Nearly one in six children in the Florida foster care system who had been prescribed psychotropic medication were given the drugs without parental consent or authorization from a judge, despite the state's increased scrutiny of the drugs' use.
That is among the preliminary findings of a review released today by the Florida Department of Children and Family Services (DCF). The review was ordered following the apparent suicide on April 16 of 7-year-old Gabriel Myers, who had been prescribed psychotropic drugs without informed parental consent or a judge's order while in the foster care system. Gabriel reportedly hung himself on a shower rod.
The review by the Florida DCF, using data from its Florida Safe Families Network (FSFN), found that of the 2,669 children in Florida's foster care system who were prescribed psychotropic drugs, there was no record of consent or a judicial order in 433 cases. The statistics did not specify the ages of the children for whom there was no consent on record.
"It's inconceivable to me, with all the attention focused on psychotropics, that the system doesn't have this right yet," Florida DCF Secretary George Sheldon said today when asked how so many children in foster care could be prescribed the drugs without proper authorization.
A 2005 law requires an agency to obtain the consent of a parent or judge before giving mind-altering medications to foster children. Consent is necessary for each prescription.
"I don't think there's any excuse," Sheldon said.
He vowed to take swift action on the 433 cases in which there is no record of parental consent or a judicial order, explaining that there are plans to bring all of the cases into compliance with the law and to get the cases reviewed by a judge by June 5.
The majority of youths without consent for their prescriptions were served by private agencies that have carried out most child welfare services in the state since the officials began privatizing the system in the early 2000s.
Sheldon conceded during today's telephone news conference that the private agencies managing the cases where youth may have been prescribed the drugs illegally could face contract reviews or termination, and the caseworkers involved could face disciplinary action..
"Stay tuned," Sheldon said, explaining that for the time being, he is more concerned with getting agencies and caseworkers to cooperate and produce reliable information on the extent of the problem of wrongful use of psychotropic drugs for children in state care.
A number of providers said that at least some of the 433 cases simply lack a paper trail; consent was given, but it was not properly documented.
Officials for Miami-based Our Kids, which the report stated had 62 youths prescribed medication with proper authorization, told Youth Today that notification of a change in prescription sometimes makes it into the state database before consent has been sought. In some cases, when youth run away from care or initially refuse to take medication, the agency stops seeking consent since the drug is not being administered, said clinical services director Michelle Montero.
Eckerd Youth Alternatives, a lead agency in Florida's Suncoast Region, had 78 no-consent cases according to the report. A spokeswoman for the agency said that over the past two weeks when it reviewed every single child in its care, it identified 25 children that fit into the no-consent category.
Eckerd spokeswoman Karen Bonsignori believes the discrepancy of 53 cases likely is due to incomplete reporting of consensual prescriptions on the part of the group Eckerd subcontracts with to provide case management. Eckerd will be entering information into FSFN from now on, Bonsignori said.
Sheldon conceded that the review's findings may be flawed and there are efforts under way to validate the findings.
"We have to get the database in better shape," Sheldon said.
Causes and Solutions
How did the actual no-consent cases happen? A primary cause cited by lead agencies is that mental health developments in a child's life can occur more frequently than visits with lead agency staff do.
"A kid can see one doctor, then move to another doctor," said Hillsborough Kids CEO Jeff Rainey, whose organization did not have consent for 52 of the psychotropically medicated youths in its care. "Sometimes the medications get changed. There's a catch-up factor."
Foster parents are supposed to let agencies know if a child is prescribed psychotropic medication as part of the bilateral agreement they have with lead agencies, said Gregory Kurth, executive director of Family Services of Metro Orlando (FSMO), which the DCF report said had 63 children on prescribed medication without consent. "That may not necessarily happen every time."
Rainey concedes that none of these factors is an excuse. "It's a complex process," he said, "but at the end of day it's our responsibility."
The Gainesville-based Partnership for Strong Families (PSF) had only one child with a non-consent prescription. PSF President Shawn Salamida said his organization has been diligent about monitoring for changes in medication for children in its care.
PSF pulls reports directly from a the Florida Safe Families Network's statewide database and cross checks it with its own records. "That tells us which kids are on psychotropics. We review that list...to make sure we're in compliance."
Salamida said the organization also holds frequent "staffings," regular reviews of cases that bring together caseworkers, quality management staff, attorneys and parents in some situations.
The lead agency that managed Myers case, ChildNet, said it "is one of the few Community Based Care lead agencies throughout the state that has internal policies and procedures in place to document and monitor use of psychotropic medications. Our policy and procedures were in place since our inception in 2005."
Sheldon stressed that it's important for parental consent to be actual informed consent rather than on paper only. In the case of Gabriel Myers, for instance, Gabriel's mother signed a blank consent form when she was high on drugs, Sheldon said.
"It's not just enough to get a signed parental consent form," Sheldon said. "It must clearly be informed. That means the parent is clearly explained the use of psychotropics."
Gabriel, who had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) had been prescribed Vyvanse in December 2008. In the weeks leading up to his death, he had also been prescribed Lexapro, which was later discontinued and replaced with Symbyax.
Asked for his own views on the use of psychotropic drugs, Sheldon said: "I'm not a psychiatrist, and I'm not anti-medication. But I have serious questions when it comes to the administration of psychotropic drugs to children. I think it should be done as a last resort" and then only when reviewed by medical professionals.
At Family Services of Metro Orlando, Kurth is considering using a medical consultant to review any prescription for psychotropics made for one of its children. He does not intend to become a final say on the drugs, but thinks a consultant can make sure doctors have considered every option and asked every question before resorting to serious medication.
More info on the Myers case: www.dcf.state.fl.us/admin/GMWorkgroup/index.shtml