A settlement in a federal lawsuit against the Missouri Department of Social Services and its Children’s Division for its failure to adequately supervise the use of psychotropic medications in foster children was given preliminary approval by U.S. District Court Judge Nanette Laughrey on Monday.

The civil rights action, M.B. v. Corsi, is the first federal class-action lawsuit in the U.S. focused on the use of psychotropic medications among youth in foster care, according to St. Louis University School of Law, which filed the case through its Legal Clinics with the law firm Morgan, Lewis & Bockius, Children’s Rights and the National Center for Youth Law. The suit was filed on behalf of all minor children and youth who are or will be placed in Missouri foster care.

An estimated 13,000 children are in Missouri’s foster care system.

Filed in 2017, the suit alleged that Jennifer Tidball, acting state director for the Department of Social Services, and Tim Decker, director of the Children’s Division, unlawfully allowed children to be placed on psychotropic drugs without safeguards in place — a violation of a child’s 14th Amendment right to be free from harm while in state custody.

One of the children, referred to by her initials in the lawsuit, was a 12-year-old from Columbia. In her last three years in foster care, the girl was prescribed “multiple psychotropic medications, as many as five at a time,” while neither her caregivers nor her physicians were provided with her up-to-date medical records, according to previous Missourian reporting. “As a result, she has been harmed and put at further risk of harm,” the suit alleged.

The widespread use of psychotropic drugs

Most psychotropic medications have not been approved by the FDA to treat mental health disorders in children as they can affect cognition, emotions and behavior and can create a number of risks for the children taking them. For example, children given psychotropic drugs are three times more likely to be diagnosed with Type 2 diabetes than children who are not medicated, and children who were given an antipsychotic drug were 50% more likely to have diabetes than non-medicated children, according to the lawsuit.

But children prescribed too many psychotropic medications, or at dosages too high, or children who are prescribed when they are too young, are at even greater risk because, “they are often living with caretakers who do not have detailed knowledge of their trauma background, mental health needs, or medical history,” the lawsuit alleged.

The agreement calls for overhauling state practices in the use of psychotropic medications in foster care through various reforms, including:

  • Closer monitoring of children’s medical records and medication use, with a new requirement for follow-up appointments at three-month intervals for children taking a psychotropic drug.
  • Establishing informed consent policies that require prescribers and adults with input from children to weigh the risks and benefits of a medication before prescribing it.
  • Requiring a secondary review by a child psychiatrist of a recommended psychotropic medication prescription.
  • Training all foster care case managers and resource provider staff on appropriate use and potential side effects of psychotropic medications on children.

The settlement is open for public comment. The court set a deadline of Nov. 6 for any written responses by people who are part of the class, their legal representatives or “other interested parties.”

Supervising editor is Katherine Reed.

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