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Victory for Kids in Missouri, Wake-Up Call for the Nation

Life is cruel for so many reasons for too many children in Missouri’s child welfare system. Now, a ground-breaking court settlement approved late last year means more than 13,000 children will be safer in the future.

The settlement resolves a case brought in 2017 by Children’s Rights, the National Center for Youth Law, Saint Louis University School of Law Legal Clinics, and the law firm of Morgan, Lewis & Bockius. Our goal was to stop the misuse of psychotropic drugs administered to children in foster care without clear necessity or oversight.

Their stories are heartbreaking: children put on daily doses of multiple drugs that cause confusion, hallucinations, dramatic weight gain, myriad health problems – and do nothing to address the underlying mental health disorders children suffer from because of trauma and abuse.

Children’s Rights and our partners identified numerous failures on the part of the state, including not keeping adequate medical histories for the children, or not having a mechanism to review extreme cases, such as when a child is prescribed as many as seven psychotropic medications at one time.

We knew there was a better way to provide care for these kids. Our agreement sets in motion a process for overhauling the state’s practices and protecting 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; and an independent child psychiatrist will be available to provide secondary review of prescriptions for efficacy and safety.

As the first federal class-action lawsuit in the country to focus singularly on the dangerous use of psychotropic medications among youth in foster care, the case will not only benefit children in Missouri, it also sets the stage for tackling what is a nationwide problem in the foster care system.

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 frequently leads to the prescription of psychotropic medications.

Anti-psychotics, one of the most powerful classes of psychotropic drugs, are often administered to children in foster care to treat a diagnosis, such as ADHD, that the drug was never designed to address. These medications can sometimes lead to other profound and even permanent adverse effects including psychosis, seizures, irreversible movement disorders, suicidal thoughts, aggression, weight gain, organ damage, and other life-threatening conditions.

The grave harms and risks to foster children flowing from the administration of 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. This puts children at a heightened risk of serious physical and psychological harm because of the lack of an adequate oversight system to ensure that psychotropic drugs are administered safely and only when necessary.

The settlement in Missouri will establish better practices there that prioritize the health and well-being of its most vulnerable children. But experts also hope that it marks the dawn of a national wake up call for states across the country.

John Ammann, the McDonnell Professor of Justice in American Society at Saint Louis University School of Law, said he believes the settlement will serve as a “model road map for social service agencies and advocates in other states.”

“This is a problem in many states. Kids in foster care face so many challenges. And what happened is with the growth of psychotropic medications prescribed for all sorts of mental health issues, we have fallen into a system where it is easier to give a child a pill than to be patient and engage in therapies.”