How Texas kicked a drug problem

Posted Tuesday, Sep. 02, 2014  comments  Print Reprints

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Psychotropic medications — like antipsychotics, stimulants, mood stabilizers, antidepressants and sedatives — were being over-prescribed in the state’s foster care system, endangering the lives of some of our most vulnerable citizens and costing the state millions.

But this is a success story. In recent years, Texas has dramatically reduced the use of psychotropic drugs in foster care.

The problem burst onto the scene in 2004 when then-Comptroller Carole Keeton Strayhorn released “Forgotten Children,” a report that found too many foster children on too much medication.

Advocates from across the state took up the call for reform. The Legislature in 2005 passed Senate Bill 6 by state Sen. Jane Nelson, R-Flower Mound, which required a study of the use of psychotropic medication in foster care, strengthened medical consent requirements and most notably, required the development of a new medical system that for the first time would give the state the ability to track and oversee each foster child’s diagnoses and prescriptions.

The Texas Health and Human Services Commission, the Department of State Health Services and the Department of Family and Protective Services also worked with doctors, psychologists and pharmacists to develop guidelines for psychotropic medication use.

Keeping the guidelines up-to-date and overseeing implementation is the responsibility of a workgroup that includes representatives from the state’s health agencies, the University of Texas College of Pharmacy and STAR Health.

The Legislature funded a medical director at the Department of Family and Protective Services specifically to address psychotropic medication overuse.

Former state Rep. Mark Strama, D-Austin, pushed for provisions in House Bill 915, which was approved in 2013, that added additional protections, including more oversight by the courts; additional training for adults authorized to consent to medical care for foster children; and, in a provision authored by Rep. John Zerwas, R-Richmond, required a doctor’s office visit every 90 days for children on psychotropic medication.

The Texas Supreme Court Children’s Commission convened a large working group to ensure the effective implementation of the legislation.

As a result, since 2004, according to state data, Texas has cut the number of foster children on psychotropic medication for 60 days or more by 36 percent (to less than 20 percent), the number of children on two or more psychotropic drugs by 71 percent (to less than 1.5 percent) and the number on five or more such drugs by 73 percent (to less than 0.5 percent).

Whether we can reduce use even more by improving alternative treatments and strengthening foster care is the challenge ahead.

This bipartisan, cooperative model should serve as a guide in addressing other pressing policy problems.

F. Scott McCown is a clinical professor and director of the Children’s Rights Clinic at The University of Texas School of Law.

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