Senate Backs Bill on Psychotropic Drugs for Foster Children

Updated, May 15:

Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children.

The Senate on Wednesday approved a version of the “informed consent” measure that is slightly different than the one approved by the House in April. The two chambers will conference on a final agreement before the bill is sent to the governor.

The Senate version removes a requirement that the guardian submit a form to the state health department as evidence that informed consent was given. It also allows nurses or physician assistants to perform required follow-up medical examinations.

“The committee substitute to House Bill 915 increases accountability and awareness for those making medical decisions on the behalf of foster children,” said Sen. Jane Nelson, R-Flower Mound, the sponsor of the bill. “This legislation ensures that medicating children is not the first option, or the only option considered.”

HB 915 would require that before a foster child is prescribed psychotropic drugs, the child’s guardian receive written or verbal information from a medical provider on the child’s mental health condition, the expected benefits and potential negative effects of using psychotropic medications, and information on other alternatives for helping the child.

The bill requires follow-up medical visits at least every 90 days — either in person or via telemedicine — to monitor the effects of the medications on the child. It also sets up a process to educate children 16 and older who have received permission from a court to consent to their own medical care, and it helps older children transitioning out of the foster system to continue treatments.

Original story, April 18:

The Texas House approved legislation Thursday on a voice vote that would require the guardians of foster children to give informed consent before a foster child could be put on psychotropic drugs.  

"The testimony by children coming out of foster care was tremendously moving. This is a very bipartisan approach to how we treat children in foster care," said state Rep. Lois Kolkhorst, R-Brenham, the author of House Bill 915. "The first response shouldn't be to just put them on meds."

The House is scheduled to give the measure final approval on Friday, then the bill will move to the Senate.

HB 915 would require that before a foster child could be put on psychotropic medications, his or her guardian must receive written or verbal information from a medical provider on the child’s mental health condition, the expected benefits and potential negative effects of psychotropic medications used to treat that condition, and other alternatives for helping the child. It also includes a provision requiring follow-up medical visits within every 90 days to monitor the effects of the medications on the child, and it sets up a process to educate children 16 and older who have received permission from a court to consent to their own medical care.

The overmedication of foster children with psychotropic drugs has been a hot-button issue in the state since 2004, when then-Comptroller Carole Keeton Strayhorn released the report “Forgotten Children.” One foster child described in the report was prescribed 11 medications in one month, including two antidepressants and two stimulants to treat ADHD, at a cost of $1,088 to the state’s Medicaid program.

The state has since reformed the system by placing all foster children in a single Medicaid managed care organization, STAR Health, which set up a “health passport” system to track the children’s medical histories. A variety of parameters are documented in the STAR Health medical passports to monitor foster children’s use of psychotropic medications. If triggered, they alert the state to check on the child.

This Tribune interactive shows the rates of foster children prescribed psychotropic drugs by age, and the number of foster children prescribed multiple types of psychotropic drugs simultaneously.

Andrea Sparks, director of public affairs for Texas CASA, a statewide association of more than 7,200 volunteers who advocate on behalf of foster children, said the state has made progress — “we don’t see as many kids on seven, eight medications” — but she added, “These medications are still used as a quick fix to control children’s behavior.”

If a foster child is hoarding food or running away, Sparks said that child’s guardian should be looking at ways to address the underlying trauma causing those behaviors. Although guardians are already required to consent to the prescription of psychotropic medications, the legislation would define what that consent actually means. And proponents say the legislation would ensure that guardians are educated on the child’s treatment plan and would hold guardians, medical providers and judicial courts more responsible for monitoring the child’s overall well-being.

“We need to make sure that before these children are put on these meds that those questions are asked, because there are consequences,” Sparks said.

As an example, she told the story of Jessica, a freshman at the University of Texas who entered the foster system for a second time when she was 15. After being incorrectly diagnosed as bipolar, Jessica was put on medications that made her fall asleep in her AP classes, and she began having issues in school resulting from the medication.

When HB 915 was in committee, some medical professionals expressed concern that the legislation would create an administrative burden on the already limited network of mental health providers. Kolkhorst said she worked with medical groups to improve the bill and address such concerns.  

Sparks added that the provision to educate older children on the impact of psychotropic drugs on their treatment plans is especially important, as many foster children are resentful of the medication and stop taking it when they age out of the system.

“That is so dangerous and then they have horrible withdrawal systems … or they turn to illegal drugs to self-medicate,” Sparks said. “We want to empower these children to speak up.”

Chris Hooks contributed reporting to this story.