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Poster #220 - Stakeholder Perspectives on the Informed Consent Process in Prescribing Antipsychotic Medications for Foster Youth

Sat, March 23, 12:45 to 2:00pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Background: Youth in US foster care system are prescribed antipsychotic medications at higher rates than Medicaid insured youth. In 2012, federal mandates required state child welfare agencies to develop oversight plans for youth in foster care. Critical components of this philosophy include youth engagement and youth clients’ rights to self-determination within the informed consent process in mental health treatment. This study focuses on the extent to which stakeholders involved in prescribing antipsychotic medications for foster youth understand and experience the regulatory mechanisms of Informed Consent. In part, this study explores the common emergent themes that help explain how Informed Consent can be effectively implemented for youth in foster care and its relationship to shared decision-making philosophy.
Method: Semi-structured interviews and focus groups were completed with distinct stakeholder groups with lived experience in prescribing or being prescribed or overseeing prescriptions for antipsychotic medication. This presentation presents findings from four stakeholder groups: clinicians (n= 32), foster caregivers (n = 20), child welfare caseworkers (n = 24) and foster youth alumni (n= 8 focus groups). Participants were recruited through snowball sampling methods through state agencies and advocacy organizations around the US. Trained investigators collected data using semi-structured interviews or Deliberative Discussion focus groups.
Data analysis included descriptive and bivariate summaries of stakeholders’ demographic and background information. Four trained qualitative analysts conducted the analysis using Dedoose software. Emergent and a priori coding structure was employed. The initial round of coding was conducted to identify broad themes and sensitizing concepts pertaining to each stakeholder group’s perceptions of states’ oversight mechanisms and the process of engaging with youth in clinical interactions. The second phase of the analysis was completed to determine thematic patterns for each group. Thematic findings will be presented with illustrative quotes. Interrater reliability for analysts ranged from .74 to .89 across all stakeholder groups.
Results: Study results convey how stakeholders view the important elements of this Informed Consent oversight mechanism. Across stakeholder groups, the theme of utilizing a team approach was emphasized as a tactic for success; effective communication among stakeholders was also identified as a vital component to successful informed consent. However, the analysis also revealed clinicians’ obstacles in communication and transparency with other stakeholders involved in the informed consent process. For example, the time and effort it took to communicate the specifics of a youth’s clinical case to an authority not present at the clinical visit was something that inhibited truly informed consent.
Themes of youth engagement, youth input, and stakeholder comprehension emerged as a way to maximize shared decision-making during the informed consent process, though the groups differed in their value of each component. These findings address the nuanced complexity of the tradeoffs inherent in delivering mental health care to youth involved in foster care. They reveal a tension between delivering timely, patient-centered care while also grappling with the complexity of communicating with multiple stakeholders involved in youths’ lives, many of whom had vastly different comprehension levels of youths’ cases and/or of the intricacies of prescribing and monitoring prescriptions of AP medications.

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