MICHAEL PAULSON and STEVEN GOLDSMITH
The state's top social services administrator yesterday pledged to intensify training of foster parents and social workers, to rewrite key policies and to seek an outside review of a child's death in connection with the use of mood-altering drugs to treat foster children.
The reform also includes trying to assign a primary care doctor to each of the state's 10,000-plus foster children by the end of next year.
Department of Social and Health Services Secretary Lyle Quasim outlined the seven-point plan for the use of psychotropic medication after a Post-Intelligencer series last week described occasional damage caused by medicating children in the state's care.
"We run a forward-thinking administration and we know there are problems, but I think the newspaper articles will help raise the awareness around issues of drugs and children," Quasim said. "A lot of children are in foster care because they have behavioral problems, so they have a higher incidence of medication management, and this is something we need to know."
Quasim said the American Academy of Pediatrics has agreed to review the one child death described in the Post-Intelligencer stories that was attributed to an overdose of a prescription drug. But Quasim said he does not believe his agency's social workers should be asked to second-guess the advice of physicians.
"One of the highest levels of care we can provide is to get a kid in to a specialist who is a licensed physician and board-certified, and how can a parent or a social worker substitute their judgment for that of a physician?" he asked. "How can we have social workers telling children not to take medication?"
Nonetheless, Quasim said, there are steps his agency can take to help families when children are taking powerful prescription drugs.
As Quasim implements those steps, Gov. Gary Locke is continuing to push the Legislature to hire more social workers, to support a $4 million so-called passport program to track the medical history of foster children, and to fund a review by the state Health Department of all child deaths in the state.
"The key role for the governor's office right now is to secure the budget for the passport program, for additional Child Protective Services workers and for a child fatality study," said Locke's press secretary, Marylou Flynn. "We'll be focusing our energy on that side, and the department will be focusing on implementing their next steps."
The steps Quasim said his department will take regarding concerns about the possible ill effects of medicating so many foster children:
-- Enhance training of foster parents to include information about medications commonly prescribed for behavior management of children. Quasim said the expanded training will begin by June 1.
-- Expand the material provided about medication during the initial training of social workers at DSHS. (This step has already been taken.)
-- Assign a primary care physician to every foster child. That physician would be able to provide a second opinion when a specialist recommends medication. Quasim said this step will be difficult to accomplish because of funding concerns, but he hopes to complete it by the end of next year.
-- Hold a conference in May about medication management of children. Quasim said the conference, which was previously scheduled, will be an opportunity for academics, physicians, state workers and parents to discuss many of the issues discussed in the Post-Intellingencer series.
-- Hold a conference in June about drug-affected families and child welfare. Quasim said this conference will examine the behavioral issues associated with the use of prescription and illegal drugs by parents and children.
-- Have the American Academy of Pediatrics review the death of 6-year-old Domico Presnell in a Seattle foster home and cooperate with the academy in the review. Quasim said he hopes the national study will result in better standards for physicians prescribing psychotropic medications to children.
-- Adopt a new policy to guide social workers in managing cases in which psychotropic drugs are being used to treat children. Quasim said a draft policy already is circulating in his agency and, at the request of the governor, he is seeking to speed its adoption.
The Post-Intelligencer's series documented one death and several illnesses suffered by children in Washington foster care from psychotropic medications prescribed by state-paid doctors.
While the seven-point plan responds to many problems identified in the series, some state lawmakers yesterday were considering an additional step: requiring child-welfare workers to inform adults in a foster child's circle of care when powerful psychotropic drugs are given.
"Who knows a kid better than their biological parent?" asked Rep. Bill Backlund, a Republican and a Redmond physician.
Backlund said Washington should join the 20 states that already keep records of foster children's medications and, when possible, consult a child's biological parents about psychotropic drugs.
Because it is late in this legislative session, Backlund said, lawmakers haven't decided whether to introduce a bill now or wait until next year.
"Maybe the governor can deal with DSHS to protect kids in the interim," Backlund said.
The Department of Social and Health Services, which runs Washington's foster care system, said before the series was published that it was considering implementing safeguards by summer.