Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees.

Objective: To compare the prevalence of psychotropic medication prescriptions among youth in foster care with those among nonfoster youth on Medicaid. Methods: Children ages 1-18 years in a region of a large southern state who were enrolled in their respective Medicaid plan for at least 30 days between 2014 and 2016 and had at least one health care claim were included. Medicaid prescription claims were categorized by class: alpha agonists, anxiolytics, antidepressants, antipsychotics, mood stabilizers, and stimulants. Primary mental health (MH) or developmental disorder (DD) diagnostic groups were identified for each class. Analyses included chi-square tests, t-tests, Wilcoxon sign rank tests, and logistic regression. Results: A total of 388,914 nonfoster and 8426 children in foster care were included. Overall, 8% of nonfoster and 35% of foster youth were dispensed at least one prescription for a psychotropic medication. Prevalence was higher for youth in care within each drug class and, with one exception, across all age groups. Among children prescribed a psychotropic medication, the mean number of drug classes prescribed was 1.4 (SD 0.8) and 2.9 (SD 1.4) for nonfoster and foster youth, respectively (p < 0.000). Except for anxiolytics and mood stabilizers, more children in foster care were prescribed psychotropic medications without an MH or DD diagnosis. Finally, children in foster care experienced 6.8 (95% CI: 6.5-7.2) times higher odds of being prescribed a psychotropic medication than their nonfoster peers, after controlling for age group, gender, and number of mental and developmental diagnoses. Conclusions: Across all age groups, children in foster care on Medicaid were prescribed psychotropic medications disproportionately more than their nonfoster peers on Medicaid. In addition, children in foster care were significantly more likely to be prescribed psychotropic medication absent an MH or DD diagnosis.

Mental Health and Developmental Disorder Diagnoses of Foster and Nonfoster Children Enrolled in Medicaid.

OBJECTIVE: This study used Medicaid claims to compare the prevalence of mental health disorders (MHDs) and developmental disorders (DDs) between foster and nonfoster youth. METHODS: Medicaid claims data were used to identify MHDs and DDs. Diagnosis codes were categorized into 16 MHD and 8 DD groups. Children were enrolled in their respective Medicaid plan for at least 30 days and had at least 1 health care encounter generating a claim. Prevalence was compared between children in foster care and children not in foster care overall and by age group. Logistic regression was used to compare the odds of having an MHD or DD diagnosis. RESULTS: Of the 8706 children in foster care, 20.1% had an MHD compared with 9.7% of the 392,815 nonfoster children. Overall, the 5 most prevalent MHD and DD conditions among foster youth were attention-deficit/hyperactivity disorder (ADHD) (11.0%), miscellaneous (9.3%), bipolar disorders (5.6%), communication disorders (5.4%), and depressive disorders (5.1%). The 5 most prevalent conditions among children not in foster care were ADHD (6.1%); communication disorders (3.0%); disruptive, impulse control, and conduct disorders (2.7%); specific learning disorders (2.5%); and trauma and stressor-related disorders (2.4%). Anxiety was significantly higher among nonfoster children. The prevalence of the most common conditions by age group is reported. Overall, children in foster care had 2.5 and 2.3 times higher odds of having an MHD or DD diagnosis, respectively. CONCLUSION: Children in foster care had significantly higher rates of mental health and DD diagnoses compared with children not in foster care.

An instructional design model for culturally competent community health worker training.

The Texas Public Health Training Center (TPHTC) provides quality training and education for the full spectrum of public health workers. As part of this mission, the TPHTC creates continuing education modules for nontraditional public health workers, such as community health workers (CHWs), through a culturally competent curriculum development process. CHWs, like many public health workers, must be certified by the state of Texas to practice within its borders, and continuing education is required to maintain certification. By involving CHWs and community members in its curriculum development process, the TPHTC is able to produce training modules that are more suitable for this unique and important segment of the public health workforce. The iterative curriculum development process is described here, along with a state-approved curriculum resulting from this method. As the value of the nontraditional public health workforce gains more recognition, sound curriculum design will be increasingly important to support and strengthen these nontraditional professions.