In partnership with the Alabama Department of Human Resources (DHR), the Alabama Psychiatric Review Team (APMRT) (https://cla.auburn.edu/apmrt/) was assembled to pilot a multifaceted approach against the overreliance on psychotropic medication for youth within the state’s foster-care system (Luna, Rapp, et al., 2018). Together, the project director, who is a doctoral-level board certified behavior analyst (BCBA-D), a child psychiatrist, a psycho-pharmacologist, a psychiatric nurse practitioner, several BCBAs, and master’s students in the Applied Behavior Analysis program at Auburn University (https://cla.auburn.edu/psychology/applied-behavior-analysis/) work to decrease the use of psychotropic medication as the primary treatment for challenging behaviors in foster youth, while promoting behavior analytic services in its replacement.
Behavioral, Medication Review, and Advocacy Services
In line with the team’s main objective, BCBAs and graduate students assess and treat reported problem behaviors of foster children, while also programming for the acquisition of various skills. Due to their frequent interaction with prescribers, caregivers and caseworkers are trained by BCBAs on a multi-component program which includes viewing a video series on medication advocacy, completing Behavioral Skills Training and receiving various supports to use during upcoming appointments. These videos and documents can be found on the team’s website at https://cla.auburn.edu/apmrt/foster-parents/. For clients that fall outside of the service catchment area, a medical team member can write a recommendation letter to the child’s prescribing physician.
To establish a multiple referral process and greater awareness on the potential risks of psychotropic medication, professional presentations are offered to foster parents, social workers, BCBAs, judges and prescribers. The team also works towards filling existing gaps in behavior analytic and related research for this unique population. For example, recent work by O’Brien, Rapp, and Kierce (2020) tracked medication changes in foster youth to investigate patterns of prescriber behavior, ultimately showing the absence of a systematic process for deprescribing psychotropic medication.
Overall, the team takes a systems approach to create positive and socially significant change within the lives of Alabama foster youth, while making strides to alter potentially harmful prescribing practices and disseminating the field of behavior analysis.
Luna, O., Rapp, J. T., Newland, M.C., Arena, R., La Pointe, L.L., Kierce, E., & Lusche, P. (2018). Alabama psychiatric medication review team (APMRT): Advocating for foster children. Behavior and Social Issues, 27, AA16–AA20. https://doi.org/10.5210/bsi.v.27i0.8298
O’Brien, C., Rapp, J. T., Kierce, E. (2020). Do prescribers deprescribe psychotropic medication for children in foster care? Developmental Child Welfare, 1-18.
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