Psychiatric Prescribing in Child Welfare: Barriers to Evidence-Based Practice and an Agenda for Reform

The prescription of psychotropic drugs to children in the child welfare system has rightfully attracted increased public and institutional attention. Significant challenges include (1) the integrity of the scientific literature that concerns the use of psychotropic drugs; (2) the nature and scope of the influence of pharmaceutical companies on prescribing patterns; (3) the regulatory rigor of the U.S. Food and Drug Administration (FDA); (4) the accuracy of psychiatric diagnosis that provides the basis for prescribing decisions; and (5) the efficacy of psychotropic drugs and their long-term impacts on children. This article describes the extant knowledge on these crucially important issues from the perspective of child welfare researchers and practitioners. In particular, a disconnect often exists between the scientific data and the routine psychiatric treatment of youth involved in the child welfare system. Such issues represent significant challenges for the implementation of evidence-informed clinical practice. Recommendations are made for improving the current situation at the levels of child welfare practice, policy, and education.