TABLE 5.

Pediatric psychotropic polypharmacy in the foster care population.

Data source, Study period, References	Other	Age, years	Population	Psychotropic concomitants	Outcome
2016, soutwestern state Medicaid, Keast et al. (44)	Foster care vs. non-foster care, x-sectional	<21	N = 9,325 foster care; N = 639,868 non-foster care	≥2 interclass for ≥90 overlapping days	9.2% concomitant use in foster care vs. 1.9% in non-foster care youth. As a percent of foster care psychotropic medicated youth, 41.3% had ≥2 classes: 35% w/ 2–3 classes and 6.3% w/ 4–5 classes.
Medicaid drug utilization oversight program, Colorado DUR (45)	Compare 2012 and 2015 foster care polypharmacy	<18	N = 16,789 foster care; 406,124 non-foster care.	≥2, ≥3, ≥4 interclass for ≥60 overlapping days	In 2015, 26% of foster care youth received one or more psychotropic classes, roughly 5 times greater than non-foster care; 7% received ≥2; 2% received ≥3; <1% received 4 or more. Similar pattern 12 &15.
Midwest state Medicaid, Dec 2001–May 2003, face to face surveys, Raghavan et al. (46)	To assess medication patterns in a cohort aging out of foster care	17	N = 403, Participants self-reported medication use in past month	2,3,4,5,7 concomitant classes	N = 146 with any psychotropic medication; 2 concomitant (47); 3 concomitant (22), 4 concomitant (18); 5 concomitant (7). ~One-third of medicated youth had 3, 4, or 5 or more concomitant psychotropics.
2002–2007, 47 states + D.C., 6 year trend, Rubin et al. (24)	State-specific polypharmacy prevalence	3–18	Foster care, continuously enrolled & with antipsychotic dispensing, N = 686,080	≥3 class for≥30 overlapping days	Wide variation in 3 class polypharmacy across states: 0.5%−13.6% had ≥3 classes, one of which was antipsychotic.
Southeastern state2003–2008, Brenner et al. (23)	Community intervention trial of “treatment foster care”	2–21	N = 240, parent-reports at baseline of intervention program	2, 3, or ≥4 psychotropics; point prevalence	Of the psychotropic medicated youth, 35% had 2 medications; 15.% had 3 medications and 9.2% had ≥4 concomitant medications.
Southeastern state, 2004, foster care population, Zito et al. (15)	Polypharmacy Prevalence	<20	N = 472 medicated youth in a random month	Manual review of overlapping dispensings of2, 3, ≥4 classes	Of foster care youth w/ any psychotropic dispensing, 31.1% had 2 concomitant classes; 25.4% had 3 concomitant classes; and 15.9% had ≥4 concomitant classes.