Psychotropic Medication Use in Older Foster Youth: A Focus on Racial Differences

Problem: The use of psychotropic medications among foster youth has received growing national attention due to high rates of use and concerns about the appropriateness of prescribing. Understanding medication use in older foster youth is of heightened concern as these youth are preparing to transition out of the state custody and assume the management of their mental health care. While it has been established that rates of medication use are high among this population, little is known about the demographic and clinical factors associated with high rates of medication use and what patterns of use look like over time. Methods: This study used data from a sample of 404 foster youths in Missouri from 2001-2005 to examine situations associated with medication use at age 17, then characterize patterns of use over the subsequent year for those who remained in state custody: n=294). Data were collected through structured interviews with youths including interviewer derived diagnoses using the Diagnostic Interview Schedule. Analyses focused specifically on examining racial differences between white youths and youths of color. A proposed model of pathways to medication use was tested using multi-group structural equation modeling, patterns of medication use were examined, and youths were classified into medication use subgroups using latent growth mixture modeling. Results: While rates of medication use were significantly different between white youths and youths of color, the strength of the relationship between mental health problems and psychotropic medication use was not significantly different. White youths were more likely to be taking medications in conjunction with outpatient therapy, while youths of color were more likely to be connected with mental health treatment through the psychiatric hospital or emergency room. No racial differences were identified in the types of psychotropic medications youths were taking, however, youths of color were more likely to discontinue medications over the study year. Four medication use subgroups were identified - a low/no use group: 74%), a medium stable medication use group: 14%), a declining use group: 4%), and a high stable use group: 9%). Youths in the declining and high stable use groups were not significantly different from one another at age 17 and were most likely to be taking antipsychotic medications in addition to antidepressant medications. Youths in the medium use group were primarily taking antidepressant medications and had lower rates of comorbid behavioral disorders than youths in the highest use group. Conclusion: These results suggest need to further examine racial differences in mental health treatment overall but did not point to racial disparities in medication use. High rates of antidepressant use suggest the potential to reduce medication use through evidence based treatments targeting depression and anxiety. Additional information is needed to better understand the underlying needs that are generating medication use, particularly polypharmacy, in order to develop alternative responses. Youths that took the highest number of medications also presented indicators of complex needs. Targeted interventions to assess and clarify the mental health problems of these youths could improve the quality of their treatment and prevent abrupt discontinuation as they leave state care

Development and piloting of a treatment foster care program for older youth with psychiatric problems

BACKGROUND: Older youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes. METHODS: A team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes. RESULTS: Development efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles – that of psychiatric nurse and skills coaches – very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities. CONCLUSIONS: The intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important supports for older youth with psychiatric needs

The intersection of housing and mental well-being: Examining the needs of formerly homeless young adults transitioning to stable housing

We examine the challenges formerly homeless young adults (FHYAs) face after they transition out of homelessness. Considering the adversities FHYAs face, it is unclear how transitioning to stable housing may affect their mental well-being or what types of stressors they may experience once housed. This study investigates the social environment young adults encounter in their transition to stable housing and examines trauma and social coping predictors of mental health symptoms in a sample of FHYAs to generate new knowledge for better intervening to meet their needs. Data were obtained from REALYST, a national research collaborative comprised of interdisciplinary researchers investigating young adults’ (ages 18–26) experiences with homelessness. Cross-sectional data for 1426 young adults experiencing homelessness were collected from 2016 to 2017 across seven cities in the United States (i.e., Los Angeles, Phoenix, Denver, Houston, San Jose, St. Louis, and New York City). The analytical sub-sample for this study consisted of 173 FHYAs who were housed in their own apartment (via voucher from Housing and Urban Development or another source) or in transitional living programs during their participation in the study. Ordinary Least Squares regression was used to examine the influence of trauma and social coping strategies on indicators of mental well-being. Findings indicated that higher adversity scores and higher mental health help-seeking intentions were positively associated with higher levels of stress, psychological distress, and depression severity. Higher level of social coping was associated with lower levels of depression severity. Logistic regression results showed that young adults with higher adversity scores had higher odds of reporting clinical levels of post-traumatic symptoms. The study implications suggest that FHYAs who transition to stable housing continue to need support navigating and coping with stressful life events; and interventions that help FHYAs develop strong networks of social supports are needed to promote positive mental well-being