Monthly Archives: May 2009

Florida Department of Children and Families’ records on foster children taking psychiatric drugs raise doubts

St. Petersburg Times
By Kris Hundley

The agency in charge of Florida’s foster kids thinks it has finally gotten a handle on how many of its charges are on powerful psychiatric drugs.

But a closer look raises serious questions about the validity of the recently updated database.

While Florida’s Department of Children and Families said Thursday that a review of case files found 2,669 children on psychotropic medications, the supporting data are shaky.

DCF’s records include such unlikely scenarios as an eight-year delay between the time a court approved a drug and the date it was actually prescribed.

In another case, a child started taking a drug for attention deficit hyperactivity disorder nine years before the judge gave consent.

About 100 court approvals were signed on weekends.

And of more than 5,000 prescriptions, only one child was reportedly taking Symbyax, a combination antipsychotic and antidepressant that has been on the market since 2004. Symbyax was one of the psychotropic drugs being taken by a 7-year-old foster child who committed suicide in South Florida last month.

DCF is required by law to track foster children on psychiatric drugs because of potentially dangerous side effects. Previously, the department had reported that fewer than 2,000 kids were on such prescriptions.

In this week’s review, DCF also admitted that one in six of those children did not have legally required approval by either a parent or a judge to have such a prescription.

But in hundreds of cases in which a judge’s consent reportedly was obtained, the date of that order came either long before — or long after — the prescription started.

For instance:

• In 10 cases around the state, DCF’s records show judges signing consent orders for a variety of drugs in January 2001, but the children’s prescriptions did not start until 2009.

• A 16-year-old in Marion County was approved for the antipsychotic Risperdal in August 2005, but the prescription didn’t begin until May 2009.

• A 15-year-old in Duval County had a judge sign off on another antipsychotic, Abilify, in January 2007; state records show the prescription began in May 2009.

John Cooper, DCF’s acting assistant director of operations, acknowledged shortcomings in the state’s database but said the medication start date could simply reflect the most recent prescription for a long-standing medication.

Andrea Moore, a longtime advocate for foster children, said that’s no excuse. State law requires judges to regularly review the appropriateness of psychotropic prescriptions, she said, especially if the medication is changed.

“A consent signed two years earlier is not a valid consent,” said Moore, former executive director of Florida’s Children First. “That’s particularly important when you’re talking about atypical antipsychotics where serious questions have been raised about their long-term side effects.”

Conversely, in more than 100 cases, there was an unusually long delay between the medication start and the court order.

• A 14-year-old in Brevard County reportedly on the ADHD drug Adderall since 1999 received court approval in November 2008.

• A 16-year-old in Hillsborough County began taking Seroquel, an antipsychotic, in October 2005, with a judge’s consent received this January.

DCF Secretary George Sheldon ordered a thorough review of all kids on psychotropic drugs last month after the suicide of Gabriel Myers. Myers, who had been in state custody for 10 months, was on Symbyax, as well as Vyvanse, for ADHD.

The state’s database shows only one other foster child, a 14-year-old in Marion County, currently taking Symbyax. DCF’s Cooper declined to comment on why the drug did not appear more frequently.

Symbyax has not been approved for children, although the practice that employs Gabriel Myers’ psychiatrist is currently recruiting adolescents for a clinical trial of Symbyax for bipolar depression.

The most popular medicine on the state’s database is Adderall. The next three most prescribed drugs, Risperdal, Seroquel and Abilify, are all antipsychotics

DCF’s data show the sense of urgency among caseworkers as they scrambled through files in the aftermath of Gabriel Myers’ suicide. Of the 2,433 court orders in the report, 187 of them are dated after April 16, the day the boy took his life. That includes the record of a 7-year-old in Palm Beach County who had been taking Adderall since November 2005.

The agency’s database showed that 1,653 of the 2,669 foster children taking psychotropic drugs have multiple prescriptions. However, the state’s tracking system is unable to easily identify kids on several different drugs at one time rather than multiple prescriptions for the same drug.

“We’ve noticed there are system limitations,” said DCF’s Cooper, who added that the system requires users to work through 12 screens to enter data. “As part of the Q.A. (quality assurance) process, we’re trying to get a better idea of what’s going on.”

Moore, the foster child advocate, wonders why DCF released the data before checking it against Medicaid’s records of the same children, a step DCF promises to take.

“When we’ve compared those two databases in the past, we’ve found significant under-reporting by DCF,” she said. “At least Secretary Sheldon is trying to put pressure on them to get it right. But there’s no reason, in my opinion, to trust the data they currently have.”

Kris Hundley can be reached at khundley@sptimes.com or (727)892-2996.

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psychiatric drugs – Usage Uncertain In Foster Children

Lakeland Ledger
BY KRIS HUNDLEY
and CONNIE HUMBURG

The agency in charge of Florida’s foster kids thinks it has finally gotten a handle on how many of its charges are on powerful psychiatric drugs.

But a closer look raises serious questions about the validity of the recently updated database.

While Florida’s Department of Children and Families said last week that a review of case files found 2,669 children on psychotropic medications, the supporting data are shaky.

DCF’s records include such unlikely scenarios as an eight-year delay between the time a court approved a drug and the date it was actually prescribed.

In another case, a child started taking a drug for attention deficit hyperactivity disorder nine years before the judge gave consent.

About 100 court approvals were signed on weekends.

And of more than 5,000 prescriptions, only one child was reportedly taking Symbyax, a combination antipsychotic and antidepressant that has been on the market since 2004. Symbyax was one of the psychotropic drugs being taken by a 7-year-old foster child who committed suicide in South Florida last month.

DCF is required by law to track foster children on psychiatric drugs because of potentially dangerous side effects. Previously, the department had reported that fewer than 2,000 kids were on such prescriptions.

In its review, DCF also admitted that one in six of those children did not have legally required approval by either a parent or a judge to have such a prescription.

But in hundreds of cases in which a judge’s consent reportedly was obtained, the date of that order came either long before or long after the prescription started.

For instance:

In 10 cases around the state, DCF’s records show judges signing consent orders for a variety of drugs in January 2001, but the children’s prescriptions did not start until 2009.

A 16-year-old in Marion County was approved for the antipsychotic Risperdal in August 2005, but the prescription didn’t begin until May 2009.

A 15-year-old in Duval County had a judge sign off on another antipsychotic, Abilify, in January 2007; state records show the prescription began in May 2009.

John Cooper, DCF’s acting assistant director of operations, acknowledged shortcomings in the state’s database but said the medication start date could simply reflect the most recent prescription for a long-standing medication.

Andrea Moore, a longtime advocate for foster children, said that’s no excuse. State law requires judges to regularly review the appropriateness of psychotropic prescriptions, she said, especially if the medication is changed.

“A consent signed two years earlier is not a valid consent,” said Moore, former executive director of Florida’s Children First. “That’s particularly important when you’re talking about atypical antipsychotics where serious questions have been raised about their long-term side effects.”

Conversely, in more than 100 cases, there was an unusually long delay between the medication start and the court order.

A 14-year-old in Brevard County reportedly on the ADHD drug Adderall since 1999 received court approval in November 2008.

A 16-year-old in Hillsborough County began taking Seroquel, an antipsychotic, in October 2005, with a judge’s consent received this January.

DCF Secretary George Sheldon ordered a thorough review of all kids on psychotropic drugs last month after the suicide of Gabriel Myers. Myers, who had been in state custody for 10 months, was on Symbyax, as well as Vyvanse, for ADHD.

The state’s database shows only one other foster child, a 14-year-old in Marion County, currently taking Symbyax. DCF’s Cooper declined to comment on why the drug did not appear more frequently.

Symbyax has not been approved for children, although the practice that employs Gabriel Myers’ psychiatrist is currently recruiting adolescents for a clinical trial of Symbyax for bipolar depression.

This story appeared in print on page B1

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After child’s death, DCF will do better

Miami Herald
VERBATIM
By XXXXXX
Below are excerpts from remarks by Deparment of Children & Families SecretaryGeorge Sheldon on May 28 on the Psychotherapeutic Drug Status Report.

When I learned about the death of 7-year-old Gabriel Myers, who apparently hanged himself in his foster parents’ home in Margate, I was stunned. It is incomprehensible to understand how a child so young may have deliberately and consciously made a decision to end his life. Anyone who heard of Gabriel’s story was in disbelief; parents everywhere are wondering to themselves: How could this happen?

Immediately following Gabriel’s death I appointed a work group, chaired by Dr. Jim Sewell, former assistant commissioner of the Florida Department of Law Enforcement, to review all available information regarding the factors that led to Gabriel’s death. I asked the work group to conduct a full inquiry into all the facts of the case, including the contributing effects of psychotherapeutic drugs and sexual abuse.

Poor-quality data

Some disturbing things emerged fairly quickly. Gabriel’s physician had prescribed several psychotherapeutic drugs, but this information was not reflected in our database. There also was no evidence in Gabriel’s files that the statutorily required parental consent or a court order was obtained. This report is an important first step in closely examining not only this case but in helping ensure that a tragedy of this magnitude does not occur again. We have not determined whether these drugs were a factor in Gabriel’s death. Regardless, we have a responsibility to monitor the use of those drugs and to ensure the overall care, treatment and safety of children in our care.

Here are some of the key findings: First, the report indicates that about 13 percent of the more than 20,000 children in out-of-home foster care are taking one or more psychotherapeutic medications. That is a significant number. Though obviously I have little confidence in our past data, it appears to be a reduction from where we were four years ago, when the Legislature’s concern about this led to passage of the consent law. It is also lower than other states. [However] Florida needs to get this right.

Parents’ consent

Second, we have to bring every single case into compliance with the law. Our review indicates that about 16 percent of the foster children on psychotherapeutic medications do not have either parental consent or a court order. That is unacceptable. Our attorneys with Children’s Legal Services are working with the caseworkers at our partner agencies to obtain these consents or file a status report with the courts by next Friday.

We have to make sure that parents are not just signing a consent form but really understand what they are signing. We have to get our database system in better shape, and work with other agencies like the Agency for Health Care Administration to ensure the integrity and usefulness of the data we have on these children. We are also raising the standards for the performance of our partner agencies. These partners are really the key to our success. But ultimately the Department of Children and Families is responsible.

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DCF: There is No Excuse For Foster Care Children to Die

Public News Service – FL
Gina Presson
In the wake of the apparent suicide of seven-year old Gabrielle Myers last month, the Florida Department of Children and Families (DCF) released preliminary results Thursday of the investigation into his death.

DCF Secretary, George Sheldon says, in the weeks prior to his death, Gabriel learned his mother had lost visitation rights, that he would be moving back to Ohio where he said he was sexually abused by another child, and he that he also changed psychotropic medications, therapists, and foster homes, moving three times.

“I don’t care how old you are; that much change in that space of time can be traumatic. Normally, a seven-year old boy is learning to read and tie his shoes, not contemplating death.”

Dr. David Cohen, professor of social work at Florida International University, says children in foster care often are troubled and abused, but he says psychotropic drugs should be a last resort. Many problems are better solved with dialogue not drugs, he adds.

“They say it’s this love I got; they say it’s this really nice family I was in; they talk about a counselor they saw for three years rather than ten counselors in three years. That’s what they say made a difference, not the drugs.”

Secretary Sheldon agrees, saying medication should not be a convenience but a medical necessity. He says the department is working to make sure all children are safe in their care.

“We need to keep the face of Gabriel Myers continually in our minds and in our hearts and get this right. We need to go from this tragedy to start setting the standard for the nation on how to deal with this issue.”

The study found Gabriel was taking psychotropic drugs without a valid parental consent form, and database records were not accurate. Secretary Sheldon then ordered a review of all DCF records, which found 13 percent of the 20,000 children in foster care are taking psychotropic drugs, as compared to about four percent of all Florida children. He adds 16 percent of them, like Gabriel, do not have signed parental consent forms for the drugs in their files.

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More foster kids on meds

Daytona Beach News Journal
By DEBORAH CIRCELLI
Staff writer

More local foster children are on psychotropic medications than the state average, according to a state review done following the suicide of a 7-year-old foster child in South Florida.

The state Department of Children & Families released a report Thursday showing 2,669 foster children 17 and younger are on one or more psychotropic drugs, including 127 in Volusia, Flagler and Putnam counties.

Locally, that amounts to 16.5 percent of all children in foster and group homes or with relatives or other foster placements compared to 13 percent statewide.

In more than 400 of the cases statewide, or 16 percent of the cases, there was no consent by a parent or a court order as required by law for the child to be prescribed medications which the DCF secretary said is “inconceivable.” Locally, there was no consent on three cases or 2.3 percent.

The local circuit had one of the highest percentages of foster teens, ages 13 to 17, on one or more psychotropic medications — 40.4 percent of foster children compared to 28 percent statewide.

Rachel Smith, interim chief executive officer of Community Partnership for Children, the local foster care agency, said she was surprised the local numbers are higher than the state average and the agency will be looking into why that is the case.

The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Some are used to alleviate pain.

Smith is more concerned about the 6- to 12-year-olds because the report shows 21.6 percent were on such medications and most are in foster homes. Many of the older teens are in group homes, Smith said, where in some cases the children receive therapeutic services as well.

“The biggest surprise is the younger kids,” she said.

Ray Salazar, chairman of the Community Alliance, a local DCF advisory board, said he will bring the issue up before the Community Alliance on June 10 and ask local DCF officials to look into why the local area has higher numbers.

He said the board will not take sides as to whether children should or should not be on such medications, but “it bares more of an investigation.”

DCF secretary George Sheldon said in a teleconference with reporters he has serious questions when it comes to giving children psychotropic medications and that it should be done as a “last resort” after a full review by medical professionals.

DCF has had a workgroup looking into psychotropic medications and the death of Gabriel Myers on April 16 from apparently hanging himself in the shower of his foster parents’ Margate home.

deborah.circelli@news-jrnl.com

— The Associated Press contributed to this report.

Statewide, 13 percent of 2,669 children in foster care — including those living with relatives and in foster and group homes — are on one or more prescriptions for psychotropic medications. In the local area which includes Volusia, Flagler and Putnam counties, 16.5 percent or 127 children are on the medications. The local numbers show:

5 AND YOUNGER: Five children or 1.37 percent are on one or more psychotropic medications compared to 0.81 percent statewide.

6- TO 12-YEAR-OLDS: 46 children or 21.6 percent are on one or more psychotropic medications compared to 17.6 percent statewide.

13- TO 17-YEAR-OLDS: 76 children or 40.4 percent are on one or more psychotropic medications compared to 28.7 percent statewide.

CONSENT: 72 children had court orders for medication, 52 had parental consent and three had no consent.

SOURCE: Florida Department of Children & Families

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DCF vows better drug oversight

News Press
By JANINE ZEITLIN
jzeitlin@news-press.com

The head of the state’s child welfare agency vowed Thursday to improve oversight of the 13 percent of children in care who are prescribed psychotropic drugs, and also raised concerns about use of those drugs in children.

George Sheldon, Department of Children and Families’ secretary, released findings of a review of every foster child’s files to check for parental consent or a court order for such medications, as required by law.

The inquiry came after the April death of 7-year-old Gabriel Myers, a Broward County foster child who hanged himself in the shower. The department had not obtained valid consent for medication.

“Gabriel Myers couldn’t wait for a better system,” Sheldon said. “I don’t believe any of our children can. They need us right now.”

The Children’s Network of Southwest Florida, contracted by DCF to care for local children, counted 9 percent of its population taking such drugs, which include mood stabilizers and antidepressants.

No consent was obtained in 19 percent of the 111 local children with active prescriptions, according to the state report. Nadereh Salim, the network’s CEO, said its data reflects closer to 15 percent.

“That’s still not good,” Salim said. “What we’re going to do is take each of one those files and pursue the process.”

Statewide, the report found no record of consent or order in 16 percent of the almost 2,700 children receiving medication.

Dr. John Ritrosky, a pediatrician and network board member, said Gabriel’s death points to the need to drive local attention to monitoring foster children taking the drugs.

“I think this case is a wake-up call,” Ritrosky said. “We all need to focus on these kids more and see what their psychiatric care is and see what the local psychiatric manpower is to take care of these kids.”

Sheldon sounded alarm when a psychiatrist at Thursday’s press conference said about 5 percent of children in the general population take the drugs.

“That obviously raises some red flags,” Sheldon said. “I’m not anti-medication, but I have serious questions on the administration of psychotropic drugs for children.”

This is not the first time this issue has been raised. In 2005, a study found one in four foster children were being prescribed mood-altering drugs.

Sheldon seethed about his agency’s failings.

“It is inconceivable for me … that the system doesn’t have this right yet,” he said.

Salim said local case managers do know consent is legally required, but may have obtained verbal consent or had trouble contacting the parents.

Debate percolates about whether some of the potent drugs should be prescribed.

“There really is nothing satisfactory to do for these kids,” Ritrosky said. “It’s frequently flying by the seat of the pants.”

Local advocates are concerned that the proper parties be involved in the decision to medicate.

“It’s a matter of a really good relationship with parents, foster parents, and physicians and, when that doesn’t happen, that’s when I have a problem with it,” said Liz Givens, executive director for the Lee County chapter of the National Alliance on Mental Illness.

Some worry foster children may be overmedicated. Julie Pettit of Cape Coral is a court advocate for a foster child prescribed a handful of drugs.

“I’ve objected to that in court and said, ‘Why is a 16-year-old getting all this medication?'” Pettit said.

Pettit said the teenager can be angry, but has reasons to be after moving more than a dozen times in her nine years in care.

“When a child is taken away from their parents that trauma stays with them all of their lives,” Pettit said.

Mark Geisler, network board president, warned of the system becoming too involved in medication.

“How many people are you going to have second-guessing?” he asked. “At some point, you have to say, you have licensed physicians doing their best.”

Salim plans more oversight and will take part in weekly calls on medication as mandated by DCF. The department set a June 5 deadline to obtain missing consent.

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Foster kids get mood-altering drugs without orders or consent, DCF finds

Orlando Sentinel
By Jon Burstein and Kate Santich | Staff Writers

Almost one of every six foster children on mood-altering drugs in Florida is being medicated without the court order or parental consent required by law, according to a study released Thursday by the state Department of Children and Families.

DCF Secretary George Sheldon acknowledged there was “no rational basis” for 433 foster children in Florida being given psychotropic drugs without the required documentation. He vowed that by next week, the agency would ensure that the children have parental consent to take the drugs or that their cases are scheduled to go before a judge.

The study is more fallout from last month’s suicide of 7-year-old Gabriel Myers, a South Florida boy who hanged himself in the bathroom of his foster home. At the time of his death, he had been prescribed two psychotropic drugs — Symbyax and Vyvanse — that had not been approved by either his parents or a judge.

It is not known whether the drugs contributed to his death, but DCF officials launched an investigation into how many children in the state’s care are prescribed such drugs, which include anti-depressants, anti-anxiety medication, mood stabilizers, anti-psychotics and stimulants. The officials also examined whether proper consent had been obtained.

In Central Florida, 13 percent to 20 percent of foster kids receive psychotropic drugs. Most of the medicated are teenagers.

In comparison, about 5 percent of children in the general population are on some sort of psychotropic drug, said Rajiv Tandon, a University of Florida psychiatry professor examining Gabriel Myers’ death.

But consent is spotty, varying widely from one county to the next, depending on the agency contracted to oversee the foster children. In Volusia, for instance, fewer than 1 percent of cases have no record of parental or judicial approval. In Orange and Osceola counties, the figure is nearly 30 percent.

John Cooper, director of DCF’s central region, which includes Orange, Osceola, Seminole, Lake and 12 other counties, said he was less concerned with the number of medicated children than with the effect of the drugs on those who take them and whether the children also are getting counseling.

“This is a vulnerable population,” Cooper said. “And we need to do a better job of tracking and monitoring these kids.”

At Community Based Care of Seminole — a private agency contracted by DCF to handle foster-care cases — CEO Glen Casel said the real lesson of Gabriel Myers’ suicide is for caseworkers and caretakers to treat each foster child as if he or she were their own.

“If my child were prescribed by a doctor to be put on a medication — or two or three or four medications — you’d have some explaining to do,” Casel said. “It doesn’t mean I wouldn’t do it, but I would have to be assured and comfortable that this was best for the long-term benefit of my child.”

Statewide, of the 20,235 foster children in the system, 2,669 of them — or 13 percent — are on the drugs, including 73 who are 5 or younger, the study found.

Child advocates long have been frustrated with the administering of psychotropic drugs to foster children, arguing that the medications are used more often to subdue children than to address their mental-health issues.

Jon Burstein of the ( Fort Lauderdale) Sun Sentinel can be reached at jburstein@sun-sentinel.com or 954-356-4491. Kate Santich of the Orlando Sentinel can be reached at ksantich@orlandosentinel.com or 407-420-5503.

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