This year, we are truly honored to be recognized by the Impact Fund at their 2020 Gala: Truth to Power. For nearly 30 years this remarkable organization has made it possible for civil rights advocates to get to the very root of injustice and create transformative social change.
In the case of our litigation in Missouri, The Impact Fund’s early support was pivotal to a groundbreaking victory in the first federal class-action lawsuit in the country to focus singularly on the widespread and often dangerous use of psychotropic medications among youth in foster care.
The case was brought in 2017 on behalf of approximately 13,000 children in the foster care system in Missouri by Children’s Rights and our amazing co-counsel the National Center for Youth Law, the St. Louis University School of Law, and Morgan, Lewis & Bockius.
The suit alleged a longstanding failure by the state to provide adequate oversight in the administration of powerful psychotropic medications to children in government care. At the time we filed suit, 30% of children in foster care were taking one or more psychotropic medications—more than quadruple the percent of children on Medicaid. Of these children, 20% were subjected to an outlier prescription, which means they were prescribed too many or too much psychotropic medication, or at too young an age. Some children in foster care were prescribed as many as seven psychotropic medications at one time.
Named plaintiffs in our case ranged in age from 2-14. These included a 14-year-old who had been administered more than six psychotropic drugs in three years while moving to new placements eight times. A 12-year-old who required psychiatric hospitalization when given the wrong dosage of her medications after being moved from one home to another without written medical instructions for the new caretaker. And two siblings three and two years of age who were put on an antipsychotic not approved for any reason for patients under the age of five.
For children in foster care, psychotropic medications, especially antipsychotics, are often used as chemical straitjackets to control behavior — and not to treat the limited illnesses for which the FDA has approved their use in children. Although children in foster care are often administered these drugs for months or years, there is little to no research demonstrating their impact on the developing brains of children or adolescents.
The consequences can be serious. The incidence of type 2 diabetes for children given these drugs is three times as high as for children not medicated. They can cause other profound and even permanent adverse effects including psychosis, seizures, suicidal thoughts, aggression, weight gain, and organ damage.
The grave harms flowing from psychotropic medications are exacerbated because these children often live with caretakers who do not have detailed knowledge of their trauma background, mental health needs, or medical history. And because many states do not maintain centralized or complete medical records for kids in foster care, foster parents and physicians find themselves attempting to care for a foster child while in the dark about the child’s history, past treatments, and responses to treatment. This puts children at a heightened risk because of the lack of an adequate oversight system to ensure that psychotropic drugs are administered safely and only when necessary.
At the final hearing, we heard testimony from a foster mom, a grandfather, and a birth mother all speaking with great emotion about the harm done to children they love. But the words that I found most sobering were those of a young woman who had spent her teen years in the Missouri foster care system. She was put on daily doses of multiple drugs that caused confusion, hallucinations and myriad health problems. She gained nearly 100 pounds in the course of a few months. She felt betrayed by the very system charged with keeping her safe.
Last December, a US District Court Judge gave final approval to a settlement to make sure what happened to this young woman will happen no more. Missouri is now implementing comprehensive reforms to protect children. Medical records will be monitored; doctors and caregivers, with real input from youth, will vet the risks and the benefits of medication before it is administered; an independent child psychiatrist will provide secondary review of prescriptions for efficacy and safety; and caseworkers will be trained on the appropriate use of these medications.
Our settlement will establish better practices that prioritize the health and well-being of the state’s most vulnerable children. But Missouri is far from the only state where the administration of psychotropic medications is a problem. On any given day, there are more than 440,000 children in U.S. foster care. All are victims of trauma—through abuse, neglect, and the experience of removal from their homes. Nearly all enter state custody with significant mental health needs, which too frequently leads to the prescription of psychotropic medications.
The Missouri settlement is so strong that we believe it represents a wake-up call for other states and sets the stage for similar wins nationwide. Right now, Children’s Rights and our partner advocates are investigating potential cases in several other states where children in foster care are indiscriminately subjected to psychotropic medications.
If the moral test of a society is how it treats its children, we have a long way to go. But the Missouri case sets an example for other states that reform is possible.
The Impact Fund is well-named.
They have had an enormous impact on our work, and their faith in this case will have a long tail. By raising the bar for further accountability in foster care systems nationwide, The Impact Fund is helping to keep children healthy and safe.
On behalf of everyone at Children’s Rights. Thank you.