Introduction

Psychotropic medications are substances that affect the mind and alter mental processes such as perception, mood, and behavior. Psychotropic drugs include stimulants, antidepressants, antipsychotics, and mood stabilizers. Some children need to use psychotropic medications long-term to treat mental health disorders that they inherited or developed, such as attention deficit hyperactivity disorder, major depressive disorder, or psychosis. Other children need to use psychotropic medications on a more temporary basis to help relieve severe emotional stress and help them function in school, at home, and in the community.

The use of psychotropic medication in children in foster care can be a controversial issue. Psychiatric medication may be life-saving and relieve challenging and sometimes severe symptoms of mental health disorders. Children and youth in foster care may benefit from medication to address mental illness exacerbated by the effects of trauma brought on from exposure to abuse or neglect. However, studies have shown that psychotropic medications can have serious side effects on adults using them, and relatively little research has been conducted to understand the effects of long-term use in children and adolescents. Many psychotropic medications do not have Food and Drug Administration (FDA) approved labeling for use in children.[109] Therefore, it is imperative that a comprehensive evaluation be performed before beginning treatment with psychotropic medication for a mental, emotional, or behavioral disorder. Except in the case of an emergency, a child should receive a thorough health history, biopsychosocial assessment, mental status exam, and physical exam before being prescribed a psychotropic medication.[110]

Under Tex. Fam. Code § 266.001, a “psychotropic medication” means a medication that is prescribed for the treatment of symptoms or psychosis or another mental, emotional, or behavioral disorder and that is used to exercise an effect on the central nervous system to influence or modify behavior, cognition, or affective state. The term includes the following categories when used as described by Tex. Fam. Code § 266.001(7):

•   Psychomotor stimulants;

•   Antidepressants;

•   Antipsychotics or neuroleptics;

•   Agents for control of mania or depression;

•   Anti-anxiety agents; and

•   Sedatives, hypnotics, or other sleep-promoting medications. Tex. Fam. Code § 266.001(7).

Texas led the nation in creating oversight protocols in 2005 when the 79th Texas Legislature enacted Senate Bill 6. This sweeping legislation proposed reforms for DFPS, including a plan to place all children and youth in foster care under a single comprehensive managed care system. Texas was the first state to develop a "best practices" guide for oversight of psychotropic medications for children in foster care. Released in 2005 and most recently updated in June 2019, DFPS, the Department of State Health Services (DSHS), and the Health and Human Services Commission (HHSC) developed the Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version) (Parameters).[111] The Parameters are updated periodically and serve as a resource for physicians and clinicians who care for children diagnosed with mental health disorders.

Additionally, DFPS' Behavioral Health Services Division includes a Behavioral Health Services Division Administrator, a Trauma-Informed Care Manager, six regional Trauma-Informed Care Program Specialist positions, a Behavioral Health Program Specialist Lead position, three Substance Use Program Specialists, two Child and Adolescent Needs and Strengths (CANS) Program Specialists, and a Mental Health Program Specialist. Please also see more about this division under the Bench Book chapter entitled Substance Use Disorders.

The Texas Legislature also enacted Tex. Fam. Code Chapter 266 which governs medical care and education services for children in foster care primarily through three processes:

•   Medical Consenter;

•   Agency Oversight; and

•   Judicial Review.