The drugging of foster youth

One of the dark secrets of California's troubled foster-care system is the way some young people are being drugged at the slightest sign of stress or misbehavior. State regulations provide a financial incentive for group-home "parents" to request and administer psychotropic drugs -- an option that the testimony of foster youth suggests is being exercised far too readily.

California does not attempt to track how many foster youth are given such drugs or whether they are even needed in each case. It is an unchecked system, ripe for abuse, both in terms of fiscal responsibility and humane treatment. In fact, members of a newly created state Blue-Ribbon Commission on Foster Care were caught off guard last week when the overuse of psychotropic medications emerged as a major theme of foster youth talking about what is wrong with the system. Their accounts included:

Marcus was only 11 when he was taken from his family and placed in a group home. The experience left him too frightened to talk during his first night there. His "new family" gave him Paxil, an anti-depressant, to get over it.
After spending one week at her new group home, Alex was told she needed to be on medications, even though she had never even met with a psychiatrist. At one point, she had been put on 20 different drugs. "Everyone in the group home walked around like zombies," she said.
Chenille, 17, had been put on medications since she was 13 -- Zoloff, Resperdal and a host of others. All she wanted, she said, was to find her sister, who she had been separated from when she was placed in a group home. But because she cried and seemed upset, she was given drugs. "They told me if I didn't take them, that I wouldn't get transitional housing once I aged out."

The first-hand accounts of these young people is not the only warning sign that the system needs to be scrutinized. Investigations in Texas, Florida and Minnesota have discovered alarming numbers of foster youth on behavior-altering drugs. Texas, for example, discovered that of the 12,000 foster youth who received psychotropic drugs in 2004, each child averaged 21 psychotropic drug prescriptions a year. But in California, home of the nation's largest foster-youth population, there has been no such review of psychotropic drug use. A 2004 bill by then-Sen. Dick Mountjoy to require the Department of Social Services to study the administration of these drugs to foster children was quietly shelved after encountering opposition from the California Psychiatric Association.

At the judicial level, the California Rules of Court, while including regulations on psychotropic medications, leave dangerous loopholes that allow group homes to act as mental health experts. Rule 1432.5 states: "Once a child is declared a dependent child of the court and is removed from the custody of the parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medication to the child." But the judge can only go by reports handed to him by the youth's social worker and group-home staff. If the youth does not appear in court, which is often the case, the judge has little if any input beyond the recommendation.

Equally problematic is a section of the rule that reads: "In emergency situations, psychotropic medications may be administered to a dependent with or without court authorization or court delegation of authority to a parent." The definition of an "emergency" is effectively delegated to the group homes -- which also happen to have a financial incentive to administer drugs. "A group home can get anywhere between $2,000 to $6,000-plus per foster youth, depending on how many medications they're on," said commission member Jennifer Rodriguez, legislative policy coordinator for the California Youth Connection. "That's why they're more willing to label these youth as 'troubled.'' Because so few foster youth regularly meet with their attorneys, most are unaware that they have a right to refuse the medication.

In cases where youth have resisted, they say group-home workers have punished them in various ways: docking their allowances, taking away house privileges, threatening to kick them out of the home. Again, with the ratio of attorneys to foster youth running as high as several hundred to one, many of the youths, and even the group-home workers themselves, are unaware that these punitive actions are illegal in the state.

According to Rodriguez, the California Youth Connection has tried to address the issue after concerns were repeatedly raised during discussions with foster youth from different counties. "We were told by legislators and the Department of Social Services that we couldn't legislate it because there's nobody collecting this information, and there's no way to find out how many youth are being put on meds,'' she said. "Basically, they have no one looking out for them on this issue." This lack of oversight is outrageous. The state has a moral and fiscal obligation to know what is going on with its foster children.

Medications, when used appropriately, have indeed helped thousands of children. But in some cases, foster youth appear to be given drugs to deal with a sudden surge of emotions -- grief, fear, sadness -- that are hardly surprising in children who have just been taken from their families and placed among strangers. Where will the leadership emerge on this issue? Attorney General Bill Lockyer's office should look into the allegations that the youth's legal rights are being abridged -- and determine whether tax dollars are being squandered or even exploited by a system that rewards the overuse of medications on children who may just need human care and attention.

The upshot is clear: This is a system that demands closer attention.

Editorial
11 June 2006

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2006/06/11/EDGS0INK2R1.DTL

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