Foster youth and psychotropic treatment: Where next?

Foster care children are prescribed psychotropic medications at rates significantly higher than same-aged peers. Concerns about the safety of psychoactive chemicals on developing bodies and potential misuses with foster care populations have led to varied and complex responses by the media, lawmakers, and researchers. First, we look at how foster youth are prescribed psychoactive substances, including polypharmacy (sometimes called concomitant prescription), and at the mounting and major responses by federal and state governments. Second, we consider a recent parameter published by the American Academy of Child and Adolescent Psychiatry. Third, we consider how foster care settings, what we call open systems, complicate parameter implementation, creating potential gaps among researcher, prescriber, foster caregivers, and youth medication explanatory models of treatment experience. And finally, to address gaps among researcher, prescriber, and patient explanatory models, we propose the use of arbitrage, a conceptual framework and process for the integration of competing and sometimes incommensurable explanatory models, knowledge and practice claims.