Nearly a year after a five-part news investigation shone light on the alarming rate of prescription drug use among children in California’s foster care system, lawmakers in the Golden State may soon be on their way to approving and implementing legislation that limits the psychotropic medication intake of those under state supervision.
A coalition of high-level health care officials, attorneys, and lawmakers recently unveiled a set of guidelines for doctors who prescribe medication to traumatized youngsters. The proposal calls for doctors to offer non-drug therapies, prioritize Food and Drug Administration (FDA)-approved medication for use on children, and minimize dosage. The synchronous use of two or more drugs would also be forbidden, and medical professionals would be encouraged to wean children off of mind-altering medications.
The guidelines come on the heels of legislation that, if passed, would support the aforementioned rules by requiring counties within the state to form partnerships with their community child health and disability program. Public health nurses would also be on call to monitor and limit a child’s use of mind-altering medication when they’re in California’s foster care system.
“The guidelines aren’t going to solve all the problems,” Linette Scott, chief medical information officer for the California Department of Health Care Services, the agency that oversees the state’s public health system, told the San Jose Mercury News last week. “[But] they set expectations and create a common language for offices and clinics treating California’s 63,000 foster children.”
An investigation by San Jose Mercury News last August revealed that 25 percent of children in California’s foster care system received mind-altering medication, some of which wasn’t approved by the FDA. The rates of abuse in the state’s system more than tripled that the national average, the report said. California’s foster care system has carried on these practices on 15 percent of the wards for a decade, mainly doling out psychotropics — tablets that alter the mood, perceptions, or consciousness of those who use them.
Upon further analysis of state data, reporters at the San Jose Mercury News found that 60 percent of children prescribed psychotropics in the last 10 years received the class of medication with the highest health risks. In some cases, doctors doled out up to four medications at a time to more than 10 percent of youngsters in the foster care system without any knowledge of how it would affect brain function. Reporters also discovered that the juvenile courts authorized the distribution of drugs to children in group homes, places that house 3,800 children annually.
State officials acknowledged that while they intended the medication to calm down the children, mood swings soon followed in many cases. Additionally, the lasting effects have been found to be devastating, with many children experiencing long-term weight gain, lethargy, lack of focus, an increased risk of suicide, and a shrinking brain.
“I don’t think there’s one substantive thing that we can point to that has ensured that foster children in California today are only receiving psychotropic medications appropriately,” Bill Grimm, an attorney with the Oakland-based National Center for Youth Law, told the San Jose Mercury News.
This issue isn’t endemic to California. An Inspector General for the Department of Health and Human Services report showed that children in foster care systems across the United States face similar fates, particularly with drugs touted as second-generation antipsychotics. While these medications — which include aripiprazole, olanzapine, paliperidone, quetiapine fumarate, and risperidone — have been approved by the FDA, the government agency contends that foster care officials have used them inappropriately, with its report citing quality-of-care concerns in 67 percent of the cases they examined. Those who defend the procedures say that they don’t have many other options to “contain” the behaviors that get youngsters shipped from foster home to foster home.
“What the experts tell us is… not enough resources are really directed at taking care of these kids and giving them the therapies and the intensive treatment that they need — not drugs,” CBS News Correspondent Werner said last month. “That’s a lot of time, that’s a lot of people to do that — therapists and counselors and doctors — and that of course all costs money.”
But lawmakers across the United States aren’t buying that explanation. Last year, the federal government issued a call to all states to reduce the use of psychotropic medication in foster care, with President Barack Obama including money in his 2015 and 2016 budget proposals to assist in those efforts. Some states have also taken concrete steps to reduce prescription of mind-altering drugs to children. For example, Washington, Wyoming, New Jersey, and Illinois require that children prescribed psychotropics receive second opinions. Child welfare workers, foster parents, and residential providers in Texas and Connecticut are trained on psychotropics’ effects and side effects. They also receive guidance about what questions they should ask doctors and when to seek non-drug therapies.