California’s foster children and child welfare advocates scored a huge win this week when Gov. Jerry Brown (D) signed three pieces of legislation aimed at curbing use of psychotropic drugs in foster homes.
Under the new laws, public health nurses can access the medical records of more than 63,000 children and teenagers in foster care, many of whom are prescribed psychotropic drugs. With that information, they’ll determine who relies most on the medication and take steps to cut back their intake. Child welfare workers will also receive training and oversight tools to prevent abuse.
“When we take kids away from their parents, we become their parents, and we assume the highest obligation to ensure that those kids have the best chance to thrive in life,” Frank Mecca, executive director of the County Welfare Directors Association of California, told the San Jose Mercury News. “And these bills give us the tools to make sure that kids don’t just get pills but that they get high quality mental health treatment and that their well-being is closely monitored.”
Last year, a five-part San Jose Mercury News investigation found that nearly a quarter of California’s foster children took psychotropic medications, some of which the Food and Drug Administration (FDA) didn’t approve. At the juvenile courts’ becking, officials carried out these practices for a decade, making its rates of abuse in the state’s foster system more than triple the national average.
A point of contention for child welfare advocates was that these children suffered from trauma, not severe mental illnesses for which the psychotropic medication was intended. While foster care officials doled out the treatments to calm the children down, mood swings often followed. Long-term effects — including weight gain, lethargy, lack of focus, increased risk of suicide, and a shrinking brain — devastated children throughout the state foster care system.
These discoveries sparked efforts to hold foster homes and doctors more accountable. As the landmark law made its way through the California legislation, a coalition of high-level health care officials, attorneys, and lawmakers compiled a set of guidelines for doctors who prescribe medication to youth. Stipulations forbade the synchronous use of two or more drugs, required practitioners to offer non-drug therapies, and prioritized used of FDA-approved medication.
“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 last year.
As the foster child population grows, foster care systems across the country are facing similar issues, mainly due to the use so-called “second-generation” antipsychotics. These medications — which include aripiprazole, olanzapine, paliperidone, quetiapine fumarate, and risperidone — have been approved by the FDA. Even so, a report by the Inspector General for the Department of Health and Human Services cited quality-of-care concerns in 67 percent of the cases examined. Some of these incidents took place took place in South Carolina, where doctors gave psychotropic medications at a rate two to three times that of their counterparts, mainly through a cocktail of two to three tablets.
Some doctors have defended these practices, saying they don’t have other options to “contain” the behaviors that get youngsters shipped from foster home to foster home. 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.
“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 earlier this year. “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.”
The legislation signed by Gov. Brown, in essence, takes up where previous laws left off, asking all sectors dealing with foster children to work more closely in preventing the over-prescription of medication. While the state’s latest move has gone the furthest in limiting the use of psychotropics, critics say the legislative process weakened some aspects of the law that would have held practitioners more accountable. For example, lobbying groups representing physicians and group homes saw to it that a part of the legislation requiring doctors to justify their use of medication before judges was removed.