Joshua Allen Online

Foster Children: I’m Okay, You’re Medicated

The Business of Child Abuse

By Joshua Allen

Several years ago there was a foster agency with a high percentage of children on psychotropic medication.  The reason for this was because the agency had on contract with a psychiatrist who would examine foster children brought to the agency by foster parents to determine if the abused and neglected children qualified (medically) for psychotropic medication.

This procedure was terribly convenient for the foster parents and the agency.   It is extremely difficult to get a foster child a timely appointment to see a psychiatrist.  Appointments certainly occur, but psychiatrists who take Medicaid are few and far between.  Add to that the need for Spanish-speaking therapists and you have a problem.

The agency also liked this arrangement because of referrals, (referrals = Money $) from CSW’s who wanted a quick psychiatric evaluation for abused and neglected children they believed would benefit, and importantly, this also allowed social workers to have greater input with the psychiatrist – not a small thing.

The psychiatrist in question (no longer on contract with the agency) had a favorite medication cocktail,  a mixture of Seroquel and Abilify, SSRI’s that are generally prescribed for atypical schizophrenia.  Ahem…

You can read more about the medications here: http://www.nami.org/Template.cfm?Section=Policymakers_Toolkit&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=18971

Now those in the “know” understand this is strong stuff, especially when given to children, especially when combined, and especially when given to children who suffer from behaviors and symptoms such as anger, aggression and depression that are off the generally prescribed usage.

Now the psychiatrist had a perfect right to do this and lacking an MD I won’t get into a debate.  I can and will tell you what the social workers reportedly saw from children on their caseload who were prescribed this cocktail.

In general the mixture performed its intended purpose, aggressive behaviors such as constant screaming, smashing things, and overall defiance decreased dramatically.

Now the rejoinder; “They are overmedicating our children!”   While often true, is lazy to have as a generic fall back.  We must ask, isn’t there more to this?

Are we medicating foster children just to control them? What if the choice is between medication or a locked or restrictive group home, or attendance in a regular school?

A little background:  LA county has a Psychotropic Medication Authorization desk.  Any foster child that is prescribed psychotropic medications (such as antidepressants for depression or Ritalin for ADHD) has paperwork sent by their psychiatrist to this desk where a judge reviews it, rubber stamps it and supposedly sends it to the CSW every 6 months where they happily stick it in a file.

This is one of the most difficult pieces of paper for a social worker to get, and is highly prized because every social worker knows  any child taking meds will be the first to have their file audited by county and state officials when they eventually get around to it.

Recent fatalities such as Viola Vanclief and Jorge Tarin as well as other simmering controversies virtually assure an increase in audits of all children’s files as the state and county are briefly motivated from their government induced stupor to insure no other abused children are in danger from the very system designed to protect them.

But back to the drugs…er medications.

Are we over medicating our foster children?  Probably; but the truth is I have never seen psychiatric prescription nullified by a judge or anyone else.  Recall the phrase I used above?  Rubber stamped?

Once an MD medicates a foster child, it is a done deal as long as the paperwork trail stays intact. Who but another doctor will argue?  And the only time there would be a different doctor is when the foster child is moved very far away, like to another county.

Do our teachers find it helpful to push unruly foster children (usually boys) to be medicated as a condition of staying enrolled at a particular school?

Oh yes.

And the problem here; “Best interest of the child,” is a question with no easy answer.  Further, who will advocate for this child?  The lawyer?  The CSW?  The abusive birth parent?  The foster parent?  You? Me?  Crusty the Clown?

The foster parent is probably the best advocate, and psychiatrists listen to them regarding side effects and any other difficulties, as they are the ones living with the child 24/7.

No easy answers.  And you may have your mind changed if you think it’s as easy as saying no child or just a very tiny few should ever be medicated after spending time with a few dozen difficult cases.  However, that’s not to say you’re not right!

If you are confused by all of this, good.

This means you probably have an open mind.  The subject is riddled by many folks with preconceptions.

Unfortunately, what teachers and social workers sometimes do is list textbook symptoms which correspond to the diagnosis they want the child medicated for.

This is very important because the overbooked psychiatrists who foster children see for 15 minutes or so often rely on these lists as well as communication with the foster parent.

Right or wrong, this is effective and something elementary school teachers in particular are guilty of, especially with regards to ADHD.

Foster parents may be coached (perhaps unintentionally by teachers or social workers) regarding the language to use when describing very real behavioral problems they see.

Recently, the county has insisted the foster child see a psychiatrist monthly (it doesn’t always happen) and this may have resulted in a decrease in the percentage of foster children being medicated.

Meds do calm difficult foster children and prevent the foster child, for example, from being shipped to a more restrictive environment such as a group home.  Sometimes medication seems to be the only thing keeping the child in school. Other times, it does seem like we are over medicating our children.

So call me biased, but sometimes I think it’s the right thing to do.  Call me biased, but sometimes I don’t.  No easy answers.

Got that?

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Children Services Fail – DCFS Discovers New Way to Reduce Fatalities: Less Reporting

The Business of Child Abuse

By Joshua Allen

Article first published as Children Services FAIL: DCFS Discovers New Way to Reduce Fatalities; Less Reporting on Technorati.

Another day in the business of child abuse. The LA Department of Children and Family Services (DCFS) has discovered a new way to reduce the amount of child fatalities associated with it during the past year. They have narrowed the criteria of what constitutes abuse and neglect.

Like Clinton splitting hairs about what “it,” means. The department is now redefining what it means to die by abuse and neglect.

It’s like magic! Report fewer fatalities from abuse and neglect, and fewer deaths blot the good name of the department.

While we are not in Goebbels territory (yet), it’s still pretty creepy.

This new interpretation constitutes a wonderful service for children (not) and it works for the department, too. Sadly it doesn’t work for the rest of us, or the dead children.

Garett Therolf of the LA Times, who is just about the only journalist in Los Angeles writing critically about DCFS these days, quotes LA County Supervisor Zev Yaroslavsky who said;

“I think the department has an interest in minimizing the number of cases that they put on the …list because, frankly, it makes them look better.” Oh yes indeed!

While the other County Supervisors are intent on finding out who leaked information regarding fatalities associated with the department to the LA Times, Yaroslavsky again put his neck on the line when he said what everybody else is thinking.

As an example of the new policy, eleven-year old Jorge Tarin who hung himself with a jump rope after two separate interviews with social workers, was not included in the most recent tally of child deaths associated with the department. The rationale appears to be because he did not die from abuse or neglect.

Yet just that day he had reported to school officials that he was “…tired of people hitting me all the time.”

This is a department of 6,500 individuals, just a third less personnel than the Los Angeles police department, which over the years has been subject to federal scrutiny, a consent decree and the Christopher commission.

The secretive nature of DCFS, in contrast to the police, is instructive of what happens when public audit and scrutiny is limited to a few self-serving politicians and officials who use the department and information they choose to disclose for political ends.

While talk of reforming the department remains ongoing, it reminds one of the endless conversations in the press and by the same County Supervisors (except for Ridley Thomas who was recently elected) of the decades long conversation about what to do about MLK Hospital.

And that solution was to close the place.

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The Foster Child and the Garbage Bag:

The business of Child Abuse

By Joshua Allen

With all this bothersome talk about DCFS “leaks,” and “freedom of the press,” I got to wondering what possessed Trish Plohen and DCFS to try and sneak the investigation under the radar, away from irritating eyes like the LA Times and the general public, the people who pay their salaries.

It’s arrogance of course, that and ignorance.

We encounter that a lot in foster care, and not just from abusive parents, but also from bureaucrats, administrators and apparatchiks who have never run a business, done physical labor, worried about their guaranteed pensions or worked a single day outside the confines of the DCFS public dollar.

This breeds a certain type of individual, a certain type of contempt for public audit and media sophistication.

So does spending a career working with and around abused and neglected children and their abusive and neglectful birth parents.  The latter is especially fun.  It takes a toll.

I say the latter not because it justifies trying to sneak the investigation under the public radar, but rather to add context to the utter stupidity that underlies the mentality that the pesky public needs to be kept at bay from, for example, heroes like foster parents who do the real work in caring for children who have been beaten, sexually abused and neglected.

It is hard-working with children that were abused.  That’s why social workers get the big bucks…not…

But a lot of people have tough jobs that deal with human misery, ER workers, police, hospice nurses, County Supervisors…well not the latter of course, they just cause of lot of it.

Hearing Ridley Thomas speak about the potential damage to social workers morale is like eating watery gruel.

Unlike politicians and our police department, DCFS seems clueless when it comes to the media, public perception and public audit.  And unlike politicians, they aren’t voted in or out.  Like Philadelphia, they are just there.  So why worry about what anyone else thinks?

Zev Yaroslovsky was the only voice that appeared to understand where the focus of DCFS should be rather than trying to find out who is leaking non-confidential information to the press.   Ridley Thomas may have called that a “cheap shot,” By Yaroslovsky, but he has never satisfactorily answered his own possible role in helping a foster agency with a terrible record get off of administrative hold which may have played a partial role in the killing of foster angle Viola Vanclief.

We’re still waiting for that answer.   Ridley Thomas indignation as heard on a recent radio show may be justified as he tripped on the battle for public perception, unfair or not – Zev Yaroslavsky = Truth, Justice, Savior of Children – Ridley Thomas = Lies and Cover Ups.    I’d be indignant too.

However, amid this “noise and waste” there is something – er -someone who remains a forgotten part of the conversation.

Our foster children.  The ones who remain alive that is.

You remember the children right?  They are the ones who have parents who beat them or each other.  Have parents who touch them sexually, use drugs, neglect them and leave them alone in the home as toddlers.  The ones who have parents or other adults in their lives who do unspeakable to them, things which keep social workers wondering why they have chosen this profession.

The children, remember?

They get removed from abusive parents in the middle of the night, and if they are lucky some of their clothes and perhaps a toy are stuffed inside a garbage bag as they are packed off to-Lord help us- a loving foster home while feeling fear and anger at being torn from their parents no matter what the parents had done to them.

The garbage bag;

The children’s suitcase and frankly symbol to their new life of strangers and courts, investigators and new schools, overworked and impossible to reach lawyers, and well-meaning and sometimes foolish social workers who can refer them to therapists and talk to them at length with their own version of counseling, but in the end often wonder what they can do to really help, to honestly offer some type of solution that too often is not forthcoming.

The garbage bag;

One of the first tools an abused child encounters on their excursion through

The Business of Child Abuse.

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The Death of Jorge Tarin: DCFS FAIL?

The Business of Child Abuse.

By Joshua Allen

Sometimes the wrong call is just that, an accident, it could happen to anyone.  And sometimes a wrong call is because of fatigue, a lack of information, bad policy or all three.  Without knowing the facts, we can’t make a true assessment of what happened when Jorge Tarin hung himself several weeks ago.  As excerpted in the Times report:

“Just hours earlier, Los Angeles County mental health and child abuse investigators had visited the drab apartment building to examine 11-year-old Jorge Tarin. He had told a school counselor that day that he wanted to kill himself. After speaking to Jorge privately, the county workers left.”

And:

“Although county workers had visited Jorge in disheveled homes since his infancy — noting drugs, violence and neglect in the households — the complete history was not available to the officials who interviewed him that day. Without remote access to the department’s computer system, the social worker at the scene was unable to fill in some blanks that may have changed the decision to leave Jorge at the home.”

You can read the full article here: http://www.latimes.com/news/local/la-me-child-death-20100725,0,939247.story

The facts are tragic and pathetic, and represent a breakdown in the very system designed to protect our children.  Clearly there is fault, there is guilt.  It is the “who,” which represents the complication.  This is not an easy call beyond whatever culpability exists with the parents.

Assigning blame to the DCFS investigator who left the troubled adolescent in the home is too easy and possibly, not fair.  However clearly he/she made the wrong call.

What we know now is the investigator did not have sufficient information, was unable to, or could not use the expensive tablet computers with a modem to connect to the DCFS network.  And therefore they did not have information regarding the stepfather’s previous record, or the history of allegations towards the home, birth parents and step-father.

Further, the second investigator had little information regarding what was said during the interview with Jorge at the school.

You see; the majority of Tablets and wireless modems that may have been used to access information regarding the step-father continue to sit unused, either because of training difficulties, workers refusal to use this new technology (that is if you could call 3-year-old computers “new technology”) or a lack of funds allocated to fully implement the necessary infrastructure.  I take the easy route and tend to go with all three.

The result was a dead child.  Beyond the referenced article, we now know that Jorge was treated differently than other children in the home, being made to sleep on a sofa for example instead of having his own bed.  Nothing new here I suppose, Cinderella also was treated differently from her half siblings. Only it’s not a fairytale.

No happy endings here.  Just calls for audits and heads to roll by the usual suspects.  Jorge had originally been in foster care for 15 months and then returned home about 2 year back during a time when DCFS was keeping children out of foster care at a record rate.

This policy saved money and answered critics claims that Los Angeles was putting too many children into foster care.  I suspect the nonsense program of Family Preservation had a role at one point or anther too.  And as far as “saving money,” goes, remember, the budget is almost the same amount of billions of dollars only with about a third of as many children placed into foster care.

Does anyone believe we are getting more services for our dollars?  That money is going somewhere.  Knock knock, administrators, apparatchiks, SEIU, anybody home?

Now DCFS in a temporary change in policy refuses to discuss child fatalities connected to the department with reporters in a misguided attempt to circle the wagons.  All on advice of lawyers of course.

The party line changed the next day when a different lawyer attempted to walk this back, but yes, we get the message.   It’s the era of transparency right?  And little information continues to be forthcoming.

To our utter shame as a society, many children and teens interviewed by social workers say they want to die at one time or another.  Red-flag-city every time too.  Nobody plays around with this.    Yet in the end it is always a judgment call.  It has to be.  There is no cookie cutter solution.

The school did the correct thing. (As far as this single issue of notifying DCFS)  They called the hotline and reported it.  A mental health social worker came out, interviewed Jorge but let him go home on the bus.

There were enough concerns however that the department sent another investigator out to interview the young man at home.  But as seen above, this last investigator didn’t have all the information to make a proper assessment.

If we had a nickel for every therapist who wishes they had done it differently, who had this happen to them…it is about as common as getting through your entire career as a lawyer or doctor without being on the wrong end of a malpractice suit.  It happens.

The second DCFS investigator went in there half blind, perhaps tired and at the end of their shift, and now a child is dead.

The parents?…We will have to let a higher power deal with whatever role they had concerning their moral culpability.  Social workers or for that matter therapists don’t use the word “moral,” too often during their day to day business.

But we know it when we see it.

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Who Watches the Watchmen?  The Board of Supervisors has decided to audit DCFS!

The Business of Child Abuse

By Joshua Allen

Quis custodiet ipsos custodies?  Who watches the Watchmen?  The Latin phrase from the Roman poet Juvenal not Alan Moore although the ‘Watchmen,’ was a cool comic when it first came out.

So here is my advice should the Board of Supervisors go this route.

Audit the auditors.

You know, the guys who go around and superficially talk to foster parents and kids to make sure everything be okay.

The young folks who come to the agencies and check out the cooked books allowing millions to be misspent year after year after year…

The people who have allowed DCFS to get by on the same billions of dollars budget they have had for years while serving perhaps a third of the amount of kids in foster care.  Where is all that extra money going?  (Do we really have to ask)?

The same folks who have allowed Family Preservation to become a big joke, allowing “Paraprofessionals,” to collect moonlighting income year after year knowing full well the program does little of what it is supposed to do.

The same folks who have allowed double and triple dipping executives without college degrees to run agencies into the ground or to continue drinking nectar from the golden goose year after year when everyone who gets near these places knows that something funny is happening.

The same folks who have allowed elders in their dotage to continue on full salary while they putter around the office a day or two a week on full tax payer salary because they were one of the original investors of the seed money and now know where the bodies are buried.

The same folks who bought antiquated equipment that is little used because training is too complicated for retired-in-place-investigators who can barely use their cell phones.  Or because by the time the IT department actually gets around to using the stuff the price for the infrastructure has increased to the point where there isn’t money left to implement the majority of the devices.  (Or do I have it wrong?  I think not).

Yes certainly, audit the department.  What’s a few BILLION DOLLARS a year among friends?  Amazing they never thought of this before!  Why should DCFS be any different from our schools or MLK hospital?

Thank heavens for the love and decency that come from our foster parents.  There are a lot of good ones out there and they are all that stands between the enshrinement of mediocrity that currently typifies our foster care system.

A loving foster parent is our best defense, and the rest is commentary.

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