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Monday, December 5, 2011

Medicating Foster Kids

First PBS' Frontline did a story in 2001 on how some children are over medicated to address mental health issues. Recently, ABC with Diane Sawyer revisited the topic. Both stories should help us to focus on some essential questions when managing children involved with child protection who present with behavioural and / or  mental health problems:

  1. Have we properly considered the traumas and other life experiences that the child has faced? This would include the trauma of coming into care. Few of us adapt well to being forced into a new environment. The move away from family to foster care can also be layered upon neglect, abuse, maltreatment or other losses and traumas the child has faced.
  2. Have we considered the best therapy that might be available for the problem the child presents with? Often it may include some medication but most evidence based research says that children need multi-model therapy to really change long patterns.
  3. Are we seeking the fastest intervention (medication) as opposed to the intervention that may have the longest positive impact?

In addition, we might consider the pressures that social workers, physicians and others who care for these children are under. Resources rarely match need so quick fix solutions are easier to administer.

There is often a lack of consideration to the pharmaceutical industry that works hard at creating a demand for the drugs. 

This discussion about the use of medication should form part of a larger discussion about the effectiveness of interventions with families. The New York Times reports that economic pressures may cut funding to programs found to be effective in working with families. Given the growing economic turmoil in Europe and elsewhere, pressures mount on program funding. But if we wish fewer children in foster care, then these in-home programs that are talked about in the New York Times article are needed. Otherwise, more children will come into care which in turn will increase the need for medications as the resources to support the children will also be limited.

Society gets the child protection system that it is willing to pay for. 

As well, if we are going to be successful with interventions, we should ensure we target them where the need exists. This may, at times, cause us to reconsider some families that may benefit from interventions other than removing children - even in case of addiction. As research reported in the Australian Sunday Morning Herald notes, multigenerational impacts may not be avoided as children tend to drift back to the addicted mothers. Solving the problem is more likely to be bettered focused on the mother wherever possible. Removing children permanently is hard to accomplish successfully, particularly with older children.

Thus, one might sum up these possibly disparate news stories by saying:

  • Treat comprehensively and when medication is needed for children, do it as part of a lager therapeutic effort;
  • Help families stay together wherever possible as medication is not likely going to help a kid with the grief and loss of being taken away from families
  • Use evidenced based approaches that show many families can be helped
  • Allow yourself to see how a family can be sustained even when the presenting problems have historically meant separation (such as in addiction cases).

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