Advocating for Improved Monitoring of the Administration of Psychotropic Medications to Youth in Foster Care
In early 2011 the Barton Center began a collaborative partnership with Casey Family Programs, the nation’s largest operating foundation focused entirely on foster care and improving the child welfare system, and other child advocacy partners to develop strategies to improve the systemic oversight of the administration of psychotropic medications to youth in foster care. Psychotropic medications act upon the central nervous system to affect brain function, resulting in changes to a child’s mood, behavior, consciousness, perception, and cognitive function.
Inappropriate treatment is particularly a problem for a child in foster care who does not have a loving family member advocating for or connected to the child and his or her future. Children in foster care are at extremely high risk for emotional and behavioral disturbances, arising from the initial trauma of abuse or neglect and compounded by the experience of family disruption and loss of support. Multiple placement changes, overreliance on emergency room care, lack of proper psychiatric assessment and reassessment, and gaps in the system of care create challenges to longitudinal health care coordination for children in foster care and further increase the risk of poor health outcomes for this vulnerable population. Consequently, these youth often accumulate multiple psychotropic diagnoses and are prescribed psychiatric medications more often, in higher doses, and in greater combinations than other youth populations. Recently published national studies report that the use of psychotropic medications is 3-4 times higher in the foster care population than in a comparable population of low-income, Medicaid-eligible youth.
“Tommy’s” story, first featured in a November 2010 Atlanta Journal Constitution editorial by Representative Mary Margaret Oliver, inspired the Barton Center’s efforts to improve this systemic problem. When Tommy was in first grade his toddler sister drowned in the bathtub while he was watching her and his other siblings. Tommy’s parents were arrested, and he and his siblings entered foster care, where he has remained for the past ten years. Today, Tommy is 14, living in an expensive group home and taking multiple psychotropic medications for his behavior, some of which are not FDA-approved for use by children. Tommy suffers involuntary movements and fatigue as side effects of his medications, making him less socially confident and lessening his chances of finding an adoptive family. His parents have been released and reunited with Tommy’s sibling but left him behind in Georgia when they moved out of state, leaving Tommy with no one outside of the professionals assigned to his case. Despite all of this, Tommy is a good student and wants a family.
The Barton Center’s collaborative project provides children like Tommy with an independent medical evaluation by a child psychiatrist, who assesses the child’s current diagnoses, recommended treatment, and prognosis for functioning well within a family. To date, 75 children have received this additional level of service, and reviews conducted by the independent psychiatrist document disturbing trends: multiple prescriptions targeting the same cognitive and behavioral difficulties; the steady addition of new drugs and dosage increases without efforts to taper or discontinue the existing medication burden; a failure to adhere to recommended medication laboratory monitoring; and an absence of any evidence of informed consent in the medical records. Under close medical supervision, Tommy was weaned from many of his medications over several months, and many of his side effects have subsided. As his functioning is restored, he is experiencing greater personal and interpersonal successes, which increase his confidence and his optimistic outlook that one day he will find a family.
In addition to psychiatric review and consultation, the Barton Center’s project provides training to Division of Family and Children Services case workers, foster parents, Court Appointed Special Advocates, attorneys and judges to increase their knowledge about psychotropic medications and provide them with advocacy strategies to ensure appropriate oversight of behavioral health treatment at the individual case-level. Additionally, child psychiatrists and other interested professionals are convened through the project to develop appropriate prescribing guidelines that are in line with professional standards of care. Students have conducted research to examine oversight models in other states, conducted legal analyses of related legislation pending in Georgia, and are developing recommendations for changes in state law and child welfare agency policy.
The Supreme Court of Georgia Committee on Justice for Children Cold Case Project Report in 2010 included "Provide independent oversight for children receiving mental health treatment" as one of the Cold Case Project's fifteen recommendations.
Out of this recommendation, the Committee on Justice for Children commissioned a research paper, Psychotropic Meds for Georgia Youth in Foster Care: Who Decides?, to further examine the issue and recommend action steps for Georgia.