Medicating children in state care is often an unregulated, haphazard process in which drugs are prescribed to help caregivers calm difficult children instead of treating them, according to an initial state review.
"I'm not a happy camper with the way medications are being used," said Stan Appelbaum, chairman of the Local Advocacy Council for mental health. "The first thing that I'd take away from this review is that it's not a perfect system."
The findings also point out state officials long knew of the child welfare system's shortcomings in doling out psychotherapeutic drugs but failed to institute six-year-old recommendations to protect foster children.
"Until there is more information regarding the safety and efficiency of these drugs, Florida's foster care children should be monitored closely," read a 2003 Statewide Advocacy Council report to the governor quoted in the review. "The information in this report should be immediately incorporated."
The issues were raised in a draft report from experts and state administrators convened by the Department of Children and Families to investigate the April death of a 7-year-old Broward County foster child, Gabriel Myers, who hanged himself.
Officials had not obtained valid consent for his medication. The report shows the system failed in providing supervision and oversight in his case.
Judi Spann, DCF deputy chief of staff, said the draft was "very preliminary" and a final report would likely be complete next week.
"We do know that in this case no one was stepping in to be Gabriel's champion to ensure that his particular needs were being met."
In Southwest Florida, about 13 percent, or 136, of abused, abandoned or neglected children in foster care are taking mind-altering drugs such as antidepressants and mood stabilizers.
About 70 percent are boys, almost the highest male percentage in the state, while the female percentage is the lowest.
Nadereh Salim, CEO of the Children's Network of Southwest Florida, which runs foster care locally, said she doesn't believe caregivers are able to get drugs prescribed simply to control behaviors.
After Gabriel's death, the network has been involved in trainings, organizing one with a child psychiatrist, and a local work group on the drugs.
"Since the Gabriel Myers tragic event, there's been a lot more emphasis on procedures," she said. "It was not a topic that was high on the priority list statewide. There has been quite a bit of improvements."
Frank Prado directs the regional Guardian ad Litem office, which connects children in the child welfare system with court advocates. He said the office is concerned if medication is used improperly but Gabriel's death piqued local awareness surrounding the drugs.
"We do believe that is misuse of medication to calm children down," he said. "There's so much more you can do with children. We can give them other outlets to work out their energy."
Spann said DCF hopes to use the findings to prevent further tragedies.
The review states children's rights often seem to be ignored by child welfare officials, who appear to lack a good understanding of the medication.
It recommends children who are old enough be involved and allowed to participate in court hearings about treatment.
"There is no evidence that children are routinely provided notice of the proposed treatment with information on how to object in a timely fashion," it states.
The draft highlights anecdotal evidence that youth stop using medication as adults "without suffering adverse effects."
Appelbaum, who also sits on the Children's Network board, would like to see more services to deal with behavior issues.
Drugs should be a last resort, he said.
"There are tools to use but the unfortunate part is that we're not getting enough funding," Appelbaum said.
Dr. John Ritrosky, a Fort Myers pediatrician who also is on the board, hopes to see efforts to deal with behaviors beefed up as well.
"Throwing more money at the system would help it," he said. "We definitely need to work on that. That's a little impoverished."
He'd like to see children with attention deficit disorders sorted out from those with depression or bipolar disorders and may have more need for drugs.
Salim said she couldn't estimate how much money goes to behavioral programs because it's bundled with other services.
"Can we use more behavioral therapy? Absolutely," she said, noting the network does spend "quite a bit."
The review also recommends the department require all children coming into foster care receive a comprehensive behavioral health assessments.
Those who are not receiving them may be immigrant children who are not eligible for Medicaid or children placed with relatives.
Salim said all children removed from their homes receive the assessment and others get one if they demonstrate a need.