WHAT WORKS
Psychotropic Medication in Schools
Schools have become instrumental in the detection of psychiatric disorders, particularly Attention Deficit/Hyperactivity Disorder (ADHD), and the safe administration of medication to treat them. As the number of children being treated increases, state legislatures, health departments and boards of education are offering more guidance in school health procedures that have, in the past, been under local control.
Teachers may be the first to notice that a child has a behavioral problem because they see the child daily for extended periods of time, ask him or her to focus on tasks, and can compare the behavior of one child with others. Laws in Illinois and Minnesota seek to improve the ability of teachers to help these kids by requiring that in-service training for school personnel include instruction on the identification of ADHD and its behavioral and psychotropic treatments. However, legislatures in some states have become concerned that teachers are exerting too much influence in "diagnosing" a child as having a psychiatric disorder. In response to these concerns, a 2001 Connecticut law prohibits school personnel from recommending to parents that their children take any psychotropic drug, although they may recommend that a family seek care from a doctor if they observe behavioral problems. Virginia created a similar law in 2002. The Colorado and Texas boards of education have passed measures that encourage schools to consider nonmedical alternatives to handling students with behavioral problems.
Teachers have a stake in a child's health care, given that a disruptive student can affect the ability of the whole class to learn. However, legislatures in a handful of states are stepping in to reinforce parents' ultimate authority in determining the appropriate psychiatric care for their child. Connecticut, Minnesota and Utah have passed laws to clarify that the failure of parents to medicate a child does not constitute "educational neglect," an offense-originally created to punish parents for not sending their children to school-that could warrant removal of the child from the parents' care. With the passage of a 2002 Illinois law, school boards in that state are required to develop a policy that prohibits disciplinary action-such as removing a child from the classroom-due to parents' refusal to seek medication for their child.
Although once-daily medications are becoming more common, psychotropic drugs often require multiple daily doses and necessitate that children take medication at school. The number of medications distributed in schools has greatly increased. For example, one urban school district in Minnesota reported administering 1,294 medications in 1985; by 2000, that number had increased to 35,111, according to a 2002 report to the Minnesota Legislature. The report estimates that it takes 22.5 hours per year for school personnel to safely administer Ritalin to one student with ADHD.
As more children are treated with prescription drugs for ADHD and other medical problems, school nurses' time is taxed and duties may be delegated to school personnel who do not have medical training-teachers, secretaries and volunteer parents. One national survey by the University of Iowa found that only a quarter of school nurses distributed all medication in their schools; the majority said that unlicensed personnel dispense medications to students. Although the unlicensed personnel who distribute medication usually have some form of training, it is often limited to less than two hours of instruction. According to the survey, unlicensed personnel are three times more likely to make medication errors than are school nurses. In Maine, for example, the Legislature found in 2000 that 63 percent of school personnel who were distributing drugs had two hours or less of training. (In response, legislation was passed to develop rules mandating that uncertified school personnel receive four to six hours of training before they distribute drugs, but the Legislature did not approve regulations to implement it.) New Jersey prohibits anyone but a doctor, nurse or parent from distributing medication. Although this may be a step forward for student health, in most states and school districts such a law would require hiring additional school health personnel-a move that is unpalatable for some cash-strapped schools.
Ritalin and other stimulants prescribed for the treatment of ADHD also are being abused by some students, necessitating another look at schools' medication lockdown procedures. When crushed and snorted or crushed, mixed with water and injected, Ritalin and similar controlled substances can produce a cocaine-like high. A 2001 study by the Massachusetts Department of Health found that 12.7 percent of surveyed high school students reported having used Ritalin as a recreational drug.
According to a 2001 report by the U.S. General Accounting Office (GAO), 18 states have laws or regulations covering the safe storage of medication in schools. Although these laws vary, most require that medication be stored in a locked cabinet. Massachusetts law, for example, requires that medication be stored in a securely locked cabinet that is anchored to a solid surface and has a limited number of keys. Anecdotal reports from school officials include other safeguards: limiting the number of school personnel with access to keys to the medication storage unit, installing vaults for medication, storing drugs away from outside windows, and setting up surveillance cameras outside the door of the nurse's office after school hours. Other common statutory provisions for the safe storage of medication include obtaining written authorization from a parent or doctor, requiring that pills be in their original packaging, confirming pill counts with parents, and keeping a medication log.
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