The California Guidelines for the Use of Psychotropic Medication with Children and Youth in Foster Care were adopted in 2018 by CDSS and CDHS. These prescribing standards represent the current state of best practices and are to be followed when prescribing psychotropic medications to foster youth in California.
The goal is to ensure that foster youth receive appropriate psychotropic medication (if necessary).
Before prescribing psychotropic medications the guidelines require:
- Not to be used for the purpose of discipline or chemical restraint (except as acutely necessary in true psychiatric emergencies).
- Not to be prescribed in lieu of non-pharmacological treatments. Must consider the child’s daily life including home setting, school, work, sports and clubs – to build on the child’s strengths using non-medical interventions.
- Consider if there are other factors, e.g., in the placement or school setting, that could or should be addressed first?
- Youth should have opportunities for learning self-discipline, appropriate peer interactions, tolerance for frustration, enhanced self-esteem and mastery /learned control) by participating in activities, for example: coached team sports, art, gardening, dance, caring for animals, choir/vocal groups, learning to play a musical instrument.
- Consider a pregnancy test before diagnosis as pregnancy may cause anxiety, mood changes and emotional disruption.
- Medication is never to be used as a sole intervention- must be part of an overall treatment strategy.
- Youth are not to be coerced into taking medication as a condition of placement.
- Single medication treatment should be tried before multiple medications are considered.
- Requires close monitoring according to the California guidelines for risk of adverse side-effects.
- Preference is given to medications with FDA approved for children and youth.
- Medications with the greatest chance of adverse effects, particularly antipsychotic medications, should be used cautiously and reserved for clinical situations where there is a high level of confidence, based on published evidence, that potential benefits outweigh potential harms.
- Must consider the youth’s perspective regarding the medication? Does the youth state that the medication is helpful?
- Youth have the right to refuse psychotropic medication without consequences or retaliation.
When a doctor prescribes psychotropic medication to a foster youth, this prescription must first be approved by the courts. These prescribing standards are also to be used in reviewing a JV-220(A) application for the court.
The prescribing physician must consider the psychotropic prescription guidelines and standard of care adopted in 2018 by CDSS and CDHS. These prescribing standards represent the current state of best practices.
If a youth’s prescriptions are not in agreement with the guideline documents below, the prescribing doctor must submit additional special justification documenting the medical rationale to the court.
Appendix A – California Prescribing Standards for Foster Youth – Number & Type of Psychotropic Medication by Age Group (2018)
Appendix B – California Prescribing Parameters for Foster Youth – Psychotropic Medication Dosage, Usage, Cautions, & Required Testing (2023)