The Texas House on Wednesday unanimously approved legislation that would require regular medical checkups for foster children who are prescribed psychotropic drugs.

House Bill 838 “addresses the need to have our children that are receiving psychotropic drugs be seen by their prescribing physicians in person every 90 days,” said Rep. John Zerwas, R-Simonton, the author of the bill.

Supporters say the bill will ensure that children being overmedicated or experiencing negative side effects from the drugs do not go unnoticed by trained medical professionals.

The bill now moves to the Senate. 

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Texas has instituted massive reforms to prevent the overmedication of foster children. It has been a hot-button issue in the state since 2004, when a report titled “Forgotten Children” by then-Comptroller Carole Keeton Strayhorn detailed the overuse of psychotropic medication by foster children in Texas. 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 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 which, if triggered, alert the state to check on the child.

Though the changes have improved the state’s health care system for foster children, child welfare advocates say, the rate of foster kids prescribed psychotropic drugs remains high, and accountability gaps regarding prescriptions of the psychiatric medicines persist.

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.

While HB 838 was in committee, some witnesses testified that additional language should be added to allow psychiatrists to evaluate children via telemedicine — or videoconferencing with the patient — to relieve the burden of the requirement on families and foster children in rural areas. The language wasn’t added.

The state is also in the midst of redesigning the foster care program to help children stay with siblings and be near their home community, which child welfare advocates and the state hope will alleviate some of the additional trauma experienced by foster children when they are removed from their homes and families.

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