High Rate of Foster Care Children are on Psychotropics Despite Pledged Oversight

CCHR, a mental health watchdog group, reports study showing foster care children under Medicaid are being subjected to behavior-controlling meds at rates four times greater than non-foster care kids, despite government pledges 10 years ago to curb this.

More than one-third of children on Medicaid in the foster care system are prescribed psychotropic medications, a higher amount than non-foster children under Medicaid, according to a new study led by an assistant professor of pediatrics at Baylor College of Medicine and pediatrician at Texas Children’s Hospital.[1] The psychiatric system watchdog, Citizens Commission on Human Rights International said this is a shocking finding given the outcry over psychotropic drugging of foster children in 2004 and again in 2011-2015. “Governments promised greater oversight but clearly this has been ineffective and vulnerable children are still at risk,” stated Jan Eastgate, president of CCHR International.

The study found that about 35% of children in foster care are prescribed psychotropic medications in comparison to 8% not in foster care under Medicaid. The study, “Psychotropic Medication Usage Among Foster and Non-Foster Youth on Medicaid,” was presented during the virtual American Academy of Pediatrics 2021 National Conference and Exhibition in October.[2]

Rachael J. Keefe, MD, MPH, FAAP and colleagues analyzed claims data from two Medicaid managed care organizations in southeast Texas and stated: “I think you need increased oversight, increased awareness of this overmedication.”[3]

However, CCHR points out that the epidemic of drugging foster care children was exposed over a decade ago with federal and state proposals and agreements that there would be greater oversight, which has failed.

In 2004, the drugging of foster care children in Texas—representative of the entire country—was so bad that the then-Comptroller Carole Keeton Strayhorn investigated, releasing “Forgotten Children,” a damning report on her findings. It was found that foster parents were incentivized to find “mental health problems” in the children in their care because they received up to $1,000 a day for children labeled with a mental disorder compared to $17 a day per child without such issues.[4]

The Texas Legislature responded, passing a bill which required a study of the use of psychotropic medication in foster care, strengthened medical consent requirements, and required the development of a new medical system that would give the state the ability to track and oversee each foster child’s diagnoses and prescriptions. But the problem persisted.

In 2011, the U.S. Government Accountability Office (GAO) stepped in evaluating five states (Florida, Massachusetts, Michigan, Oregon, and Texas), the data revealing that foster children were prescribed psychotropic drugs at rates 2.7 to 4.5 times higher than non-foster children in Medicaid. Many were subjected to cocktails of psychotropics. The GAO explained that “no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and non-foster children in the five states had such a drug regimen.”[5]

In 2014, JooYeun Chang, Associate Commissioner of the Children’s Bureau in the U.S. Department of Health and Human Services’ Administration (HHS) for Children, Youth, and Families testified before Congress that despite steps taken by the Administration and Congress to promote the monitoring and management of psychotropic medications, there remained an over-use of psychotropic drugs for children in foster care.[6]

A year later, an HHS Inspector General report again showed matters had not changed. It flagged 67% of those being drugged as problematic, including prescriptions to kids who were too young and prescriptions for the wrong dose or as a wrong treatment.[7] Over half of kids receiving antipsychotics were victimized by “poor monitoring” of the drugs’ risky health side effects—which include breast growth in boys [gynecomastia], cardiac arrest, extreme weight gain and diabetes,” it was reported.[8]

A 2018 JAMA Pediatric study that Investigated the patterns of mental health diagnosis and medication treatment within a cohort of children from birth to 8 years old insured by Medicaid, reported that “20% of medication users received two or more medication classes concurrently for 60 days or more.” Further, “At age 7 years, half or more of the medicated children had more than 200 days of drug exposure.” Particular attention was given to the use of antipsychotics for behavioral management in children as, “most pediatric psychotropic medication use (67%) is not approved by the Food and Drug Administration.”[9

Speaking about other antipsychotic drug risks, Harrisburg-based psychiatrist and whistleblower Dr. Stephan Kruszewski said: “Boys with gynecomastia have had breast lumps and have been lactating, and some of them have had mastectomies.”[10]

Children and youths are also put at risk of a lifetime antipsychotic side effect, tardive dyskinesia, an irreversible movement disorder.[11]

Medicaid spent about $3.5 billion a year on antipsychotics alone for all ages, largely for unaccepted uses. Nationally, about 12% of all the nation’s 500,000 foster care children had received Medicaid-paid antipsychotics at some point.[12]

Georgia spent $7.87 million a year on psychotropic drugs, according to Medicaid records and more than a third of foster children were prescribed the drugs, compared with about 4% of the general youth population.[13]

Sara Bartosz, writing for the American Bar Association website about “Protecting Foster Youth from Unsafely Administered Psychotropic Drugs,” noted: “Though the federal government has placed increased focus on the vital need for structured oversight of psychotropic medication usage in foster care, many state child welfare agencies are behind in implementing such safety mechanisms.”[14]

CCHR, which has obtained state and Federal legislation to help curb psychotropic drug use in children, calling for accountable oversight of psychotropic drug use in the foster care system, penalties for high prescribers and the use of antipsychotics reduced to zero. Report foster care drug abuse to CCHR.

[1] “‘Increased oversight’ needed: One in three kids in foster care prescribed psychotropics,” Heleo, 12 Oct. 2021, www.healio.com/news/pediatrics/20211012/increased-oversight-needed-one-in-three-kids-in-foster-care-prescribed-psychotropics

[2] www.eurekalert.org/news-releases/930197

[3] Op. cit., Heleo, 12 Oct. 2021

[4] jonisaloom.files.wordpress.com/2015/01/forgotten-children-carole-keeton-strayhorn-texas-comptroller-forgotten-children-2004.pdf; reason.com/2013/08/07/foster-children-put-on-psychotropic-medi/

[5] www.cchrint.org/2015/04/28/national-child-abuse-prevention-month-stop-mass-drugging-of-foster-care-kids/; www.gao.gov/assets/files.gao.gov/assets/gao-12-270t.pdf

[6] www.childrensdefense.org/child-watch-columns/health/2015/overmedicating-children-in-foster-care/

[7] www.buzzfeednews.com/article/nidhisubbaraman/missouri-foster-kids-psychotropic-drugs

[8] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[9] Hannah Emerson, “Study details Medicaid- Open Excellence insured birth cohort’s exposure to psychiatric medications and mental health services,” 11 July 2018, openexcellence.org/poor-foster-care-children-likely-diagnosed-treated-psychiatric-drugs/

[10] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[11] www.cchrint.org/2021/10/11/consumers-beware-of-antipsychotics-long-term-debilitating-effects/

[12] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[13] “Foster Children on Psychotropic Medication – 1/2 of group home children use them,” Invisible Children, 15 June 2020, www.invisiblechildren.org/2020/06/15/foster-children-on-psychotropic-medication/

[14] Sara Bartosz, “Protecting Foster Youth from Unsafely Administered Psychotropic Drugs,” American Bar Association, 13 Jan 2016, www.americanbar.org/groups/litigation/committees/childrens-rights/articles/2016/protecting-foster-youth-from-unsafely-administered-psychotropic-drugs/

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