Updated guidelines for psychotropic medication use for children and adolescents in Colorado's Child Welfare System released

Children and youth who come to the attention of the child welfare system have disproportionately high rates of emotional and mental health challenges, and are prescribed high rates of psychotropic medications. Nationwide, over 10% of children/youth in foster care take psychotropic medications. In Colorado, 18% received at least one psychotropic medication and 5% took at least two psychotropic medications.

This week, CDHS and HCPF published the 2017 Colorado Guidelines for Psychotropic Medication Use for Children and Adolescents in Colorado's Child Welfare System  which reflects: 

  • more detailed data on psychotropic prescribing, such as trending prescribing patterns over time;
  • decision aides for obtaining mental health services;
  • new guidelines and treatment algorithms; and 
  • progress made pursuing nationally recognized standards for appropriate prescribing of psychotropic medications. 

For example, it is now known that psychotropic prescribing increased overall for all Medicaid youth in Colorado between 2012-13 and 2015-16, but increased at a lower rate for youth in foster care. This update also showcases decision aides for obtaining mental health services for children and adolescents in out-of-home care, and for obtaining consent to treat for mental health. Treatment algorithms for common forms of mental illnesses have also been adapted from Seattle Children’s Hospital, as have standardized side effect rating scales from the Ministry of Government Services in Ontario, Canada. The 2017 guidelines include best prescribing practices, and show instances of prescribing patterns that are likely to trigger a review and prior authorization from Medicaid, as well as discussing prescribing practices that may in the future be considered for prior authorization. 

In 2012, the Colorado Department of Human Services (CDHS) and the Department of Health Care Policy and Financing (HCPF) joined together with representatives of the county directors in Colorado, the University of Colorado, residential child care facilities, former foster youth, the Foster Care Advisory Board, Colorado Access, Colorado Association of Family and Children’s Agencies (CAFCA), the Kempe Center, Children’s Hospital, Beacon Health, Office of the Child’s Representative, Denver Health, Aspen Pointe, Colorado University School of Pharmacy, Banner Health, Value Options, Colorado Regional Health Information Organization (CORHIO) and the Department of Public Safety to form the Psychotropic Medication Steering Committee. The committee was charged with developing recommended guidelines for the state of Colorado in keeping with the requirements of the Fostering Connections to Success and Increasing Adoptions Act of 2008 (Public Law 110- 351), and the Child and Family Services Improvement and Innovation Act (P.L. 112-34). The original guidelines were produced in 2013, and since then, much has changed.  

The 2017 guidelines also discuss a number of developing initiatives aimed at providing improved mental health access and prescribing practices, such as ECHO modules to train pediatricians about safe prescribing, a child psychiatric consultation hotline to aid the informed consent process and telehealth to increase access to care. 

Watch a short video to learn more about the 2017 Colorado Guidelines for Psychotropic Medication Use for Children and Adolescents in Colorado's Child Welfare System.

Download the complete guidlines by visiting www.colorado.gov/cdhs > news > publications & reports > child welfare publications and reports > 2017 Colorado Guidelines for Psychotropic Medication Use for Children and Adolescents in Colorado's Child Welfare System

The primary rationale for the guidelines is to affirm best practices in caring for our children and youth in out-of-home care, and to highlight the progress occurring in Colorado as we address concerns around psychotropic prescribing. It is predicated upon the assumption that treatment with psychotropic medication should be used to reduce unwanted mental health symptoms and to restore meaningful quality of life for youth.  

Medication should never be used as a punishment, as a condition of placement, as a means to restrain a youth except in emergency situations, or for the convenience of caregivers. Whenever possible, the youth should have a voice in their treatment, and should clearly understand why they are being given a medication. Above all else, medication prescribing should keep youth safety in mind, with constant vigilance for short-term and long-term adverse effects from taking it. 

While the 2017 guidelines are intended for the use of practicioners working with children and adolescents involved in the child welfare system, practiciers working with children and youth involved in other systems may find the guidelines helpful. 


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