Antipsychotic Use Among Youth in Foster Care Enrolled in a Specialized Managed Care Organization Intervention

J Am Acad Child Adolesc Psychiatry. 2020 Jan;59(1):166-176.e3. doi: 10.1016/j.jaac.2019.04.022. Epub 2019 May 6.


Objective: Little is known about whether interventions implemented by specialized Medicaid managed care organizations (MMCOs) contributed to recent stabilization of antipsychotic prescribing to youths in foster care. This study examined a multimodal antipsychotic intervention implemented by a specialized MMCO for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications.

Method: Employing a difference-in-differences design, intervention effectiveness for youths in foster care (age 6-17 years) compared with adopted youthss was examined. Analyses were stratified by FDA-indicated conditions, other externalizing conditions, and other internalizing conditions. Outcomes included predicted annual probabilities of any antipsychotic dispensed, antipsychotic dispensed for ≥90 consecutive days, and glucose and lipid testing.

Results: Intervention-enrolled youths with FDA-indicated conditions, relative to comparison youths, experienced a 0.6% reduction in any antipsychotic dispensed and 3.1% increase for ≥90 consecutive days dispensed in the 2 years following implementation, both nonsignificant differences. Youths with other externalizing disorders experienced significant reductions, relative to comparison youths, in any antipsychotic dispensed (-6.3%, p < .001) and in ≥90 consecutive days dispensed (-5.5%, p < .001). Youths with other internalizing disorders experienced a significant reduction, relative to comparison youths, in any antipsychotic dispensed (-7.6%, p < .001) and in ≥90 consecutive days dispensed (-5.1%, p < .001). Glucose and lipid testing increased at statistically comparable rates for both groups.

Conclusion: MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.

Keywords: Medicaid; antipsychotic agent; drug utilization review; managed care organization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Antipsychotic Agents*
  • Child
  • Drug Prescriptions / statistics & numerical data*
  • Drug Utilization / statistics & numerical data*
  • Female
  • Foster Home Care*
  • Humans
  • Male
  • Managed Care Programs*
  • Medicaid*
  • Retrospective Studies
  • United States
  • United States Food and Drug Administration


  • Antipsychotic Agents