There have been several high profile media reports on the high use of psychotropic drugs being used with foster children. Thus, a study by the Government Accountability Office (GAO), an office of the United States government, has provided a useful look at the practices in 5 US states. As seen in the media reports, they find that foster children are indeed prescribed drugs at rates significantly in excess of non-foster children. They have not succumbed to hyperbolae however and note that children in foster care can also present with much higher mental health issues. Yet, they also challenge the practices that they have found, particularly when children are being prescribed high doses or high numbers of drugs.
One crucial issue that has often been missed in the debate is that the problem is not restricted to foster children. As they state:
In other words, there are significant reasons to be concerned about the ways in which these medications are being used with children in general. There is no doubt, however, that the foster child population is receiving these medications at a much higher rate. When asking why, the GAO notes:
One of the more concerning aspects is that medication is being prescribed because child protection has apparently not found ways to sustain stable foster care placements. Unlike issues such as pre-foster care trauma, placement is an issue which might often be better managed. Multiple changes in where children live, lead to greater emotional angst, re-occuring abandonment and loss and an inability for symptoms arising from trauma to settle. Rather than treat with medications, other solutions might be appropriate that would include greater emphasis on placement stability, better efforts to sustain children within family systems and faster decisions for permanency for children (be that back to family, kinship care or other long term placements such as adoption). Placement instability may be one of the most damaging experiences for children. If you have no regular place to call home, then you also have no persistent safe haven possible.
The American Academy of Child and Adolescent Psychiatrists (AACAP) recommends that there be a clear consent process for children in foster care that includes clarity on who can consent to treatment and that this be based on a clear understanding of diagnosis and what, why and how medications are being used. They also recommend that child protection have a consultation process so that cases are carefully managed and monitored.
This report raises some thoughtful ways through which good case management can occur emphasizing that those who manage these issues be well informed about what is happening with each case and why. They also recommend that child protection and caregivers be kept informed about what medications are being used and the positive and negative implications.
UPDATE:
Dr. Peter Breggin, a noted psychiatrist and commentator on psychiatric medications has written an op-ed piece that also considers the GAO report.
One crucial issue that has often been missed in the debate is that the problem is not restricted to foster children. As they state:
According to our experts, no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and nonfoster children were prescribed such a medication regimen. Similarly, thousands of foster and nonfoster children were prescribed doses exceeding maximum levels cited in guidelines based on FDA-approved drug labels, which our experts said increases the potential for adverse side effects, and does not typically increase the efficacy of the drugs to any significant extent.14 Further, foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which our experts said have no established use for mental health conditions in infants and could result in serious adverse effects. (p.7)
In other words, there are significant reasons to be concerned about the ways in which these medications are being used with children in general. There is no doubt, however, that the foster child population is receiving these medications at a much higher rate. When asking why, the GAO notes:
These factors included the greater exposure to trauma before entering state care, frequent changes in foster placements, and varying state oversight policies. However, our literature search identified a relatively small number of studies that have been conducted to determine to what extent each of these factors contributes to higher prescription rates, or whether additional factors are involved. (p.10)
One of the more concerning aspects is that medication is being prescribed because child protection has apparently not found ways to sustain stable foster care placements. Unlike issues such as pre-foster care trauma, placement is an issue which might often be better managed. Multiple changes in where children live, lead to greater emotional angst, re-occuring abandonment and loss and an inability for symptoms arising from trauma to settle. Rather than treat with medications, other solutions might be appropriate that would include greater emphasis on placement stability, better efforts to sustain children within family systems and faster decisions for permanency for children (be that back to family, kinship care or other long term placements such as adoption). Placement instability may be one of the most damaging experiences for children. If you have no regular place to call home, then you also have no persistent safe haven possible.
The American Academy of Child and Adolescent Psychiatrists (AACAP) recommends that there be a clear consent process for children in foster care that includes clarity on who can consent to treatment and that this be based on a clear understanding of diagnosis and what, why and how medications are being used. They also recommend that child protection have a consultation process so that cases are carefully managed and monitored.
This report raises some thoughtful ways through which good case management can occur emphasizing that those who manage these issues be well informed about what is happening with each case and why. They also recommend that child protection and caregivers be kept informed about what medications are being used and the positive and negative implications.
UPDATE:
Dr. Peter Breggin, a noted psychiatrist and commentator on psychiatric medications has written an op-ed piece that also considers the GAO report.
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