Patient-centered psychiatric care for youth in foster care: a systematic and critical review

Youth in the U.S. foster care system are prescribed risky psychotropic medications at high rates. In response, state child welfare agencies have developed policies, yet there is little research to inform patient-centered care (PCC) approaches. To fill this gap, we aimed to identify (1) the perspectives of youth in or formerly in foster care and their caregivers and providers regarding how psychiatric care aligns or does not align with PCC, and (2) effectiveness of interventions aiming to improve PCC within this context. We conducted a systematic review of the literature based on PRISMA-P guidelines, searching four databases and gray literature. Eleven studies met inclusion criteria and quality appraisal benchmarks, none of which were interventions. We applied narrative synthesis techniques to six studies that described youth/former youth perspectives. They described a pervasive lack of knowledge, perceived little voice in decision-making, and described imbalanced power between patients and providers and weak therapeutic relationships, whereas feeling understood by providers and being provided autonomy in decisions were helpful. Systemic barriers also contributed to many concerns. We make a limited number of recommendations to leaders and policy-makers based on our synthesis, however, many critical research steps are needed.