Guidelines Address Psychiatric Rx Use in Calif. Foster Care System

On Friday, the California departments of Health Care Services and Social Services released guidelines for physicians who prescribe psychiatric medications to children in the state's foster care system, the San Jose Mercury News reports (de Sá, San Jose Mercury News, 4/10).

Background

Last year, a Mercury News investigation found that children in the California foster care system are prescribed psychiatric drugs at a rate three times higher than the national average.

Specifically, the investigation found that nearly 25% of California children in foster care have been prescribed psychiatric drugs, including:

• Antipsychotics;
• Antidepressants;
• Mood stabilizers; and
• Stimulants.

In 1999, state lawmakers passed legislation requiring juvenile courts to approve psychiatric drug prescriptions for foster youth and review the decisions every 180 days.

However, the investigation found that the law has "done nothing" to lower such prescribing rates (California Healthline, 2/2).

Details of Guidelines

The guidelines were developed by a group of health care officials, lawyers, public policy leaders and other advocates that formed in 2012 as part a state-sponsored "Quality Improvement Project" regarding the care of kids in the foster care system.

The guidelines urge physicians to:

• Give preference to FDA-approved drugs for children;
• Keep drug dosages at a minimum;
• Make available non-drug therapies; and
• Occasionally, wean children off of psychiatric medication entirely.

In addition, the guidelines discourage doctors from prescribing more than one drug at a time.

The guidelines also state that "[p]sychotropic medications should not be used for the purpose of discipline or chemical restraint, except as acutely necessary in true psychiatric emergencies."

Comments

According to the Mercury News, advocates applauded the guidelines but said work still needs to be done to ensure that reforms are enforced.

Linette Scott, DHCS chief medical information officer, said, "The guidelines aren't going to solve all the problems," but "they set expectations and create a common language" for those who treat children in the foster care system.

Meanwhile, other experts have said that the next step is for the state to develop a method for holding physicians accountable (San Jose Mercury News, 4/10).