubMed] [Google Scholar]
  • 7.Abel C, Goldsmith CAW, Marzerka M. Pharmacists can improve medication management in the vulnerable population of foster care youth. J Am Pharm Assoc (2003). 2019;59(5):629-32. 10.1016/j.japh.2019.05.011 [DOI] [PubMed] [Google Scholar]
  • 8.Mackie TI, Hyde J, Palinkas LA, Niemi E, Leslie LK. Fostering psychotropic medication oversight for children in foster care: a national examination of states’ monitoring mechanisms. Adm Policy Ment Health. 2017;44(2):243-57. 10.1007/s10488-016-0721-x [DOI] [PubMed] [Google Scholar]
  • 9.Barnett ER, Concepcion-Zayas MT, Zisman-Ilani Y, Bellonci C. Patient-centered psychiatric care for youth in foster care: a systematic and critical review. J Public Child Welfare. 2019;13(4):462-89. 10.1080/15548732.2018.1512933 [DOI] [Google Scholar]
  • 10.Heise AM, Qureshi I. The role of the pharmacist on an inpatient child and adolescent psychiatry unit. Child Adolesc Psychiatr Clin N Am. 2025;34(1):1-12. 10.1016/j.chc.2024.07.010 [DOI] [PubMed] [Google Scholar]
  • 11.Stutzman DL, Leiby LE, Temelie A, Maroney M, Williams AM, Parmentier BL, et al. Role of board‐certified psychiatric pharmacists in child and adolescent psychiatry. J Am Coll Clin Pharm. 2024;7(2):149-59. 10.1002/jac5.1880 [DOI] [Google Scholar]
  • 12.Haight RJ, Di Polito CN, Payne GH, Bostwick JR, Fulbright A, Lister JF, et al. Psychotropic stewardship: advancing patient care. Ment Health Clin. 2023;13(2):36-48. 10.9740/mhc.2023.04.036 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Dopheide JA, Werremeyer A, Haight RJ, Gutierrez CA, Williams AM. Positioning psychiatric pharmacists to improve mental health care. Ment Health Clin. 2022;12(2):77-85. 10.9740/mhc.2022.04.077 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Lambert TL, Tidmore LM, Holbrook M, Shropshire D, Nesser N, Keast S. Practical opportunities for pharmacists to optimize psychotropic medication use among foster youth. J Am Pharm Assoc (2003). 2020;60 Suppl 5):S7-10. 10.1016/j.japh.2020.05.019 [DOI] [PubMed] [Google Scholar]
  • 15.Love RC, Wehring HJ, Coulter JS. Psychotropic medication use in foster children: an opportunity for psychiatric pharmacists. Ment Health Clin. 2013;2(11):347-9. 10.9740/mhc.n145471 [DOI] [Google Scholar]
  • 16.Palmer L, Herd T, Swanson AS, Felt J, Font S. A longitudinal analysis of concerning psychotropic medication regimens among adolescents in foster care. J Adolesc Health. 2023;73(3):452-60. 10.1016/j.jadohealth.2023.04.022 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Stutzman DL. Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing. Ment Health Clin. 2021;11(6):320-33. 10.9740/mhc.2021.11.320 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.National Committee for Quality Assurance . HEDIS Measures and Technical Resources [Internet]. [cited 2023. Jun 12]. Available from: https://www.ncqa.org/hedis/measures/
  • 19.Zito JM, Zhu Y, Safer DJ. Psychotropic polypharmacy in the US pediatric population: a methodologic critique and commentary. Front Psychiatry. 2021;12:644741. 10.3389/fpsyt.2021.644741 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Keast SL, Tidmore LM, Shropshire D, Nesser N, Lambert TL. Characterization of chronic multiclass psychotropic polypharmacy and psychotherapy in foster care youth in a state Medicaid population. JMCP. 2019;25(12):1340-8. 10.18553/jmcp.2019.25.12.1340 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.American Academy of Pediatrics . Mental and behavioral health needs of children in foster care [Internet]. [cited 2021. Jul]. Available from: https://www.aap.org/en/patient-care/foster-care/mental-and-behavioral-health-needs-of-children-in-foster-care/
  • 22.Crystal S, Mackie T, Simmel C, Akincigil A, Neese-Todd S, Cook S, et al. Examining effects of state policies to mental health medicines for children in foster care [Internet]. Patient-Centered Outcomes Research Institute (PCORI); 2021. [cited 2024 Sep 9]. (PCORI Final Research Reports; ). Available from: http://www.ncbi.nlm.nih.gov/books/NBK599283/. PubMed PMID: 38232219. [PubMed] [Google Scholar]
  • 23.Kelleher KJ, Rubin D, Hoagwood K. Policy and practice innovations to improve prescribing of psychoactive medications for children. Psychiatr Serv. 2020;71(7):706-12. 10.1176/appi.ps.201900417 [DOI] [PubMed] [Google Scholar]
  • 24.Schmid I, Burcu M, Zito JM. Medicaid prior authorization policies for pediatric use of antipsychotic medications. JAMA. 2015;313(9):966-8. 10.1001/jama.2015.0763 [DOI] [PubMed] [Google Scholar]
  • 25.DeLucia M, Martens A, Leyenaar J, Mallory LA. Improving hospital-to-home transitions for children entering foster care. Hosp Pediatr. 2018;8(8):465-70. 10.1542/hpeds.2017-0221 [DOI] [PubMed] [Google Scholar]
  • 26.Bakhsh HT, Perona SJ, Shields WA, Salek S, Sanders AB, Patanwala AE. Medication errors in psychiatric patients boarded in the emergency department. Int J Risk Saf Med. 2014;26(4):191-8. 10.3233/JRS-140634 [DOI] [PubMed] [Google Scholar]
  • 27.Beal SJ, Nause K, Lutz N, Greiner MV. The impact of health care education on utilization among adolescents preparing for emancipation from foster care. J Adolesc Health. 2020;66(6):740-6. 10.1016/j.jadohealth.2019.12.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.American Medical Association . 2024 AMA prior authorization physician survey [Internet]. 2025. Available from: https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
  • 29.Administration for Children and Families . Promoting the safe, appropriate, and effective use of psychotropic medication for children in foster care [Information Memorandum] [Internet]. U.S. Department of Health and Human Services; 2012. Apr [cited 2025 May 14]. Available from: https://acf.gov/sites/default/files/documents/cb/im1203.pdf [Google Scholar]
  • 30.Stutzman DL, Accomando M, Dick M, Temelie A, Payne GH, Ott CA. Foster care psychotropic prescribing regulations are complex and insufficient. Ment Health Clin. 2026;16(4):171-84. 10.9740/mhc.2026.08.171 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Psychotropic medication utilization parameters for children and youth in Texas public behavioral health: medication tables (7th version) [Internet]. [cited 2024 Sep 9]. Available from: https://www.hhs.texas.gov/sites/default/files/documents/psychotropic-medication-utilization-parameters-medication-tables.pdf
  • 32.Pennap D, Burcu M, Safer DJ, Zito JM. The impact of a state medicaid peer-review authorization program on pediatric use of antipsychotic medications. Psychiatr Serv. 2018;69(3):293-9. 10.1176/appi.ps.201700177 [DOI] [PubMed] [Google Scholar]
  • 33.Perry B, Walsh KH, Plawecki MH, Fodstad JC, Blake HS, Hunt A, et al. Change in psychotropic prescribing patterns among youths in foster care associated with a peer-to-peer physician consultation program. J Am Acad Child Adolesc Psychiatry. 2019;58(12):1218-22.e1. 10.1016/j.jaac.2019.06.014 [DOI] [PubMed] [Google Scholar]
  • 34.Palombi LC, Koh-Knox CP. The drug court pharmacist: expanding pharmacy practice and addressing substance abuse. Innov Pharm. 2016;7(3). 10.24926/iip.v7i3.455 [DOI] [Google Scholar]
  • 35.Hostutler CA, Valleru J, Maciejewski HM, Hess A, Gleeson SP, Ramtekkar UP. Improving pediatrician’s behavioral health competencies through the Project ECHO teleconsultation model. Clin Pediatr (Phila). 2020;59(12):1049-57. 10.1177/0009922820927018 [DOI] [PubMed] [Google Scholar]
  • 36.Kaye DL, Fornari V, Scharf M, Fremont W, Zuckerbrot R, Foley C, et al. Description of a multi-university education and collaborative care child psychiatry access program: New York State’s CAP PC. General Hosp Psychiatry. 2017;48:32-6. 10.1016/j.genhosppsych.2017.06.003 [DOI] [PubMed] [Google Scholar]
  • 37.Lu DH, Dopheide JA, Wang D, Jeffrey JK, Chen S. Collaboration between child and adolescent psychiatrists and mental health pharmacists to improve treatment outcomes. Child Adolesc Psychiatr Clin N Am. 2021;30(4):797-808. 10.1016/j.chc.2021.06.006 [DOI] [PubMed] [Google Scholar]
  • 38.Davis B, Qian J, Ngorsuraches S, Jeminiwa R, Garza KB. The clinical impact of pharmacist services on mental health collaborative teams: a systematic review. J Am Pharm Assoc (2003). 2020;60 Suppl 5):S44-53. 10.1016/j.japh.2020.05.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Dillon C, Lynch G, Dean J, Purvis C, Becket L. Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity. N Z Med J. 2021;134(1539):9-20. PMID: 34320611 [PubMed] [Google Scholar]
  • 40.Accomando M, DeWitt K, Porter B. Pharmacist impact on medication reconciliation of behavioral health patients boarding in the emergency department. Ment Health Clin. 2022;12(3):187-92. 10.9740/mhc.2022.06.187 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.March KL, Peters MJ, Finch CK, Roberts LA, McLean KM, Covert AM, et al. Pharmacist transition-of-care services improve patient satisfaction and decrease hospital readmissions. J Pharm Pract. 2022;35(1):86-93. 10.1177/0897190020958264 [DOI] [PubMed] [Google Scholar]
  • 42.Ngo NUT, Tangpraphaphorn S, Kahaku D, Canamar CP, Young A. Clinical pharmacist transition of care model improves hospital system practice by reducing readmissions. J Healthc Qual. 2023;45(5):272-9. 10.1097/JHQ.0000000000000384 [DOI] [PubMed] [Google Scholar]
  • 43.Stuhec M, Batinic B. Clinical pharmacist interventions in the transition of care in a mental health hospital: case reports focused on the medication reconciliation process. Front Psychiatry. 2023;14:1263464. 10.3389/fpsyt.2023.1263464 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Simmel C, Bowden CF, Todd SN, Thorp K, Hyde J, Crystal S. Youth in foster care: highlighting the importance of youth engagement in mental health treatment decisions. Children Youth Serv Rev. 2025;169:108094. 10.1016/j.childyouth.2024.108094 [DOI] [Google Scholar]
  • 45.Nunes JC, Naccarato T, Stafford RS. Antipsychotics in the California foster care system: a 10-year analysis. J Child Adolescent Psychopharmacol. 2022;32(7):400-7. 10.1089/cap.2022.0040 [DOI] [PubMed] [Google Scholar]

Articles from The Mental Health Clinician are provided here courtesy of American Association of Psychiatric Pharmacists

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