Findings from the study indicate that 15 percent of children in child welfare systems across the country reported taking psychotropic medications for emotional, behavioral, learning, attention, or substance abuse problems, and that the rates of medication use varied from 0 percent to 40 percent. Factors affecting medication use at the child level included older age of the child, being male, having emotional and behavioral problems, and having insurance. The purpose of this study was to examine effect of geography on the rate of psychotropic medication use among children in child welfare systems across the United States. Data for this study were obtained from 92 child welfare catchment areas that participated in Wave 1 of the National Survey of Child and Adolescent Well-being. A sample of 2,504 children ranging in age from 2-15 were evaluated to determine whether rates of psychotropic medication use varied in relation to child, community, child welfare, and health system-level factors. The study results indicate significant geographical variation in the rates of use of psychotropic medications for controlling behavior problems for children in child welfare systems across the United States. Implications for policy implementation are discussed. Tables, figure, and references