An estimated 30% of Missouri youth in foster care or group homes are on psychotropic drugs of some sort — nearly twice the national average for kids that age. Many are on multiple drugs. And powerful anti-psychotic drugs have been used to treat conditions like ADHD and conduct disorders, even though the Federal Drug Administration hasn’t approved them for that use.
Two years ago, a class action lawsuit aimed to change the way Missouri foster kids are medicated. Filed by the St. Louis University School of Law Legal Clinics in conjunction with nonprofit children’s advocacy groups and the Morgan, Lewis & Bockius law firm, the suit charged that anti-psychotic medications were being overprescribed, wrongly used and badly monitored.
On Thursday’s St. Louis on the Air, John Amman, who ran the St. Louis University Legal Clinics until his recent retirement, explained some of the troubling facts that led to the lawsuit — and outlined how the settlement agreement hopes to fix them.
Amman was joined by former court-appointed special advocate Kris Dadant, who was one of the lead plaintiffs in the litigation, and Dr. Katie Plax. The division chief of adolescent medicine in the Department of Pediatrics at the Washington University School of Medicine, she is also the medical director of the SPOT, or Supporting Positive Opportunities with Teens. In that role, she’s worked with more than 700 Missouri foster kids.
Dr. Plax explained that many foster kids endure trauma that would be best treated with cognitive behavior therapy, which is akin to “changing the channel” from something dark and scary to, in her words, “the Hallmark Channel.”
A desire for quick fixes can lead instead to the prescription of psychotropic drugs, which the lawsuit describes as a “chemical straitjacket.”
“That phrase related to our perception, and reporting by many kids in foster care, that they were being kept quiet, they were being kept placid, with medications, so they didn’t cause a problem,” Amman explained. It stemmed from the idea, he said, that “we’ve got these violent behaviors, we have these disruptive behaviors at home and at school. We have to do something now!
“And the kind of therapies that Dr. Plax is talking about, they take time, they take patience,” he continued. “And people want a quick answer. The message of the lawsuit was that, too often, the answer was to turn to the medications. Too many, too early, too often, too much of a prescription, and a lot of drugs that were off-label, not prescribed for that use.”
Used incorrectly, Plax said, the drugs can have lifelong repercussions.
“With ongoing monitoring, these drugs can be used safely. But they can’t be prescribed without monitoring,” she said. That monitoring is now part of the settlement agreement with the state.
For more details about the settlement, and the ways the litigators hope to hold the system accountable, listen here:
“St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill, Lara Hamdan and Tonina Saputo. The engineer is Aaron Doerr and production assistance is provided by Charlie McDonald.
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