Bowden Cadence F, Simmel Cassandra, Mendez Alicia, Yu Melanie, Neese-Todd Sheree, Crystal Stephen
School of Social Work, Rutgers University, 390 George Street, New Brunswick, NJ, 08901, USA.
Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
Adm Policy Ment Health. 2022 Sep;49(5):821-833. doi: 10.1007/s10488-022-01203-4. Epub 2022 Jun 28.
Youth in the US foster care system are disproportionately prescribed antipsychotic and psychotropic medication compared to youth not involved with foster care. Research on the relationship between experiences of trauma, mental health symptoms, evidence-based treatment, and safe psychotropic prescribing practices for youth in foster care is limited. We explored stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. We conducted semi-structured individual and group interviews with foster caregivers, caseworkers, prescribing clinicians, and alumni of the foster care system. Data were recorded and transcribed verbatim, and analyzed using a directed content analysis approach. Five themes emerged across and within stakeholder groups: (1) acknowledging trauma; (2) role of psychotropic medication; (3) psychosocial resources; (4) additional supports; and, (5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. There was not consensus around the role of psychotropic medication in treating trauma; however, most stakeholders felt that it was overused. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system, and emphasized the importance of support from individuals with common lived experiences. Results demonstrate the need for a system that emphasizes trauma-sensitive clinical interactions and psychosocial supports. Improving training and education for stakeholders, and providing additional sources of support for youth in foster care, could help better identify and treat the effects of trauma and the safe pharmacotherapy for youth in foster care.
与未参与寄养的青少年相比，美国寄养系统中的青少年被过度开具抗精神病药物和精神药物的处方。关于寄养青少年的创伤经历、心理健康症状、循证治疗以及安全的精神药物处方实践之间关系的研究有限。我们探讨了利益相关者对寄养青少年精神药物与创伤知情护理（TIC）之间关系的看法。我们对寄养照顾者、个案工作者、开处方的临床医生以及寄养系统的校友进行了半结构化的个人和小组访谈。数据被逐字记录和转录，并采用定向内容分析方法进行分析。在利益相关者群体内部和之间出现了五个主题：（1）认识创伤；（2）精神药物的作用；（3）社会心理资源；（4）额外支持；以及（5）培训与教育。利益相关者将创伤知情护理视为寄养青少年心理健康服务的重要组成部分。对于精神药物在治疗创伤中的作用没有达成共识；然而，大多数利益相关者认为它被过度使用了。受访者建议增加支持团队成员，以帮助引导青少年通过心理健康治疗系统，并强调有共同生活经历的个人提供支持的重要性。结果表明需要一个强调对创伤敏感的临床互动和社会心理支持的系统。改善对利益相关者的培训和教育，并为寄养青少年提供额外的支持来源，有助于更好地识别和治疗创伤的影响以及为寄养青少年提供安全的药物治疗。
