Ensuring the appropriate use of psychotropic medications among youth in foster care requires vigilant monitoring and oversight. In 2012, the Administration for Children and Families issued an information memorandum outlining several “red flags” related to the prescribing of psychotropic medication to children in child welfare—simply stated, too many, too much, and too young. To address these issues, many states have implemented red flag and response mechanisms as part of their psychotropic medication oversight and monitoring systems.

These mechanisms vary from state to state, with some states enacting policies through the child welfare agency, and others codifying red flag policies in regulations or through policies in the Medicaid agency. Some response systems use a prospective approach and others a retrospective approach when responding to prescribers/prescriptions that trigger a state’s identified red flags.

During this technical assistance webinar, presenters from Maryland and Wyoming described their states’ red flags and response systems, highlighting program design, data collection/monitoring strategies, program evaluation, and lessons learned. Unique aspects of each program were discussed, including Maryland’s focus on whether a child in foster care is referred for therapy services before or in addition to being prescribed psychotropic medications, and Wyoming’s red-flag-triggered referrals to the state’s care management entity. At the conclusion of this session, participants gained a greater understanding of how red flags were identified and implemented in each state, and how the response systems were executed and operate.


  • James Bush, MD, FACP, State Medicaid Medical Officer, Wyoming Office of Health Care Financing
  • Susan dosReis, PhD, Associate Professor, Department of Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy
  • Gloria Reeves, MD, Associate Professor, Division of Child and Adolescent Psychiatry, University of Maryland, School of Medicine