Governing
In the United
States, low-income and foster-care kids are prescribed psychotropic
drugs at an alarmingly higher rate than their peers in America or
abroad. Governing recently wrote about the
problem and what states are doing to deal with it in March. But since
then, California began closing in on a package of bills that could make
the state a leader in controlling overmedication.
Earlier this month, the California state Senate unanimously passed
four bills that would strengthen the state’s monitoring system for
foster kids' prescriptions, require stronger evidence documenting the
need for medications, add more medical expertise in the area of
oversight and force group homes that overprescribe to develop plans to
change their practices. Some of those ideas aren't new, but experts say
adopting all of them together could make California a model.
"We feel pretty confident that this package of four bills is really
more comprehensive and targets so many different aspects of the problem
that other states really have not been targeting,” said Bill Grimm of
the National Center for Youth Law, the group behind the legislation.
Psychotropic drugs range from amphetamines, which are often
prescribed for ADHD, to antidepressants and antipsychotics.
Antipsychotics were originally intended for the treatment of severe
mental health illnesses but have increasingly been prescribed to
children with behavior issues since the 1990s. Numerous studies show
low-income children, particularly those in foster care, are prescribed
psychotropic drugs at rates far above privately insured kids. The Office of Inspector General has raised alarms
in numerous reports. Since 2011, federal authorities have required
states to report annually about steps they’re taking to curb
psychotropic prescriptions.
California is one of only a few states that requires a judge to
approve prescriptions for psychotropic drugs, but according to an investigative newspaper series, it still prescribed them to about a quarter of foster kids (compared to just 4.8 percent
of privately insured children), over the past decade. The bills would
revamp the court system of prior approval. The form that doctors submit
to judges, for instance, would have to show that doctors tried other
therapeutic services first. Judges would also have the power to request a
second opinion or return the form for more information, and doctors
would have to get the written consent of children 14 and older. The bill
also offers training to everyone from judges to group-home employees on
the appropriate uses of these drugs and expands data-sharing between
the Medicaid system that pays for care and the child welfare system.
The two most notable changes, though, are increased monitoring of
group homes and expanded use of nurses -- both of which are uncommon.
The newspaper series highlighted links between group homes for foster
kids and high rates of prescription medications, which children often
had to take as a condition of staying there. With better data-sharing,
state officials would flag group homes with the highest rates of
psychotropic prescribing and require them to make plans to reduce
overmedication. Nurses, meanwhile, would monitor the side effects of
antipsychotics such as serious weight gain, diabetes and neurological
disorders.
The bills haven’t encountered opposition, but they still need to pass
the California Assembly and get the signature of Gov. Jerry Brown who's
been fairly quiet on the issue even though it generated a lot of
interest after the newspaper investigation. The bills come at an
estimated cost of $5 million in the first year, with about $4 million
thereafter. To Anna Johnson, a policy analyst with the National Center
for Youth Law, Brown's reputation as a budget hawk means he's less
likely to support the bill package.
“His main legacy here has been that he’s had this balanced budget,
but for foster kids [for] whom every day feels like a rainy day, we feel
like he could do more to protect them,” she said.
When asked for his opinion on the package of bills, his press office
said Brown doesn’t typically comment on pending legislation.
Shadi Houshyar, vice president of child welfare policy at the
advocacy group First Focus, agrees that the bills would be a positive
step, but she also thinks states are generally behind on an element
that’s critical to actually replace drugs: access to services like
intensive counseling and individualized case management.
“The biggest challenge is how you increase the use of evidence-based
therapies for kids in addition to the monitoring strategies,” she said.
The way to do that, according to Houshyar, is to offer those services
through Medicaid, which allows states to leverage federal funding, and
make them accessible through child welfare departments. Some notable
examples of places that do that are Arizona -- which has a Medicaid plan
specifically for foster children -- Michigan and New Jersey.
For California, the money is there, said Grimm. Since 2004, the state
has raised $13 billion for mental health services from a ballot measure
that raised taxes on people earning more than $1 million a year. But an
independent state oversight agency found
recently that much of the spending is unaccountable and poorly
prioritized, with little sense of exactly how the money is being spent
and what it’s producing. Grimm’s group wants to ensure that money is
going to children in the foster-care system.
“There is a considerable amount of money and resources out there,”
he said. “The question is to what extent is that money being used for
children?”
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