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, severe depression, or psychosis. Other children need to use psychotropic medications temporarily 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 has been the subject of a heated national debate. Psychiatric medication may be life-saving and relieve disabling and sometimes deadly symptoms of mental health disorders. Children and youth in foster care may benefit from medication to ameliorate 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 little yet is known about the effects of long-term use in children.

In 2013, the 83^rd Texas Legislature amended Tex. Fam. Code § 266.001 to add a definition of a psychotropic medication. 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 79^th Texas Legislature enacted Senate Bill 6. This sweeping legislation proposed reforms for DFPS, including a plan to place all foster children 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, 6^th Edition (Parameters).[125] The Parameters serve as a resource for physicians and clinicians who care for children diagnosed with mental health disorders. Additionally, DFPS's newly formed Behavioral Health Division is fully staffed and includes a Behavioral Health Services Division Administrator who manages Substance Use Disorder, CANS, Trauma-Informed Care, and Mental Health subject matter experts. You can read more about this division under the “Substance Use Disorders” chapter.

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.