Medicated: Many children in SLO County foster care are prescribed psychotropic drugs 

Each year, thousands of children pass through foster care systems in the state of California—and many of those children are prescribed powerful drugs for psychological and mental health conditions. 

According to a report released by the California State Auditor’s Office Aug. 23, more than 17 percent of the children in SLO County’s foster care system were prescribed psychotropic medication during the 2014-2015 fiscal year.

The report comes as the state grapples with concerns over gaps in how foster children are prescribed such medication and how the drugs, which can cause severe and serious side effects in children and adolescents, are distributed and regulated by the state, county, and judicial entities charged with taking care of them.

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• SOURCE: THE OFFICE OF THE CALIFORNIA STATE AUDITOR
• JAGGED LITTLE PILL: An estimated 17 percent of SLO County foster children are taking psychotropic medication, including powerful anti-psychotic drugs.

“This issue is of particular importance to California, which has the largest population of foster children in the country,” the report stated.

Psychotropic drugs are prescribed to treat children both in and out of the foster care system for a variety of psychiatric disorders and illnesses, such as anxiety disorders, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, and others. According to the report, children who are overprescribed psychotropic drugs face a particularly high risk of experiencing severe side effects from those drugs, including weight gain, sleep disturbance, and even depression. The report also noted that some medical journals also linked psychotropic medications to sudden cardiac death.

According to the report, of the 460 children who passed through the foster care system in SLO County during fiscal year 2014-2015, 79 received a prescription for psychotropic medication at some point. The same report also stated that doctors signed off on 977 prescriptions for those SLO County foster children for the same year.

Antipsychotic drugs topped the list of prescriptions written for youth in the SLO County foster system that year, making up 38 percent of the total prescriptions written for them in fiscal year 2014-2015. Following close behind were stimulants and antidepressants. The majority of those medications, roughly 73 percent, were prescribed to foster children between the ages of 12 and 17, according to the report.

Children enter the foster care system through one of two avenues—a county’s child welfare and social services or the court system—and are evaluated for psychiatric conditions that might necessitate medication. While many of those children likely need such medication, the state’s report raised concerns about the system’s oversight and implementation. The report found that many California foster children receiving psychotropic medications were prescribed quantities and doses that exceeded the state’s guidelines, and that in some cases, counties failed to follow up with health care providers to ensure the safety or necessity of the medications within 30 days of prescribing the drugs to the children.

SLO County Health Officer Dr. Penny Borenstein told New Times she was aware of the report but had not read it yet. However, she did say that she was aware that the issue was a hot topic and something the department had reviewed over the last few months. 

“We found that our rate in our county of children on psychotropic medication is less than the statewide average,” Borenstein said.

According to Borenstein, that review found that the majority of the county’s foster children who are on psychotropic medications were on just one or two such medications, and that instances of children on three or more were “rare.”

In addition, Borenstein said the county has a nurse embedded in the county’s department of social services who is tasked with providing care for and reviewing the medical needs of foster children, including the need for psychotropic medication.

“She gets reports for all psychotropic medication and reviews them for appropriateness,” Borenstein said. “She makes sure all the information is complete before it goes to a judge.” 

Whether the issues of concern laid out in the report are present on the Central Coast or not, one local elected official is pushing the state’s lawmakers to pass reforms that would impact SLO’s and every other county’s foster care systems.

State Sen. Bill Monning (D-Carmel) introduced a bill last year that would require the court system to use recognized health care standards when considering whether to authorize medicating a foster child with psychotropic drugs. According to a statement from Monning’s office, current state law does not provide any such guidelines for a court when making that decision.

“The bill provides the courts with key factors to consider when making the potentially life-changing medical decision to prescribe psychotropic drugs to a foster child,” Monning said in an Aug. 24 statement. “It is our obligation to protect the well-being of foster youth in California and, given the serious risks associated with the administration of these powerful drugs, there needs to be thoughtful guidelines prior to authorization.”

The bill, known as SB 253, would require judges to make those decisions based on “clear and factual evidence” and mandate lab tests and other screenings before deciding to medicate a foster child. The bill would also require the judges to get a second opinion in cases where a child is prescribed multiple antipsychotic medications, or for foster children between the ages of 0 and 5.

As of Sept. 1, the bill has been approved by both houses of the state Legislature and is awaiting approval from Gov. Jerry Brown. 

Staff Writer Chris McGuinness can be reached at [email protected], or on Twitter at @CWMcGuinness.