ORIGINAL PAPER Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status Lynn A. Warner • Na Kyoung Song • Kathleen J. Pottick Published online: 10 December 2013 Ó Springer Science+Business Media New York 2013 Abstract Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and cor- relates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is simi- lar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociode- mographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medi- cation for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented. Keywords Foster care  Psychotropic medication  Medication use  Child and adolescent mental health services Introduction Increasing rates of psychotropic medication use among youth (Aparasu and Bhatara 2005; Comer et al. 2010; Martin and Leslie 2003; Olfson et al. 2002; Thomas et al. 2006; Zito et al. 2003) along with safety and efficacy concerns (Lakhan and Hagger-Johnson 2007; Leo 2006; Vitiello 2007) have generated substantial activity by policy makers and providers to establish prescribing guidelines and quality of care indicators. Because of the unique vulnerabilities of child welfare- involved youth, concerns about psychotropic use among this subgroup of the youth population are especially acute, and specialized oversight plans for youth in foster care are being considered at federal and state levels (Longhofer et al. 2011). There are several reasons that standards of care tailored to foster care populations may need to be developed. First, available sources of data on medication rates have raised questions about potential over-use of psychotropics in the child welfare population (Government Accounting Office 2011). Second, polypharmacy, which has limited evidence to support its use in pediatric populations (Safer et al. 2003), may be more common for youth in foster care than for other vulnerable youth (dosReis et al. 2005, 2011). Third, continuity of mental health care may be compro- mised when youth are moved from their homes or between foster care settings (DiGiuseppe and Christakis 2003); such disruptions may also jeopardize adherence to medication regimens and preclude the level of oversight needed to L. A. Warner (&)  N. K. Song School of Social Welfare, University at Albany, Albany, NY 12222, USA e-mail: lwarner@albany.edu K. J. Pottick School of Social Work, Rutgers University, New Brunswick, NJ, USA 123 J Child Fam Stud (2014) 23:652–665 DOI 10.1007/s10826-013-9885-0