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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