National Center for Youth Law

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Legislature Considers Comprehensive Approach to Reduce the Overuse of Psychotropic Medications on Foster Youth


April 21, 2015

Lewis Cohen, 510-835-8098 x3045

In response to mounting concern over the widespread use of psychotropic medications for children in foster care, the California Senate Human Services committee will consider four pieces of legislation today.  These bills would improve information gathering and monitoring while strengthening regulation of the drugs’ use on children in foster care.

Foster children are medicated with antipsychotic and other psychotropic medications far more often than children in California who are not in the foster care system.  Children are being medicated in large numbers in the absence of FDA approval of their medications and without solid understandings of the drugs’ effects on children. The potential for lasting harm makes issues of over-prescribing, incorrect prescribing, and excessive usage urgent, especially in group homes, where usage rates are particularly high.

In 2011, President Obama signed the Child and Family Services Improvement and Innovation Act, which requires child welfare agencies to adopt policies for appropriate use and monitoring of psychotropic medications for foster children.  Nearly four years later, California has not met this mandate.

The following bills – all sponsored or co-sponsored by the National Center for Youth Law – take a comprehensive approach to curtail excessive use of psychotropic medication and to limit use of such drugs to children for whom they are appropriate.

SB 238

Senate Bill 238, authored by Senator Holly Mitchell and also sponsored by the County Welfare Directors Association of California (CWDA), would provide social workers with critical information on prescriptions and also make that information available to judges, attorneys and others advocating for the child. The bill directs the Department of Health Care Services and the Department of Social Services to report monthly to counties on usage of these drugs for foster children, and for those reports to also be made available to courts and children’s attorneys. SB 238 would create a system to alert practitioners about potentially dangerous situations arising from combinations of drugs or dosages that depart from standard practices for children. The bill also ensures that information is collected about how the medications fit into a comprehensive behavioral health treatment plan for the child.

Frank Mecca, Executive Director of CWDA, added that the legislation would provide training to county child welfare agency staff so that they can better oversee the use of psychotropic medications for the foster children entrusted to their care. “ We become the parents of these children when they come under our care, and just like parents we depend upon doctors’ professional guidance. It is critical for everyone involved in the care of these children have complete information so we can ask the right questions and make the best decisions together for their well-being and trauma recovery.”

SB 253

Legislation enacted in 1999 assigned the juvenile courts responsibility for overseeing psychotropic medication of foster children, but the legislation did not provide the courts the means to do so.  Senate Bill 253, authored by Senator Bill Monning, would augment the information available to the judges.  The bill is based on the principle that psychotropic medications are only part of a comprehensive approach to mental health care. “SB 253 will provide the courts with key factors to consider when making the potentially life-changing medical decision to prescribe a foster child psychotropic drugs,” Senator Monning said.  “Too often foster children are prescribed psychotropic drugs without the proper oversight.  There are serious risks associated with the administration of these powerful drugs and there need to be thoughtful guidelines when prescribing to foster children.”

SB 253 requires prescribers to provide evidence that the use of psychotropic drugs is medically necessary. Bill Grimm, Senior Attorney at the NCYL, observes that this as a matter of Constitutional rights. “California statutes and case law uphold the rights of convicted felons, sexually violent predators, and those adjudicated not guilty by reason of insanity to refuse the administration of antipsychotic medications unless specific circumstances exist and due process is afforded them. Certainly we can and must afford our foster children even greater protections against the misuses of these medications. SB 253 recognizes that children, too, are entitled to the protections of our Constitution.”

SB 319

Senator Jim Beall authored SB 319 to require standard medical monitoring of the child’s responses to psychotropic medication. Such monitoring is essential to alert physicians and caregivers when adverse physiological effects may outweigh benefits.

Under SB 319, public health nurses would be given the responsibility for oversight and monitoring of the administration of psychotropic drugs to foster children. “Children taking these drugs may suffer irreversible damage without on-going medical monitoring, “ said Assemblymember David Chiu, principal co-author of SB 319 and the other bills in the package. “Public health nurses are a strength of our system and are best qualified to see that mental and developmental well-being of these children are protected.”

SB 484

Senator Beall also authored SB 484, which would reduce the use of psychotropic drugs in group homes where, at present more than half the children are being administered psychotropic drugs. SB 484 establishes a process to identify group homes where the use of psychotropic drugs appears excessive and to mandate inspections and plans of corrective action for those facilities.

“Senate Bill 484 steps up the state’s ability to identify group homes that depend on psychotropic medications as the easiest means to control the behavior of foster youth,’’ Beall said. “Drugging and sedating children should never be considered the primary option in lieu of counseling, therapy, and appropriate treatment.’’