There's not enough oversight of psychotropic prescriptions for foster kids

111021 full
111021 full

Some children in foster care in Southern California are receiving high doses of psychotropic medications without follow-up care, and without required parental or court approval, a report by the California State Auditor revealed Tuesday.

The agency pulled 80 case files from child welfare departments in four counties, including Los Angeles and Riverside, and found ongoing problems with how the drugs are handled. In some cases, children received medications, but no known counseling. In others, dosages were higher than recommended. Looking at overall state data, auditors found 65 percent of children were prescribed at least one medication without legally required court approval.

"The fact that there's such a high rate of failure to comply with the law is shocking," said Bill Grimm, senior attorney with the National Center for Youth Law. 

Lisa Sorensen, the division chief for Health Management Services with the L.A. County Department of Children and Family Services, said bad paperwork flow could explain at least part of the problem. Prescriptions are simply being reported by hospitals and psychiatrists after the filing deadlines. 

But, she said, the problem is real and DCFS's hands are largely tied. 

"Even though there are all these laws in place, any psychiatrist can write a prescription for a foster child, and any caregiver can take that prescription to their pharmacy and get it filled, with or without the court's approval," she said.

A judge can get upset about it retroactively, she said, but they can't prevent it from happening. 

Among the audit's findings:

  • In two cases out of 20 reviewed in Los Angeles, and seven out of 20 in Riverside, kids taking psychotropics were supposed to see a provider for a check-up within two weeks, but there's no indication they had any follow-up care. That can be a problem, the report found, because such medications can cause severe side effects and children may require therapy in addition to or instead of medication. 
  • In Los Angeles, six out of 20 cases showed children were prescribed dosages higher than generally recommended for children.
  • Auditors found three cases out of 20 where foster children in Riverside County were prescribed multiple psychotropics, exceeding general medical guidelines.

Riverside County officials issued a statement saying the audit failed to account for some major improvements to mental health care for foster kids in the county.

"Although not reflected in the audit, mental-health services provided to our foster youths has increased 35 percent in the last few years," the statement from the Riverside County Department of Public Social Service said, citing improvements to in-home services, trauma-based care and changes adopted this year to improve how medications and follow-up care are tracked. 

Child advocates worry about how medications are overseen because foster children take drugs for things like depression, anxiety, and attention deficit disorder at high rates. About 12 percent of California's 79,000 foster children take psychotropic drugs, compared to 4 to 10 percent of their peers who aren't in foster care. In L.A. County, 3,194 foster children had filled prescriptions for psychotropic drugs in 2015, about a third of them for anti-psychotics used to treat things like schizophrenia and bipolar disorder.

"These medications are used as chemical restraints," Grimm said. "With so many of these children who present behavioral problems, present difficulties for caregivers, the way to address that quick and easily and effectively is to give them a pill."

Sorensen said L.A. County has worked for decades to reduce the number of psychotropics prescribed to foster children, but they do have a place.

"It's very challenging to take a group of children who are as severely abused and neglected as the children in today's foster care have been and not see psychiatric symptoms," she said. 

Legislation passed in 2015 tightened some controls on prescribing medications to foster youth. At least three additional bills are in the legislature to add more such regulations this year. Those bills propose to add outside reviews to county health plans for foster youth, conduct a statewide analysis of whether psychotropics are overprescribed, and add additional court oversight of medications. 

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