Maine’s Department of Health and Human Services reached a settlement Friday with child welfare advocates over a 2021 lawsuit, agreeing to enact reforms that will improve safety measures and oversight at the agency to ensure proper use of strong medications given to foster children in the state system.

The lawsuit, filed by national advocacy organization Children’s Rights, law firm Bernstein, Shur, Sawyer & Nelson, and Maine Equal Justice, alleged that Maine foster children as young as 5 were being given powerful psychotropic drugs without sufficient safeguards and oversight. Defendants named in the suit were Jeanne Lambrew, commissioner of the Maine Department of Health and Human Services, and Todd Landry, the former director of the Office of Child and Family Services.

Psychotropic medications include stimulants such as Ritalin and Adderall, antidepressants such as Zoloft and Xanax, antipsychotics and other mood-altering drugs. Experts urge caution when prescribing such medications to young children, and the lawsuit detailed adverse effects the drugs had on six Maine foster children.

“We are thrilled that Maine officials have stepped up and collaborated closely with us in developing these groundbreaking reforms, holding itself accountable for the children in its care,” Marissa C. Nardi, lead counsel at Children’s Rights, said in a statement. “These reforms will help hundreds of children and their representatives make truly informed decisions about potent psychotropic medications, with a heightened ability to access information they need to make those decisions, and with ample checks and balances on the system to avoid children falling through the cracks.”

The parties agreed to a set of three critical reforms that the state will implement under the supervision of an implementation reviewer, who will track their progress.

The first of the three reform areas calls for improvements to the medical records system at DHHS. Per the settlement, the state will develop and disseminate a new portable health record that moves with a foster child from system placement to placement, and is routinely updated with critical medical, mental health and behavioral health information.

The medical records changes are meant to ensure that all decision-makers have access to current and accurate health information when considering a prescription for psychotropic medication, and that caregivers have access to key information when administering the drugs.

The second reform requires the state agency to create a new informed consent process by designated adults and youth age 14 and older. The changes aim to enable meaningful decision-making regarding the risks and benefits of psychotropic prescriptions prior to receiving the medication.

The third reform will create a psychiatric clinical review team to conduct secondary reviews both before and after psychotropic drugs are administered to children. The review team can identify and address outlier prescription practices, offer consultation on psychotropic medication and provide second opinions upon request.

A DHHS spokesperson did not respond to a request for comment Friday night.

“After over eighteen months of negotiations, we are delighted that we were able to reach an agreement with the state which will help protect children in Maine’s foster care system who are prescribed psychotropic medication,” said Jack Woodcock, an attorney with Bernstein, Shur, Sawyer & Nelson. “The State has agreed to real reforms and committed to meaningful oversight to make sure it makes good on those promises.”