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:
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instances of inadequate clinical assessment;
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minimal mental health training and experience
among primary care physicians who prescribe
these medications; |
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the absence of psychosocial interventions
that ought to be provided in combination with
medication; |
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the infrequent involvement in medication
management of child and adolescent psychiatrists;
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inadequate monitoring of medication
effectiveness and side effects; and
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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.
