Friday, January 11, 2013

In Focus: Psychotropic Drugs and Foster Care

http://www.childrensrights.org/psychotropic-drugs-and-foster-care/

As hard as she tried, Mia couldn’t stay awake in class.

“They would bang on the desk near my head to wake me up and I never would,” the former foster child, now 19, told Children’s Rights. At the time, she was on “five or six” medications. “I couldn’t even function,” she said.

undefinedMia is one of thousands of foster kids who have been prescribed powerful psychotropic drugs to help them cope with a variety of mental health issues — from depression, anxiety, and post traumatic stress disorder, to reactive attachment disorder and bipolar disorder.

Mia, who suffered from serious depression, believes such medications can help – to an extent.

“I hit a very low point in my life. I feel like if I hadn’t been on at least one or maybe two and then going to therapy and really working on the issue, I don’t know where I would be now,” she said. Still, she is adamantly against putting kids on too many medications, doses that are too high, and drugs they don’t need. “I don’t condone relying on pills to try to fix everything,” she said.

Shaquita Ogletree, a former foster youth who now works as a peer support coordinator for the Multi-Agency Alliance for Children (MAAC) in Atlanta, agrees the drugs are not always warranted.

“Youth are moved from place to place, and every time they move, they have to adapt to the rules of the placement,” Ogletree said. “And so many times when youth act up – jumping on beds, shouting, normal things kids would do – they are medicated. No one is sitting down and talking with them and figuring out what exactly is wrong. What has happened to them to make them feel like this?”

Children in foster care prescribed drugs at a higher rate

Psychotropic drugs affect brain activity associated with mental processes and behavior. While such medication “can have significant benefits for those with mental illnesses, they can also have side effects ranging from mild to serious,” including drowsiness, suicidal thoughts, hallucinations, loss of coordination, blurred vision, tremors, weight gain and high cholesterol, according to a report released in 2011 by the U.S. Government Accountability Office (GAO). The report was the result of a five-state study on the rates at which kids both in and out of foster care were prescribed psychotropic drugs through Medicaid in 2008.

According to the GAO, foster children in Florida, Massachusetts, Michigan, Oregon and Texas were prescribed psychotropic drugs at rates 2.7 to 4.5 times higher than children not in foster care. This gap may be because kids usually enter foster care after being abused or neglected and living through traumatic experiences — all factors that can affect their mental health.

But the GAO report also found that in each of the five states studied, foster kids were more likely to be on five or more psychotropic medications, and on doses that exceed U.S. Food and Drug Administration (FDA) approved levels for their ages – increasing the potential for adverse side effects. Some of the medications have not even been approved as safe and effective for children by the FDA.

Recently child welfare systems throughout the country have been facing tough questions about their oversight of prescriptions. Are kids on too many medications? Are their medical histories being tracked? Are they receiving the right treatment for their conditions? Are they getting the counseling and mental health support they need?

“Much of the challenges young people in foster care have are related to behavioral issues, and instead of recognizing issues of trauma, we are over-diagnosing them with mental illness,” Bryan Samuels, Commissioner of the U.S. Administration on Children, Youth and Families, said during a Senate subcommittee hearing on the use of psychotropic drugs in foster care held last year. “These children are expressing symptoms because of stuff that happened to them. If we can make those separations, we can reduce the use of psychotropics and target medications to the children who would benefit the most.”

The problem in Massachusetts

Of the five states studied by the GAO, Massachusetts was noted to have the highest percentage of foster children on psychotropic drugs. Almost 40 percent of kids in state care were prescribed these medications, compared to 10 percent of children outside of the child welfare system, according to the report.

Children’s Rights is currently waging a legal campaign to make the Massachusetts foster care system safer for kids. As part of our fight, we secured an independent expert report, written by Dr. Christopher Bellonci, professor of Child and Adolescent Psychiatry at Tufts University School of Medicine, examining the administration of these powerful drugs to children in the state’s care.

“The report shows that Massachusetts fails to meet the minimum standards of care for foster children with mental health needs,” said Marcia Robinson Lowry, executive director of Children’s Rights. “The state lacks an oversight system and qualified staff to ensure children are safely and appropriately administered medication.”

According to Dr. Bellonci’s report: caseworkers are charged with providing consent for children’s prescriptions, but do not get adequate training to do this in an informed way; Massachusetts lacks a system to raise and monitor “red flags” signifying risk of harm, such as kids taking multiple medications at the same time; and the state has no simple means of determining what medication a child is taking on any given day.

“If a parent could not tell what medication they were administering to their child it would be considered neglect by the very state agency for whom this is a daily occurrence,” Dr. Bellonci wrote in his report.

Improving mental health care for kids

Children’s Rights agrees with experts that in some cases psychotropic medications can be warranted in combination with mental health services — but child welfare systems have the responsibility to provide rigorous oversight to ensure kids in their care are given the safest and most appropriate treatment for their conditions.

“Someone has to watch out for these kids, and in the worst of cases it takes class action lawsuits to force systems to improve their practices and policies to ultimately give foster children the care and protection they need and deserve,” said Lowry, executive director of Children’s Rights. “We will continue to fight for kids to get the mental health treatment they need to help them overcome the trauma they’ve endured.”

THE RESULTS: CR Advocacy Leads to Psychotropic Safeguards

The roadmaps for sweeping foster care reform that Children’s Rights negotiated in New Jersey, Michigan and Tennessee prohibit child welfare officials from using psychotropic medications as a method of discipline or control for any child.

Children’s Rights also ensured that these states are required by force of law to hire medical directors — a position that didn’t previously exist — to monitor the usage of psychotropic drugs in foster care.

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