Experiences of child welfare workers regarding psychotropic medications: Results from a mixed-method evaluation of a critical medication curriculum

This study reports on a mixed-methods evaluation of the impacts of an educational curriculum designed to engage psychosocial professionals in child welfare in critical thinking about psychotropic medication-related issues. Caseworkers in two counties (n = 20) received the curriculum and were compared at baseline and 30-day follow-up to caseworkers (n = 46) in non-intervention counties on general attitudes toward medication. Follow-up focus groups with 13 caseworkers examinined self-reported changes in practice behaviors and the broader contexts shaping medication-related practices for youth in foster care. The CriticalThinkRx curriculum resulted in modest changes in attitudes toward greater perceived harms, with a small-to-medium effect size. Following the curriculum, caseworkers reported asking more questions about medications, increasing their advocacy roles, and adopting a systemic perspective on the use of medications. Across counties, caseworkers described a practice context characterized by a systemic reliance on medications, uncertain roles and lack of education of caseworkers, poor client education about medications, inflexible professional hierarchy, and lack of time or options. Despite nationwide calls for improved psychotropic medication practices in child welfare, myriad professional and systemic barriers exist that perpetuate the primacy of drugs for treating youths’ emotional and behavioral distress.