Child Welfare Ideas from the Experts, #12: Regulating Psych Meds for Foster Youth

The Chronicle of Social Change is highlighting each of the policy recommendations made this summer by the participants of the Foster Youth Internship Program (FYI), a group of 12 former foster youths who completed congressional internships.

The program is overseen each summer by the Congressional Coalition on Adoption Institute, with support from the Sara Start Fund.

Each of the FYI participants crafted a carefully researched policy recommendation during their time in Washington. Today we highlight the recommendation of Matthew Broderick, 22, a student at the University of Arkansas, Little Rock.

The Proposal

Broderick proposes federal mandates regarding the prescription of psychotropic medications to children in foster care. He specifically calls for two things to be in place before such drugs are administered:

  1. Documentation of a “comprehensive treatment plan” in which therapeutic treatments have preceded a prescription for psychotropics.
  2. Merits of the prescription must be verified by an “independent agent in the state.”

The Argument

Broderick cites a recent federal report that suggests that between 50 and 75 percent of youth in care have “behavioral or social competency problems that may warrant mental health services.”

The health care professionals who initially assess foster children, Broderick argues, are not likely to be fully “trained or equipped to treat a foster child who experienced extensive trauma.”

Additional national research has well established that foster youth are prescribed psychotropic drugs at a rate that far exceeds the general youth population. And last year, the Center for Health Care Strategies reported that about half of the foster kids treated with psychotropics were given “two or more in the same year,” often at the same time.

In His Own Words

Matthew
Matthew Broderick

“My younger sister was placed in a very strict group home that did not allow children to have much freedom to be ‘normal.’ Dealing with this major life transition and past trauma, and separated from her siblings, the environment led my sister…into depression. She was prescribed psychotropic medication that completely altered her personality and caused her to be in a constantly sad, zombie-like state with suppressed emotions.

When I first heard that my little sister had ‘acted out’ and been placed on psychotropic medication, I thought she must have gone crazy or developed serious mental issues. I visited her and saw her morbid state. She was so different; it was frightening. It was only after she stopped taking the medication and slowly came back to her normal, jovial self that it became apparent the medication only had negative effects.

My sister was a victim of an all too common, unfortunate circumstance. Rather than receiving comprehensive therapeutic support, she was treated like a problem in need of medication.”

At the moment, Broderick writes, there is no federal law guarding against overprescribing to foster youth; there are only ‘minimal federal guidelines.’

The Chronicle’s Take

As we mentioned in our analysis of Ms. Spataro-Haynes’ proposal, there is congressional interest in addressing the use of psychotropic meds on foster kids. Nobody is more passionate about the issue than Sen. Tom Carper (D-Del.), who along with Sen. Ron Wyden (D-Ore.) vowed a year ago to “play offense” on curbing prescriptions. Rep. Karen Bass (D-Calif.) this summer expressed interest in developing federal legislation.

Thus far, nothing of substance has moved through either chamber. President Obama continues to include in his annual budget proposal a 10-year, $750 million program aimed at driving down the use of psychiatric meds on foster children.

Broderick’s ideas are rooted in the efforts already at hand in several states. The Texas Department of Family Protective Services requires comprehensive efforts before a prescription, he notes. The Illinois Department of Children and Families has already contracted with a university to start reviewing and monitoring the use of psychotropics.

The question is how to embed this into federal law? How do you put it on the books in a way that truly compels states to get in line? The blunt truth is this: the closer you tie a policy to the potential loss of money, the stronger that policy will be.

When you’re talking about policies that specifically target foster kids, the logical first look is at Title IV-E, the multi-billion dollar entitlement that currently funds only foster care services. However, IV-E is not a major conduit of mental health dollars, though, and at the moment the funds are tied only to the foster youth who come from the poorest households. So tying mental health requirements to IV-E might lead to different guarantees for different kids.

But there might be a better and more persuasive place to inject Broderick’s mandates, and that would be right into the heart of the action: Medicaid.

Every child in foster care is Medicaid eligible, and a high percentage of health care services rendered to them is paid for through the massive federal-state partnerships. Medicaid can also be used to pay for other therapeutic interventions for foster youth, ones that involve actual professionals trying to help them understand and work through the trauma inflicted upon them.

But a quality continuum of therapeutic responses can be expensive and difficult to manage and develop; certainly more so than writing a prescription (or two, or three) and filling it.

So what would happen if Medicaid refused to pay out on psychiatric prescriptions for foster youth unless the state could produce a secondary review and a plan that included other interventions? Two things, we’d guess: the number of prescriptions would plummet, and the ones that were made would be connected to meaningful attempts to treat foster youth.

Click here to read Broderick’s entire proposal and those of his fellow FYI participants.

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John Kelly
About John Kelly 910 Articles
John Kelly is senior editor for The Chronicle of Social Change.

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