Longitudinal MRI template of the baboon brain from birth to adolescence.

Approximately 390 000 youth are enrolled in foster care in the United States, with neglect and caregiver substance use among the most common reasons for foster care entry. Youth in foster care are consistently prescribed psychotropics at higher rates relative to their same-aged peers. Although the reasons for this are complex, high rates of early childhood trauma or neglect, a lack of a consistent caregiver or guardian, inconsistent medical providers, and gaps in transitions of care are likely key contributors.,, Population-based studies have shown that the demographics of foster care youth is not characteristic of the general population; race, ethnicity, socioeconomic status, and other social determinants of health also play a role in higher healthcare usage and poorer health outcomes., In addition to higher rates of psychotropic use, foster care youth experience higher rates of psychotropic polypharmacy, off-label medication use, supratherapeutic medication dosing, and low rates of evidence-based medication monitoring.,,,, In response to these concerns, federal and state policymakers, accreditation organizations, and mental health agencies have increased efforts to develop standards for evidence-based use of psychotropic medications among youth in foster care.,, The Fostering Connections to Success and Increasing Adoptions Act and the Child and Family Services Improvement and Innovation Act are key pieces of legislation that mandate oversight of psychotropic prescribing by child welfare agencies and state Medicaid programs.,, Regulatory standards, including the Healthcare Effectiveness Data and Information Set (HEDIS) and professional practice guidelines, are additional supports for evidence-based prescribing and monitoring in foster care youth. In accordance with these national efforts, there has been substantial growth in state-wide interventions. Specialized managed care models, psychotropic medication use guidelines, educational strategies, health home models, and collegial peer review have been described as promising strategies for improving safe and judicious use of psychotropic medications among youth in foster care.,,,