After three years of joining efforts with more than 100 high-level health care professionals, attorneys, foster youth/caregivers/advocates, and the Department of Social Services, California has unveiled a sweeping set of guidelines aimed at cracking down on the overuse of  psychiatric medication in foster care (de Sá, April 2015).

The exhaustive efforts began in 2012 and have given birth to the new proposed measures which recently passed the Senate and are now in the Assembly to be finalized (de Sá, July 2015).    

How It All Came About

When the federal inspectors set out to investigate the use of psychotropic medications in foster care, they found an alarming report that poor children and foster kids covered by Medicaid are prescribed too many antipsychotic drugs at the wrong dosages, too young, for too long, not always deemed as medically necessary (de Sá, March 2015).

Based on a new five-state review by the U.S. Department of Health and Human Services, it was discovered that powerful antipsychotic drugs were being used on children in the nation's public health systems. What’s more, these medications are often prescribed to control troubled children's behavior despite their debilitating side effects (e.g., obesity, diabetes and irreversible tremors) which could potentially hamper a child’s development long term (de Sá, 2014).

According to the report, more than half the children nationwide were poorly monitored, more than 40 percent received inappropriate treatment based on inaccurate or wrong diagnoses, and more than one-third was simply over-medicated (ibid).

Consequently, the department has ascertained quality-of-care concerns in at least two-thirds of cases which eventually spearheaded the conception of the state's first comprehensive effort to address the issues (de Sá, April 2015).

What the Measures Will Do

First and foremost, the bills would ensure that no powerful psychotropic drugs be used excessively without close monitoring and/or in place of other effective or necessary treatments.

The directive calls on physicians to offer non-drug therapies, and if prescribed, to keep dosages to a minimum with a "start low and go slow" approach. It discourages the use of two or more meds with the ultimate goal of tapering off the mind-altering drugs altogether (de Sá, July 2015).

The measures would further empower medicated foster youth to exercise their rights to have their experiences heard by judges, caregivers and attorneys, giving them a stronger voice in their own care with rights to refuse medication (de Sá, April 2015).

Consequently, the new laws will help curtail the effects of abuse, neglect and abandonment in foster care and instead call for more holistic treatment modalities in lieu of psychotropic medication as the choice of treatment for foster youth.

Under the proposed laws, the way the state's juvenile courts approve prescriptions will also be streamlined via more stringent system of monitoring and reporting how often foster children are being medicated. For example, when multiple psychiatric drugs are prescribed to very young children in high dosages, social workers would be alerted. Especially in residential group homes, prescribing would be more closely monitored and subject to corrective action (de Sá, April 2015).

Significance of the Legislation

This initiative is a major step toward curtailing the excessive use of psychiatric drugs on foster children, serving as a model across the country. If approved by the state Assembly and signed by the governor, the proposed laws would become the nation's first and most sweeping set of legislative reforms to rein in on the foster care system's excessive reliance on psychotropic medications, further tightening its overall monitoring system to ensure quality care (de Sá, 2014).

This new California legislation has paved the way for other states to follow suit in taking a more comprehensive approach to policy change, which could ultimately take effect on a federal level (de Sá, March 2015).

The new measures are also backed by the federal government, calling on all states to reduce the excessive or unmonitored use of psychotropic medications in foster care and to expand more effective treatment with proposed budgets for both 2015 and 2016 to assist those efforts (de Sá, July 2015) .

Next Step

The new legislation is clearly not the panacea and won’t solve all the problems at once. Nonetheless, it is sending a potent message that every child’s challenge may be a reflection of the society’s problem to address as a whole but one that can’t be simply resolved through drugs.

Perhaps it is yet another sobering affirmation that there isn’t a short cut or much room for compromise when it comes to ensuring children’s safety and quality care they deserve.

The responsibility is not exclusive to the state or federal legislature. It behooves all parents, foster parents, social workers, teachers, and health care professionals to be jointly proactive in tackling the flaws in the system. 

Given the stunning reality, it could no longer remain as an aspiring option but an unavoidable duty that falls on each and every adult to ensure that the new measures be implemented thoroughly before one more child’s life is endangered along the way.

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References

de Sá, K. July 11, 2015. San Jose Mercury News California. California foster children would be better protected from overprescribing physicians under proposed new laws now in the Assembly. Retrieved from http://webspecial.mercurynews.com/druggedkids/?page=more

de Sá, K. April 10, 2015. San Jose Mercury News California. California creates first guidelines for prescribing psych meds to foster youth. Retrieved from http://webspecial.mercurynews.com/druggedkids/?page=more

de Sá, K. March 27, 2015. San Jose Mercury News California. Federal study finds alarming use of antipsychotics among nation's poor children, foster kids. Retrieved from http://webspecial.mercurynews.com/druggedkids/?page=more

de Sá, K. September 19, 2014. San Jose Mercury News California. Drugging Our Kids: California calls for new checks on psych meds for foster kids. Retrieved from http://www.mercurynews.com/health/ci_26562339/drugging-our-kids-california-calls-new-checks-psych