Mental Health Advocacy
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To request authorization to prescribe a specific medication, the physician, usually a family practice doctor completes a county form and submits it to the Court. It is then forwarded to the child’s county social worker, who completes the State of California JV-220 form (“Application and Order for Authorization to Administer Psychotropic Medication”) and submits it to the Court. The Court must then judge the merits of the request – a particularly difficult position given the judge’s lack of clinical training. Attorneys who represent children and parents are also handicapped by the lack of clinical and medical expertise. The situation is made more difficult by the fact that most psychotropic medications used in children are not FDA-approved as safe and effective in this age group. Rather, their use is based on research and the combined clinical experience of the psychiatric profession, and these criteria are not readily accessible to non-clinicians. The court has the authority to make orders regarding psychotropic medications if the child is adjudged a dependent and has been removed from his or her parents.

Disproportional use of Psychotropic Medication Among Foster Youth

Research has shown that foster children are far more likely than other children to experience mental health disorders. A study conducted in 2002, by the University of California Berkeley, states “Because of family disadvantage and parental abuse and neglect, mental health problems occur relatively frequently among children in child-welfare. Results from one study employing a widely used measure of dysfunctional behavior, the Child Behavior Checklist (CBCL), indicated that youth in foster care had scores in the clinical or borderline range at two and three times the rate found in the general population.”

According the Sacramento County Department of Mental Health, between the periods of August 2004-2005, there has been 740 initial requests for the administration of psychotropic medications and 1210 reauthorization for continuous administration of existing prescriptions for children in the dependency system for Sacramento County. It is believed that these numbers are as bad, if not worse, on a statewide basis.

As a participant and observer of health planning for children in the foster care system, SCA has developed an extreme concern regarding the prescribing of psychotropic medication to foster care children. Specifically, we are concerned about the following issues:

	instances of inadequate clinical assessment;
	minimal mental health training and experience among primary care physicians who prescribe these medications;
	the absence of psychosocial interventions that ought to be provided in combination with medication;
	the infrequent involvement in medication management of child and adolescent psychiatrists;
	inadequate monitoring of medication effectiveness and side effects; and
	the failure to regularly, collaboratively, and systematically review the child’s response to treatment.

It is important to SCA that children and youth with psychiatric illnesses receive effective treatment. In some instances, this will include the use of psychotropic medications. It is just as important that all interventions, especially the use of medication, be done safely and with expertise.

Mental Health Services

The State Board of Control Victims of Crime Program (VOC) assists our child victims by paying for counseling services on approved claims. In March of 1993, the court authorized SCA to apply for VOC funds for all our child clients who might be eligible for the Program.

Since 1994, SCA has filed VOC claims. SCA clients received hours of counseling to assist them to overcome the trauma of their victimization through these funds.