Report: Fla. child welfare lacks accountability

Date: 2009-08-13

The Associated Press

FORT LAUDERDALE — The head of the state’s child welfare agency is recommending stricter rules for prescribing powerful anti-depressants and other drugs to foster children after a 7-year-old in state care committed suicide.

George Sheldon, the new secretary of the Department of Children and Families, said Thursday he is recommending additional review for all children in state custody on such medications and the appointment of a new in-house state medical director to keep tabs on cases.

The department released a 55-page preliminary finding in the case Thursday, four months after Gabriel Myers hung himself with a retractable showerhead at his foster home.

“If you (prescribe psychotropic meds) there’s got to be a treatment plan in place, there’s got to be an end date in place and there’s got to be ongoing dialogue,” Sheldon told The Associated Press.

The new report found a lack of accountability and inadequate supervision in every step of Gabriel’s case.

The state has been struggling to admit and fix such problems since 2002, when a 4-year-old girl went missing for a year before state officials realized it. She is presumed dead.

“If everybody is responsible for your children then no one is responsible,” Jim Sewell, Former Assistant Commissioner of the Florida Department of Law Enforcement, said at one meeting of the task force that issued the report.

In Gabriel’s case and others like it, workers did not use procedures adopted years ago, such as keeping a form that included his diagnosis and medications. Gabriel was on several psychiatric drugs linked by federal regulators to potentially dangerous side effects, including suicide, but the risks may not have been adequately communicated to his foster parents.

A records check after he died found nearly 2,700 children, 13 percent of all those in out-of-home foster care, taking psychotropic drugs, compared with an estimated 4 to 5 percent in the general population.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” the report says.

The records check showed that 433 of those children, or 16 percent, had not had their drugs approved by parents or court orders. Even if they had, people on the task force said, such approvals was often just a rubber stamp from judges with little understanding of such drugs and their side effects.

Sheldon also said cases need to be reviewed again after an initial diagnosis when a child enters foster care.

“When a child comes into care, that’s when they’re the most traumatized, probably sad, bordering on depression, should we be making a long-term assessment at that point that will follow them for the rest of their care?” he asked.

Those assessments need to be re-evaluted a month or 90 days later, Sheldon said.
In Gabriel’s case, Sheldon said, he was flooded with services, therapuetic sessions, medical evaluations and psychiatric appointments, “but nobody in the case was acting as a parent.”

The report found that caseworkers didn’t talk to doctors. Teachers didn’t talk to caseworkers. Caseworkers and the psychiatrist made the same cookie cutter notes in Gabriel’s file nearly every visit, despite his increasingly troubled behavior. Nearly every opportunity to help him instead became a symbol of the department’s inefficencies and blame shifting.

Red flags were repeatedly ignored, the panel found.

Myers choked himself so badly he once left red marks on his neck. He stole knives at his foster home, telling classmates he would kill them and repeatedly touching classmates’ private parts. He later told a therapist he had been sexually abused by a 12-year-old boy while living in Ohio with his grandparents.

A Florida therapist recommended the state place Myers in a residential program that deals with abused children, but that never happened.

Task force member Dr. Rajiv Tandon, a psychiatrist with the University of Florida, called Myers case a “10 in terms of a red flag for a child who is crying out....but this information was not all pulled together.”

Kimberly Foster, who was on psychotropic medications every day during a decade in foster care, hopes the department will make changes to help children like her. She told the panel that children in state care are overmedicated.

“They looked at me as a troublemaker instead of a child who is coming out of a troubled environment, said Foster, now 25. “If you cry, you’re depressed. If you act out in school, you’re a behavior problem. We’re so quick to put these diagnoses on children.


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