Start: April 2012

End: February 2015

Funder: The Annie E. Casey Foundation


Use of psychotropic medications among children and adolescents in the child welfare system is a high-priority, public sector concern. Rates of psychotropic medication use are especially high among children and youth in child welfare, who typically rely on Medicaid to cover their physical and mental health service needs. Recent legislation requires that plans for the oversight and coordination of health care services for children in foster care — to be developed jointly by child welfare and state Medicaid agencies — include protocols for the appropriate use and monitoring of psychotropic medications.

To help states address this complex issue, CHCS conducted a three-year quality improvement collaborative. Illinois, New Jersey, New York, Oregon, Vermont and Rhode Island (a Casey Special Interest Site) each convened a cross-agency team — including state Medicaid, child welfare, and behavioral health agencies — as well as families, youth, and providers, to develop and implement new approaches to psychotropic medication use for this child population. The state teams worked to strengthen: (1) inter-agency partnerships; (2) appropriate data-sharing among agencies; (3) coordination of oversight and quality assurance processes; and (4) care coordination. The collaborative provided intensive technical assistance to assist states in developing and adopting more effective protocols for psychotropic medication use.

Peer faculty from other states were invited to share best practices throughout the course of the three-year collaborative. Lessons identified through the collaborative activities were disseminated broadly to guide other states in developing effective policies and practices for the appropriate use of psychotropic medications, so as to improve care and outcomes for children in foster care with behavioral health needs.

While the quality improvement collaborative has now ended, technical assistance remains available to leaders in Medicaid, child welfare, and behavioral health agencies in all 50 states through CHCS’  Psychotropic Medications Virtual Learning Community, supported by the Substance Abuse and Mental Health Services Administration.