California Lawmakers Set To Tackle Excessive Prescribing of Psych Meds to Foster Children UPDATED

“California lawmakers will consider a major overhaul this year of how the state cares for thousands of traumatized foster children, a sweeping effort to curb the excessive use of psychiatric drugs in the child welfare system.

Legislation to boost caregiver training, strengthen court oversight of prescriptions and give foster youth the right to alternative treatments is in the works in the state Senate to address problems revealed in this newspaper’s yearlong investigation “Drugging Our Kids.”

After years of growing concern — but no legislative action — new Senate President Pro Tem Kevin de León said he is “optimistic that oversight will result in overdue reform.”

Psychotropic drug use in foster care is “one of the top issues on the child welfare agenda this session,” said Susanna Kniffen, policy director at the nonprofit Children Now advocacy group.

This newspaper’s series “on the overprescribing of psychotropic medications has shed a spotlight on a deeply troubling aspect of the system,” de León said. “The Senate will be investigating the plight of the adolescents highlighted in these articles, as well as foster children generally.

The series revealed how many in the foster care system have come to rely on a drug-first approach to managing the behavior of thousands of troubled children. While the drugs do little to help abused and neglected youth cope with their trauma, they often lead to debilitating side effects, such as obesity, diabetes and tremors.

But there are signs that the legislative reform effort will not go unchallenged. Statewide associations representing foster care residential group homes and medical professionals are speaking out against a new state policy — introduced in October, weeks after the newspaper’s series began — that makes it more difficult for doctors to prescribe antipsychotics to children on public benefits, including foster youth. Some of that sentiment may surface in legislation to oppose the new rule.

The final deadline to submit bills is not until late February, but preliminary language now being drafted would ensure that kids, caregivers, attorneys and judges are informed about medications and their side effects. The bills would also:

• Grant kids the right to alternative treatments that do not involve powerful drugs, as well as the right to a second medical opinion when potentially dangerous combinations of drugs or high dosages are prescribed

• Train caregivers to understand medications’ risks and benefits — and better handle children who display difficult behaviors
•  Ensure children on medications receive baseline monitoring so that side effects can be caught early.
•  Identify group homes where children are being overmedicated.
• Empower public health nurses to ensure psych meds are used appropriately.

Youth advocates and former foster children such as Tisha Ortiz, of Hayward, applaud the flurry of legislative action.

“I am extremely happy now that lawmakers are trying to push this thing forward,” said Ortiz, 22, who suffered through multiple moves and heavy doses of medications.
Ortiz — who serves on a statewide expert panel examining the use of psychotropics — said children, particularly in group homes, must be allowed to refuse medications without being punished like she was. She encouraged lawmakers considering bills to focus on allowing youth “to be more active in their treatment plans, rather than leaving them on the sidelines while everyone else controls them.”

Lawmakers, including state Sens. Jim Beall, D-San Jose, and Holly Mitchell, D-Los Angeles, and Assemblyman David Chiu, D-San Francisco, have each submitted early language to the Legislative Counsel’s Office, their staff members confirmed. Other bills that address prescribing psychotropics in group homes are also in the early stages.

The influential California Welfare Directors Association is working with Mitchell’s office on legislation that would provide more information to judges, social workers and others in the lives of foster children about their medication and treatment history. That information would give judges who authorize medications more than just a prescriber’s recommendation. It would include observations from social workers, caregivers and the children themselves.

“We’ve been very concerned about making sure that only kids who really need these drugs are getting them,” said Frank Mecca, the welfare director association’s executive director.

Yet, opposition has already surfaced over the state Department of Health Care Services’ decision last fall to require that doctors receive extra authorization to prescribe antipsychotics to children 18 and younger in the public health system.

In a November letter to health care director Toby Douglas, the California Alliance of Child and Family Services representing group homes, the California Pharmacists Association and the California Academy of Child and Adolescent Psychiatry, among others, called the new policy “alarming” and stated it has resulted in “medically necessary medications” being delayed or denied.

“Even if, as recent media accounts report, there is an issue of overprescribing of antipsychotics to youth, the DHCS solution uses a shotgun approach to address a problem that needs surgical precision,” the letter states.

But Chiu, who plans to co-author a bill, wants to make sure that medications are not being used as “a chemical restraint” for foster children who have been abandoned and uprooted, and sometimes lash out because of their trauma.

“For me, the steady increase in the use of psychotropic medications for our foster youth has been incredibly alarming, and the lack of standards to authorize the use of medications appears to be irresponsible at the least, and potentially life-threatening at the worst,” Chiu said.

“Children’s brains are still developing, and the idea of requiring a child to take one, two, three, four or even more mind-altering medications without taking other health impacts into account is irresponsible.””

With a half dozen legislators exploring bills, de León’s staff has been working behind the scenes, attending meetings of a statewide reform group and meeting with advocates led by the Oakland-based National Center for Youth Law and lawmakers considering bills.

“When the government takes the extraordinary step of removing a child from their families because of abuse or neglect, it assumes the tremendous responsibility of ensuring they are cared for and not further abused or neglected by the system,” de León said in an email.

California lawmakers set to tackle excessive prescribing of psych meds to foster children[Contra Costa Times 1/31/15 by Karen de Sá ]

REFORM Puzzle Piece

Update:”In a major step toward curtailing the excessive use of psychiatric drugs on foster children, the California Senate on Thursday approved a package of bills that is already being eyed as a model in Washington, D.C., and across the country.

The four proposed laws — if approved by the state Assembly and signed by the governor — would become the nation’s most sweeping set of legislative reforms to curb the foster care system’s reliance on psychotropic medications, the subject of this newspaper’s yearlong investigation “Drugging Our Kids.”

“I know that it will inspire other states. I have no doubt about it,” U.S. Rep. Karen Bass, D-Los Angeles, said in response to the bill package. “We are going to continue to make sure that we can do the same on a federal level.”

The newspaper’s investigation found the powerful medications, which can cause debilitating side effects, are often prescribed to control troubled children’s behavior. But the bills, approved unanimously in the state Senate on Thursday, would improve how the state’s juvenile courts approve prescriptions; create new training programs; expand the ranks of public health nurses; and require ongoing reporting of how often foster children are being medicated.

Social workers would be alerted when kids receive multiple medications or high dosages and when psychiatric drugs are prescribed to very young children. And residential group homes, where prescribing is typically the highest, would be more closely monitored and subject to corrective action.

“The Senate has sent a clear message: The system must never permit powerful psychotropic drugs to replace other effective and necessary treatments,” said Sen. Jim Beall, D-San Jose, who authored the bills along with Sens. Holly Mitchell, D-Los Angeles, and Bill Monning, D-Carmel.

While the legislation faces no formal opposition, some child psychiatrists have expressed concerns that too many new rules could hinder care when access to medication is vital. The bills also carry a multimillion dollar price tag that could threaten their passage if they reach the governor’s desk.

The newspaper’s investigation found almost one in four California teens in foster care have been given psychotropic drugs over the past decade, the vast majority receiving antipsychotics, which can cause dramatic weight gain, diabetes and irreversible tremors.

But now, the state’s reform efforts are being watched by children’s advocates across the country.

“We can all look to California because I really don’t know of any other state that has taken such a comprehensive approach,” said Shadi Houshyar, vice president of the national children’s advocacy group First Focus. The bipartisan organization has spent eight years pushing states and the federal government to reduce psych med use in foster care, and to increase funding for more effective and proven treatments for trauma. “This is a really promising process, and we’d like to see other states tackling it in this way.”

Other states are addressing the problem through more limited legislation and policy changes. For example, a bill signed into law in April by Washington Gov. Jay Inslee requires a second medical opinion by a psychiatrist for all antipsychotics prescribed to foster children. In 2009, Oregon strengthened an existing statute, requiring regular data reports and a second medical opinion for kids prescribed more than one drug or any antipsychotic.

The Oregon law empowered caseworkers to question the appropriateness of medications, but did not go far enough in strengthening the rights of foster youth to refuse the drugs, said Steve McCrea, who supervises court-appointed child advocates in Multnomah County.

McCrea said California’s legislation, by contrast, would allow medicated foster youth greater opportunity to have their experiences heard by judges, caregivers and attorneys.

Former foster youth are encouraged that the reforms will give some of California’s most vulnerable kids a stronger voice in their own care.

“I know how it feels to have someone tell you something is wrong with you, to have someone sit down and tell you the only way you can be normal is to take these medications,” said DeAngelo Cortijo, 22, a former foster child and an intern with the National Center for Youth Law. “These bills will bring us a wider and more holistic perspective, so we don’t just say, ‘Let’s just control them by giving them meds.’ ”

Bass, who held public hearings on the issue a decade ago when she served in the state Assembly, said she was astounded to learn then that kids on psychotropics were often unable to stay awake, and that they could be punished in group homes for refusing to take their pills. With new laws, she said, kids suffering the effects of abuse, neglect and abandonment will receive more helpful therapies.

Bass and 15 of her congressional colleagues recently signed a letter supporting President Barack Obama’s $250 million budget proposal to fund state programs that reduce psych med use among foster youth by creating programs that more effectively treat trauma.

Bass said she will bring the reforms California is proposing to her 160-member Congressional Caucus on Foster Youth, to the Ways and Means Committee, and ultimately will consider possible federal legislation.

“My hope is that we treat youth in the foster care system the same way we would want our own children treated,” Bass said. “If our own children were facing challenges, we would address those challenges, we wouldn’t drug them. Why are we drugging children who don’t have families?””

California Senate passes sweeping reforms to curb psych medications in foster care[Contra Costa Times 6/3/15 by Karen de Sá ]

Update 2:”The state Assembly on Tuesday unanimously approved legislation to better protect California foster children from too many psychiatric drugs through greater oversight by nurses, social workers, caregivers and court professionals.

The three-bill package authored by state senators Jim Beall, D-San Jose, and Holly Mitchell, D-Los Angeles, aims to correct the often dangerous overprescribing revealed in this newspaper’s investigative series “Drugging Our Kids.”

A fourth bill in the package — introduced by state Sen. Bill Monning, D-Carmel — would have strengthened court oversight of doctors who prescribe to foster children. That bill, however, was unexpectedly pulled from the legislative package last week, after heavy lobbying from physician groups and ongoing concerns from state health officials about costs. Monning has vowed to reactivate his bill in January for consideration next year.

Assembly member David Chiu, D-San Francisco, is a co-author on the bills and called for Tuesday’s floor vote.

“Today’s actions by the Assembly to pass these bills that would provide much-needed oversight over the use of psychotropic drugs in the foster care system is a start in making sure our foster youth aren’t being unnecessarily drugged,” Chiu said in a statement. “I’m encouraged by today’s votes, and look forward to continuing the work on these issues in the days and months ahead.”

The three currently pending bills now head back to the Senate for a final concurrence vote and then are expected to be delivered to Gov. Jerry Brown. The governor has until Oct. 11 to approve or veto the bills.”

Assembly passes three bills to curb psych drugs in California foster care

[Contra Costa Times 9/8/15 by Karen de Sá ]