In this Q&A, I interview San Jose Mercury News Investigative Reporter Karen de Sá about her explosive series on the psychotropic “drugging” of foster youth.
De Sá wrangled with gargantuan California state bureaucracies to access data that tells a startling story of the foster care system’s over-reliance on psychotropic drugs. She also made sure to include the stories of current and former foster youth throughout.
This mixture of systemic analysis coupled with real-life experience is de Sá’s forte. In 2008, she wrote a series on the juvenile dependency court system using the same technique, which had lasting impact.
Her latest series is still unfolding, but it is already rattling public policy around psych meds and foster youth. The Medical Board of California will start investigating whether or not Medi-Cal providers are acting reasonably when writing prescriptions to foster youth.
This was prompted in August, after de Sá’s stories started breaking, and State Senator Ted Lieu (D-Sacramento) sent a request to the medical board asking for more information on how judiciously subscriptions were being administered.
For reporters, public officials and the foster youth who are often subjects of news stories, De Sá’s words are very important to hear.
This interview was recorded as part of the Journalism for Social Change Massive Open Online Course that I teach, and which is being offered in January:
Daniel Heimpel: Right now you are in the midst of releasing stories as a part of this big series on the drugging of foster youth. To do this you had a monumental task in terms of extricating data from these huge public administrations. So how hard was that process?
Karen de Sá: We wrangled with the State Department of Health Care Services and the State Department of Social Services for more than nine months to get quality data that we could really use to examine the prescribing patterns, and it was a huge and difficult battle that is still ongoing. We based the series on…pharmacy benefit claims for Medi-Cal, how many prescriptions were actually being paid for, and children’s voices and young people voices.
DH: So how did you get your hands on that data?
KdS: This is a state agency so we filed a California Public Records Act request, which we got a number of responses to and I think the state would argue that, ‘Hey we worked with Karen, we went back and forth with her and gave her a lot of different stuff.’ A lot of what they gave me was either inaccurate, fundamentally flawed, or really a shadow of what we asked for. So it was a long process to get some substantive information.
DH: So coupled with that hard information, you conducted numerous interviews over this year-long process with current and former foster youth who had this situation where they were over-prescribed or had an experience with psychotropic or anti-psychotic drugs. So how important was that series of interviews in terms of creating your narrative arc?
KdS: So first let me say that the findings from the data were that almost one in four of the youth age 12 to 18 had received a psychotropic medication, which is quite astounding and almost triple the rate of youth of that age demographic nationwide. And one of the most alarming findings was that of the psychotropic medications that children were being prescribed, kids of all ages, hundreds of kids under age five each year, 60 percent were receiving antipsychotic medication. And those are the most powerful type of psychotropic drugs that have the most serious side effects.
So the power of the youth voices in this was them describing in really painful to hear testimony, which we captured on video as well, of how it felt to be on those drugs and what their lives were like and the lack of power they had to refuse the medications.
DH: We’ve discussed to a certain degree the ramifications of that exposure for these young people. How did you go about being sensitive to protecting them while also empowering them to tell the story that needed to be told?
KdS: This story could not be told without the current and former foster youth. It could not be told with any kind of impact and I could not truly understand it without interviewing them directly. There is no way I could have prattled off statistics or interviewed a bunch of clinicians or caregivers to really get what they were going through. And so it was absolutely vital.
That said, it took an incredible amount of bravery and courage on the part of the foster youth and I salute them for their courage. I often have said to myself, you know, if I looked around my newsroom at a bunch of middle-class professionals and someone asked them to turn over their entire medical files or their entire case history inside and out, and allowed a random reporter to interview their doctors, and their therapists and their clinicians and their parents…would any of us do that? No.
So these kids chose to take this risk and chose to tell me these things and they desperately want the story told, and they were willing to sacrifice their privacy really to get this story out. And I think that it was important for them to do and it felt good to them to do and it was empowering.
That said, I took tremendous precautions with them and I always do this with foster youth who I have included in stories for most of my twenty years in journalism. And what I do is I put them in the driver’s seat and let them know that they can refuse to answer questions, they can change their minds up to a certain point, they can take things back if its starting to feel scary or uncomfortable, you know up until, when it gets close to publication I let them know its hard to turn the train around, but they can back out.
I make sure they have a supportive adult in their life; many of them don’t. If not we find one. I make sure there is someone. For instance, some of the kids saw their case files, court records for the first time after I interviewed them. There were some surprises there, they learned things maybe they didn’t know.
One young woman found out her father was incarcerated her entire life, and she never knew that he had written the court to try to get her placed with his family. I mean that was a really hard thing for her to hear because she was not placed with his family and she grew up in dozens of foster homes.
So I do that, and then I make sure that when we are putting the stories together, they know exactly what’s coming. There are no surprises. I read them their parts, I read them their sections, I read them their quotes.
I talk to them about the video. I explain to them what it is going to look like and feel like. I’m going on about this a little bit because it’s important.
In one instance I walked through the streets of Oakland with one of my young interviewees, and I showed him the newsstand. I said, ‘You are going to see your face right there glaring out of this news box. Think about how that is going to feel.’ I showed him other articles I have done with the kids on the front page. There’s no way to know and live an experience you haven’t lived, but I try to prepare them as much as possible.
DH: So I can see some serious parallels between this latest investigative series and your early investigative series on the courts. I am wondering what parallels you see and to what degree your understanding of this larger child welfare system has changed or this latest story has confirmed what you have seen before.
KdS: I would like to think that I am always learning and growing and expanding my knowledge of the child welfare system.
The really key thing about this is in 1999, California tried to get its hands around this potential overprescribing of psychotropic medications by putting the judicial court in charge of approving the drugs. That was something that no state had ever done, and to this date it’s our understanding that California is the only state that a judicial officer — and I say that because they are not always judges — has to sign off and approve every single prescription. And still, we have found that over a ten-year period, the rates have not gone down at all.
We interviewed some of the really long time judges in the juvenile court, including Michael Nash of Los Angeles. He does not feel that the oversight is adequate. He does not feel that judges a) are equipped to question doctors, [and] b) are getting the information they need to make good decisions.
So it tied in pretty neatly with our earlier series that a lot of the decisions made in the juvenile dependency court are slap dash, they are not thought out, they are not based on good information. And clearly, the youth voices are not being heard because the kids are protesting taking these drugs a lot. You know, the California Youth Connection, the youth advocates, have been saying for years, ‘This is not fair, this is not right. We want some standards around the drugs that are being prescribed, we want second opinions, we want our medical records there at least when we are being prescribed.’
Some of these drugs are being prescribed to youth when there is literally no family history of medical records. So doctors don’t even know if the kids have a drug allergy. I mean, that’s not okay. I think that there is real concern that the court is often perhaps rubber-stamping these requests for psych meds.
Daniel Heimpel is the founder of Fostering Media Connections and the publisher of The Chronicle of Social Change.