Monthly Archives: May 2009

Many foster kids being medicated in Florida

Florida Times Union
By Brandon Larrabee Story updated at 4:45 AM on Friday, May. 29, 2009

TALLAHASSEE – Almost 2,700 foster children are on psychiatric medicines, including hundreds in Northeast Florida, even though the Department of Children and Families has no authority to give the drugs to more than 16 percent of those children, according to a state report issued Thursday.

The report follows an ongoing review by DCF after the assumed suicide this year of 7-year-old Gabriel Myers in Fort Lauderdale.

Gabriel was taking psychiatric, or psychotropic, medications. But DCF later found that those caring for the boy hadn’t obtained the parental consent or court order required by state law.

According to the report, 2,669 children being cared for outside of their home – or almost 13.2 percent of foster children – are taking some form of psychotropic drugs. The agency couldn’t find evidence of parental consent or a court order in 16.2 percent of those cases.

“It is inconceivable to me … that the system doesn’t have this right yet,” said DCF Secretary George Sheldon, speaking to reporters after the agency released the information, a picture of Gabriel projected on the wall behind him.

Sheldon, who took over at DCF late last year, said there was no excuse for the agency to wait until the boy’s death to make sure the law was being followed.

“In my opinion, there’s absolutely no rational basis, no argument that can be made,” he said. “We’ve got to get it right. We will get it right.”

Sheldon also said he has rescinded a memo saying case managers didn’t need to get parental consent or a court order if the drug was prescribed for a non-psychiatric purpose.

“That is not the statute,” he said. “That is not the law.”

Psychotropic drugs, particularly anti-depressants, have become controversial because of worries that they might increase thoughts of suicide in children, prompting the FDA to put a “black box” warning on the medications.

Across Northeast Florida

In the Fourth Circuit, which is Duval, Clay and Nassau counties, 205 children in foster care are taking at least one psychotropic drug. That number is 136 for the Seventh Circuit, comprised of St. Johns, Putnam, Flagler and Volusia counties, and 76 in the Eighth Circuit of Baker, Union, Bradford, Gilchrist, Alachua and Levy counties.

The agency found no authorization for 22 children, or about 5 percent, in the agency’s 19-county Northeast Region – comprised of the Fourth, Seventh and Eighth circuits, along with the Third Circuit.

The agency will try to obtain parental consent for children taking the drugs by June 5, or it will take the cases to court.

Lawmakers said the report raised troubling questions about how well the agency has kept tabs on children taking the mind-altering drugs.

“Some place along the line, I think they’ve got to get control of that,” said Sen. Steve Wise, a Jacksonville Republican who sits on the committee overseeing DCF.

Rep. Lake Ray, a member of the House committee responsible for the agency, said the breakdown also stretched beyond DCF.

“I’m really amazed,” said Ray, R-Jacksonville. “I’m amazed that the doctors don’t have a policy in place.”

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Children in state foster care get mind-altering drugs at much higher rate

Vero Beach Press-Journal
BY DARA KAM
The Palm Beach Post
May 29, 2009

TALLAHASSEE — Three times more children in state care are being given mind-altering drugs than kids in the general population, according to an audit of the Department of Children and Families.

And the state is giving the drugs to many children without the legal authority to do so, the preliminary review found.

“That is unacceptable,” said DCF Secretary George Sheldon, who ordered the review after the April 16 death of a 7-year-old Broward County boy in foster care.

Gabriel Myers, who apparently hung himself, was on a mix of the psychotropic medicines, but none of the drugs showed up in the agency’s computer database. And his file did not include a consent form for the medication from a parent or judge as required by state law.

Gabriel’s death exposed endemic problems within the department regarding the use of the psychotropic drugs that Sheldon pledged “to make right.”

For example, the department’s database contained missing elements including consent orders, prescription drugs, dosages and assessment dates. So the information the review is based on is incomplete or could be inaccurate.

The problems exist four years after the legislature changed the law to require the informed consent orders before children in foster care could be put on drugs.

“The good news is that the secretary is trying to get to the bottom of the problems here. The bad news is that they still don’t have a handle on why three times as many children in foster care are on psychotropic medication as children in the general population,” said Andrea Moore, an attorney and child advocate who first challenged the department’s widespread use of the psychotropic drugs nearly a decade ago.

She and others worry that the drugs are being used not as a last resort but as a chemical restraint.

“I can’t tell you how troubling it is to me,” said Ronda Storms, R-Brandon, chairwoman of the Senate Children, Families and Elder Affairs Committee. “Perhaps treating children with drugs may have become the default treatment because it’s easier.”

Sheldon said that he, too, has serious concerns about whether the drugs are being over-prescribed and has asked the auditing team to look into it.

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Florida Department of Children and Families review finds shortfalls in monitoring of foster children on psychiatric drugs

St. Petersburg Times
By Kris Hundley

Spurred by the shocking suicide of a 7-year-old on psychiatric drugs, the agency in charge of Florida’s foster children has discovered serious shortcomings in its monitoring of kids on such powerful prescriptions.

After reviewing its files, the Department of Children and Families determined it had under-counted the number of foster kids on such medications as Risperdal and Adderall, overlooking hundreds of cases.

It also has failed to meet its legal requirement that such prescriptions be given only after parental consent or court order.

On Thursday, DCF said a review of the files of more than 20,000 children currently in the state’s foster care showed 2,669, or 13.19 percent, are taking one or more psychotropic medications.

That compares to about 4 or 5 percent of children in the general population who are on such prescriptions.

Of those foster children taking drugs, DCF discovered 16 percent had no proof either a parent or judge had signed off on the prescription, as required by a 2005 Florida law.

“That is unacceptable,” said DCF’s secretary George Sheldon. “We’re going to bring every single case of a foster child on drugs into compliance with the law.”

Concerns about pediatric use of anti-psychotic and anti-depressants have been growing along with increased warnings of such side effects as suicide, diabetes and weight gain. Few of the drugs have been tested or approved by the FDA for children, though physicians can prescribe them for this age group.

Robin Rosenberg, a Tampa lawyer and deputy director of Florida’s Children First, said advocacy groups like hers have been fighting for oversight of psychotropic drugs for years. “We’re not as far along as we should have been if the state had followed up on serious concerns starting in the late 1990s,” she said. “It’s a shame we’re in this place today.”

Sheldon, who was named to the top job at DCF in October, left no doubt that he had been deeply affected by Gabriel Myers, the 7-year-old who hanged himself on a shower hose in south Florida in mid-April. The boy was in his third foster home and on Vyvanse, a medication for ADHD, as well as Symbyax, a combination of anti-psychotic and anti-depressant.

Though his caseworker repeatedly said Gabriel’s mother had agreed to the medications, that was not true. The boy’s psychotropic medications also had not been entered in the state’s tracking system.

To correct ongoing problems, Sheldon set a deadline of June 5 for action on cases without consent. This could include scheduling new doctors’ appointments, gaining informed consent from parents or expediting a judge’s review of the prescription.

Sheldon said he also was going to focus on the cases of 73 children under age 6 found to be on psychotropic drugs.

“I want a sense of urgency, but I also want to get it right,” he said. “I want to move forward, but I think it’s important for the agency to apologize for misinformation it may have put out in the past.”

Flaws in DCF’s record-keeping became clear in the immediate aftermath of Gabriel’s death. An initial review of the state’s database showed only 1,950 kids on psychotropic prescriptions. After a thorough review of individual records, however, that number grew by more than 700.

Preliminary data released in mid-May also showed some questionable dates on judicial consent. Though it’s not inconceivable a judge might sign an order on a Saturday or Sunday, early returns showed weekend consent orders on 129 occasions.

The final database, including information on types of drugs and diagnoses, was not available Thursday. Sheldon said a summary of the drug data would be posted on the DCF Web site and updated weekly.

“I’ve got a lot more confidence in these numbers than I had two weeks ago,” he said. “But any database is only as good as the quality of the information being put into it.”

One ongoing area of concern, Sheldon said, is the validity of any consent given by parents whose kids are in the state’s custody.

“A parent whose child is taken into our care is going to sign virtually anything and that’s not informed consent,” he said. “My preference is that the biological parent have a dialog with the psychiatrist.”

Now that DCF has a handle on the number of foster children on psychotropic drugs, Sheldon said the department can begin to address the bigger issue of the efficacy of such drugs.

He has asked an independent panel investigating Gabriel Myers’ death to make recommendations on improving DCF’s oversight of these medications. Sheldon said a second-party review of all such prescriptions might be necessary; currently, only prescriptions for kids under age 6 require such review.

DCF has set up a page on its web site that tracks the progress of the panel investigation into the boy’s suicide. The page includes a photo of the smiling boy.

“We have his face on the screen watching us to see how well we learned from his life and death,” Sheldon said. “We cannot let him down.”

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

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Report focuses on Fla. foster kids’ prescriptions

MLive.com – (Michigan)
BILL KACZOR
The Associated Press

(AP) — TALLAHASSEE, Fla. – Proper authorization wasn’t obtained for 16 percent of the Florida foster children who have taken antidepressants and other prescribed psychotropic drugs, according to a study ordered after one of those youngsters apparently committed suicide.

Florida Department of Children and Families Secretary George Sheldon announced the findings at a news conference Thursday.

A photo of 7-year-old Gabriel Myers was projected onto a screen behind Sheldon, who said there was no excuse for failing to comply with a law that requires parental consent or a court order for such prescriptions.

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.

Gabriel was found hanging from a shower cord in the bathroom of his foster parents’ Margate home April 16.

“Anyone who’s heard of Gabriel’s story, I know, is in disbelief and parents everywhere are wondering themselves how could this have happened,” Sheldon said. “Normally a 7-year-old boy is learning to read and tie his shoes, not contemplating death.”

Sheldon has appointed a task force headed by Jim Sewell, a former Florida Department of Law Enforcement assistant commissioner, to determine if the drugs he was taking or alleged sexual abuse were factors in his death. Records show he had allegedly been molested by an older boy in Ohio, where he had lived until last June.

The panel also is looking into whether psychotropic drugs are being prescribed for the wrong reasons. Critics say they are misused as a chemical restraint for unruly children.

Sheldon said he expects to receive the panel’s finding within two months.

Officials early on realized the department’s database failed to show Gabriel had been taking the drugs and they had been prescribed without proper authorization, Sheldon said.

Sheldon then ordered a check of all foster children’s records. The resulting report shows parental consent or court orders had not been obtained for 433, or 16 percent of 2,669 foster children receiving such drugs.

“That is unacceptable,” Sheldon said.

The report also indicates the 2,699 children taking psychotropic drugs comprise 13 percent of all Florida children in out-of-home foster care. That compares to only an estimated 4 to 5 percent of children in the general population.

It’s a discrepancy that raises a “red flag,” Sheldon said, but he added that he’ll wait for the task force’s findings before making any judgments.

“We need to constantly keep the face of Gabriel Myers continually in our minds and in our hearts and get this right,” Sheldon said.

Sheldon said he didn’t believe an erroneous memo issued by his department contributed to failures to obtain parental consent or court orders. It said those requirements could be bypassed if psychotropic drugs are prescribed for non-psychiatric purposes. Sheldon said few people knew about the memo and he rescinded it when he found out about it.

The department, private contractors working for the agency and legal service lawyers will try to obtain parental consent or court orders for all children who have been prescribed such drugs by June 5. Sheldon said he also is asking dependency judges to expedite those cases.

Parents must be advised about specific drugs including warnings of potential hazards before giving informed consent, Sheldon said.

Standard medical consent forms, such as one Gabriel’s mother signed, do not meet that requirement. Sheldon said Candace Myers also may have been high on prescription drugs when she signed the form as authorities took the boy away from her in a restaurant parking lot. Xanax and other prescription drugs were found in her car.

During the last few weeks of his life, Gabriel’s mother lost her visitation rights and he lived in three different foster homes, was told he was going back to Ohio, lost his toys, changed therapists and switched psychotropic drugs, Sheldon said. He said those changes would have been traumatic for anyone regardless of age.

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State survey: Almost 1 Florida foster child in 6 being given drugs without necessary OK

Sun Sentinel

Study is more fallout from suicide of 7-year-old foster child in Margate
By Jon Burstein

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

DCF Secretary George Sheldon acknowledged there was “no rational basis” for 433 foster children in Florida being administered the psychotropic drugs without the required permission, as the study found. The agency is working so that by next week the children have parental consent to take the drugs or are scheduled to go before a judge for a court order, Sheldon said.

The study is more fallout from last month’s suicide of 7-year-old Gabriel Myers. The boy hanged himself April 16 with a shower hose in the bathroom of his Margate 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.

In Broward County, the DCF study found that only seven of the 212 foster children on psychotropic drugs–3 percent of the total–did not have the required approval.

In Palm Beach County, the results at first seemed much more eye-popping: of a total of 149 foster children on mood-altering drugs, 41–or 28 percent–did not have the necessary consent. But the nonprofit agency that manages the county’s foster care system reported that there were only eight children taking medication without the proper consent. The other 33 had the proper approval, but their data files were incomplete, said Judith Warren, chief executive officer of Child and Family Connections.

DCF concluded that inaccurate and incomplete information in its databases had caused it to previously underreport the number of foster children in Florida on psychotropic drugs.

Of the 20,235 foster children in Florida, 2,669 of them–13 percent–are on the drugs, including 73 who are 5 years old or younger, the study found.

Prior to the study, the database listed 1,954 foster children as taking the medications.

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 who is part of a panel examining Gabriel Myers’s death.

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.

“The study tells me more what the department doesn’t know than what they do know,” said Andrea Moore, a Coral Springs attorney and child advocate.

She said she finds it “extremely troubling” that according to the DCF’s latest findings, 16 percent of the foster children taking psychotropic drugs are doing so without a judge’s approval or parental consent even though the state law requiring such approval was passed four years ago.

Jon Burstein can be reached at jburstein@SunSentinel.com or 954-356-4491.

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Hundreds of Northeast Florida foster kids on psychotropic drugs

Florida Times Union
Brandon Larrabee

TALLAHASSEE — Almost 2,700 foster children in state care are on pyschiatric medicines, including hundreds in Northeast Florida, even though the agency has no authority to give the drugs to more than 16 percent of those children, according to a state report issued Thursday.

The report follows an ongoing review by the Department of Children and Families after the assumed suicide earlier this year of 7-year-old Gabriel Myers in Fort Lauderdale.

Gabriel was taking psychiatric, or psychotropic, medications. But DCF later found that those caring for the boy hadn’t gotten the parental consent or court order required by state law.

According to the report Thursday, 2,669 children being cared for outside of their home are taking some form of psychotropic drugs. The agency couldn’t find evidence of parental consent or a court order in 16.2 percent of those cases.

“It is inconceivable to me … that the system doesn’t have this right yet,” said DCF Secretary George Sheldon.

In the Fourth Circuit, which includes Duval, Clay and Nassau counties, 205 children in foster care are taking at least one psychotropic drug. That number is 136 for the Seventh Circuit, which includes St. Johns, Putnam, Flagler and Volusia counties, and 76 in the Eighth Circuit, which includes Baker, Union, Bradford, Gilchrist, Alachua and Levy counties.

The agency found no authorization for 22 children, or almost 5 percent, in the agency’s 19-county Northeast Region, which includes the Fourth, Seventh and Eight circuits, along with the Third Circuit.

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Study: 13.19% of Florida foster kids take psychiatric drug

Miami Herald
BY CAROL MARBIN MILLER
cmarbin@MiamiHerald.com

Almost three of every 10 teenage foster children in Florida have been prescribed at least one mental health drug, and 73 foster children younger than 6 are taking mind-altering drugs, according to a detailed study released Thursday by the state’s child welfare agency.

In all, a total of 2,669 children — or 13.19 percent of all Florida foster children — are being administered powerful psychiatric drugs, says the study, commissioned last month by Department of Children & Families Secretary George Sheldon. The largest group of such children, or almost 60 percent, includes teens age 13 to 17.

Sheldon ordered the study of every child in state custody after The Miami Herald reported that 7-year-old Gabriel Myers, who hanged himself April 16 at a Margate foster home, had been prescribed several mental health drugs without the required consent of a parent or state court judge.

Gabriel’s foster care records showed he had been taking at least two psychiatric drugs at the time of his death. And though his caseworker had repeatedly checked off a box indicating the state had obtained parental consent, no such approval had ever been sought or received.

”This report is an important first step closely examining — not only this case — but to help ensure this type of tragedy never happens again,” Sheldon said Thursday at a news conference.

”This department is responsible to monitor the use of these drugs, to ensure the care, treatment and safety of our children,” he added.

Sheldon, a former deputy attorney general, said he had ”serious questions” in general about the use of mental health drugs on children. Many such drugs have never been approved by the Food and Drug Administration for use on children, and many are linked to serious side effects.

”I think this should be done as a last resort, after a full review by the appropriate kinds of medical professionals,” Sheldon said.

Sheldon also acknowledged the concerns of many Florida child advocates that mental health drugs are being used as ”chemical restraints” to control the behavior of difficult-to-manage foster kids. ”These medications should not be used for the convenience of parents or foster parents,” Sheldon said.

Among the 20,235 children whose case files were studied, investigators found no parental or judicial consent on record for 16.2 percent of the children, the report says.

Like prior studies, the new report shows that children in foster homes, group homes or other institutional settings are far more likely to be taking mental health drugs than children living with relatives. Overall, only 4.3 percent of children in relative care have been prescribed psychiatric drugs, compared with 21 percent for foster homes and 26 percent for other out-of-home settings.

The disparity is particularly acute among older children: Among children 13 to 17, 11.8 percent living with relatives have been prescribed at least one mental health drug, compared with 35 percent in foster care and 33 percent in other institutional settings, the report says.

The five-page report outlines a host of steps DCF administrators will take in coming days, including:

• State child welfare lawyers will seek consent from parents who still have authority to make decisions on their children’s behalf, or go to court to seek approval for drugs for children who currently lack such consent.

• Administrators are launching an ”immediate” review to determine how reliable the state’s computerized child welfare database is, in light of findings that the database did not accurately reflect about one-third of kids in state care who are taking psychiatric drugs.

”The top priority of this review will be children 5 and under,” the report said.

• DCF administrators and the heads of privately run foster care agencies throughout the state will discuss ongoing issues over the use of psychiatric drugs by foster children once each week by telephone.

”The purpose of these calls is to ensure effective communication on improvements that must take place, to respond to any questions from [the private agencies] concerning psychotropic medications and to resolve outstanding issues,” the report said.

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