Monthly Archives: June 2009

Child’s death exposes problems in Florida foster care

Bradenton Herald

It wasn’t that long ago when the Florida Department of Children & Families was seen as a hapless bureaucracy. Whether it was their seeking to incarcerate an 8-year-old to ensure he received proper care, or simply losing youngsters supposedly under its care, it didn’t take much for DCF to make a mockery of its role in child welfare.

The good news is that DCF is no longer that troubled agency. Unfortunately, many of those problems that once bedeviled DCF now belong to local nonprofits and government agencies that are under contract with the state to provide foster care and other child protective services. Thank community-based care for that.

Community-based care came about during the first term of then-Florida Gov. Jeb Bush, who combined his zeal for public private partnerships with the need to improve the state’s largest government agency to create a largely successful policy initiative. Today, more people are involved in the critically important care of Florida’s children.

Yet, cases like the death of 7-year-old Gabriel Myers continue to expose holes in what remains a major governmental reform. Myers’ body was found hanged in his Margate home. The youth’s suicide is problematic enough, but it is only compounded by the prescription of powerful anti-psychotic drugs that brought periods of calm into the child’s life but may have produced unwanted side effects. One of Myers’ drugs, Symbyax, contains a “black box” warning that it causes suicidal thoughts and behavior in children.

Worse, the medication was prescribed without a court order or parental consent, a clear violation of state law, and Myers wasn’t alone. According to a recent study released by DCF, the social agencies that are under contract with DCF aren’t complying with benchmarks governing the use of psychotropic medication among foster children. So what began as a horrific case in Broward County remains a statewide problem.

The task of caring for foster children remains difficult. The onus to make sure that the reform called “community-based care” succeeds now rests with groups like Broward County’s Child Net and Child and Family Connections in Palm Beach County, which must shoulder a greater responsibility of ensuring that wards of the state under their jurisdiction receive proper care.

BOTTOM LINE: The onus now is on local groups running foster care.

— Sun Sentinel, Fort Lauderdale

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THE ISSUE: Child’s death exposes a big problem in foster-care reform

Sun Sentinel
Sun Sentinel Editorial Board

It wasn’t that long ago when the Florida Department of Children & Families was seen as a hapless bureaucracy. Whether it was their seeking to incarcerate an 8 year-old to ensure he received proper care, or simply losing youngsters supposedly under its care, it didn’t take much for DCF to make a mockery of its role in child welfare.

The good news is that DCF is no longer that troubled agency. Unfortunately, many of those problems that once bedeviled DCF now belong to those local nonprofits and government agencies that are under contract with the state to provide foster care and other child protective services. Thank community-based care for that.

Community-based care came about during the first term of then-Florida Gov. Jeb Bush, who combined his zeal for public private partnerships with the need to improve the state’s largest government agency to create a largely successful policy initiative. Today, more people are involved in the critically important care of Florida’s children.

Yet, cases like the death of 7-year-old Gabriel Myers continue to expose holes in what remains a major governmental reform. Myers’ body was found hanged in his Margate home. The youth’s suicide is problematic enough, but it is only compounded by the prescription of powerful anti-psychotic drugs that brought periods of calm into the child’s life but may have produced unwanted side effects. One of Myers’ drugs, Symbyax, contains a “black box” warning that it causes suicidal thoughts and behavior in children.

Worse, the medication was prescribed without a court order or parental consent, a clear violation of state law, and Myers wasn’t alone. According to a recent study released by DCF, the social agencies that are under contract with DCF aren’t complying with benchmarks governing the use of psychotropic medication among foster children. So what began as a horrific case in Broward County remains a statewide problem.

The task of caring for foster children remains difficult. The onus to make sure that the reform called “community-based care” succeeds now rests with groups like Broward County’s Child Net and Child and Family Connections in Palm Beach County, which must shoulder a greater responsibility of ensuring that wards of the state under their jurisdiction receive proper care.

BOTTOM LINE: The onus now is on local groups running foster care.

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DCF found many children are given powerful medications

Lakeland Ledger
Officials Struggle to Reform Foster System

FORT LAUDERDALE | Kimberly Foster was on psychotropic medications every day during the decade she spent in foster care.

Locked in a mental facility with green walls, barred windows and four-point restraints from the age of eight, Foster said her actions were easy to explain: she was sadshe couldn’t be with her mother.

“They looked at me as a troublemaker instead of a child who is coming out of a troubled environment. If you cry, you’re depressed. If you act out in school, you’re a behavior problem. We’re soquick to put these diagnoses on children,” the 25-year-old Foster said Thursday in a meeting with officials from the Department of Children and Families. “Youth in foster care are overmedicated, overdiagnosed.”

As state officials wade through the systemwide failures that led to the suicide of 7-year-old foster child Gabriel Myers in April, two issues come up repeatedly: the alarming use of psychotropic medications and the inability of doctors, foster parents and case workers to track problems with such powerful medications.

About 2,699 children in out-of-home foster care, or about 13 percent, are taking psychotropic drugs. That compares with about 4 percent to 5 percent of children in the general population, according to a recent DCF study.

Problems range from simply incorrectly entering basic information like a child’s gender and age into a database to overloaded and inexperienced case workers who are expected to understand warning labels on psychotropic medications.

Even logistics of accompanying a foster child to a doctor’s appointment fell short. Forty percent of the 112 foster children’s files studied, were not accompanied to their appointment. Many were dropped off by medical transport, making it that much harder for an adult to communicate crucial details about the child’s treatment.

Some officials proposed further training for foster parents and case workers, while others worried a four-hour training session on psychotropic drugs and what to look for would change little. Especially in a system with a nearly 50 percent turnover rate among case workers.

“Global training is important but I don’t think it’s going to get us to the level of specificity that we need,” said William Janes, a member of the work group examining the boy’s death. He stressed the importance of case managers.

“It’s not about psychotropic medications solely,” he said. “It’s about the care that this boy did not get.”

Basic analysis of medications for children in state care – such as what medication they were taking, why and when it was prescribed, and whether it worked – is not being completed in many cases. That information was supposed to be collected beginning in 2005.

“But it did not see the light of day,” said Dr. Rajiv Tandon, a work group member who is a psychiatrist at the University of Florida. “This particular form was an integral part of that plan and it never happened.”

In Gabriel’s case, his foster parents and teachers reported disturbing behavior, including sexual advances toward classmates. At one point, the child admitted to trying to strangle himself.

Yet his doctor continued on the same treatment plan.

“The whole system broke down in the community,” Janes said. “Everybody involved in this case was disconnected from that level that we would expect at some degree.”

Mez Pierre, who entered the foster system at age 5, said he was given plenty of medication but very little emotional support.

“I felt like I was an animal in a farm being tested on,” the 22-year-old told DCF officials Thursday. “Irresponsibility is just not worth a life. We need to do whatever we can to make sure another Gabriel does not happen again.”

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Kids need care, not pills, ex-foster children tell panel


Miami Herald

A state group looking at the suicide of a young foster child met Thursday to discuss ways to improve care and listened to adults who said they were overmedicated in the foster-care system.
BY AMY SHERMAN
asherman@MiamiHerald.com
As Florida child-welfare administrators study failures in the foster-care system believed to have led a 7-year-old boy to kill himself in April, they turned Thursday to experts they don’t often consult: young adults who came of age in state care.

Mez Pierre, 22, and Kimberly Foster, 25, both from Broward County, told the group that mental health drugs — already at the center of the investigation of Gabriel Myers’s tragic death — aren’t the answer for many foster youth. Children need caring adults who will look at the causes of their difficult behavior, they said — not simply write prescriptions in an attempt to control it.

Foster said doctors prescribed medication when she got upset about being removed from her home. She was ultimately placed in facilities with locked windows and restraints.

”They were trying to control the symptoms I had from being put into the system. . . . How I reacted was normal,” Foster said. “I was sad. I was taken away from my home. Because of that they felt medication was the right way to treat me.”

Florida Department of Children & Families (DCF) administrators and child advocates who formed a work group to study Gabriel’s death held their third meeting Thursday in Fort Lauderdale. Gabriel hanged himself in the bathroom of his Margate foster home in April. He had been prescribed several psychiatric drugs during his nine months in foster care.

Workgroup members spent much of the day talking about issues such as how to improve communication between various professionals who care for foster kids. The leaders discussed various forms and documents collected for each child, and the potential roadblocks in gathering the data — sometimes as simple as a fax not going through.

Anne Wells, pharmacy director for the state Agency for Health Care Administration, questioned how some of these efforts will help children in foster care. .

”I don’t mean to criticize, but I have listened to improvements, and checked boxes, forms and paperwork. I’m sorry. I just don’t get it,” she said. “Where does all of this stuff head off the outcome that Gabriel had?”

Wells also questioned whether administrators were too quick to blame medication for Gabriel’s death, rather than talking about what led to his being medicated in the first place.

OVER-MEDICATED

But both Pierre and Foster told the group that they were over-medicated as foster children.

”To hear a story about a foster youth who lost his life, I take that very, very personally,” said Pierre, who choked back tears during his presentation. “I went through a lot of things that Gabriel went through and to see one loss is very painful.”

Gabriel ‘wasn’t being cared for. He was just told `you have problems,’ ” Pierre said.

Pierre added that he was first prescribed medications when he entered the foster-care system at age 5. He was given multiple pills and various diagnoses, including attention deficit/hyperactivity and bipolar disorders.

”When I was on medications, I always felt like a zombie,” he said. “I felt drowsy. I didn’t feel human. I felt like I was an animal on a farm being tested.”

Today, Pierre is doing what many told him he couldn’t do: living a successful life without medications. Pierre, who lives in Deerfield Beach, said he has a job, attends Broward College and hopes to become a lawyer.

”Consider the lives . . . even though it’s a difficult job,” he told the group. “That doesn’t mean to neglect your responsibility and to not work together.”

Foster said she took herself off the medications when she was 18 and pregnant. She now lives in Pompano Beach with her husband and son.

NEVER SUICIDAL

”I have never displayed any suicidal ideations, no mutilations, no disorientations,” Foster said. ‘We are lost if we send a message to youth, `if you cry you are depressed.’ We are so quick to put diagnoses on a child for a lot of times being a normal adolescent.”

Both Pierre and Foster are active in a group called Florida Youth Shine which, among other things, testifies in Tallahassee about foster-care issues.

A Miami Herald article that showed Gabriel had been on several drugs, including anti-depressants associated with a higher risk of suicide, prompted DCF to investigate the prescribing of mental health drugs to children.

DCF Secretary George Sheldon formed the work group as part of the wide-ranging investigation.

The group Thursday discussed a recent state review of more than 100 foster children age 5 or younger receiving psychiatric drugs. The study revealed that child welfare administrators are ignoring rules designed to protect the children.

In the majority of cases, for example, there was no documentation to show that case managers coordinated with the prescribing practitioner to obtain a psychiatric evaluation.

Broward County’s top child-welfare judge, Circuit Judge John A. Frusciante, read a statement that he recently wrote to ChildNet, Broward’s private foster care agency, in response to child advocates in recent hearings who had no knowledge about the existence of ”black box warnings” on medications. He called for more education of case workers.

”It is deeply disturbing that child advocates have no knowledge of the FDA’s highest warnings for possibly life-threatening adverse effects of medications,” he wrote.

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Struggle to fix foster system

Sarasota Herald Tribune
TRACKING PROBLEMS: Changes prompted by suicide of 7-year-old
By KELLI KENNEDY The Associated Press

FORT LAUDERDALE – Kimberly Foster was on psychotropic medications every day during the decade she spent in foster care.

Locked in a mental facility with green walls, barred windows and four-point restraints from the age of 8, Foster said her actions were easy to explain: She was sad she could not be with her mother.

“They looked at me as a troublemaker instead of a child who is coming out of a troubled environment. If you cry, you’re depressed. If you act out in school, you’re a behavior problem. We’re so quick to put these diagnoses on children,” Foster, 25, said Thursday in a meeting with officials from the Department of Children and Families. “Youth in foster care are overmedicated, overdiagnosed.”

As state officials wade through the systemwide failures that led to the suicide of 7-year-old foster child Gabriel Myers in April, two issues come up repeatedly: the alarming use of psychotropic medications and the inability of doctors, foster parents and caseworkers to track problems with such powerful medications.

About 2,699 children in out-of-home foster care, or about 13 percent, are taking psychotropic drugs. That compares with about 4 percent to 5 percent of children in the general population, according to a recent DCF study.

Problems range from incorrectly entering basic information like a child’s gender and age into a database to overloaded and inexperienced case workers who are expected to understand warning labels on psychotropic medications.

Even logistics of accompanying a foster child to a doctor fell short. Forty percent of the 112 foster children whose files were studied were not accompanied to their appointment. Many were dropped off by medical transport, making it harder for an adult to communicate crucial details about treatment.

Some officials proposed further training for foster parents and case workers, while others worried a four-hour training session on psychotropic drugs and what to look for would change little. Especially in a system with a nearly 50 percent turnover rate among case workers.

“Global training is important but I don’t think it’s going to get us to the level of specificity that we need,” said William Janes, a member of the work group examining the boy’s death. He stressed the importance of case managers.

“It’s not about psychotropic medications solely,” he said. “It’s about the care that this boy did not get.”

Basic analysis of medications for children in state care — such as what medication they were taking, why and when it was prescribed, and whether it worked — is not being completed in many cases. That information was supposed to be collected beginning in 2005.

“But it did not see the light of day,” said Dr. Rajiv Tandon, a work group member who is a psychiatrist at the University of Florida. “This particular form was an integral part of that plan and it never happened.”

In Gabriel’s case, his foster parents and teachers reported disturbing behavior, including sexual advances toward classmates. At one point, the child admitted to trying to strangle himself.

Yet his doctor continued on the same treatment plan.

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DCF studies failures in child’s hanging death

ABC-3 WEAR
June 18, 2009

FORT LAUDERDALE, Fla. (AP) — A 25-year-old woman who spent a decade in foster care told Department of Children and Families officials she believes children in foster care are overdiagnosed and overmedicated.

Kimberly Foster made the comments to state officials Thursday in Fort Lauderdale.

Officials are reviewing system wide failures that led to the hanging death of 7-year-old foster child Gabriel Myers. Two issues keep returning: the alarming use of psychotropic medications and an inability for doctors, foster parents and case works to track these powerful medications.

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Fla. officials struggle to reform foster system

Miami Herald
By KELLI KENNEDY
Associated Press Writer
FORT LAUDERDALE, Fla. — Kimberly Foster was on psychotropic medications every day during the decade she spent in foster care.

Locked in a mental facility with green walls, barred windows and four-point restraints from the age of eight, Foster said her actions were easy to explain: she was sad she couldn’t be with her mother.

“They looked at me as a troublemaker instead of a child who is coming out of a troubled environment. If you cry, you’re depressed. If you act out in school, you’re a behavior problem. We’re so quick to put these diagnoses on children,” the 25-year-old Foster said Thursday in a meeting with officials from the Department of Children and Families. “Youth in foster care are overmedicated, overdiagnosed.”

As state officials wade through the systemwide failures that led to the suicide of 7-year-old foster child Gabriel Myers in April, two issues come up repeatedly: the alarming use of psychotropic medications and the inability of doctors, foster parents and case workers to track problems with such powerful medications.

About 2,699 children in out-of-home foster care, or about 13 percent, are taking psychotropic drugs. That compares with about 4 percent to 5 percent of children in the general population, according to a recent DCF study.

Problems range from simply incorrectly entering basic information like a child’s gender and age into a database to overloaded and inexperienced case workers who are expected to understand warning labels on psychotropic medications.

Even logistics of accompanying a foster child to a doctor’s appointment fell short. Forty percent of the 112 foster children’s files studied, were not accompanied to their appointment. Many were dropped off by medical transport, making it that much harder for an adult to communicate crucial details about the child’s treatment.

Some officials proposed further training for foster parents and case workers, while others worried a four-hour training session on psychotropic drugs and what to look for would change little. Especially in a system with a nearly 50 percent turnover rate among case workers.

“Global training is important but I don’t think it’s going to get us to the level of specificity that we need,” said William Janes, a member of the work group examining the boy’s death. He stressed the importance of case managers.

“It’s not about psychotropic medications solely,” he said. “It’s about the care that this boy did not get.”

Basic analysis of medications for children in state care – such as what medication they were taking, why and when it was prescribed, and whether it worked – is not being completed in many cases. That information was supposed to be collected beginning in 2005.

“But it did not see the light of day,” said Dr. Rajiv Tandon, a work group member who is a psychiatrist at the University of Florida. “This particular form was an integral part of that plan and it never happened.”

In Gabriel’s case, his foster parents and teachers reported disturbing behavior, including sexual advances toward classmates. At one point, the child admitted to trying to strangle himself.

Yet his doctor continued on the same treatment plan.

“The whole system broke down in the community,” Janes said. “Everybody involved in this case was disconnected from that level that we would expect at some degree.”

Mez Pierre, who entered the foster system at age 5, said he was given plenty of medication but very little emotional support.

“I felt like I was an animal in a farm being tested on,” the 22-year-old told DCF officials Thursday. “Irresponsibility is just not worth a life. We need to do whatever we can to make sure another Gabriel does not happen again.”

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