Child-welfare panel: Psychotropic drugs relied on to manage foster kids

(MIAMI HERALD)   Admitting for the first time what critics have claimed for years, state child-welfare authorities say caregivers for children in state custody frequently use powerful mind-altering drugs to manage unruly kids, rather than treat their anger and sadness.

A panel of child-welfare experts, including two top administrators from the state Department of Children & Families, examined the death of a 7-year-old Broward foster child who was on psychotropic medications — without the required consent — when he hanged himself in a Margate home.

The panel’s report, expected to be released publicly later this month, says child welfare authorities too often rely on the potent medications to manage abused and neglected children — but fail to offer psychiatric treatment to help them overcome the trauma they suffered.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” the report says. It adds: “We have not clearly articulated the standard of psychiatric care expected for children in state foster care.”

Gabriel Myers hanged himself from a detachable shower hose April 16 at a Broward foster home. He had been in foster care since the previous June, when his mother had been found slumped in her car, surrounded by a stash of narcotics.

After The Miami Herald reported that Gabriel had been given several psychiatric drugs linked by federal regulators to potentially dangerous side effects, including suicide, DCF Secretary George Sheldon appointed a work group to study the care given to the boy, as well as the agency’s overall reliance on mind-altering drugs.

Sheldon said Wednesday that serious questions arose over why so many children in state care are on psychotropic medications — and why so many claim they feel fine once the drugs are discontinued.

“There was a lot of evidence presented to the work group — from kids and from folks in the system — raising a lot of concern over the purpose of these drugs,” Sheldon said.

Sheldon cautioned that the draft of the report is not final and “is subject to a lot of change” after work group members review and tweak it.

An overarching theme of the work group’s discussions, and of the draft report, was the lack of a parent figure — or “champion” — for Gabriel, who the report said had become “overwhelmed” by change and disruption. While the youngster’s life crumbled around him, caseworkers took copious notes and documented each new development.

But the report says, “there was no sense of urgency driving the agencies and individuals responsible for the welfare of Gabriel Myers,” and “no one person stepped forward to act as his parent.”

Though Gabriel was in regular contact with agency-referred therapists and a psychiatrist, the report says, the “intensive therapy” was aimed almost exclusively at preventing the reoccurrence of sexually inappropriate behaviors that may have resulted from his molestation when he was a small child in Ohio.

“Gabriel Myers was not provided specific and upfront therapy to deal with identified trauma, possible post-traumatic stress disorder, and depression,” the report says.

The use of psychiatric drugs among children in state care is widespread.

Records updated by DCF last week show that, among children in state care aged 6-12, more than 22 percent are being given psychiatric drugs.

Almost one-third of the adolescents aged 13 to 17 are on psychiatric drugs, the updated records say.

Among the adolescents, close to four in 10 children in licensed foster care are on such drugs.

The smallest percentage of adolescents taking psychiatric drugs, 12 percent, live with relatives or family friends.

For almost a decade, children’s advocates have maintained that Florida has used potentially dangerous psychiatric drugs as “chemical restraints” on children who endured hellish abuse and neglect — and act out, sometimes violently, as a result.

“It’s heartening that they are admitting what has long been the agency’s dirty little secret,” said Coral Springs attorney and children’s advocate Andrea Moore, who told a DCF Broward administrator in 2001 that doctors were concocting mental health diagnoses for foster kids to justify using unnecessary drugs.

Among the report’s other findings:

Foster children being administered psychiatric drugs with federal “black box” warnings of potentially dangerous side effects are not “adequately monitored” by foster parents, doctors or caseworkers. The children are not well-informed or involved in decisions about their medication.

Caregivers for the state’s foster children are not required to report adverse incidents arising from psychotropic medication.

Psychiatrists and pediatricians “often lack [a] medical history” for the foster children they treat, “yet still prescribe medications.”

Biographical, medical and educational information contained in the Florida Safe Families Network, DCF’s statewide child-welfare database, is “frequently incomplete and inaccurate.”

A “significant” number of dependent children have been given psychiatric drugs without the informed consent of a parent or judge, as state law requires. “Too often, parents and/or the court are unaware of critical issues involving medications, procedures are not followed, and documentation requirements are ignored.”

Mental healthcare for foster children is “fragmented,” poorly funded and often does not include caregivers, who receive little to no training. Disabled children in state care often are excluded from mental healthcare because Medicaid will not pay for therapies specially geared to children with intellectual impairments.

The state has failed to implement recommendations from prior task forces that studied the deaths of foster children or the use of psychiatric drugs. Indeed, DCF has failed to even assign “responsibility” or “accountability” for implementing such reports.

“Let’s just hope they don’t put this on a shelf and ignore it like all the other reports,” Moore said.

Members of the Gabriel Myers task force that authored the report on psychotropic medications:

Jim Sewell, special assistant to the secretary of the Department of Children & Families, former assistant commissioner of the Florida Department of Law Enforcement

Bill Janes, DCF assistant secretary for substance abuse and mental health, state drug czar

Anne Wells, pharmacy director for the state Agency for Health Care Administration

Robin Rosenberg, attorney and child advocate from Florida’s Children First

Dr. Rajiv Tandon, psychiatrist with the University of Florida

http://www.miamiherald.com/news/southflorida/v-fullstory/story/1183698.html

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