ABSTRACT
Over the past two decades, there has been a steady rise in the use of psychotropic medications to treat children and adolescents with emotional and behavioral problems (Zito et al. 2000). Public concern, oen driven by media accounts, over the high rates of psychotropic medication use among youth in foster care has led to increased scrutiny about its appropriateness in this vulnerable population. Studies show that youth in state custody, including those in foster care and the juvenile justice system, have higher rates of psychotropic medication use, singly and concomitantly, than do youth who are eligible for Medicaid through income or disability qualications (dosReis et al. 2001; Zito et al. 2008). Recent federal legislation also imposes increased oversight of prescribers to youth in state custody. ese facts have led many states to adopt legislation requiring state agencies to monitor the treatment of children in their care. Practitioners have responded to these evolving standards, which are intended to promote the best care for young psychiatric patients in state custody. (For the purposes of this chapter, “youth in state custody” refers generally to two main groups of youth: those in foster care and those who are in various stages of an adjudication process managed by the juvenile justice system.)
In the United States, parents typically are the “guardians” of their children, and are authorized to direct their medical care, which includes decision making regarding psychiatric treatment and providing informed consent to such treatment (Feigenbaum 1992). When a minor is taken into state or county custody, the state or county must provide for the youth’s basic health-care needs, including mental health and substance abuse treatment. However, medical services cannot begin without obtaining the appropriate consent for care. Entry into the foster care or juvenile justice systems does not automatically remove a parent’s right to consent to their child’s health care. For purposes of this chapter, when referring to youth in foster care or the juvenile justice
system, the assumption is that parental guardianship has been temporarily or permanently terminated, and that the state has been appointed the legal guardian of, and assumed all parental responsibilities and decision making related to, the child.
