Girls in foster care are more likely to be diagnosed with mental health conditions, be prescribed multiple medications and become pregnant as teenagers, according to a report by Wyoming researchers.
The study, which was conducted over an 11-year period and followed more than 5,000 15-year-old girls to their 18th birthdays, shows stark disparities in the challenges its subjects face. For instance, nearly 30 percent of 743 foster care girls on Medicaid gave birth by the time they turned 18. More than 63 percent of 16-year-olds in that group were diagnosed with a mental health issue.
For girls who were the same age but had private insurance and were not in foster care, less than 1.5 percent gave birth by 18. Just 13.5 percent of those 16-year-old girls had a mental health diagnosis.
The project started as part of an effort to understand the effects of polypharmacy, or the prescription of multiple medications to a single individual.
Researchers from the Wyoming Department of Family Services and Cheyenne-based health information company HCMS examined teen girls from three groups: 743 were in foster care and received Medicaid, 2,636 received Medicaid but were not in foster care and 1,947 received private insurance and were also not in foster care.
The study examined the intersection of the social, sexual and medical lives of teenage girls in Wyoming. There, researchers found a strong correlation between polypharmacy and teen pregnancy. When foster care was added into the mix, pregnancy rates went up even higher.
“Foster children, including in Wyoming but nationwide, are prescribed at much higher rates, specifically psychotropic medications, than normal children are getting,” said Dr. Marty Nelson of the family services department. Psychotropic drugs can range from medications to treat bipolar disorder to Xanax and adderall.
The study also revealed that the same group of teen girls in foster care were more likely to be prescribed opiates. Nearly 40 percent of 18-year-olds were taking narcotics, compared with 20 percent of girls on private plans.
Nelson said there’s the “low-hanging fruit explanation” for why these particular children are given more drugs: They’ve had serious, potentially traumatic, life experiences. The study cites research showing that “young people in foster care face a complex set of challenges, often including years of neglect, abuse, and instability. It’s little wonder that many of them have severe behavioral issues.”
“When we get children, it’s because something has gone terribly wrong,” Nelson said.
A child may enter the system and need medication, he added, but the effectiveness of that drug may not be monitored long-term. In typical households, a parent might be able to watch how a child responds to a medication; that caregiver can then adjust or remove it as necessary. But in the less stable world of foster homes, teenagers often are only given new medications, to the point where they’re taking five psychotropic drugs at one time.
Indeed, according to the study, 15-year-old girls in foster care averaged nearly six prescriptions. Their peers who had private insurance and lived with a parent or guardian had two.
The study’s lead researcher, Dr. Hank Gardner of HCMS, said there’s a “very linear path” from the first medication prescribed to the cascade of pills that follow.
While he agrees with Nelson that foster children’s pasts may increase their need for medications, Gardner speculates it also has to do with a trend of medicalizing social issues. Many of the children have “high incidence of social instability,” he said, which may lead to the belief that they need to be medicated. As an example, he pointed to normal hyperactivity being labeled — and then treated — as attention-deficit disorder.
“Once you put a medical label on it, it opens the door for prescriptive medications,” he said, and without the supervision of a consistent home life, it can be difficult to effectively monitor the effectiveness and necessity of those medications. “At the root of this whole issue is the tremendous ease with which one can be medically labeled and prescribed a medication.”
While the higher rates of diagnoses and prescriptions are troubling enough, researchers then discovered the correlation between teen pregnancy and polypharmacy. They cautioned that they did not have an explanation for why the link existed, though the study cites common academic theories.
“There may be a logical connection between the judgment-altering effects of psychotropic, narcotic, and other medications and adolescent decision-making regarding sexual behavior, use of birth control, and pregnancy,” the study says.
Teens on those medications may see pregnancy as a way to discontinue the drugs, while others may view it as a way to seize agency in lives that are otherwise influenced by the foster care system and pills.
Nelson and Gardner said the solution to the polypharmacy piece — which may in turn be the solution to the pregnancy rate increase — is increased education: for the child, about healthy habits, relationships and lifestyles; for the parents to whom children may return; and for the caregivers to whom the teens are otherwise entrusted.
The study notes that other states have instituted prescribing guidelines to combat polypharmacy. Officials in Wyoming “informally monitor physicians prescribing patterns” to combat doctors who too often rely on powerful medications.
Nelson added that non-medication forms of treatment, like therapy, should also be stressed.
“Pills can’t do all the heavy lifting,” Nelson said. “The answers to the child’s previous trauma and their current anxieties is not all pills. It can’t do it. We really need to increase those other supports.”