Vulnerable kids in foster care were taking too many — or too few — psychiatric drugs when the systems in charge of their welfare weren’t paying attention, a new government report released Monday found. One nurse coordinator listed in the report — conducted by investigators at the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services — questioned why a 6-year-old boy in foster care was prescribed four psychotropic drugs, especially since a dosage increase in one of the drugs negated the need for another medication he was on. There wasn’t any evidence that a treatment plan was developed before the boy started taking the drugs, government investigators discovered, despite the fact that his state required it. On the other hand, an 11-year-old child in foster care couldn’t get either of his two psychotropic medications for three months. In that span of time, he lost the ability to maintain normal psychological function. There wasn’t any state requirement that caseworkers follow up with the child’s foster mother about his outcome — or determine what would happen if he went without his drugs.
Foster children, many of whom rely on Medicaid, are often prescribed drugs at higher rates than non-foster kids because they’re more likely to experience mental health issues. The report examined the Medicaid claims and foster care eligibility data of the five states with the highest percentages of children in foster care that were also being treated with psychotropic drugs — Iowa, Maine, New Hampshire, North Dakota and Virginia — from October 2014 through the end of March 2015. The investigators then selected a random sample of 125 children from each of the states, but wound up excluding 36 kids from the study population.
In five states, investigators found that 34 percent of children in foster care didn’t receive required mental health treatment planning or medication monitoring over a period of time. That means one in three kids in the systems across those states largely went without critical oversight of their prescribed medications — antidepressants, antipsychotic drugs and sedatives, for example — despite repeated calls to action from advocates, physicians and even government investigators to do so over the last several years.
The medications, while helpful in some instances, are only effective when taken as prescribed and can carry severe side effects like drowsiness, weight gain, tremors, and more. In the investigators’ research, they also discovered that:
- 8 percent of those kids didn’t get any treatment planning or medication monitoring.
- 20 percent of the children didn’t get treatment planning, or some method of organizing communication between caseworkers, foster parents, and prescribers about the drugs a child was taking.
- 23 percent of children in foster care didn’t receive medication monitoring, which can reduce the risk of inappropriate dosing or combinations of drugs.
An estimated 500,000 kids are currently living in foster care in the United States, and that rate has been pushed higher by the opioid epidemic over the last three consecutive years, according to the Brookings Institute. Officials in states like West Virginia have said they’re in crisis, with too many kids and too few families and caseworkers to go around.
“Foster care children, unlike children in intact families, have lost a consistent primarily interested party,” said Ann Maxwell, assistant inspector general for evaluations in the Department of Health and Human Services’ Office of the Inspector General. “They’ve lost a singular point of advocacy, and instead, who is trying to support them is fragmented.” “The paperwork, frankly, becomes their bridge,” Maxwell added.
Right now, that bridge isn’t all there.
And this isn’t the first time a government agency has called out the foster care system, either. In 2011, the U.S. Government Accountability Office (GAO) released an alarming report that a significant number of children, some of them infants, in the government’s care in Florida, Maryland, Massachusetts, Michigan, Oregon and Texas were being prescribed five or more psychotropic drugs at a time. After the GAO’s report, the U.S. Health and Human Services’ Office of the Inspector General found in a 2015 review of kids on Medicaid that there were serious “quality-of-care concerns” in the treatment of children with second-generation antipsychotic drugs, such as poor monitoring of kids, potential for incorrect treatment and too many prescription drugs with harmful side effects. Officials from the five states in Monday’s report told investigators that there are barriers in their agencies to providing required services, such as a lack of data, limited access to mental health services or inadequate assistance from the federal government. They also cited high rates of turnover among caseworkers. “No system can ensure perfect compliance,” Maxwell said. “That doesn’t mean we shouldn’t keep trying, these kids are already vulnerable.”
Cover image: In this May 10, 2018 photo, a foster mother holds two pairs of shoes from two of her former foster care children outside her home in Pleasant Grove, Kan. (Nick Krug /The Lawrence Journal-World via AP)