Recent research has shown that foster children are more likely to use psychotropic medications than children on Medicaid who are not in the foster system, and are more likely to use multiple psychotropics at once. Based on NSCAW II, Wave 2 data, this spotlight examines psychotropic medication use, alone and in combination with other services, among children involved with the child welfare system. High levels of unmet mental health service needs still remain among children in the child welfare system, despite similar findings published almost a decade ago from the NSCAW I study. One third to one half of children meeting clinical symptom criteria did not receive any specialty services in the past 18 months. Psychotropic medications were used alone, in absence of any other service, by a larger percentage of children living out of home (9.4%) than children living in-home (1.8%) (differences in level of mental health need were not taken into account in this comparison).