Curbing the Misuse of Psychiatric Medications in Foster Care
In 2011 the Federal Government Accounting Office issued a report finding numerous problems in the use of psychotropic drugs on foster children. According to report nearly one in four children in foster care are receiving powerful psychotropic drugs. Of all children taking psychotropic medications in California 52% are given antipsychotics which have risk factors that can lead to life-long disabilities such as tremors, obesity, and diabetes (More coverage).
NCYL is partnering with California legislators and the state administration on four bills this legislative cycle that are designed to address the overuse of psychotropic drugs on children and youth in foster care. NCYL’s PsychDrugs Action Campaign staff has been working with Senators Jim Beall and Holly Mitchell to gather data about this largely unmonitored practice in order to highlight and target those unsafe practices most urgently in need of attention.
So far NCYL has been able to assemble data showing that thousands of children are prescribed psychotropic medications each year. We now know that 51% of foster children prescribed medications are given an antipsychotic, more than 30% are on multiple medications, and hundreds are on more than one antipsychotic at the same time for the long term. In light of this information, we are working on establishing comprehensive legislative solutions that will reduce children’s exposure to dangerous prescribing methods and to drugs with high-risk profiles.
NCYL’s efforts culminated in the drafting of SB 238, SB 253, SB 319, and SB 484. These bills, if enacted, will strengthen the ability of judges, caregivers, child welfare workers, and other professionals to ensure safe and appropriate treatment, using theraputic and trauma-informed health approaches, with the aim of reducing the inappropriate uses of psychotropic medications.
Specifically, the bills would:
1) Strengthen the court authorization process to require clear and convincing evidence for any prescription and evidence that other treatments have been attempted prior to medications;
2) Provide for training, data collection, and systems to red-flag questionable practices;
3) Increase the oversight role of public health nurses to ensure that vital signs are monitored for all foster children prescribed psychotropic medications; and
4) Identify the group homes that are most over-reliant on the riskiest psychotropic medication treatments and require these homes to develop corrective action plans that are monitored for progress.
On February 24, 2015, NCYL Senior Attorney Bill Grimm and Policy Analyst Anna Johnson were among 21 witnesses who testified at a Senate Joint Oversight Hearing, “Misuse of Psychotropic Medication in Foster Care: Improving Child Welfare Oversight and Outcomes within the Continuum of Care.” The Hearing Background Paper is available online.
Panelists conveyed a sense of urgency noting that similar hearings occurred a decade earlier and stating that 10 years has been long enough to take action. There was overall agreement among the witnesses that what is in place in California is not enough to ensure safe treatment along a normal continuum of care. While some children benefit from medications, more must be done to protect children from dangerous prescribing. Fortunately, there has been a wave of support for this work from federal agencies and the President as well as mature and promising practices to draw upon from other states.
Panelists further stated that California’s approach to treating trauma needs an overhaul. State agencies are working on long-term solutions to this, but NCYL is working to ensure safer treatment now. Many current and former foster youth talked about the importance of relationships, trusting mentors and providers, and normal healthy programs to meet their developmental and mental health needs while in foster care. It was apparent from testimony that the current service approach takes away the agency and voice of the child in their treatment. It is imperative that children and young adults have involvement and say in any type of treatment.
As these long-term initiatives progress it is important to put controls in place for the approval of prescriptions and to initiate medical monitoring for all children on meds. Treatments for those children who are experiencing polypharmacy (prescription of multiple medications) and high dosages of medications need to be reviewed. The Department of Health Care Services must immediately compile the data to alert counties about those children whose treatment will need a review, a hearing, or child and family team meeting to ensure unsafe treatment ends now and safe, appropriate treatments are put in place.