LA Daily News: California reforms to cut use of foster care psych meds will cost millions
California will have to invest millions of dollars to better protect its 63,000 foster children from the excessive use of powerful psychiatric medications in a state where prescribing physicians, caregivers and the courts have long supported the drugging of as many as 1 in 4 foster teens.
Cost estimates for a package of bills moving swiftly through the state Senate vary, but spending could reach $8 million a year — and possibly more than $22 million — to curb the child welfare system’s heavy reliance on mind-altering medicine for behavior management. That cost is significant but not excessive in populous California, and the legislation has so far received unanimous, bipartisan support. Now, all eyes are on Gov. Jerry Brown, who will weigh the investment this fall if the bills pass both houses of the Legislature.
“When you consider the long-term harm and consequences to the kids being doped up like this, it’s really pennies — I personally believe $8 million is budget dust,” said Mike Herald, a legislative advocate with the Western Center on Law and Poverty. “But in my experience, just about anything is subject to his rejection if it’s going to cost millions of dollars.”
In an early sign of possible support, however, Brown’s $115.3 billion budget plan released Thursday included two surprises: $149,000 to improve data on prescribing to foster children and an increase of $1.5 million for social worker training that includes psychotropic medication issues.
“This is an exciting development,” said Kathryn Dresslar, who was chief of staff to former Senate President Pro Tem Darrell Steinberg and is now with the nonprofit advocacy group Children’s Partnership. “The fact that there are dollars in the budget right now that specifically mention training for psychotropic drugs and the kind of tracking that we need is good news. I think that means that the administration intends to address this problem in some way to a greater extent than they have in the past.”
Under four bills inspired by this newspaper’s ongoing investigation “Drugging Our Kids,” a mix of federal and state funds would be used to hire 38 new public health nurses; provide second medical opinions; and train social workers and caregivers to watch out for side effects and to advocate for alternatives to mind-numbing meds. Juvenile court judges could not approve prescriptions for foster children without lab tests and ongoing monitoring and unless kids 14 and older consented in writing. Social workers would be alerted about prescriptions for young children and those on multiple meds, and there would be new oversight of residential group homes, where the medications are most frequently prescribed.
Policy analysts say the four reform bills authored by Sens. Jim Beall, D-San Jose; Holly Mitchell, D-Los Angeles, and Bill Monning, D-Carmel, will save the state money, with fewer costly and unnecessary drugs billed to the public health system. California taxpayers spend more on psychotropics than on drugs of any other kind for foster children, this newspaper found, more than $226 million over a decade.
As his two bills sailed through the Human Services Committee last month, Beall touted the return on investment, saying: “I can’t wait for this to get to the appropriations committee, because this is going to save the state of California a lot of money.”
Costs still pending
The precise cost of the reforms is still in dispute. The most costly bill, authored by Mitchell, could total more than $12 million alone, according to an early analysis prepared for the Senate.
But Frank Mecca, executive director of the County Welfare Directors Association of California, said its costs are not yet final and that federal funding will be available for as much as three-fourths of the social worker training.
“The authors of all of these bills know that there’s going to be some investment to put the reforms in place on a mandatory basis,” Mecca said. “But there’s a consensus that the state needs to do more, and none of these bills are bank-breakers.”
The Judicial Council has not taken a position on the two bills that would improve court oversight. But it projects a $9.4 million annual cost for new administrative duties and additional hearings. That figure was found to be “greatly overstated,” by the National Center for Youth Law, however. And the court costs may soon be revised downward, according to the council’s government affairs office.
The $8 million to $22 million expense places the bill package well within the cost range of other foster care reforms. Dependency court attorneys are seeking $33 million to lower caseloads, and the governor’s January budget proposes $7 million in state general funds aimed at reducing reliance on residential group homes.
Leslie Heimov, executive director of the Children’s Law Center of California, which represents 33,000 children, supports the psych med bills. But she said her lawyers cannot fulfill the work they require unless the statewide average of 248 kids per attorney is significantly reduced; in at least one county, caseloads are as high as 1,000.
Judges rely on the attorneys to relay how foster kids are faring on meds and to ensure they appear in court to speak for themselves whenever possible. Under the pending bills more hearings could be needed, requiring more attorney time for interviews with clients, teachers, doctors and caregivers.
“There’s a very obvious intersection between the psych meds issue and caseloads,” Heimov said. “And without us, the court will not know what the child is experiencing.”