California Auditor Blasts Oversight of Psychotropic Medications for Foster Youth

A report from California’s state auditor found that children in the state’s foster care system were prescribed psychotropic medications without proper oversight from the counties responsible for their care.

In response to a request from the California Joint Legislative Audit Committee about the use and oversight of these powerful medications, the office of the California State Auditor reviewed 80 case files for 80 foster children in Los Angeles, Madera, Riverside, and Sonoma Counties and analyzed existing statewide data.

Nearly 12 percent of California foster children were prescribed psychotropic medications during the fiscal year 2014-15, according to an analysis of state data by the state auditor’s office. By comparison, studies suggest that around 4 to 10 percent of children who are not in the child-welfare system are prescribed those medications.

The report, “California’s Foster Care System: The State and Counties Have Failed to Adequately Oversee the Prescription of Psychotropic Medications to Children in Foster Care,” includes an analysis of the practices surrounding the prescription of medications and a series of recommendations for the state legislature, the California Department of Social Services and counties.

In looking at the case files, the auditor’s office found that many foster youth were prescribed psychotropic medications in amounts that were above the state’s guidelines for recommended dosage. Counties failed to oversee the doctors who prescribed the medications, and many of the counties also neglected to obtain required court or parental approval before allowing doctors to provide foster children with prescriptions for psychotropic medications.

The report describes that many children did not receive follow-up visits from the doctors after they began taking medication. One-third of the foster youth who were part of the cases reviewed by the state auditor’s office did not receive an appointment with their prescribing doctor or other healthcare provider within 30 days after taking new psychotropic medication. The report also found that many prescribing doctors did not regularly use psychosocial services that are sometimes used along with prescriptions for psychotropic medications or as alternatives to medication.

The auditor’s report also faulted the fragmented nature of the state’s child-welfare system as a reason why oversight of psychotropic medications has proved difficult. Several different entities at the state level share oversight of the prescription of psychotropic medications to foster youth, and despite some collaboration, the state lacks a comprehensive plan to address the issue.

The state auditor’s office also found substantial data gaps around psychotropic medication from the two agencies that oversee the mental health of foster children in California, the Department of Social Services (DPSS) and the Department of Health Care Services. As a result, in all of the 80 cases reviewed by the state auditor’s office, information about the start and extent of psychotropic medication prescriptions in the children’s Health and Education Passports was incorrect. The passports are designed to provide important information to caretakers, health care providers, social workers and others, and are especially important to decision-making when children change placements.

Some of the report’s recommendations include the following:

  • The state legislature should require DPSS to collaborate with counties and other stakeholders to develop a system of oversight.
  • California counties should more closely examine requests for psychotropic medications for foster youth that go beyond the state guidelines in terms of dosage and multiple prescriptions.
  • Counties should do a better job of updating court documents and case files around authorization of psychotropic medications and follow up with prescribing doctors to make sure the new prescription requests are all medically necessary.
  • All foster children should be mandated to have a follow-up within 30-days of starting a new psychotropic medication.
  • Counties should make sure that California foster children have access to mental health and related support services before and while they are taking psychotropic medication.

Legislation to increase court oversight of the prescribing of psychotropic medications for foster youth in the state reached the governor’s desk yesterday.

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