Foster Youth Over-Medicated And Sometimes Jailed As Number Of Foster Homes Declines Nationwide

HHS Secretary Robert F. Kennedy Jr. is leading the charge in the deprescribing movement of psychotropic drugs on the basis that the medication is being overprescribed and it is difficult for patients to wean off the drugs safely. The discussion often fails to mention the substantially high rates that children in foster care receive these drugs compared to other children in the United States.

Boston College psychiatric nurse practitioner Victor Petreca wrote a July commentary stating that the “gravest harms” do not fall on middle-class families. Petreca said the prescribing of “antipsychotics for foster children, polypharmacy in jails, and sedation in nursing homes” are major concerns. Particularly, these groups have stability and structural problems that lead to behavioral issues that cause doctors to diagnose these children and elderly patients with a biological disorder.

A 2017 Government Accountability Office review found children in foster care were prescribed psychotropic medications at much higher rates than other Medicaid-enrolled children, including regimens of five or more drugs at once that experts said were not supported by research. The Imprint later reported that a federal review of Medicaid claims for more than 700,000 child-welfare-involved youth found 24 states prescribing psychotropics to at least 30 percent of that population, two to four times the rate for other children on Medicaid. That included nearly 100,000 youths on two or more psychotropics at once. That claims review covers the same child-welfare Medicaid population analyzed in a 2023 JAMA Pediatrics study of 2019 data.

The 2023 JAMA-published study found 26.25% of child-welfare-involved youth were prescribed psychotropic drugs and 13.27% experienced “psychotropic polypharmacy,” meaning they were prescribed drugs from multiple drug classes at the same time. Among other Medicaid-enrolled youths, 9.06% were prescribed a psychotropic medication and 3.11% experienced psychotropic polypharmacy. Foster youth were nearly three times more likely to be prescribed a psychotropic drug and four times more likely to experience psychotropic polypharmacy compared to other Medicaid youth.

A 2025 meta-analysis published in an Australian journal reviewed 61 studies, primarily from the United States. That review found a 42% pooled rate of out-of-home care youth being prescribed psychotropic medications, which includes family foster care, kinship care, congregate or residential care, and pre-adoptive homes or other supervised placements. Kinship prescriptions are usually lower, while group home drug prescription rates are typically higher.

Petreca explains that foster children are often dysregulated from moving around to different house placements, which results in restlessness and difficulty concentrating. Instead of understanding this as a problem of circumstances outside the child’s control, the medical system diagnoses the child with ADHD and promptly prescribes medication to treat the condition. Petreca compared it to a homeless man who “presents with a low mood and lack of pleasure,” for whom the medical system will diagnose depression and promptly give him pills as the resolution.

“Those assessments might be correct, but each might also be a structural problem that gets a biological label because that’s what the system can document, bill and treat,” Petreca wrote. “The medication is prescribed, but the conditions that produce the distress don’t improve, so the problem isn’t solved.”

A Maryland class-action lawsuit citing state data alleges one-third of the state’s foster care youth are receiving psychotropic meds, and most of them do not have a documented psychiatric diagnosis. Auditors of the Florida program couldn’t find logs detailing the frequency and dosage of the medication in 66% of the files they reviewed.

A report on psychotropic drugs for foster care children in Texas found 804 children aged 4-5 received psychotropic drugs in 2024, representing 9.9% of all foster care children of that age group in Texas. There were also 128 three-year-old children (3.2%) and 261 (2.2%) under the age of three receiving drugs for psychiatric conditions in the foster care system.

In a 2008 training paper for New York courts, child psychiatrist Martin Irwin, M.D., described a 7-year-old in foster care who had ADHD and had been stable for months. After a 15-minute medication visit, the boy’s psychiatrist decided the ADHD had come back and raised his Ritalin. The child kept getting worse and was sent to residential treatment a few weeks later. Irwin took over the case and found the boy had just been separated from his brother, the only consistent person in his life. He kept telling anyone who would listen, “You were just going to get rid of me anyway.”

This was not breakthrough ADHD according to Irwin. A child who does not believe he is worthy of love, and who expects every adult to leave, has little reason to behave. From the child’s point of view, it can make sense to wreck the placement first, rather than attach and then be rejected. Irwin said the higher Ritalin dose further activated him and helped push the placement apart.

Petreca said the overprescribing crisis is real, but the response requires more than an HHS plan to wean middle-class adults off antidepressants. Structural issues that are leading to the behavioral problems of foster care youth need to be addressed. Petreca also stressed that nonpharmacologic options “should be standard, reimbursed and supported.” He added that the deprescribing plan from HHS and Secretary Kennedy assumes the patient has a “voice, agency and a sound relationship with the healthcare system,” but foster care children, homeless individuals, and elderly care patients often don’t have those things.

A March 2026 report from the Government Accountability Office found that all 49 state child welfare agencies that responded to the survey had challenges finding appropriate placements for foster care youth. Officials told GAO that “a lack of foster homes and youths’ challenging behaviors made placing youth with families difficult.”

The Imprint’s 2026 Who Cares survey found there was a significant decrease in the number of licensed foster care homes across the country from 220,002 in 2019 to 178,026 in 2025, which is a 19% decrease. In its review of the GAO data, the Imprint said 18 states reported placing foster youth in hotel rooms, office buildings, and hospital emergency rooms. The GAO said hotel rooms and short-term rentals are used when no alternate foster home or congregate living facility was available.

An April 2026 report prepared by the staff of Senator Jon Ossoff and Representative Jen Kiggans says there are seven states that have held foster youth in juvenile detention facilities because there is no other placement option. Four of those states have locked up foster youth who have never had any criminal record or charges because there is no other placement alternative.

The GAO report states that the “most significant service-related challenges for child welfare agencies were the lack of community-based mental and behavioral health services, other specialized services for youth in child welfare, and substance use treatment services for youth.”