USA: Medication for foster children under new scrutiny, say doctors

[23 August 2014] - 

The runaways from the foster care system who would see Liz Gomez for counseling came in with pockets full of pills.
“Many were on medications that were unnecessary,” said Gomez, the executive director for Sober College, a Woodland Hills-based drug and alcohol rehabilitation center for teens and young adults.
Gomez, who worked with homeless and at risk youth in Los Angeles for two decades before heading up Sober College, said she isn’t against the use of psychotropic drugs that can help youth with anxiety, depression and other issues.
But it appeared to her, she said, that there was a growing use of those drugs to control behavior as opposed to talk therapy.
“I was horrified with some of the medications,” Gomez said. “We saw many young people come in on pretty strong drugs they really did not need. They just needed therapy and love.”
A 10-month investigation by this news organization has found that over the last decade nearly one out of every four adolescents in California’s foster care system received prescribed psychiatric drugs, or 3.5 times the rate for all adolescents nationwide.
While the figures seem startling and raise questions about the dependency on meds to control negative behavior, those who work within Los Angeles County’s foster care system say they are trying to improve protocols to minimize overprescribing. But challenges remain, especially since the county oversees the largest foster care system in the nation, said Los Angeles County Superior Court Judge Michael Nash.
Nash, a child advocate, is presiding judge of Juvenile Court.
“In California, Juvenile Court judges are required by law to authorize the use of psychotropic drugs in out-of-home care,” Nash said. “This is a huge issue for us.”
Nash estimated that 13 to 15 percent of the 19,000 foster care youth who live in out-of-home care are on some form of medication such as Ativan and Xanax.
California is one of a handful of states that place decisions regarding psychotropic medication of foster children in the hands of the Juvenile Court. The goal behind the law was to reduce the use of medication as a means of controlling troublesome behaviors of foster children.
Instead, some say there have been increases across the Golden State.
Nash said Los Angeles county remains vigilant on such issues, but that judges have to rely on recommendations made by partnerships with the Department of Mental Health. Officials there review every request received for the use of a psychotropic drug.
As a member of the county’s psychotropic medications committee, Nash said there are many youth who benefit from the medications, but he knows it’s not a perfect system. One challenge is making sure the youth who age out of the foster care system continue to receive medications.
“Many kids, sadly, end up growing up in foster care. We have to do a better job of ensuring that we have engaged in the process in how they can access the medication when they are out of the system,” Nash said. “In Los Angeles, we’ve covered the landscape pretty well and everybody knows their responsibility. In a system as a large and busy as this one, it’s important to know why we prescribe the medication. It’s important to continually monitor the child so we make sure that the medication be used right.”
At the Child Family & Guidance Center in Northridge, Dr. Alpa Patel said she works with a small population of foster care youth who use some medication. She said she has seen the protocols in the county change for the better in the last year.
“In the past, the court would have gone ahead and authorized any request,” she said. “Now they are a bit more stringent. They require more from the prescribing physicians to determine whether or not continuation of this regimen is helpful,” Patel said.
Patel said the use of medication on foster care youth is to help them resolve trauma associated with their pasts.
“The children who end up in foster care have had more trauma in there lives then those in their age match,” Patel said. “I’m absolutely a proponent of minimizing medication, but in some cases, without them, therapy can’t progress.”

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