Many states and the federal government have produced recommendations related to appropriate use of psychotropic medication among children in foster care through recommendations and policy papers. This section compiles state and federal guidance including letters, memos, and reports.

State Guidance

State Prior Authorization Parameters for Psychotropic Medication for Children and Youth in Medicaid (March 2018) – This tool summarizes psychotropic medications prior authorization requirements from select states to guide other states in ensuring appropriate medication usage for children covered by Medicaid.

Florida Best Practice Psychotherapeutic Medication Guidelines for Children and Adolescents (January 2017) – These guidelines provide best practices to clinicians in using psychotropic medications to treat children with behavioral health conditions.

Texas Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care (March 2016) – This guide gives recommendations for the appropriate use of psychotropic medications for children in foster care and includes nine criteria that indicate a need to review a child’s clinical status.

Connecticut Guidelines for Psychotropic Medication Use in Children and Adolescents (June 2014) – These guidelines for prescribers of psychotropic medications to children and adolescents provide recommendations around assessment, consent processes, monitoring protocols, and reporting of adverse drug reactions.

New Jersey Department of Children and Families Office of Child Health Services: Psychotropic Medication Policy (May 2011) – This policy provides best practices for the treatment of children in out of home care with psychiatric illness, who require psychopharmacologic therapy as part of treatment. It outlines expectations regarding the development and monitoring of treatment plans, informed consent, and medication safety.

New York State Quality Concerns in Psychotropic Prescribing (2011) – This web page offers recommendations to prescribers, consumers, and families for reducing psychotropic polypharmacy (the concurrent prescription of multiple mental health medications).

Federal Guidance

HHS Has Taken Steps to Support States’ Oversight of Psychotropic Medications, but Additional Assistance Could Further Collaboration (February 2017) – This report, from the Government Accountability Office, looks at how the federal Department of Health and Human Services has been working with states to reduce the use of psychotropic medications among children in foster care. It explores the positive results of these efforts by the department, as well as the challenges it faces in ensuring the appropriate prescribing of psychotropic medications.

Additional Federal Guidance Could Help States Better Plan for Oversight of Psychotropic Medications Administered by MCOs (May 2014) – This report, from the Government Accountability Office, shares findings from a review of foster and medical records in five states, which discovered varying quality in the documentation supporting the use of psychotropic medications for children in foster care. It offers guidance to states around screening, assessment, and treatment planning, as well as medication monitoring.

Collaborative Efforts and Technical Assistance Resources to Strengthen the Management of Psychotropic Medications for Vulnerable Populations (August 2012) – This informational bulletin, from the Center for Medicaid and CHIP Services, informs states about additional opportunities and resources to address the use of psychotropic medications in vulnerable populations. It offers states additional tools and mechanisms to promote the appropriate use, and enhance oversight of, psychotropic medications for children in foster care.

Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Care (April 2012) – This memo, from the Administration for Children and Families, defines the issues surrounding psychotropic medication use by children in foster care, highlights available resources for states, and encourages increasing access to clinically appropriate screening, assessment, and evidence-based interventions for children in foster.

Letter to State Medicaid Director on Psychotropic Medications among Children in Foster Care (November 2011) – This letter describes expanded opportunities for states and territories to strengthen their systems of prescribing and monitoring psychotropic medication use among children in foster care.

The Child and Family Services Improvement and Innovation Act (October 2011) – This memo, from the Administration for Children and Families, details the Child and Family Services Improvement and Innovation Act, which requires state agencies to include ongoing oversight and coordination of health care services for children in foster care, including protocols for the appropriate use and monitoring of psychotropic medications.