It's bedtime in Louisville, Ky., and 7-year-old Jeremiah squirts "Monster Spray" under his bed, in his closet and on his pillow before saying his nightly prayers. The spray -- a homemade concoction of water, food coloring and a dab of courage -- is an old standby for many parents with children afraid of the dark, but in this instance, it's been prescribed by Jeremiah's therapist, David Crowley, to protect Jeremiah from memories of the past that haunt his nights.
Jeremiah and his three siblings are part of the foster program run by Maryhurst, a nonprofit agency that devotes itself to neglected and abused children in Kentucky. The agency takes in foster children who have endured some of the most horrific situations in the state. In Jeremiah's case, he and his siblings entered foster care in 2009 amid allegations of extreme neglect. They rarely saw doctors or went to school, and were frequently hungry. Jeremiah still has nightmares of a house fire that nearly killed them.
In therapy, Jeremiah talks about the fire with Crowley.
"It was getting bigger and bigger," he said.
To control his moods, Jeremiah was prescribed a psychotropic medication. At Maryhurst, Crowley also uses therapy to help Jeremiah work through his bad memories.
"We focus on relying on the strengths that the child has and using a team approach by consulting with psychiatrists, with the individuals that work with them on a daily basis, with the therapists, with parents, and with foster or adoptive parents," Crowley said. "If we just focus solely on medications to fix acting out behavior or to help improve their mood, then if you take those medications away, then the core issue's still there."
Three-quarters of the children who enter Maryhurst's program are on psychotropic drugs, but by the time they leave, well over half are on reduced or no medication at all.
"Our children come to us on many medications, but over time we want to reduce the medication as much as possible and hopefully, to where they wouldn't need any at all. That's a fine balance, but we want them to be able to participate in the treatment and if they're overmedicated, they can't do that," said Maryhurst president and CEO Judy Lambeth.
It's an old-fashioned approach to taking care of kids within a foster care system that's under increased scrutiny this week. A Government Accountability Report released Thursday revealed that America's foster children have been prescribed powerful psychotropic drugs at doses beyond what the Food and Drug Administration has approved. At a congressional hearing Thursday, lawmakers were interested in hearing about both the problem and possible solutions.
"We need to find out what works and do more of that," said Sen. Thomas Carper, D-Del., who asked for the GAO investigation.
Former foster child Ke'onte Cook, 12, testified at the hearing, Ke'Onte was on multiple psychotropic medications during the four years he was in foster care, but is now on none.
"I think therapy is a better choice over meds if meds are not a necessity in that moment," he said.
The children at Maryhurst agree -- and say it's the patience and care of the staff that has changed them.
Gabby, 16, says that being at Maryhurst saved her life. When she was 12 years old, she moved into one of Maryhurst's residential treatment facilities weighing 220 pounds. She says the weight gain was a result of all the psychotropic medications she was prescribed in foster care.
"Strattera, Remeron, Risperdol, Wellbutrin, Seroquel, Depakote, Trilyptal and Abilify," Gabby says. "The doctors didn't even ask me if I was okay taking the medicine, did not explain to me what it was for. I just took them."
At Maryhurst, though, Gabby built a strong relationship with the staff psychiatrist and together, they decided to reduce her medication.
"We decided to try taking me off of them to see how I would do and I did fine. I started acting myself again," she says. "After I was off the medicine, I was happier than I've ever been in my life."
Off the medication, Gabby also began losing weight – and is now nearly 100 pounds lighter than she was when she entered Maryhurst. She's also been adopted and is now focused on graduating from high school next year.
Back at Maryhurst, Jeremiah continues his treatment with Crowley. They meet once a week. Given the choice, Jeremiah says he'd rather talk to Crowley than take his medications. Why? "Because I have lots of fun," he says.