Report says foster children receive too many medications

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One kid called it "the brainwash pill." Some said it made them put on weight or provoked teasing from schoolmates when they were called to the nurse's office.

But for others, it was even worse. One foster child, interviewed by researchers studying how medication is given to children in the Allegheny County system, said the meds the doctors prescribed deadened all feelings, taking away what it means to be a kid.

"I couldn't eat, I couldn't move," the child said. "It was like I was in a full body straitjacket."

A report prepared for the Allegheny County Department of Human Services shows children in foster care are more than twice as likely to be prescribed psychotropic drugs than the average child receiving county services. According to researchers, a study of 1,850 youths in foster care found 27 percent receive psychotropic medication, compared to just 11 percent of children who receive Medicaid services at home.

Indeed, a small minority of the foster population -- 3 percent, or 58 children -- are on three different medications at once.

"Medication by itself without really good psychotherapy is not a good course," said Walter Smith, DHS's deputy director for the Office of Children, Youth and Families. "For all of us that look at the rates, we need to make sure there are other things happening along with medication."

The study was prepared in part by Community Care Behavioral Health, a nonprofit that serves Medicaid recipients in Allegheny County. Researchers examined the medical records of youth who use Medicaid services, tallying prescriptions for those in foster care against those who live at home.

The report also convened focus groups, bringing together 16 caregivers and eight foster children to hear their stories.

A common complaint among both parents and children: Doctors didn't take the time to explain the plan behind prescriptions, handing over medication with little explanation given about side effects.

"They are too quick to put kids on meds," one child told county researchers. "Kids are going to act like kids -- especially when they are taken away from their family. ... Of course, a kid is going to act out or be depressed."

Psychotropic medication is generally prescribed to help patients address mental and emotional conditions, all the way from depression to severe mental illnesses. But opponents fear child service agencies are overmedicating their charges, finding pharmaceutical solutions for behavior problems that could be addressed in other ways.

In Allegheny County, the age of children taking medication varies widely. Most are teenagers, but some are far younger. Out of the 496 medicated foster children included in the study, 153 were younger than 12 years old. One child was less than a year old.

The findings are not unique to Allegheny County. In 2011, a national study published in the medical journal "Pediatrics" showed foster children were much more likely to be prescribed anti-psychotic drugs than their peers.

Shortly after, the Government Accountability Office released a report showing children in foster care were 4.5 times more likely to receive psychotropic drugs than children who remained with their families.

These figures stuck with James Schuster, Community Care Behavioral Health's chief medical officer and one of the authors of the local report.

"I think, by and large, providers are trying to do a good job and provide good care," he said. "But you want to make sure these are reviewed carefully and that you continue to keep this issue high in the mind of prescribers."

Mr. Smith said his department has worked hard to reduce the number of children put into foster care, cutting placements from more than 3,000. Children that still are kept away from home may have behavioral or mental health issues that make medication more necessary, he said, explaining part of the percentage jump.

The report recommended the county form a local group to address the abundance of prescriptions being given to children in placement, as well prepare educational materials for parents about the effects of psychotropic medication and its alternatives.

Family Division Judge Kathryn M. Hens-Greco, also would like to see additional research done in Allegheny County and beyond, particularly into the types of medications used.

She was one of the judges who raised the issue in Pennsylvania, flashing back to the times she's seen children in the courtroom who were clearly medicated.

" 'This kid just doesn't look right to me. There's something wrong here,' " she remembers thinking. "This is a bigger problem than just me."


Correction, posted Oct. 25, 2013: Family Division Judge Kathryn M. Hens-Greco's title has been corrected.


Andrew McGill: amcgill@post-gazette.com or 412-263-1497.

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