National Center for Youth Law


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Movement in the Fight to Reduce the Use of Psychotropic Medications on Children in Foster Care

88aceb5fb5The publication of an investigative series “Drugging our Kids” in the San Jose Mercury News this fall is bringing renewed attention to the dangerous use of psychotropic drugs on children in California’s foster care system. The articles spurred a flurry of activity in the State Capitol including the release of the first new regulation to come from the State of California’s three year old review process, the Quality Improvement Project (QIP), as well as a nascent investigation by the State Medical Board into prescribing practices. In addition, several counties have begun their own reviews into the use of these powerful medicines on children in foster care.

Since October of 2012, NCYL senior attorney Bill Grimm, of counsel Edward Opton, and policy advocate Anna Johnson have participated in the three QIP workgroups convened to improve the quality of psychotropic medication services delivered to children in foster care. NCYL’s goals have been to improve dangerous prescribing practices, identify states and counties that have seen success in reining in dangerous practices, and establish the means to ensure appropriate treatment. NCYL has also supported the participation of foster youth on the workgroups and expert panel to ensure inclusion of this vital perspective.

The QIP expects to establish data measures and finalize guidelines for the use of these medications by Spring of 2015, and there has been some progress towards this goal. The Clinical Workgroup produced a series of documents guided by NCYL’s research, the input of medical and scientific advisory board members, and the coalition of advocates. These include:

  1. State guidelines to improve prescribing of psychotropic medications to children;
  2. A checklist of safety items to review with a medical professional before medications are approved as a means of monitoring before prescriptions are filled; and
  3. A list of recommendations for supporting the California courts in deciding to authorize medications.

The QIP Youth, Family, Education Workgroup also produced two documents that NCYL staff drafted and worked on in collaboration with foster youth, their advocates, and mental health professionals:

  1. A mental health bill of rights citing the laws and regulations for proper treatment that are available to foster youth statewide. This includes legal clarification that children have the right to refuse psychotropic medication and have the right to not be penalized for refusing to take psychotropic medication; and
  2. A “Questions to Ask” list for a child’s doctor, pharmacist, attorney, and social worker to help children and youth become fully informed before and during the use of psychotropic medications.

On September 10th, 2014 NCYL policy advocate Anna Johnson, along with former foster youth Rochelle Trochtenberg, delivered a presentation on the QIP to the California Child Welfare Council and the Department of Health Care Services (DHCS). The presentation’ accompanying foster youth video can be viewed here. The Council is taking steps to involve its members in the state work and has helped to guide state agencies to improve the QIP process.

Lack of Data Hinders Effort

Despite requesting specific information and aggregate trends about prescriptions given to foster youth since 2012, NCYL has received little meaningful information from the state agencies. DHCS has obstructed data collection by providing incorrect file matching, generalizing results so they are unusable for monitoring medications, and partially answering requests. The Data and Technology Workgroup has achieved no tangible outcomes to date except for the ability to share information between DHCS and the Department of Social Services. The group has been unable to establish an implementation plan for the following:

  1. Creating a single data set that allows information about foster children who have a court authorization for psychotropic medications to be checked against  prescriptions that have actually been filled.
  2. Naming and defining data measures for quality assurance including: existing measures from the 16-state study performed by the Medicaid Medical Directors Learning Network, the new The Healthcare Effectiveness Data and Information Set measures, and additional indicators that are best practices from other states.

NCYL senior attorney Bill Grimm is meeting with legal and data staff from the Department of Health Care Services, to resolve these issues and to offer legal guidance in order to ensure the appropriate data is available to better oversee high priority concerns including the prescription of antipsychotics, the use by one foster child of multiple psychotropic medications at a time, and the prescribing of adult dosages for children.