Are Foster Children Over-Medicated?

A two year investigation by the Government Accountability Office has shown that foster children are prescribed psychiatric durgs 2.7 to 4.5 times more than non-foster children and at much higher doses. 

Hundreds of foster children are being prescribed five or more of the medications at once, which can have severe side effects.  The report offered several explanations for the high prescription rates, noting the children had greater exposure to trauma before entering foster care and that state agencies were lax in overseeing the prescriptions.  Critics say the drugs are overused as a chemical restraint for unruly children.

"I do believe that medications are being used almost in default and my concern is that is being used in lieu of psycho-therapeutic interventions," Bellonci said.

The new report found foster children in some areas were twice as likely to be prescribed five or more of those drugs at the same time compared to non-foster children. Texas foster children were prescribed five or more medications most often.

"No evidence supports the use of five or more psychotropic drugs in adults or children, and only limited evidence supports the use of even two drugs," according to the report.

As a therapist who treats children in foster care, I have seen this myself.  As the article states, children in the foster care system are usually there because of serious abuse and/or neglect, so their psychiatric symptoms are typically much more severe than the average child.  And those "symptoms" are directly related to the abuse and neglect.  The trauma which results from such treatment requires lots and lots of counseling not just tranquilizing them and warehousing them. 

So Why are They So Heavily Medicated?

Heavy medication may be required upon entering the shelter in order to keep them calm and allow them to adjust.  But a stringent counseling component should be in place to help them develop the coping skills they need so that medication can be decreased as a safe environment is provided and adequate coping techniques are acquired. 

One of the major barriers to this is the Medicaid system which makes the paperwork for requesting counseling treatment extremely laborious and riddled with obstacles.  After filing extensive paperwork (which is a huge violation of the child's privacy), treatment for counseling is typically only approved for 3 months.  At the end of three months the entire process has to be repeated just to request another 3 months of treatment.  And counselors are not compensated for their time at a rate that is commiserate with the time and experience needed to treat children with such severe problems.  For every two hours of treatment we provide we spend another hour on the phone fighting with the insurance company trying to get paid a pittance of what it costs to provide the service. 

Americans don't like to admit it, but we place a very low value on our children in this country.  The children who are the most compromised are usually the least cared for.  Instead of skimping on the services we provide to children we should expand them, realizing that treating people in childhood may help us prevent severe behavioral problems as adults.  The Medicaid system should allow for unlimited amounts of counseling for any children placed into the foster care system.  They are there for a reason, and that reason requires serious treatment. 

What happens when you skimp on treating children with trauma issues?

I have had the misfortune to work at a homeless shelter and see these same children, after they age out of the foster care system, now roaming around in the homeless population.  Drug abuse, violent relationships and a general inability to function are rampant.  The more "successful" ones manage to navigate the disability system to get an SSI check and to qualify for public housing.  This stabilizes them but puts them permanently out of the game of life.  But at least they are housed and safe.  The less functional ones wander the streets and the homeless shelters.  Many now self-medicate themselves with drugs and alcohol to maintain the sedation which was used to treat them as children.  Some maintain their psychiatric medication through the city's medical assistance programs or the county MHMR.

I can't help but wonder if sufficient treatment as children would have changed the course. 

We can either invest in these children today or we can spend the rest of their lives locking them up for drug violations and criminal behavior or maintaining them on disability because they are too impaired to function.

 

 

 

 See the article.

 

Comments

[felix]

Kellen, Why can you not help but wonder?

I know what your gut feeling is telling you, why do you appear to doubt yourself?

You have seen the foster children age out of the care system and live on the streets yourself. You know the base cause of their problem is the trauma - because you have worked for years surrounded by the effects.

Do you use the word "wonder" to avoid seeming arrogant?

We all know how correct you are, now, what are you going to do about it?

Do other countries have a better system?

Do therapists in the us collate their findings to provide meaningful statistics - will someone listen?

In the eyes of many a government, the homeless are not worth the care nor the cost; How would you propose to alter that attitude?

Are the authorities governing the foster care system in some way influenced by the drug and insurance companies in the same way as other areas of your health care system? Talk to them Kellen.

[Calli]

I’ve read through a few of your articles and I find them to be extremely interesting and honest. Many blogs that I go on talk about depression as if it’s a disease or merely state the diagnostic criteria. I like that you write quite frankly that people need to see depression as an indicator for change (going outside in the sun, exercising, socializing). Right now, I’m considering medication and it’s difficult to make an informed decision. My therapist has recommended medication. I went to the psychiatrist but she says that I can take it if I want to but there are ‘underlying issues’. It has me a bit confused. I’m not a doctor neither am I a mental health care provider. The “I can take it if I want to” sounds to me like you don’t need it but if you feel like taking it I’ll just write a prescription. It's like eating candy. One of your articles was saying that there are a lot of people out there that don’t know how to cope. What happens when you’re just drained, why you're 'coped out' and you’ve had one trial after another? What happens when you’re not performing like your counterparts who had parents to teach them what life is about, how to do well on the job and play the game, finding a career that you love and that you are competent in (not just choosing a job that gets the bills paid, where you can get paid a reasonable sum of money (being a kindergarten teacher vs being a doctor) and have that support? I’m doing school and work and I’m now at a point where I’m just sitting there staring at the screen. I don’t want to do it anymore. I hate it. I’m in graduate school in my early 20’s. I can’t just say I’m unhappy with work and school so I’m going to quit both and start afresh. I still have to pay rent and everything else. That should be motivation enough. Reading through the internet all I see are horror stories about how antidepressants have messed up people’s lives, how bad the side effects are (lack of focus, sleepiness). Sure, it’s nice to keep in mind “look at how far I’ve come” but the external world is not going to look at you in that way. They are going to compare you to others and if you’re not up to par you will be found wanting and be rejected. Will antidepressants work to help with coping and take away the depression and anxiety so that I actually can compete?