Published online by Cambridge University Press: 23 March 2020
There are increasing concerns regarding long-term psychotropic polypharmacy prescribed for foster care youth 3.5 to 5 times more often than in at-home youth (Kreider et al., 2014). Polypharmacy risks include weight gain, glucose intolerance and type 2 diabetes. (De Hert et al., 2011). In view of these risks, novel interventions are essential to safeguard foster care youth from overmedication.
To present guidelines for identification and management of polypharmacy in foster care youth.
To demonstrate a novel intervention to monitor and diminish polypharmacy and enhance psychiatric care in foster care children.
Polypharmacy is identified using LA County Juvenile Court Mental Health Service (JCMHS) Psychotropic Parameters* to review medication consent forms from treating psychiatrists. Polypharmacy triggers an in-person JCHMS consultation. *(Parameters 3.9 for JCMHS PMAF Review, Revised May 2015).
JCMHS Psychotropic Parameters (summary):
– age 0–5 years:
– 2 or > psychotropic medications,
– Any antipsychotic (*except Risperidone in ASD);
– age 6–8 years:
– 3 or > psychotropic medications;
– age 9–17 years:
– 4 or > psychotropic medications;
– All age youth:
– 2 or > psychotropic medications in the same class (antipsychotics, antidepressants, stimulants, mood stabilizers, alpha agonists).
Psychotropic medication doses in excess of recommended (*LA County Department of Mental Health Parameters 3.8 for use of Psychotropic Medications for Children and Adolescents).
Approximately 25% of JCMHS annual psychiatric consultations were initiated by JCMHS parameters for polypharmacy. Corresponding consultations included education and recommendations discussed with treating psychiatrists regarding polypharmacy and optimal psychiatric management.
JCMHS Psychotropic Parameters is a useful tool to identify polypharmacy and enhance psychiatric care of foster care youth.
The authors have not supplied their declaration of competing interest.
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