WASHINGTON — Thousands of foster children may be getting powerful psychiatric drugs prescribed to them without basic safeguards, says a federal watchdog agency that found a failure to care for youngsters whose lives have already been disrupted.

A report released Monday by the Health and Human Services inspector general’s office found that about 1 in 3 foster kids from a sample of states were prescribed psychiatric drugs without treatment plans or follow-up, standard steps in sound medical care.

Kids getting mood-altering drugs they don’t need is only part of the problem. Investigators also said children who need medication to help them function at school or get along in social settings may be going untreated.

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The drugs include medications for attention deficit disorder, anxiety, PTSD, depression, bipolar disorder and schizophrenia. Foster kids are much more likely to get psychiatric drugs than children overall.

“We are worried about the gap in compliance because it has an immediate, real-world impact on children’s lives,” said Ann Maxwell, an assistant inspector general.

Among the situations investigators encountered was the case of a 6-year-old boy diagnosed with ADHD, learning and speech disorders, outbursts of temper and defiance, and hair-pulling disorder. He had been put on four psychiatric drugs.

But a medication review questioned the need for some of the medications. Of the four, two were discontinued and one was reduced in dosage, investigators said. Two different medications were then prescribed.

Investigators found no evidence that a treatment plan for the boy had been developed in the first place, before starting him on medication.

In another case, an 11-year-old boy had been put on two medications after being diagnosed with ADHD, anxiety and behavior problems. But over a three-month period his foster mother had problems getting prescription refills. By the fourth month, the boy’s life was out of control. His decline included stealing, lying, bullying and an in-school suspension.

Investigators found there was no requirement in that state for case workers to follow up with foster parents about medications. The lack of effective follow-up contributed to the boy’s downward spiral.

“These children are at greater risk of not getting the medications they need, but equally important, they are at risk of getting powerful medications that they do not need,” Maxwell said.

The inspector general is recommending that the HHS Administration for Children and Families develop a strategy to help states meet their existing requirements for prescribing psychiatric drugs to foster children, and to generally raise standards for case-by-case oversight.

In a formal response to the report the children’s agency said it may need additional legal authority. The agency also said it is committed to making sure foster children get psychiatric medications only when medically appropriate. Officials noted that the inspector general’s findings covered just five states.

Foster children come into the mental health system with added complications. Their most basic connections in life have been stressed or severed.

They may have suffered neglect or abandonment. They may have witnessed or been a victim of abusive behavior or violence.

A 2010 study from the Tufts Clinical and Translational Science Institute found that estimated rates of psychiatric drug use among youth in foster care are much higher (13 percent to 52 percent) than among youth overall (4 percent).

Compounding the challenge for foster children is the fact that responsibility for their well-being is often divided among foster parents, birth parents, relatives and case workers. That can increase chances for miscommunication and conflict, not to mention everyday problems going unaddressed until they escalate.

Caring for foster kids is a shared responsibility of state, local and federal agencies. The federal government provides grants to state programs and also covers health care for foster children through Medicaid, which spends hundreds of millions of dollars annually on psychiatric drugs.

Nationally, it’s been estimated that about 120,000 children in foster care take at least one such medication.

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The inspector general scrutinized a sample of 125 cases from each of five states with the highest overall percentages of foster children treated with psychiatric drugs. Those states were Iowa, Maine, New Hampshire, North Dakota and Virginia. The cases covered the period from October 2014 through March 2015. Investigators looked at each state’s compliance with its own particular requirements for treatment planning and follow-up.

Maxwell said the finding that 34 percent of children did not have either treatment plans or follow-up monitoring translates to about 4,500 children in the five states examined. She said the national number would certainly be higher but the design of the inspector general’s review did not allow for a simple extrapolation. Even among the five states cited there were wide differences.

— Ricardo Alonso-Zaldivar

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  • There are many legit reasons for high rates of medication utilization: high rates of PTSD in foster kids (after all, they’re in foster care BECAUSE they’re traumatized), higher than usual rates of mental illness in their biological family, leading to a greater propensity for inheritable conditions like ADHD, and higher rates of fetal drug and alcohol exposure (which in turn produce ADHD-like symptoms that are often more difficult to control than normal ADHD). Now consider that many of the kids in the system have multiple of the above factors. Considering all of the above, 33% is about the number of kids one would expect on meds taking all covariates into account. Now does this mean all foster kids are appropriately medicated? No, but drawing the distinction between kids in foster care and other children is not helpful or worthwhile.

  • We need the home address of the inspector, or else, STFU about paper work. We are going to send these children to her house. She can show us how to manage them. Treatment plans are worthless quackery. They are corporal punishment and physical abuse of staff to deter clinical care.

    When you broke a rule in class, you got a writing assignment. It was corporal punishment. By inflicting PTSD, it deterred future rule breaking in class.

    The inspector general must be fired for suborning quackery and for promoting physical abuse of the staff.

    • I’m totally with you about so-called treatment plans. Most auditors could determine the treatment plan if they were intelligent enough and patient enough to read a sequence of progress notes, but the fact is that if the “treatment plan” doesn’t contain the elements they want, auditors deem it deficient. There’s another aspect to deeming care deficient: you don’t have to pay for it. That’s more of what this argument is really about, but it is being couched in humanitarian terms that are at best disingenuous.

  • They have been doing this for years, even though there is no evidence it benefits the children. Medicating children makes them docile and easier to handle, a plus for Foster Homes, and treatment centers. The side effects have not been evaluated, nor have any long term studies been done. They have created a generation of adults damaged by these medications. Often the initial dosing, can be brutal, if the subject resits in any way or questions it. According to Psychiatrists and the workers who gleefully carry out these druggings, any child that questions the need for medication proves they are in need of drugging. They don’t acknowledge the trauma the child might experience when, they are held down by 4 or more security guards.
    Many of these children end up in these faculties due to their parents problems, abuse of psychopathology, yet the children are forcefully medicated. The children’s behavior or background has no bearing on the forceful medication. Something like marijuana possession, can led to brutal forceful injection of psychiatric drugs. The children who are neglected and ignored at home, raised in front of a TV, or lack a place to sleep are all candidates for ADHD medications, since the environment or facts are unnecessary to these child abusers.
    This criminal behavior has gone unchecked, perpetuated by pharma, since these drugs are carefully marketed to these “experts.” Like everything else, in this field, no long term objective outside observation is ever done. The death rate among these damaged children, when they are discharged at 18, usually to the streets is uncounted. These Psychiatrists, and their friends at pharma along with the industry that enriches themselves by torturing children, decided that collecting data would be inconvenient and unprofitable.

    • Again. We need the home address. We are going to send these kids to your house. Show us the proper way to manage them. No meds for the kids at your house, however.

  • Foster Care children have been removed from their homes usually due to family addiction or some sort of abuse or severe neglect. Many foster parents rely on state funding for taking in children.
    Anna Freud created the Hampstead Nursery – herself a refugee she discovered even the benign removal of English children during Word War II from urban areas to rural villages created trauma that sometimes was never totally resolved.
    Where is a statement from NASW, APA, and the various groups of the AMA? Don’t they all have a Code of Ethics? And what perchsnce happpens when the treatment plans are copied from work books to fit the need of state regulations, or a script is written without a thorough developmental history?
    When our first president fought in the Revolutionary War he faced a problem with the Congress. He wrote letters decrying the lack of funding and political will while his soldiers were starving and dieing.
    The society that cares for ALL its citizens is a high watermark. We have failed – the elephants do better.

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