On any given day nearly one in four
children in foster care is taking at least one psychotropic medication—more
than four times the rate for all children. Nearly half of children living in residential
treatment centers or group homes take psychotropic medications. Children in
foster care are more likely to be prescribed multiple psychotropic medications at
very high doses, although research shows higher doses can result in serious side effects.
Viewers
of the ABC News program 20/20 may remember Ke’onte
Cook from a few years ago, a 10-year-old who had already spent four years
in foster care being treated with a dozen different medications for conditions including
seizures, bipolar disorder, and ADHD. Ke’onte had never been diagnosed with the
conditions some of the medications were meant to treat. Under his adoptive parents’
care he stopped taking all the medications and started relying on therapy, and
with that new treatment plan he was transformed. Why are some children in foster
care being overmedicated, and what steps do we need to take to do
something about it?
Psychotropic medications act on the
brain and central nervous system to cause changes in mood, behavior, or
perception. They can be effective treatments for certain serious mental health conditions
but there is a growing concern that too many children in foster care are overmedicated—in
some cases as a form of behavior control.
Children
who come into foster care often have been exposed to multiple traumatic events
including the removal from their families, and may be at higher risk for mental
health problems and emotional disorders. Too often multiple medications may be
used without other kinds of effective treatments that might better address the underlying
trauma children are experiencing. There’s evidence some children in foster care
are subjected to powerful medications at very young ages and/or in combinations
and amounts that are unsafe for children of any age. Many psychotropic
medications are not approved for use in children at all.
Often children in foster care are prescribed drugs without
any psychotherapy because resources aren’t available. They may not receive a
proper initial diagnosis or any of the ongoing monitoring or extra services that
should accompany the use of such powerful drugs—all essential considering the
serious side effects from some that can include nightmares, hallucinations, suicidal
thoughts, and even death. The 20/20
special included the heartbreaking story of Gabriel
Myers, a Florida seven-year-old who hung himself in his foster family’s
bathroom. A state investigation concluded the use of psychotropic drugs was a
contributing factor in his death. His foster father said the doctor who prescribed
the many drugs Gabriel was taking—some so strong that even the pharmacy filling
them raised red flags—would spend no more than five minutes with the little boy
before sending him out the door with another prescription.
We must do better. Last year JooYeun Chang,
Associate
Commissioner of the Children’s Bureau in the Department of Health and Human
Services’ Administration for Children, Youth, and Families (ACF), testified
before Congress that despite important steps taken by the Administration and
Congress to promote the monitoring and management of psychotropic medications
and the development of trauma-informed practices, too many child welfare
agencies lack the proper non-pharmacological treatments to address the mental
health needs of children in foster care. This year, for the second time, in President
Obama’s budget proposal ACF and the Centers for Medicare and Medicaid Services
(CMS) have jointly proposed a demonstration to promote trauma-informed
psychosocial interventions to meet the complex needs of children who have
experienced maltreatment and other trauma and to address the over-use of psychotropic
medications for children in foster care.
The Administration seeks to reduce the
over-reliance on drugs and increase the use of appropriate screening,
assessment, and interventions. ACF is asking Congress for $250 million over five
years to create the necessary infrastructure to do this, including creating a
special workforce to recruit families who can care for children receiving
alternative treatments; better training in trauma-informed practice for child
welfare professionals; better coordination between child welfare and Medicaid
agencies in case planning and case management; and better data collection and information
sharing by child welfare agencies, Medicaid, and behavioral health services. The
budget request also includes an additional $500 million for CMS to provide
incentives to states that demonstrate improvements to reduce inappropriate drug
prescribing practices and overutilization of psychotropic medications, increase
access to evidence-based and trauma-informed therapeutic interventions, promote
child and adolescent wellbeing, and improve outcomes for children in the child
welfare system. These common sense and necessary steps build on best practices
already in place in some states. May is National Foster Care Month
and now is the right time to ensure children in foster care get the treatment
and care they truly need.
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Marian Wright Edelman is President of the Children's Defense Fund whose Leave No Child Behind® mission is to ensure every child a Healthy Start, a Head Start, a Fair Start, a Safe Start and a Moral Start in life and successful passage to adulthood with the help of caring families and communities. For more information go to www.childrensdefense.org.
Mrs. Edelman's Child Watch Column also appears each week on The Huffington Post.
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