The Obama Administration told states last week of its intention to find out more about their practices when it came to monitoring the use of psychotropic drugs with children in foster care. Today, the reason for the interest became apparent, and calls for federal regulation of use of the drugs on foster children could soon follow.
A Government Accountability Office (GAO) study released this morning recommended that the Department of Health and Human Services “consider endorsing guidance for states on best practices for overseeing psychotropic prescriptions for foster children.”
The GAO reviewed nearly 100,000 foster children in five states - Florida, Massachusetts, Michigan, Oregon and Texas – found thousands of children on psychiatric medications, many at higher doses than are approved by the Food and Drug Administration.
Hundreds of these children were prescribed five or more drugs at the same time, a mixture of medications that has never been proven effective and which significantly increases the potential for side effects.
The findings support a burgeoning base of research that indicates foster children and youths in the juvenile justice system are prescribed psychotropics at a rate far higher than other children:
*A 2009 study by Rutgers found that foster children are given antipsychotics - a particularly potent group of psychotropics approved mostly for bipolar and schizophrenic adults - at a rate 9 times higher than children not in foster care.
*A Youth Today investigation of anti-psychotic medication in juvenile facilities found most states did little to monitor usage. In the five states that could provide prescription and diagnosis information, there were a total of 5,200 prescriptions in one year, and 70 percent were filled for conditions other than bipolar disorder or schizophrenia.
“I believe that overall, the foster care system itself has become addicted to psychoactive medications and has difficulty withdrawing from their use,” said David Cohen, a Florida International University professor, in an e-mail to Youth Today. “There is no real evidence…that psychoactive drugs truly help kids who are distressed and misbehaving, besides some short-term suppression of obvious 'symptoms'.”
Cohen is based in Florida, where problems with foster children and psychotropics were brought into specific relief by the case of Gabriel Myers, a 7-year-old foster child who committed suicide in 2009. Myers had been prescribed three different psychiatric medications, one of which was an anti-psychotic drug.
George Sheldon, who currently heads the Administration for Children and Families at HHS and signed last week’s letter to states, was Commissioner of Florida’s Department of Children and Families when Myers took his own life.
He established a working group to develop lessons learned from the case, banned the use of DCF wards in clinical trials that involved psychotropics, and began to post monthly prescription data on the DCF website.
But the attention has yielded little change in the percentage of Florida foster children on the drugs. 14.6 percent of foster children (2,732) in the state were on psychotropics in January of 2010; 13.4 percent (2,454) were on them in January of 2011, and 13.1 percent (2,624) were on them as of last month.
A Federal Solution?
The HHS letter to states suggests only a desire to hear about state monitoring procedures and share best practices. But with a high percentage of foster care and Medicaid money flowing to states from HHS, the agency could easily establish regulations on prescribing psychiatric medications to foster children.
One possibility is a prescription oversight requirement, where state-designated health professionals would need to approve a psychiatrist’s attempt to place a foster child on psychotropics. On a very small scale, such a regulation proved effective in Florida with very young children and anti-psychotic drugs.
In April of 2008, Florida Medicaid instituted a requirement that any anti-psychotic prescription for a child on Medicaid under the age of six had to receive prior authorization. The number of prescriptions of these potent drugs to kids in this age group plummeted nearly 75 percent in the first year, and there were 40 percent fewer doctors who wrote even one anti-psychotic prescription for a young child.
“It had an immediate effect,” said Ken Kramer, a public records researcher whose website, Psychsearch.net, compiles reports on Florida psychiatrists. “A good first step in truly stemming psychiatric drugging of our nation's foster children would be to require prior authorization on all ages of children for all psychiatric drugs in every state.”