Federal health officials are failing to monitor how state agencies are doling out powerful psychotropic drugs to foster children, according to a comprehensive investigation released Thursday showing foster kids are prescribed the drugs 2.7 to 4.5 times more than non-foster children and often 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 including diabetes and suicidal behavior. In some regions, foster children as young as 1 year old were twice as likely to be prescribed the medications, according to a two-year investigation by the Government Accountability Office. The investigation looks at 2008 data from more than 100,000 foster children in Florida, Massachusetts, Michigan, Oregon and Texas.
Sen. Tom Carper, D-Del, requested the investigation's release after media reports of high prescribing rates and anecdotes from former foster children who said they were on multiple medications at the same time. The report was released ahead of a hearing Thursday by his congressional sub-committee that deals with federal services.
"This report we are releasing today confirms some of our worst fears," Carper said.
Some of the drugs have "black box" label warning for children's safety and are not approved for use by young children. But doctors often prescribe them off label. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Little is known about the long term side effects of the drugs and drug, experts said.
"We're kind of flying blind as far as knowing the safety and efficacy long term risks (for children)," said Dr. Christopher Bellonci, a child psychiatrist at Tufts Medical Center.
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.
Child welfare advocates say there's a nationwide shortage of child psychiatrists, often leaving pediatricians to handle complex behavioral problems.
"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.
Six-year-old Brooke was on two psychiatric medications for an ADHD diagnosis when Todd and Lisa Ward adopted her out of Florida foster care in 2010.
Over the next two years, doctors put her on an array of powerful drugs as her parents watched her behavior become more aggressive, erratic and agitated. She twice tried to kill the family dog, pulled skin off her nose and wiped blood on the walls, threw tantrums as doctors plied her with more than a dozen medications over the years, her mother said.
"Her hands would just shake insanely and they would tell us, `oh that's just her'. But it wasn't her. It stopped once she went off the medication," he mother said.
The Wards tried desperately to get her into a psychiatrist but wait lists were typically nine months long, so she ended going back to the same mental health center that Ward said constantly overmedicated her. The Wards finally found a psychiatrist last year who helped decrease Brooke's medications and stabilize her behavior.
But this summer an incident with her sister triggered Brooke and she tried to set the house on fire in an attempt to kill her sister, said Lisa Ward, a 39-year-old accountant who adopted Brooke and her two siblings.
The Wards placed her in a residential facility where she got intensive therapy for the first time, including yoga and play therapy. Three months later, Brooke is home and down to one medication.
"The difference in her was night and day. She actually can express emotion," Lisa Ward said. "They were able to figure out what this girl had held inside for eight years."
Lisa Ward, who started a nonprofit to link other foster parents to doctors and therapists, says the medication was just a bandage and notes the girls no longer have the ADHD they were diagnosed with when the Wards adopted them from foster care.
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.
Eleven-year-old Ke'onte Cook, who entered Texas foster care at age 4, testified he was on 20 drugs during his time in foster care, sometimes taking five drugs at once. He didn't know why he was taking them and was never told of possible side effects.
"It was the worst things someone could do to foster kids. I was upset about my situation and not because I was bipolar or had ADHD," said Ke'onte, who has since been adopted and stopped taking all medications. "Meds aren't going to help a child with their problems. It's just going to sedate them for a little while until it comes back again."
Thursday's hearing comes a week after federal health officials notified state child welfare leaders they will have to provide more details about how they control the medications for foster kids starting next year.
A federal law passed in 2008 lays out oversight provisions required by law, but many states aren't following them.
In most states, child welfare workers don't have access to the Medicaid database to identify which medications their child is taking and the Medicaid database can't identify which patients are foster kids.