Nearly 25% of Calif. Foster Care Children Prescribed Psychiatric Drugs
Children in the California foster care system are prescribed psychiatric drugs at a rate that is three times higher than children nationwide, according to a recent investigation by the San Jose Mercury News.
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 Mercury News notes that the law has "done nothing" to lower such prescribing rates. According to the Mercury News, courts frequently lack details about the prescriptions and do not often question doctors' recommendations.
There currently are more than 60,000 children in California's foster care system, according to the Mercury News.
Details of Investigation
For the investigation, the Mercury News examined de-identified Medi-Cal pharmacy benefit claims data for fiscal years 2004-2005 through 2013-2014 from the state Department of Health Care Services. Medi-Cal is California's Medicaid program.
The investigation also included interviews with more than 175 individuals, including:
- Current or former foster children;
- Legal advocates; and
Children that had been shifted from Medi-Cal to a managed care plan -- accounting for 38% of foster children in 2014 -- are not reflected in the data.
The investigation found that nearly 25% of California children currently in foster care have been prescribed psychiatric drugs, including:
- Mood stabilizers; and
Such drugs often can have side effects that include lethargy, obesity and diabetes.
In addition, 12.2% of foster children in 2013 who were on one psychiatric medication were prescribed additional psychiatric drugs, compared with 10.1% in 2004.
Further, nearly 60% of foster children over the past decade who were prescribed psychiatric drugs were given an antipsychotic medication, which carries the highest risk of side effects, according to the investigation.
Meanwhile, the investigation found that Medi-Cal spent more than $226 million on psychiatric medications for foster children over the past 10 years.
Will Lightbourne -- director of the state Department of Social Services, which oversees the foster care system -- acknowledged that psychiatric drugs are overprescribed among foster children but said that the department is working to address the issue.
Lightbourne also noted that the number of children in the state's foster care system has declined over the past decade, and therefore the number of such individuals prescribed psychiatric drugs has declined -- even if the percentage has remained steady.
George Stewart, a child psychiatrist in Berkeley who treats foster children, said, "To be prescribing these medications so extensively and so, I think, thoughtlessly, with so little evidence supporting their use, it's just malpractice."
However, some stakeholders point out that foster children often have greater mental health care needs and that psychiatric drugs are the only treatment option for some individuals.
Robin Randall, medical director at the Edgewood Center for Children and Families in San Francisco, said, "It's not that doctors want to get kids on a ton of meds. They're putting out fires and not allowed the time," adding, "The system is set up in a way that everyone is adding, adding, adding and doesn't allow for a space to safely take them off" the drugs (De Sá, San Jose Mercury News, 8/24).
Meanwhile, state lawmakers on Monday called for a change after the investigation was published.
State Senate President Pro Tempore Darrell Steinberg (D-Sacramento) noted the "serious" side effects that psychiatric medications can have on foster children, adding, "This report and these numbers tell me that this money is not being well spent in many instances."
Senate Committee on Human Services Chair Jim Beall (D-San Jose) said his panel will consider legislation to address the issue when the new Legislative session begins in December (De Sá, San Jose Mercury News, 8/26).
Editorial Calls for Action
A Mercury News editorial states that "massive drugging of California's foster children is not a problem that can wait," adding, "The state needs to act now."
The editorial adds, "There are things the state can do now to at least begin to control the damage to children's minds and physical health" from the use of psychotropic drugs (San Jose Mercury News, 8/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.