In 2015, Children’s Defense Fund founder Marian Wright Edelman, JD, drew attention to the problems with prescribing psychotropic medications to foster children. She noted that serious deficits persisted regarding inadequate informed consent and insufficient oversight and that there was a dearth of education and availability of nonpharmacological treatments to address the mental health needs of children in foster care. This plight was further exposed in the 2017 filing of the first class action lawsuit to focus on the overprescription and overreliance on psychotropics with at-risk children in state custody, M.B. v. Tidball. This Missouri case addressed long-term and dangerous mismanagement of these medications. It also highlighted failures in medication administration, inaccurate medical record-keeping for the children, a lack of timely reviews, and few cases of meaningful informed consent for these prescriptions.
M.B. was one of the named plaintiffs in the class action lawsuit. He had been prescribed more than six psychotropic medications when he was a patient at a psychiatric facility, but his newly appointed foster parent received no information about his medications when she picked him up from the facility. She was handed a bag of medications with no directions and no opportunity to ask questions. The complaint also alleged that the foster parents were not provided with any information on these children’s trauma backgrounds, mental health needs, or medical histories, and that such information was also rarely passed on to the children’s subsequent physicians. Moreover, the plaintiffs detailed the children’s division of state social services directors’ knowledge of, but lack of attention to, these failures over several years.
In December 2019, the parties crafted a settlement agreement outlining the procedures to be put in place to improve care. These included improving case management, implementing staff training on procedures for psychotropic medication use and monitoring, creating a statewide system for medical records of foster care children, and following strict informed consent and assent requirements.
So, what can psychologists do to address similar issues in their states? Education on the potential harms and benefits of psychotropic medications is key, particularly for foster children, who often have been exposed to complex trauma. The effects of overmedicating children can be mentally and physically devastating. The Tidball case illustrated the potential risks for using psychotropics on children, including psychosis, seizures, suicidal thoughts, and organ damage. Psychologists can help by monitoring compliance, side effects, and behavioral changes. They can talk with patients in foster care about their medications to ensure that they understand the rationale for their use and determine whether the patient received meaningful informed consent. Developing relationships with prescribing clinicians also allows psychologists to advocate for their patients’ needs. The APA Ethics Code offers relevant guidance: “Special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making.” They “consult with, refer to, or cooperate with other professionals and institutions to serve the best interests of those with whom they work.”
Psychologists who observe agency mismanagement and harm to foster children should consider connecting with attorneys to pursue legal action and offering their expertise to remedy such injustice.
“Judicial Notebook” is a project of APA Div. 9 (Society for the Psychological Study of Social Issues).
