Getting to the Heart of Foster Children’s Problems

This article is adapted from an earlier piece that ran in the San Jose Mercury News.

By Adam Pertman and Graham Wright

It is heartening to hear that California’s Legislature may finally address the chronic overuse of psychotropic medications for children in foster care in that state, a problem that unfortunately exists from coast to coast.

As lawmakers across the country craft solutions, however, it is critically important to point out that genuinely helping the many thousands of children at risk – in the short term and for the long run – will require systemic changes that go far beyond more wisely writing prescriptions, reducing their numbers and finding alternatives to them.

The child welfare system — including foster care — is huge and complex, with each element intended to protect children and to further their optimal development. Sadly, the barriers to these goals also are big and complicated – and they are most certainly not limited to overmedication. Hopefully, legislative hearings in state after state will examine the full range of these issues, but here are just a few examples to make the point:

  • There is no sufficiently comprehensive structure in place in most states for assessing the individual needs of children placed into foster care. Remember that these girls and boys have typically undergone traumatic experiences such as physical, sexual or emotional abuse; they can and do experience grief, loss, confusion, fear and anger; and so their ability and willingness to attach to caring adults is frequently undermined, and their outward behavior often reflects the turmoil inside of them.

They need help, and it is every state’s legal responsibility to provide it, but one size does not fit all. To optimize their individual prospects for healing and having a shot at better lives, processes and systems need to be established – along with the funding and other resources necessary to make them work, or this is all a charade – to get the correct diagnosis and comprehensive treatment regime for each child.

  • Staffing, training and support are inadequate across the board, across the country.

In California, for instance, social workers’ caseloads are often more than twice as high as the Child Welfare League of America’s recommendation of 12-15. Philip Browning, Director of the Los Angeles County Department of Children and Family Services, has pegged the current average caseload for L.A. County social workers at 32, more than twice the legal state limit for nonprofit foster care agencies.

Attorneys who represent the children’s interests in juvenile court are similarly stretched and strained; the Judicial Council of California recommends 188 cases for each such lawyer, but many of them juggle 100 or more child clients than that, according to Leslie Heimov, executive director of the nonprofit Children’s Law Center, as reported by Southern California Public Radio.

It is a no-brainer to suggest that too few overstressed, overworked professionals dealing with too many struggling, traumatized children may not be doing as good a job as is possible. Furthermore, it is important to keep in mind that this is the context in which medication grew into too easy a response in too many cases.

  • A child’s severe and sometimes delayed behavioral response to maltreatment does not automatically justify medication but, rather, requires more individualized assessment and treatment in the context of family and community care, which lawmakers also should examine. Instead of making and monitoring specific diagnoses, however, medication is too often used inappropriately as a stop-gap to try to manage behavior and to prevent yet another move into yet another placement.

Notably, multiple placements are one of those systemic issues that need to be addressed by legislators, because they in themselves can trigger an array of problems; notable among them is that each move that a child makes from one home to another can lead to yet another prescribing physician coming into his or her life.

Certainly there are some children who are and should be appropriately treated with drugs, but we should be thoughtfully determining which ones those should be and under what controlled circumstances, and not widely medicating girls and boys simply because it’s an expedient way of dealing with behavioral issues.

Many of the children in foster care are angry and, given their life experiences, they have good reason to be. Getting to the heart of their anger and pain and trauma, and acting comprehensively to address their needs, is the key to short-term stability and long-term success. Just writing fewer prescriptions won’t do the trick.

Correction: This piece has been updated to correct misstatements by the authors about the CWLA recommendations on caseloads and California’s procedural standards on caseloads.

Adam Pertman is president of the National Center on Adoption and Permanency. Graham Wright is an NCAP senior consultant based in San Jose, Calif.

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About National Center on Adoption and Permanency 2 Articles
The mission of the National Center on Adoption and Permanency is to transform adoption – and other forms of permanency – from a model that primarily focuses on child placement to one that enables children and their families to succeed.


  1. Should be more like the chronicle of social abuse. Everyone here got a beamer? Thank my children for that.

  2. You forgot to mention that it is the SS worker who writes the referrals to the psychiatrist. I guess when ss workers can’t do their job, they just drug the children and that’s exactly what’s happening here. Your broken corrupt foster system and lazy social workers drug children so their phones ring less. You people are so greedy, stealing children, then drugging them because you can’t handle the needless trauma you put children and families through.

    What a great con you guys got going…

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