Advertisement

Minding the complexities of psychotropic medication management for children and youth in the foster care system

Paper 1: The facilitators and barriers to learning about trauma-informed medication management

      Overarching abstract

      The phenomenon of inappropriate polypharmacy among the foster care population arises in part due to the challenges related to integrating trauma-informed principles into service delivery. It is further exacerbated by the complexity of intersecting systems in which child welfare case workers need to communicate, including foster and biological parents, social service agencies, and advocates. Yet, there is limited research about trauma-informed psychotropic medication management interventions for child welfare staff. This pilot study was conducted to evaluate a trauma-informed psychotropic medication management intervention and is reported in two manuscripts, pertaining respectively to the facilitators and barriers to learning, and perceived individual and institutional trauma responsiveness. The intervention comprised of a 2-hour-long training session for child welfare staff and a 3-month web-based curriculum for leadership personnel, aiming to increase their understanding of trauma-informed psychotropic medication management. In the first paper, we report on the facilitators and barriers to learning, grouped into three categories: teacher attributes, learner attributes, and situational factors. In the second paper, in addition to trauma responsiveness ratings, we also provide a detailed account of one participant's life experience and perceptions of the intervention provided, as an exemplar of the psychosocial facets of resilience. The ABC Medication Scale scores that measured staff knowledge, attitudes, and behaviors associated with medications used to treat mental health symptoms showed a significant change in scores following training. Based on these findings, we provide practical solutions to address situational factors that are worth considering when providing training for child welfare staff.

      Paper 1 abstract: the facilitators and barriers to learning about trauma-informed medication management

      Given that foster care children experience many challenges that threaten their well-being, their physical and mental health needs tend to be greater than those of their peers who are not in foster care. However, owing to the transient nature of the foster care placements, as well as continuous changes in medical providers and counselors, the screenings, supportive interventions, and treatments they receive may be fragmented. This is particularly problematic when considering that many of these children are medicated as a means of managing their behavior. Moreover, children in foster care are also more vulnerable to having the medications and diagnoses accumulate due to frequent placement changes and lack of treatment continuity. Our research was guided by the question “What are the facilitators and barriers to learning about trauma-informed psychotropic medication management?” We developed an intervention to address the issue of inappropriate polypharmacy and examined the facilitators and barriers to learning using a mixed methods design. The facilitators to learning were instructor-specific (e.g., reputation, teaching style, capacity for selecting and implementing relevant resources), learner-specific (altruism, capacity to see personal relevance in the learning situation, desire for knowledge/competence, career advancement/recognition-seeking), and situational (immediacy/on-demand resources, reinforcement of pleasant learning experience). Barriers were largely situational (workload and family demands). Based on these findings, we provide practical strategies for addressing situational factors that are worth considering when designing training curricula aimed at child welfare staff.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Barnett E.R.
        • Concepcion-Zayas M.T.
        • Zisman-Ilani Y.
        • Bellonci C.
        Patient-centered psychiatric care for youth in foster care: A systematic and critical review.
        Journal of Public Child Welfare. 2019; 13: 462-489
        • Beatty B.J.
        Hybrid-flexible course design: Implementing student-directed hybrid classes.
        1st ed. EdTech Books, 2019
        • Bertram J.
        • Boyle-Duke B.
        Children in out-of-home placement.
        in: Yearwood E.L. Pearson G.S. Newland J.A. Child and adolescent behavioral health (pp. 444–457). 2021 (Wiley-Blackwell)
        • Bertram J.E.
        • Tokac U.
        • Brauch A.
        • Fish A.F.
        Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting.
        Perspectives in Psychiatric Care. 2022; : 1-10https://doi.org/10.1111/ppc.13101
        • CAST
        Universal design for learning guidelines version 2.2.
        • Correia A.
        Healing the digital divide during the COVID-19 pandemic.
        Quarterly Review of Distance Education. 2020; 21: 13-22
        • Cotes R.O.
        • Fernandes N.K.
        • McLaren J.L.
        • McHugo G.J.
        • Bartels S.J.
        • Brunette M.F.
        Improving cardiometabolic monitoring of children on antipsychotics.
        Journal of Child and Adolescent Psychopharmacology. 2017; 27: 916-919
        • Crawford D.W.
        • Jackson E.L.
        • Godbey G.
        A hierarchical model of leisure constraints.
        Leisure Sciences. 1991; 13: 309-320
        • Crystal S.
        • Mackie T.
        • Fenton M.C.
        • Amin S.
        • Neese-Todd S.
        • Olfson M.
        • Bilder S.
        Rapid growth of antipsychotic prescriptions for children who are publicly insured has ceased, but concerns remain.
        Health Affairs. 2016; 35: 974-982
        • Davis D.W.
        • Lohr W.D.
        • Feygin Y.
        • Creel L.
        • Jawad K.
        • Jones V.F.
        • Pasquenza N.
        High-level psychotropic polypharmacy: A retrospective comparison of children in foster care to their peers on Medicaid.
        BMC Psychiatry. 2021; 21: 1-11
        • Denlinger M.
        • Dorius C.
        Communication patterns between foster parents and case managers.
        Children and Youth Services Review. 2018; 89: 329-339
        • Dubois-Comtois K.
        • Bussières E.L.
        • Cyr C.
        • St-Onge J.
        • Baudry C.
        • Milot T.
        • Labbé A.P.
        Are children and adolescents in foster care at greater risk of mental health problems than their counterparts? A meta-analysis.
        Children and Youth Services Review. 2021; 127: 1-11https://doi.org/10.1016/j.childyouth.2021.106100
        • Fosslien L.
        • Duffy M.W.
        How to combat zoom fatigue.
        Harvard Business Review, Business Communication, 2020, April 29
        • Greiner M.V.
        • Beal S.J.
        • Nause K.
        • Ehrhardt J.
        Developmental service referrals and utilization among young children in protective custody.
        The Journal of Pediatrics. 2021; 234: 260-264
        • Gypen L.
        • Vanderfaeillie J.
        • De Maeyer S.
        • Belenger L.
        • Van Holen F.
        Outcomes of children who grew up in foster care: Systematic-review.
        Children and Youth Services Review. 2017; 76: 74-83
        • Herrenkohl T.I.
        • Jung H.
        • Lee J.O.
        • Kim M.-H.
        Effects of child maltreatment, cumulative victimization experiences, and proximal life stress on adult crime and antisocial behavior.
        • Hughes S.
        • Cohen D.
        • Lacasse J.R.
        • Alessi L.
        • Colonnieves K.
        • Rudisill S.
        Experiences of child welfare workers regarding psychotropic medications: Results from a mixed-method evaluation of a critical medication curriculum.
        Children and Youth Services Review. 2020; 116: 1-9https://doi.org/10.1016/j.childyouth.2020.105193
        • Hyde J.K.
        • Mackie T.I.
        • Palinkas L.A.
        • Niemi E.
        • Leslie L.K.
        Evidence use in mental health policy making for children in foster care.
        Administration and Policy in Mental Health and Mental Health Services Research. 2016; 43: 52-66
        • Keast S.L.
        • Tidmore L.M.
        • Shropshire D.
        • Nesser N.
        • Lambert T.L.
        Characterization of chronic multiclass psychotropic polypharmacy and psychotherapy in foster care youth in a state Medicaid population.
        Journal of Managed Care & Specialty Pharmacy. 2019; 25: 1340-1348https://doi.org/10.18553/jmcp.2019.25.12.1340
        • Keefe R.J.
        • Van Horne B.S.
        • Cain C.M.
        • Budolfson K.
        • Thompson R.
        • Greeley C.S.
        A comparison study of primary care utilization and mental health disorder diagnoses among children in and out of foster care on Medicaid.
        Clinical Pediatrics. 2020; 59: 252-258
        • Kelleher K.J.
        • Rubin D.
        • Hoagwood K.
        Policy and practice innovations to improve prescribing of psychoactive medications for children.
        Psychiatric Services. 2020; 71: 706-712
        • Mackie T.I.
        • Hyde J.
        • Palinkas L.A.
        • Niemi E.
        • Leslie L.K.
        Fostering psychotropic medication oversight for children in foster care: A national examination of states' monitoring mechanisms.
        Administration and Policy in Mental Health and Mental Health Services Research. 2017; 44: 243-257
        • Mackie T.I.
        • Schaefer A.J.
        • Karpman H.E.
        • Lee S.M.
        • Bellonci C.
        • Larson J.
        Systematic review: System-wide interventions to monitor pediatric antipsychotic prescribing and promote best practice.
        Journal of the American Academy of Child & Adolescent Psychiatry. 2021; 60: 76-104https://doi.org/10.1016/j.jaac.2020.08.441
        • McKanry J.B.
        Building community in online faculty development.
        ProQuest Dissertations Publishing, 2019
        • Miranda M.
        • Molla E.
        • Tadros E.
        Implications of foster care on attachment: A literature review.
        The Family Journal. 2019; 27: 394-403
        • Mitchell M.B.
        “No one acknowledged my loss and hurt”: Non-death loss, grief, and trauma in foster care.
        Child and Adolescent Social Work Journal. 2018; 35: 1-9
        • Ninan A.
        • Stewart S.L.
        • Theall L.
        • King G.
        • Evans R.
        • Baiden P.
        • Brown A.
        Psychotropic medication monitoring checklists: Use and utility for children in residential care.
        Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2014; 23: 38-47
        • Richards T.
        • Bertrand J.
        • Newburg-Rinn S.
        • McCann H.
        • Morehouse E.
        • Ingoldsby E.
        Children prenatally exposed to alcohol and other drugs: What the literature tells us about child welfare information sources, policies, and practices to identify and care for children.
        Journal of Public Child Welfare. 2022; 16: 71-94
        • Scheid J.M.
        Challenges and strategies in foster care.
        The Psychiatric Times. 2020; 37: 30-31
        • Strauss A.
        • Corbin J.
        Basics of qualitative research: Techniques and procedures for developing grounded theory.
        2nd ed. Sage, 1998
        • Thackeray J.
        • Crane D.
        • Fontanella C.
        • Sorter M.
        • Baum R.
        • Applegate M.
        A Medicaid quality improvement collaborative on psychotropic medication prescribing for children.
        Psychiatric Services. 2018; 69: 501-504
        • Thompson R.W.
        • Duppong Hurley K.
        • Trout A.L.
        • Huefner J.C.
        • Daly D.L.
        Closing the research to practice gap in therapeutic residential care: Service provider university partnerships focused on evidence-based practice.
        Journal of Emotional and Behavioral Disorders. 2017; 25: 46-56
        • Tooley U.A.
        • Makhoul Z.
        • Fisher P.A.
        Nutritional status of foster children in the US: Implications for cognitive and behavioral development.
        Children and Youth Services Review. 2016; 70: 369-374
        • Turney K.
        • Wildeman C.
        Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey.
        Child Abuse & Neglect. 2017; 64: 117-129
        • Villagrana M.
        Racial/ethnic disparities in mental health service use for older foster youth and foster care alumni.
        Child and Adolescent Social Work Journal. 2017; 34: 419-429https://doi.org/10.1007/s10560-016-0479-8
        • Walter H.J.
        • DeMaso D.R.
        Fostering the initiation of discretionary psychotropic medication reviews by child welfare caseworkers.
        Child Welfare. 2018; 96: 23-45
        • Winkelmes M.
        • Boye A.
        • Tapp S.
        • Felten P.
        • Finley A.
        Transparent design in higher education teaching and leadership: A guide to implementing the transparency framework institution-wide to improve learning and retention.
        Stylus Publishing, 2019