Wednesday, December 21, 2011

State of Young America: Youth Housing

According to The State of Young America: Economic Barriers to the American Dream:

The share of young households spending more than 30% of income on rent was stable for two decades, but grew after 2000 to reach 41% in 2009.

Long-term economic trends, rising rental costs, and the Great Recession can all be seen in the decision to move home with parents.

The State of Young America: Student Financial Aid

According to The State of Young America: Economic Barriers to the American Dream:

Student financial aid has not kept up with increasing costs. In 1980 the maximum Pell Grant covered 69% of attendance, today it covers 34%.

The State of Young America: Lower Earnings for Young Adults Without a High School Diploma

According to The State of Young America: Economic Barriers to the American Dream:

Young men without a high school diploma have experienced a 28% drop in earnings since 1980. Young women’s earnings also lost ground, dropping 8 percent.

Monday, December 19, 2011

Authentic Youth Engagement

The Jim Casey Youth Opportunities Initiative recently released a publication titled: Authentic Youth Engagement: Youth-Adult Partnerships.

Unpacking the "Why" Behind Authentic Youth Engagement:
  • "Engaging adolescents in planning and decisionmaking regarding their own lives—and the larger community—reaps critical benefits throughout the process of transitioning to adulthood."
  • "Emerging knowledge in the field of neuroscience tells us that during adolescence and young adulthood the brain is undergoing extensive remodeling and that experience plays a critical role in how the brain matures."
I completely agree that:
  • "Young people in foster care have often been removed from natural opportunities for decisionmaking, community engagement, and leadership and they experience a sense of powerlessness and isolation."
  • "The intentional creation of leadership and community engagement opportunities is therefore particularly important for this group of young people."
Read more in this excellent resource...

Friday, December 02, 2011

What If Every State Had Foster Care Medical Review Panel?

What if every state had a Foster Care Medical Review Panel, serving in a role similar to a Medical Ombudsman, that foster care youth, alumni, foster parents, CASA/GAL, etc. could contact with  concerns about over-medication?   

Forgotten Children A Special Report on the Texas Foster Care System Comptroller Carole Keeton Strayhorn (April 2004)


  • DPRS exercised little meaningful oversight over the treatment of foster children with psychotropic medications.
  • No formal investigation related to psychotropic medications had ever been conducted.
  • YFT did not attempt to assess the appropriateness of medications.
  • Many foster children were being prescribed psychotropic medications by physicians who were not trained in child psychiatry.
  • Even though federal law requires a foster child’s medical records to be reviewed, updated and given to foster care providers, foster care providers of 46% children in a study conducted by the OIG never received medical histories of the children in care, including children with serious medical conditions.   Without access to a child’s medical records, it was difficult for foster parents to effectively care for foster children.

Challenges Noted:
The Advisory Committee recognized that “[c]oncerns exist regarding the inappropriate use of psychotropic medication and inadequate monitoring of prescribed medications.  

There was also a lack of data available regarding physician prescribing practices and child outcomes.  Children in foster care may be subject to widely varied standards of care.  There is currently no way to monitor the quality of care and no system for resolving concerns associated with the use of psychotropic medication for children. 

Also there is no method for “second” opinions to be easily obtained by DFPS staff when they have concerns or questions.”

In response, their plan was to:
  • Develop review panels of medical professionals including (trauma-informed) child psychiatrists to provide recommendations regarding care for foster children where there is a question on whether their care is clinically appropriate.
  • Establish clinical guidelines and protocols for psychotropic medications and a review process for identifying children’s medical records that fall outside the guidelines and reviewing them for inquiry or possible corrective action.
  • Develop a medical and educational passport for each child that follows the child through placement changes and is readily available to healthcare providers and schools electronically.

The Financial and Societal Costs of Medicating America's Foster Children

A Senate hearing was held yesterday, "The Financial and Societal Costs of Medicating America’s Foster Children."

Mr. Bryan Samuels, Commissioner, Administration on Children, Youth and Families, U.S. Department of Health and Human Services, gave the following testimony: "During my tenure as Director, DCFS developed a comprehensive system of protocols and safeties to ensure that psychotropic medications are prescribed responsibly and monitored consistently."

This included:
  • Requiring that all prescriptions be reviewed and approved at the State Deputy Director level; 
  • Establishing time-limits for reviews to ensure that necessary treatment was not delayed;   
  • Developing an electronic database for tracking all prescriptions for children in foster care;
  • Creating “red flags” in the database that elevated certain cases, such as those in which three or more medications were prescribed, for more thorough review; and
  • Establishing best practice guidelines and distributing them to prescribers. The electronic database was also designed to identify providers whose patterns of prescribing differed from the guidelines.

Drugging Foster Youth - Influence of Pharmaceutical Companies

Quotes from Time Magazine article: Szalavitz, Maia. Why Are So Many Foster Care Children Taking Antipsychotics?Time Magazine, November 29, 2011 .
  • "The influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving anti-psychotic medications in the study were given atypical anti-psychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised .
  • "All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.
  • " The main condition that antipsychotics are approved to treat —schizophrenia — is extremely rare in children . The rate of schizophrenia in children under 12 is an estimated 2 cases per 1 million children; it affects fewer than 1% of older teens. Anti-psychotics are also approved to treat bipolar disorder, a diagnosis that is highly controversial in children . Some studies suggest that it affects 0.2% to 0.4 % of children, and up to 1% of adolescents.
  • And yet, between 1994 and 2003, rates of bipolar diagnoses in youth under 19 rose by a factor of more than 40, according to the National Institute on Mental Health. It seems unlikely to be a coincidence that this rise occurred during the period when atypical anti-psychotics were being illegally marketed for children ."
  • "Indeed, most of the anti-psychotics used in foster-care youth were for conditions that the drugs were not approved to treat . Fifty-three percent of prescriptions were written for attention deficit/hyperactivity disorder (ADHD), a condition that is ordinarily managed with drugs that have the opposite pharmacological effects as anti-psychotics. The stimulant medications like Adderall and Ritalin, widely used for ADHD, tend to increase levels of dopamine, while anti-psychotics tend to decrease it."      

Unnecessarily Drugging Foster Care Youth

A concern that comes up again and again with foster care youth and young adults is the issue of overmedication in foster care.
A new study, Antipsychotic Treatment Among Youth in Foster Care , examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:
  • More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
  • Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.
In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. 

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the u tilization of psychotropic medication for children in foster car e.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.