Sonoma County foster children given too many psychotropic drugs, report finds

A state review of four counties, including Sonoma County, found that local foster youth are given too many mood-altering drugs, echoing longtime critics.|

Sonoma County does not adequately monitor the use of psychotropic drugs among local foster youth, raising the possibility the county may be inappropriately medicating children or over-prescribing the mind-altering medications, according to a report released Tuesday by the California Auditor’s Office.

County officials, however, strongly questioned some of the findings and insisted state auditors reviewed only limited documentation of the care foster youth received. The state did not review such documents as patient medical records and foster placement records, officials said.

Sonoma County was among four counties selected for review in the report, but the findings were indicative of statewide trends, the report said. The others were Los Angeles, Madera and Riverside.

Among the many findings, the audit found Sonoma County often failed to show that it properly tracked cases where foster kids were prescribed multiple psychotropic drugs from the same class, which the state discourages; failed to show it was reviewing cases where drug dosages exceeded state guidelines; and did not show that youth were receiving adequate follow-up visits after being prescribed new psychotropic medications.

The audit, which reviewed 20 specific foster youth cases from each of the four counties, also found that some local foster youth were being prescribed psychotropic drugs without court authorization or parental consent, as required by law.

“This system is broken and too many people have known about this broken system for far too long,” said state Sen. Mike McGuire, D-Healdsburg. “For me, it’s not just any one county. The problem exists across the state, in every corner of California.”

McGuire, who along with the Senate Human Services Committee requested the audit more than a year ago, has been critical of the state foster care system, saying it over-prescribes psychotropic medications.

The state and counties, McGuire said, must immediately respond to the report with corrective actions because “the lives of foster kids depend on it.”

Michael Kennedy, Sonoma County mental health director, and Nick Honey, Sonoma County’s director of Family, Youth and Children’s Services, both agreed better monitoring and documentation of psychotropic drugs in the local foster care system was needed. They welcomed many of the recommendations made in the audit, such as ensuring that prescribing physicians follow up within 30-days of prescribing foster kids new medications.

But they rejected the suggestion that the county was not providing adequate care to its foster youth, or that it was negligent in its use of psychotropic drugs.

“I don’t think there’s evidence that foster kids are being over-medicated,” said Kennedy. “The majority of the psychiatrists that are prescribing are doing it in a responsible way and compassionate way.”

Many children in the foster care system suffer from emotional and behavioral issues and often have greater need for mental health care than children in the general population. But foster youth advocates have raised concerns about the higher-than-usual prescription rates for foster kids.

State guidelines recommend that foster children should take no more than one psychotropic drug from each medication class, which include antipsychotics, antidepressants, mood stabilizers, stimulants and anti-anxiety drugs.

The report found that 12 percent of the state’s more than 79,000 foster youth were prescribed psychotropic medications during the 2014-2015 fiscal year.

According to the report, almost 23 percent of Sonoma County’s 661 foster kids were prescribed psychotropics during that time period. That share is slightly less than 23.6 percent in two years prior.

Honey said that even two years before the state launched its audit, the county had already identified psychotropic medication rates as an issue of concern. The topic was addressed in the county’s 2014-2019 System Improvement Plan.

“We’re not doing this because of the state audit,” Honey said. “We’re doing this because our data showed that there was something we need to pay attention to.”

Officials said systemwide changes have been made since then, including the use of a “second-opinion” psychiatrist to review the court document that must be signed by a judge to approve the use of psychotropic medications for foster youth. Kennedy said he wants to extend the second opinion review to cases where parents give consent for the use of psychotropic medications.

Kennedy said some changes will require guidance from the state Department of Social Services and the state Department of Health Care Services, as well as more funding.

The report found that a “fragmented oversight structure” has led to numerous problems in monitoring the use of psychotropic drugs among foster kids. For example, many of the children’s “health and education passports” - which follow kids as they go through the foster system - contained errors and omissions.

The county is considering hiring more public health nurses to beef up health and education passports.

“The important point is that we agree with the recommendations from the auditor,” said Honey. “There’s work to do. Our focus is the health and well-being of foster children.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com.? On Twitter @renofish.

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