GAO Investigates Drugging Foster Kids

[Dethgurl]

At the request of Congress, GAO is seeking information regarding cases in which state foster children have been prescribed psychotropic medication outside of federal regulations or accepted medical standards of practice.  
These may include very young foster children prescribed certain kinds of psychotropic drugs, children prescribed psychotropic drugs in dosages that exceed accepted standards, children prescribed psychotropic drugs for purposes other than a medically accepted indication, or children taking numerous psychotropic drugs concurrently.  
If you have information about state foster children being prescribed psychotropic medication outside of regulatory and/or medical guidance and are willing to provide details, please e-mail GAO at FosterKids@gao.gov.

 
Scott Clayton

Analyst, Forensic Audits and Special Investigations

U.S. Government Accountability Office (GAO)

1999 Bryan Street, Suite 2200

Dallas, TX 75201-6848

(214) 777-5721          

(214) 777-5758 Fax

[Whooter]

At the request of Congress, GAO is seeking information regarding cases in which state foster children have been prescribed psychotropic medication outside of federal regulations or accepted medical standards of practice.  
These may include very young foster children prescribed certain kinds of psychotropic drugs, children prescribed psychotropic drugs in dosages that exceed accepted standards, children prescribed psychotropic drugs for purposes other than a medically accepted indication, or children taking numerous psychotropic drugs concurrently.  
If you have information about state foster children being prescribed psychotropic medication outside of regulatory and/or medical guidance and are willing to provide details, please e-mail GAO at FosterKids@gao.gov.

 
Scott Clayton

Analyst, Forensic Audits and Special Investigations

U.S. Government Accountability Office (GAO)

1999 Bryan Street, Suite 2200

Dallas, TX 75201-6848

(214) 777-5721          

(214) 777-5758 Fax

If a foster parent can show that one or more of their children is special needs then they will get more compensation from the state.  The more screwed up the child is the more money they get.  So there is an incentive to screw up the child with medication.  Also if the child is on anything good then the foster parents can restrict it from the child and sell it or take it themselves.  

Huge loop holes



...

[Dethgurl]

I agree, this happens all of the time.
The System has FAILED.

[AuntieEm2]

I'm glad to hear this. The GAO investigations of abuse, maltreatment and death of teens in residential programs have been enormously helpful to advocates for protecting teens, and damning to the industry. The GAO has also documented the widespread use of deceptive marketing practices by the wildly profitable "troubled teen" industry, and the abuses and death caused by use of seclusion and restraint in such programs.

Here are some links:
http://www.gao.gov/new.items/d08146t.pdf
http://www.gao.gov/new.items/d08713t.pdf
http://www.gao.gov/new.items/d09719t.pdf

The investigations led to passage of HR-911.

Auntie Em

[seamus]

There is a documentary, called Generation RX, that somebody I know has on dvd, that covers a shitload of this and similar topics,mostly about drugging children. If I had alink Id post it. I solidly recomend watching this. :nods:

[Whooter]

The GAO provides a vital service to the American People with its mission of exposing corruption and improving performance.  By investigating and exposing the corruption within the foster Care system it will hopefully result in improving the Foster Care system as it has done with the TTI.  There is no intent on shutting the Foster Care system down.  The investigation will hopefully result in exposing the holes (legal and non-legal) which are being used to exploit the system and the children within it.  This will ultimately result in strengthening the system and providing a safer environment for our children as it has with the TTI in passing HR-911.



...

[heretik]

There is a documentary, called Generation RX, that somebody I know has on dvd, that covers a shitload of this and similar topics,mostly about drugging children. If I had alink Id post it. I solidly recomend watching this. :nods:

Netflix's, go there. Not plugg'in but it is a cheap way to watch "everything". It is either streaming or DVD.  Generation RX is there, Netflix's is $10 a month.

[seamus]

The GAO provides a vital service to the American People with its mission of exposing corruption and improving performance.  By investigating and exposing the corruption within the foster Care system it will hopefully result in improving the Foster Care system as it has done with the TTI.  There is no intent on shutting the Foster Care system down.  The investigation will hopefully result in exposing the holes (legal and non-legal) which are being used to exploit the system and the children within it.  This will ultimately result in strengthening the system and providing a safer environment for our children as it has with the TTI in passing HR-911.



...

The GAO seriously needs to look at the FDA.....Diagnostic manuals edited by folks on the payroll of big pharma? I definately call shenanigans on that shit. :nods:
                                                 Again please watch Generation RX,well worth it :nods:

[Whooter]

The GAO provides a vital service to the American People with its mission of exposing corruption and improving performance.  By investigating and exposing the corruption within the foster Care system it will hopefully result in improving the Foster Care system as it has done with the TTI.  There is no intent on shutting the Foster Care system down.  The investigation will hopefully result in exposing the holes (legal and non-legal) which are being used to exploit the system and the children within it.  This will ultimately result in strengthening the system and providing a safer environment for our children as it has with the TTI in passing HR-911.



...

The GAO seriously needs to look at the FDA.....Diagnostic manuals edited by folks on the payroll of big pharma? I definately call shenanigans on that shit. :nods:
                                                 Again please watch Generation RX,well worth it :nods:

I will see if I can find that, Seamus, thanks.



...

[axe murderer]

PBS series Need to Know aired a segment on the misuse and overuse of psychiatric medications on foster children:

http://www.pbs.org/wnet/need-to-know/he ... dren/6232/

[Dethgurl]

ABC NEWS November 30, 2011 - Psych Drugs - Kids

http://http://youtu.be/ZY-kzjF_d8w

[Dethgurl]

Taxpayer money used to overmedicate foster children

http://http://www.cbsnews.com/8301-31727_162-57334092-10391695/taxpayer-money-used-to-overmedicate-foster-children/

Children in foster care in five states are taking psychotropic drugs at a rate "two to over four times higher" than non-foster children in Medicaid according to a draft of a new government report obtained by CBS News.

Data in the new report from the Government Accountability Office (GAO) shows that in the five states examined, 609 foster children and over 1,100 non-foster children were taking five or more psychotropic drugs at one time, a "high-risk practice" that lacks sufficient scientific data, according to experts consulted for the study. The report also found that over 20,000 foster and non-foster children were taking dosages that "exceeded the maximum standards published in medical literature."

Read a draft of the GAO report:http://http://www.cbsnews.com/htdocs/pdf/GAO_REPORT_DRAFT_192343.pdf

Psychotropic drugs are used to treat mental disorders in adults and in some cases are approved for use in children. Data from five states: Oregon, Florida, Massachusetts, Michigan and Texas was included in the report.

"The GAO report will hopefully spur states to strengthen their oversight and control over the effective management of psychotropic medications prescribed to youth in foster care," said Dr. Mark Olfson, Professor of Clinical Psychiatry at Columbia University who authored the key 2009 study on foster children and anti-psychotic use, "For foster children with psychiatric disorders, careful medication management strategies are central to improving quality of care," he said.

Almost 40 percent of children in the Massachusetts foster care system are taking at least one psychotropic drug according to the report that is raising concerns among officials at the U.S. Department of Health and Human Services.

In a recent letter to state Medicaid directors obtained by CBS News, the head of the U.S. Administration for Children and Families said the agency has become "increasingly concerned about the safe, appropriate and effective use of psychotropic medications among children in foster care."

The report also found almost 4,000 foster and non-foster care infants - under a year old - on Medicaid in five states were taking psychotropic drugs. Researchers said the risks these drugs pose to children are "not well understood".

The five states in the report spent $375 million for psychotropic prescriptions for children covered by Medicaid including $59 million for children in foster care.

The GAO report will be the subject of a Senate hearing Thursday on Capitol Hill.

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

http://http://abcnews.go.com/US/study-shows-foster-children-high-rates-prescription-psychiatric/story?id=15058380#.TtebJVqF8sp

By DR. MARK ABDELMALEK, BRINDA ADHIKARI, SARAH KOCH, JOSEPH DIAZ and CLAIRE WEINRAUB

Nov. 30, 2011

The federal government has not done enough to oversee the treatment of America's foster children with powerful mind-altering drugs, according to a Government Accountability Office (GAO) report to be released Thursday.

ABC News was given exclusive access to the GAO report, which capped off a nationwide yearlong investigation by ABC News on the overuse of the most powerful mind-altering drugs on many of the country's nearly 425,000 foster children.

The GAO's report, based on a two-year-long investigation, looked at five states -- Florida, Massachusetts, Michigan, Oregon and Texas. Thousands of foster children were being prescribed psychiatric medications at doses higher than the maximum levels approved by the Food and Drug Administration (FDA) in these five states alone. And hundreds of foster children received five or more psychiatric drugs at the same time despite absolutely no evidence supporting the simultaneous use or safety of this number of psychiatric drugs taken together.

GAO Key Findings

Overall, the GAO looked at nearly 100,000 foster children in the five states and found that nearly one-third of foster children were prescribed at least one psychiatric drug.

The GAO found foster children were prescribed psychotropic drugs at rates up to nearly five times higher than non-foster children, with foster children in Texas being the most likely to receive the medications compared to foster children in the other four states.

Although the actual percentages of children who received five or more psychiatric drugs at the same time were low in the five states included in the GAO report, the chances of a foster child compared to a non-foster child being given five or more psychiatric drugs at the same time were alarming.

In Texas, foster children were 53 times more likely to be prescribed five or more psychiatric medications at the same time than non-foster children. In Massachusetts, they were 19 times more likely. In Michigan, the number was 15 times. It was 13 times in Oregon. And in Florida, foster children were nearly four times as likely to be given five or more psychotropic medications at the same time compared to non-foster children.

Initially part of GAO's investigation, Maryland was later excluded from GAO's analysis "due to the unreliability of their foster care data" according to the report, a problem ABC News learned many states face.

Foster children were also more than nine times more likely than non-foster children to be prescribed drugs for which there was no FDA-recommended dose for their age.

For the most vulnerable foster children, those less than 1 year old, foster children were nearly twice as likely to be prescribed a psychiatric drug compared to non-foster children.

When Sen. Thomas Carper, D-Del., lead requestor of the GAO report, first learned of the report's findings, he said, "I was almost despondent to believe that the kids under the age of one, babies under the age of one were receiving this kind of medication."

ABC News has reviewed dozens of medical studies published in recent years that echo GAO's findings -- research showing foster children receive psychiatric medications up to 13 times more often than kids in the general population.

In some parts of the country, as many as half of foster kids are on one or more psychiatric medications. This, compared to just 4 percent of kids in the general population.

Dr. George Fouras, a child psychiatrist and co-chairman of the Adoption and Foster Care Committee of the American Academy of Child and Adolescent Psychiatry (AACAP), said, "There is an incredible push to use medications to solve these problems as if it is a magic wand."

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.

Background on the Drugs

Antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers are some of the so-called psychotropic drugs -- psychiatric medicines that alter chemical levels in the brain, which impacts mood and behavior.

Of the psychotropics, antipsychotics, like Ke'onte's Seroquel and others like Abilify, Risperdal, Zyprexa, Geodon, Invega, Latuda, Fanapt, Clozaril, Saphris and Solian, are among the most powerful.

Of all the psychiatric medications, antipsychotics are, by far, the most prescribed, especially for foster children. Foster children are given antipsychotics at a rate nine times higher than children not in foster care, according to a 2010 16-state analysis by Rutgers University of nearly 300,000 foster children.

While doctors aren't exactly sure how or even why antipsychotics work, most experts believe antipsychotics block specific receptors in the brain, which are thought to be overactive in patients with symptoms of psychoses, such as hallucinations and delusions.

Antipsychotics were initially designed for schizophrenia and bipolar disorder. Only Seroquel, Abilify, Risperdal, and Zyprexa have very limited FDA-approval for use in children.

However, antipsychotics are being widely prescribed off-label, meaning for conditions the FDA has not approved them for, for things like agitation, anxiety, acting out, irritability, behavior issues and even as sleeping aids.

Dr. Jeffrey Thompson, chief medical officer for Medicaid in the state of Washington, said, "Nobody gets up in the morning to overdose kids. It just happens that it's a momentum in the system. Kids get aggressively diagnosed and sometimes we look for the easy solution, which is a pill over psychotherapy or better parenting."

Critics charge that, because of their sedating properties, antipsychotics are actually being used in foster care treatment facilities as chemical restraints.

Dr. Fouras is particularly concerned about the use of these drugs as chemical restraints.

"We are trying to put a nice shiny term that sounds [as if] 'oh, we're just restraining the kid,' [when] really what you are doing is just knocking them out to make them less of a problem for you," Fouras said.

This widespread and frequently unchecked use of antipsychotics is concerning considering the serious side effects of these medications. Antipsychotics change a person's metabolism, frequently cause significant weight gain and can increase the risk of diabetes.

In addition to tremors, muscle spasms and restlessness, antipsychotics can cause tardive dyskinesia, a permanent and irreversible condition where a person has involuntary movements of the tongue, lip, mouth, and arms and legs.

While less common with newer antipsychotics, each year 5 percent of people on antipsychotics will develop tardive dyskinesia, according to the National Institute of Mental Health.

Many experts are also concerned about the prolonged use of antipsychotics in children, given there are absolutely no long-term safety studies for their use in children.

Fouras said, "Some of these medications have only been out for 10 to 15 years, so that is not enough time to know what is going to happen over the long term."

World News:http://http://abcnews.go.com/watch/world-news-with-diane-sawyer/SH5585921/VD55155741/world-news-1130-too-many-meds-for-foster-kids

[axe murderer]

The National Coalition for Child Protection Reform (NCCPR)'s response to LAST NIGHT's ABC News 20/20 Special on foster care: http://www.nccpr.org/reports/abcnews.pdf

[Ursus]

Here's that piece by Richard Wexler of NCCPR:

-------------- • -------------- • --------------

National Coalition for Child Protection Reform / 53 Skyhill Road (Suite 202) / Alexandria, Virginia, 22314  (703) 212-2006 / http://www.nccpr.org / http://bit.ly/6neiVw) Indeed, though this is the second time in five years ABC has done such a commercial for the same residential treatment center, Maryhurst, in Kentucky, in neither case was there any independent evaluation of the program – only children put forward by the institution itself and the institution's own director.

What makes this almost Orwellian is the fact that the topic of the whole program was the misuse and overuse of psychiatric medication on foster children. And across the country residential treatment centers are the places most likely to misuse and overuse psychiatric medication on children. To suggest such places as a solution is to endanger children.

ABC News claimed that children left Maryhurst on no meds or fewer meds 75 percent of the time. But that can mean simply that they went from five drugs to four. As with everything else about Maryhurst there was no independent verification, and you can bet ABC News didn't check. But most important, the notion that you have to institutionalize children to get them off psychiatric medication was contradicted by the rest of the program, which featured children who got off the meds without being institutionalized.

While the institution got its commercial ABC got a chance to exploit a couple of kids.

I have no problem with showing children's faces on camera and even having them discuss the pain in their lives – if there is someone with the legal and the moral authority to provide informed consent. That means someone who loves that child, not a person or an institution who will gain personally.

In almost every case on this program there was someone with that moral authority – an adoptive parent. That was even true with the youngest children at Maryhurst. But not the teenagers. Who, then, gave consent? Presumably the institution itself.  And the bromides from the director notwithstanding, institutions do not love children. The institution also had a vested interest in giving this permission. It was child exploitation by the institution and  child exploitation by ABC News.

Granted, in 2006, it was worse. As we discussed in detail on our child welfare blog at the time, available here: http://bit.ly/uLqEq4, then they put on camera an 11-year-old with an unusual first name who was seen not only talking about being abused, but becoming an abuser herself. She was seen during some of the most painful imaginable moments of her young life.

After my organization and a grassroots family advocacy group, the Child Welfare Organizing Project (http://www.cwop.org) met with ABC News producers to complain, that child’s photo and information were removed from the ABC News website. But I also hoped ABC would raise its standards beyond the improvement seen tonight – fewer children exploited and they were older.

THE DISNEY VERSION

But all this was necessary to maintain the larger fiction that all parents who lose children to foster care supposedly are sick or evil, while white middle-class foster and adoptive parents are saints. As ABC's parent company might say, that's the Disney version.

The reality is a lot more complicated. Many children never needed to be taken from their own homes in the first place. Contrary to the common stereotype, most parents who lose their children to foster care are neither brutally abusive nor hopelessly addicted. Far more common are cases in which family poverty is confused with "neglect." (Details at http://www.nccpr.org) As it happens, there is another video just out that tells the stories ABC News systematically omitted. It's not quite as slick, but it's a whole lot more real: http://vimeo.com/32337815

When children really must be taken, study after study has shown they are better off – and safer – placed with relatives.  They're also a lot less likely to be overmedicated. Florida found that when a child is placed with a grandmother or other relative he is dramatically less likely to wind up on meds than when that child is placed in an institution, a group home, or even a foster home with a stranger.

It's not hard to figure out why. Unlike the strangers, grandparents typically love the children they're caring for – so they'll put up with a lot more instead of rushing to seek a prescription to make a child docile and easier to manage.

You can't fix this with another regulation because you can't legislate love. The only way to significantly reduce the use of psychiatric medication in foster care is to significantly reduce foster care.

THE FEDERAL ROLE

Nevertheless, the federal government is doing more than ABC News let on – again, because it would spoil the network's "master narrative."

The network left the impression that no one at the federal Department of Health and Human Services would talk to them except one bureaucrat from the FDA seemingly sent up by central casting to play the role of "heartless bureaucrat." (And, in fact, it's good that ABC exposed the fact that the FDA is clueless about the special issues involving foster children, and chose to put forward to discuss the issue someone who displayed all the empathy and compassion of former BP CEO Tony "I want my life back" Hayward.) But the program also left the impression that no one at HHS wants to take ownership of this issue.

That's not true, and ABC News knows it.

Ever since he took the job of Acting Assistant Commissioner for the part of HHS specifically responsible for foster children, the Administration for Children and Families, only six months ago, George Sheldon has made trying to control overmedication of foster children a top priority. And it was only in these past six months that HHS finally began moving on this issue.

ABC News didn't say if it tried to interview Sheldon in his present job. But ABC already had interviewed Sheldon for this program when he held his previous job, Secretary of the Florida Department of Children and Families. He was running the agency when Gabriel Myers, whose case was discussed on the program, died – and he led the effort to reform the misuse of overuse of psychiatric medication in Florida as a result.

But of course, showing any of that interview, noting his accomplishments in Florida and then noting Sheldon's new job would have ruined the whole "heartless, clueless bureaucrats" theme that was another part of the network's "master narrative."


####

[cmack]

I watched the 20/20 segment. It didn't really tell me anything I didn't already know. I don't think we're going to see a solution to the problem anytime soon. For years I was opposed to the UN treaty on the Rights of Children because I thought it would result in nothing more than a government power grab, but until we as a nation recognize than young people have individual rights apart from their parents and caregivers we are going to continue to see such abuses.

I support laws such as exist in Washington State http://cafety.org/index.php?option=com_ ... &Itemid=35, to grant to those 13-years of age or older the right to consent or refuse consent to mental or substance abuse treatment. Also, I think they should be able to make decisions regarding their medical care. Young people are capable of doing a lot more than we often give them credit for.