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)

Findings

• 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.

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.    

Picture Books About Foster Care

HELPING CHILDREN TALK ABOUT THEIR FOSTER CARE EXPERIENCE

A Child is A Child by Brigette Weninger, 2004. After two young frogs are abandoned by their parents, Mama Mouse mobilizes the entire animal community to help care for them.

Aunt Minnie McGranahan by Mary Skillings Prigger, 1999. Based on a true story; when nine orphans came to live with her, Aunt Minnie came up with a solution: "The oldest looked after the youngest, the ones in the middle looked after each other, and Aunt Minnie looked after them all.”

A Father Like That by Charlotte Zolotow, 2007. A boy growing up without a father lists the activities that he wishes they could share, and decides to grow up and become the type of father that he never had.

Foster Parents by Rebecca Rissman, 2011. Describes what foster families are and how they care for children who need help until they return to their original families or move on to a permanent family.

Goodbyes by Shelley Rotner, 2002. Simple text, accompanied by photos, explains that sometimes people live in more than one home, and that goodbyes might not be forever, but might be just “bye for now.”

Kids Need to be Safe by Julie Nelson, 2005. This book is designed to help foster children understand why they aren’t currently with their biological parents, and offer them hope and reassurance.

Let’s Talk About When Your Parent is in Jail by Maureen K. Wittbold, 1997. Having a parent in jail can be one of the reasons that children enter foster care. This book answers many questions that children can be harboring.

Maybe Days: A Book for Children in Foster Care by Jennifer Wilgocki and Marcia K. Wright, 2002. Provides a simple explanation for children in foster care about the processes impacting their lives, and acknowledges the questions for which there is no easy answer, such as: “When am I going home?”

A Mother for Choco by Keiko Kasza, 1992. A motherless bird searches for the right place to belong – and finally finds it with Mrs. Bear, who takes Choco into her loving home and introduces him to his new siblings.

Murphy’s Three Homes by Jan Levinson Gilman, 2008. A puppy who moves from home to home learns that it is not his fault, and finds a family who will love him even if he struggles to obey their rules.

My Dog Is As Smelly As Dirty Socks by Hanoch Piven, 2007. During their time in foster care, children often create Life Books with pictures and stories about their biological families. This book, while not specifically geared towards foster care, suggests creative collage techniques that might work well in Life Books. 

Our Gracie Aunt by Jacqueline Woodson, 2002. Initially reluctant to open the door to a social worker asking how long their mother has been gone, two children find comfort and safety at their Aunt Gracie’s house.

When I Miss You by Cornelia Maude Spelman, 2004. Various situations can cause a child to be separated from parents – for a short or long time. This book is a tool for caregivers to assist children of all backgrounds to share what it feels like to miss someone and problem-solve what to do while waiting to be reunited.