Rhode Island is the most recent state to institute significant policies to reduce excessive prescription of psychotropic medications for foster children. The state’s Department of Children, Youth, and Families, headed by Dr. Janice DeFrances, has not yet posted the new policies, but they can be accessed here.
The new regulations direct local child welfare administrators to obtain concurrence from its psychiatric consultant, Elizabeth A. Lowenhaupt, MD, before signing consent forms for psychotropic medication prescriptions. Dr. Lowenhaupt explained to the Providence Journal, “There are too many kids on meds and too many kids on multiple meds . . . . It’s really about making sure we have services that are alternatives to the meds.”
Rhode Island is not the only state to institute such protections. Illinois has a similar system. Other states may require a “second opinion” psychiatric consultation, but the number of such states is difficult to determine because no agency has compiled nationwide data.
Rhode Island’s new regulations respond to some troubling data. As of late 2013, the state was medicating 22 percent of children in state care . (Providence Journal, 6/4/14.) More concerning still, Rhode Island authorities were treating 54 percent of medicated children with multiple psychotropic drugs. Some were given three, four, and even as many as six drugs simultaneously, a pattern that has been reported in other states as well.
Rhode Island has made a much needed move on two fronts.
(1) The state has adopted regulations likely to reduce the number of foster children subjected to risky and medically dubious control by psychotropic medication.
(2) The state has released data on the number of foster children administered one, two, three, or more psychotropic medications simultaneously. Statistical data such as this is essential to the formulation of policy and the evaluation of its effectiveness.
Other states should follow the lead of Rhode Island and other jurisdictions that have medication review policies. They also should be looking closely at the high long-term costs of overprescribing psychotropic medications to foster children and at the greater efficacy and lower long-term cost of trauma-informed systems of care.