New Study Shows U.S. Government Fails to Oversee Treatment of Foster Children With Mind-Altering Drugs

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Meet Ke'onte

The stories include kids like 11-year-old Ke'onte from Texas, whose journey was documented by ABC News over the past year and who will be testifying before Congress on Thursday about the overuse of psychiatric medications in foster children.

Neglected and often left home alone with his 1-year old sister, Ke'onte became a ward of the state at the tender age of four. Ke'onte was placed with a relative who, he said, beat him with belts, switches, and extension cords -- which not only left him with the physical scars on his body he showed ABC News, but, understandably, with anger and despair.

Simply too much for the relative, the state of Texas bounced Ke'onte between six foster homes and hospitals over just four years.

Along the way, Ke'onte's trauma was treated with an onslaught of psychotropic drugs -- powerful mind-altering medicines like the mood-stabilizer Depakote, the stimulant Vyvanse, the antidepressant Lexapro, clonidine for ADHD and the antipsychotic Seroquel.

"I was put on bipolar meds. I am not bipolar at all," Ke'onte told ABC News' Diane Sawyer.

Ke'onte was on at least 12 psychiatric medications while in foster care, up to four of them at the same time.

"I was on a whole lot of medicines that I should have not been on," Ke'onte told ABC News.

READ: A Resource Guide for Children in Foster Care

But Ke'onte is lucky -- a member of a select group of foster kids, about one in 10, who leave state custody to enjoy the security and stability of being adopted by a loving family, according to the latest data from the Administration for Children and Families.

And his new family, Carol and Scott Cook, were on a mission to get Ke'onte off drugs; he is now in therapy, beginning to heal. Additionally, his doctor now says Ke'onte doesn't have ADHD and he's not bipolar.

Meds Aren't Always the Answer

While almost all experts acknowledge children in foster care have more emotional and behavioral issues, experts ABC News spoke to do not believe this alone justifies the magnitude of the overuse of psychiatric medications in this vulnerable population.

"The general consensus is that when you're treating young children, you always try behavioral intervention before you go to medication," said Dr. Charles Zeanah, director of child and adolescent psychiatry at Tulane University.

Experts are also beginning to question the accuracy of diagnoses such as bipolar disorder and other mental illnesses in children, especially in foster children who may not always have access to comprehensive mental health services.

Stephen Crystal, director of the Center for Education and Research on Mental Health Therapeutics at Rutgers University, said while foster kids may be three times as likely to be diagnosed with bipolar disorder, "the validity of these diagnoses is uncertain, and the fact of being in foster care may itself increase the likelihood of psychiatric conditions being diagnosed."

While the National Institute of Mental Health reports schizophrenia affects just 1 percent of the population and bipolar disorder less than 3 percent of the population, antipsychotics have become one of the top-selling classes of medications in the United States, with 2010 prescription sales of $16.2 billion, according to IMS Health.

Concerned about numerous reports of waste and the abuse of psychiatric medications in foster children, Republican and Democratic United States senators, led by Sen. Carper, requested an independent GAO investigation on the growing problem nearly two years ago.

In the five states included in this week's GAO report, more than $375 million was spent on psychiatric drugs in 2008, $200 million of which was spent in Texas alone.

Medicaid spends at least $6 billion a year, nearly 30 percent of its entire drug budget, on psychiatric drugs, more than double what was spent in 1999, according to the Centers for Medicaid and Medicare Services.

GAO Holds HHS Accountable

The GAO report is an indictment on HHS's oversight of the nation's foster care children and asks that "HHS consider endorsing guidance for states on best practices for overseeing psychotropic prescriptions for foster children."

Several factors may be contributing to the increasing number of psychotropic prescriptions for foster children: greater exposure to trauma before entering the foster care system, frequent changes in foster placements and lax oversight policies on the part of states.

"You know, there are a lot of people you need to talk to, to find out as much as you can about what the child's behavior is like in a variety of different situations before you make a determination that you're going to use something like a very powerful medication to treat them," Zeanah said.

The GAO found that Texas, Massachusetts, Michigan, Oregon, and Florida each "falls short of providing comprehensive oversight as defined by the American Academy of Child and Adolescent Psychiatry" with regards to prescribing and overseeing the use of psychotropic drugs.

Currently, HHS simply provides "informational resources for states to consider for their programs" when it comes to psychotropic drugs provided to children in state custody according to the GAO.

States are not obligated to follow consent and oversight best principle guidelines set by the American Academy of Child and Adolescent Psychiatry for medicating foster children.

However, many states are also not following oversight provisions required by law, according to the Child and Family Services Improvement and Innovation Act passed in September 2011 and the Fostering Connections to Success and Increasing Adoptions Act of 2008.

In addition to providing guidance, HHS also has the authority to withhold federal funds from states that do not comply with strengthened oversight measures.

Sen. Carper said Congress has a responsibility, too -- "to try to get to the bottom of this, and armed with that information, to make sure that behavior is changed, that's going to be beneficial to children."

HHS Sends Letter to States the Day Before Thanksgiving

HHS was given an early look at the GAO report and issued a letter to states the day before Thanksgiving regarding the effective use of psychotropic medications among children in foster care.

"Too many states, I'm afraid, just don't know what best practices are," Carper said.

But states have been asking for help for years.

One state official told researchers at Tufts, "[We] need guidelines to determine whether medications are needed and, if so, for how long."

HHS said it will "offer expanded opportunities to states and territories to strengthen their systems of prescribing and monitoring psychotropic medication use among children in foster care."

Dr. Christopher Bellonci, a child psychiatrist and author of a 2010 Tufts study that showed nearly 50 percent of states either didn't have, or were still in the process of developing, policies regarding foster care psychotropic drug use, thinks HHS guidance for states on best practices, while good, are not enough.

Bellonci told ABC News the states should have to report pharmacy claims of actual psychotropic drugs given to foster children.

"We need to be able to benchmark states around one another, then at least it is all public record," Bellonci said.

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