About the Settlement

On December 5, 2019, United States District Court Judge Nanette Laughrey granted final approval to the Joint Settlement Agreement entered into by the parties regarding children in foster care and the use of psychotropic medications.

The best practices agreed to by both parties, and approved by the court, are detailed in the settlement and include:

  • Medical records collection:  Children’s Division has instituted a robust medical record collection process, with the help of a specially trained Health Information Specialist (HIS) team, and created additional methods of documentation to ensure that placement providers and prescribers seeing the children have historical knowledge regarding a child’s medical care.
  • Informed consent, youth assent, and emphasis on the rights of the parties: Children’s Division will continue to engage in open conversations about the need for treatment with psychotropic medications. Parents and other members of the family support team will be aware of their roles in those discussions, will be provided with written copies of their rights, and will be consulted about recommended medication changes. Children’s Division will work to ensure bodily integrity for all children in foster care and will ensure that informed consent and assent are pursued prior to any new psychotropic prescription.
  • Secondary reviews & excessive dosages: Children's Division will continue to work with experts as clinical consultants who will conduct required reviews of certain psychotropic medication prescriptions, including those that exceed dosage guidelines. The Psychotropic Medication Advisory Committee (PMAC) was appointed to provide policy and practice advice to Children's Division. A subcommittee of the PMAC has created an annotated excessive dosage guidelines list for all psychotropic medications. If any psychotropic medication exceeds maximum dosage, outside of age guidelines or safety and efficacy have not been established a referral to the Center for Excellence in Child Wellbeing is required prior to consent.
  • Training: All foster care case management staff and resource providers receive pre-service and annual training regarding psychotropic medications and informed consent. Other trainings are offered regarding psychotropic medication and related information to help educate other child welfare partners concerning behavioral health practices for children.
  • Monitoring: Children who receive a psychotropic medication have routine medication monitoring appointments. Case managers document informed consent, distribute the Learn Your Rights (health care) - Parents and Learn Your Rights (health care) - Youth flyers, and provide medical history information to foster parents. Supervisors review behavioral health as part of case conferences with case managers. Data is collected through randomized case reviews done by the HIS team and a data validator will be monitoring the data collection and results to ensure adherence to best practices and the terms of the settlement. Regular reports regarding the progress of Children’s Division’s compliance with the terms of the settlement will be posted to this page. 

This settlement resolves all issues brought in the lawsuit originally filed in 2017.


If you have any questions about the settlement or our reports, please email CD.PsyMedSettle@dss.mo.gov.

For any other questions, please contact Class Counsel at sbartosz@childrensrights.org or john.ammann@slu.edu.