Critics: States quick to drug foster kids

Critics: States quick to drug foster kids

DAVID CRARY

The Associated Press

NEW YORK — Coast to coast, states are wrestling with how best to treat the legions of emotionally troubled foster children in their care. Critics contend that powerful psychiatric drugs are overused and say poor record-keeping masks the scope of the problem.

Nationwide, more than 500,000 children are in foster care at any one time, and more than half have mental illnesses or serious behavioral problems, according to the Child Welfare League of America.

"The child-welfare system wasn't prepared for the deluge of kids that have mental-health problems," said Dr. Chris Bellonci, a child psychiatrist in Needham, Mass. "By default, it's become a mental-health delivery system, and it's ill-equipped to do that."

Some states have taken broad action, often in response to overdose tragedies, lawsuits or damning investigations. California requires court review of any psychotropic drug prescription for a foster child; Illinois has designated a prominent child psychiatrist to oversee such reviews.

In other states, however, experts say the issue is not being adequately addressed and basic data are lacking that would show the extent of medication usage.

"It's a problem that's really ugly and growing under a rock, and no one wants to turn the rock over," said Dr. Michael Naylor, the psychiatrist in charge of Illinois' review program.

Some parents and advocacy groups say child-welfare authorities routinely resort to drugs to pacify foster children without fully considering nonmedication options.

"Children who are having normal reactions to the trauma of being separated from their families are often misdiagnosed or overdiagnosed as suffering from psychiatric problems, and the system is too quick to medicate," said Mike Arsham, of the Child Welfare Organizing Project. "It's a chemical sledgehammer that makes children easier to manage."

Among the aggrieved parents is Sheri McMahon, of Fargo, N.D., whose son Willy was in foster care for 28 months, from 2001 to 2003, because of an inspector's ruling that the home was substandard.

McMahon said Willy, now 17, had been diagnosed with multiple disorders and was taking an antidepressant when he entered foster care. But she said that in a residential foster-care facility, he was placed on five psychotropic medications simultaneously, becoming sleepy and overweight and developing breathing difficulties.

"When he came back home, his pediatrician and psychiatrist expressed concern about the number and doses of medications," McMahon said. "It took many months to get them down to a level where he had a chance of attending school regularly."

Some child psychiatrists are concerned about a possible overreaction against the use of psychotropic drugs, saying many foster children do need them.

But they acknowledge that a shortage of money and resources complicates the daunting task of effectively diagnosing and treating mental illness in foster children. One problem, Bellonci said, is a nationwide shortage of child psychiatrists, often leaving pediatricians to handle complex behavioral problems.

Bellonci helped Tennessee's Department of Children's Services — the target of a sweeping lawsuit — overhaul its procedures for psychotropic drugs after an investigation found that 25 percent of foster children were taking them, often without legal consent. Tennessee's policies are now considered among the best, encouraging expert reviews of prescriptions and urging prescribing doctors to consult with the youth, caseworkers and the biological and foster parents before deciding on medication.

The issue is alive in several other states. Among them:

• In Florida, child-welfare officials will be reporting to the Legislature within weeks on the effects of a 2005 bill that tightened rules on when foster children can be given psychotropic drugs. The law requires prior consent of a foster child's parents or a court order before such drugs can be used. The bill's approval followed a report concluding that mood-altering drugs were being prescribed to 25 percent of Florida's foster children.

• In Texas, departing state comptroller Carole Keeton Strayhorn issued a stinging report in December on psychiatric treatment of foster children, including the use of medication. "The picture is bleak, and rooted in profound human suffering," said the report, which recommended hiring a full-time medical director for foster children and requiring prior approval for certain prescriptions.

• In California, Assemblywoman Noreen Evans introduced a bill last month that would require the state to collect the necessary data to show whether foster children are being overmedicated. "Many foster youth have told me that they are given pills instead of counseling," Evans said. "The state doesn't track who receives prescriptions and why. We need to do that in order to prevent abuses."

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