Monthly Archives: July 2009

Officials working on better way to track foster kids’ medical, court histories


St. Petersburg Times

By Ileana Morales

TAMPA — The group formed after the 7-year-old boy’s suicide in April.
The idea was to examine his death and prevent similar ones, but the group has found itself struggling to solve the problem of simplifying paperwork for the medical histories of Florida’s foster children.

The Department of Children and Families’ Gabriel Myers Workgroup met for the fifth time on Friday. Members want fewer but better forms tracking foster children to lessen the burden on case managers already swamped with cases of paperwork in their cars.

But the question of how to do that remains unanswered.

Gabriel Myers, 7, hanged himself with an extendable shower hose in his South Florida foster home. He was taking a combination of psychotropic drugs without state-required approval from his parent or a judge.

After Gabriel’s death, DCF secretary George Sheldon said he intended to require consent for each prescription of psychiatric drugs. Then he started the task force.

Still, problems abound. Case workers didn’t provide prior medical information to prescribing physicians in 65 percent of cases and failed to inform parents of prescriptions in 85 percent of cases, according to a recent DCF report.

Employees need support from a better system, said Bill Janes, DCF assistant secretary for substance abuse and mental health.

Maybe a checklist for case managers, said Dr. Rajiv Tandon, a University of Florida psychiatry professor.

Sheldon encouraged the panel to create a whole new system if necessary and leave the worry of budgetary constraints to him.

Our Kids, a group focusing on child welfare in Miami-Dade and Monroe counties, presented on Friday its progress with an electronic database of documents for 3,500 foster children. It highlights each child’s current prescriptions and missing paperwork in the electronic case files. Medical histories and scanned court orders or other related documents are available through the program.

“We didn’t do this with millions and millions of dollars,” said Pat Smith, the agency’s chief information officer. “It’s a very simple program.”

Wurm hopes DCF gets on board to find the quickest route to the group’s statewide goal. One way may be through new legislation.

The next public meeting is Aug. 5 at the DCF Suncoast Regional Office, 9393 N Florida Ave., in Tampa.

Ileana Morales can be reached at imorales@sptimes.com or (813) 226-3403.

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Foster care drug oversight lacking

Tampa Tribune
By CATHERINE DOLINSKI

TALLAHASSEE – State law requires clear, informed consent from a judge or parent before doctors can prescribe psychotropic drugs for foster children. But no one gave such consent for 7-year-old Gabriel Myers to take a powerful drug known to trigger suicidal thoughts in children.

Myers, of Margate, hanged himself April 16 after taking several psychotropic drugs including Symbyax, an antidepressant that has not been approved for children and can increase suicidal thoughts in those who take it. A work group of child welfare officials and experts meets in Tampa today to continue probing the factors that contributed to Myers’ death.

A recent investigation by the Department of Children & Families has revealed that proper authorization has been missing in many cases where foster children are taking psychotropic drugs. The June 4 report showed that, statewide, consent was lacking for 435 such children, or 14.2 percent.

The issue was nearly as much of a problem locally. The same report showed that Hillsborough Kids Inc., a state-contracted foster care agency, had not obtained proper consent for 45 children taking psychotropic medication, a failure rate of 13.7 percent.

But more recently, the news has improved, as both the state and Hillsborough Kids have vastly improved their compliance rates. According to a July 17 report, proper authorization existed statewide in all but 4.6 percent of cases, or a total of 14. Hillsborough Kids had obtained consent in all but 14 cases, or 4.4 percent.

The 9 a.m. work group meeting is at 9393 N. Florida Ave.

Reporter Catherine Dolinski can be reached at (850) 222-8382.

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Gov. Charlie Crist urged to stop ‘chemical restraint’ of foster kids

Miami Herald
FOSTER CARE
Gov. Charlie Crist urged to stop ‘chemical restraint’ of foster kids
A pair of adoptive parents are urging Gov. Charlie Crist and lawmakers to stop the `chemical restraint’ of children in state care.
BY MARC CAPUTO

TALLAHASSEE — As Gov. Charlie Crist barnstormed the state to boast about record adoptions in Florida, two adoptive parents urged him Tuesday to go a step further and stop what they called the “chemical restraint” of over-medicated children in state care.
Mirko and Regina Ceska told Crist that when they adopted their two 12-year-old children last year, each was taking 11 pills daily, including the powerful anti-psychotic drug, Seroquel.

“These girls were overdosed and would fall asleep right in front of us several times a day,” Mirko Ceska said.

“It seems to be a prerequisite for foster children to be on medication,” he added. “So many are on psychotropic drugs.”

The Crawfordville couple weaned the girls off their medication, and their behavior markedly improved, they said.

Crist thanked the Ceskas for their story but focused his comments on declaring July 22 “Explore Adoption Day” and touting the record-breaking number of adoptions last year in Florida: 3,700.

Crist also appeared to soften his support for Florida’s ban on gay adoptions, by saying he’d “have to see” whether he’d support legislation that would lift the ban.

LINKED TO SUICIDE

Shortly after the Ceskas spoke, Crist’s head of the Department of Children and Families, George Sheldon, asked them to testify Friday in Tampa before a special panel that’s investigating the April suicide of a Margate 7-year-old, Gabriel Myers.

Like the Ceskas’ adopted children, Gabriel was prescribed a number of medications including a psychotropic drug. One of the drugs, the anti-depressant Symbyax, isn’t supposed to be prescribed to children and has been linked to suicidal behavior.

The committee’s findings — and testimony such as the Ceskas’ — will likely form the backbone of legislation aimed at curbing and improving the monitoring of prescription drugs for minors in state care.

MEDICATED

Of the 20,000 children in state care, about 3,100 or 15.5 percent are medicated, primarily with psychotropic drugs, Sheldon said. In the general population, he said, about 4 to 5 percent of children are on some medication.

A DCF study of the 268 6- and 7-year-olds medicated while in state care found that child-welfare doctors and case managers routinely failed to complete legally required treatment plans, share information or properly document the prescribing of powerful psychiatric drugs.

“Nobody has studied the interactions of those drugs children are being prescribed, which makes it a very frightening situation,” said Andrea Moore, a Broward attorney and child advocate.

Regina Ceska, a nurse, said she and her husband found a “shocking” number of children in the foster system appear to be medicated with Seroquel, which she said shouldn’t be used on children.

“This is, in my profession, considered a chemical restraint,” she said.

Sheldon said children in the foster-care system might require more medication, but it’s not clear how many kids are being over-prescribed psychotropic drugs. He said the Ceskas’ testimony helps shed light on the problem.

“Regrettably, the story they’re telling is far too common,” Sheldon said. Marc Caputo can be reached at mcaputo@MiamiHerald.com

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Concerns over drugs and foster children cloud adoption celebration

Tampa Tribune
By CATHERINE DOLINSKI

TALLAHASSEE – While state officials celebrate Florida’s much-improved adoption rate this week, inquiries continue into the prescription of psychotropic drugs for children still in foster care.

Gov. Charlie Crist kicked off “Explore Adoption Day” on Wednesday by announcing at a roundtable discussion that 3,776 children found homes through the state’s adoption system last fiscal year. That breaks the previous record of 3,674 adoptions in 2007-2008.

As well, the number of children in foster care has dropped since 2007 from 30,000 to less than 20,000, said Jim Kallinger, the governor’s chief child advocate.

The discussion was mainly celebratory — until it was Mirko Ceska’s and Regina Ceska’s turn to talk about their 12-year-old adopted daughters.

The Ceskas told Crist that while in foster care, the girls had been prescribed 11 pills a day, including the anti-psychotic drug Seroquel. Regina Ceska, a nurse, said the dosage of Seroquel was far larger than what she administers to her geriatric patients – and even at those low doses, she said, state law requires monitoring patients for side effects and documenting results every eight hours.

“This drug alters the brain, and it is unconscionable to administer it to young children whose brains are still developing,” she said.

Psychotropic drugs became a hot issue after Gabriel Myers, a 7-year-old foster child in South Florida, hung himself in April. Myers was taking an anti-depressant that can trigger suicidal thoughts in children. Audits by the Department of Children and Families have since shown that doctors and case workers have too-often failed to comply with legal rules for psychiatric drug treatment.

DCF Secretary George Sheldon said Wednesday he was inviting the Ceskas to appear before the work group he appointed to evaluate the Myers case.

“Regrettably, the story they’ve told is not new to me,” Sheldon said. “Ultimately … it’s about everybody who works with these kids, needing to work with that child as if it’s their own child.”

The Gabriel Myers work group meets Friday in Tampa from 9 a.m. to 3 p.m. at DCF’s office at 9393 N. Florida Avenue. Members of the public may attend or listen in by calling (888) 808- 6959 (code: 413-7303).

Reporter Catherine Dolinski can be reached at (850) 222-8382.

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Editorial: State Department of Children and Families needs to continue painstaking review of foster-care system

TC Palm
Editorial Board

The level of disclosure and openness may be unprecedented for a state agency in Florida.

Spend time on the Department of Children and Families’ Web site (www.state.fl.us/cf_web) and it becomes clear the agency is firmly committed to improving its delivery of services to foster-care children and their families.

What is fueling the commitment? The case of 7-year-old Gabriel Myers, a foster child in DCF’s care who died April 17 of an apparent suicide in his foster parents’ home in Margate.

Myers had been prescribed drugs for depression and possible schizophrenia.

DCF Secretary George Sheldon, who appears to have been touched deeply by Myers’ death, immediately promised a thorough, painstaking review of the agency’s policies and procedures governing the prescription of psychiatric and behavior-altering drugs to foster-care kids.

DCF created a separate link on its Web site to update the public about the Myers’ investigation. Sheldon established the Task Force for Fostering Success and charged its members to “identify and implement improvements to the system.” He created the Gabriel Myers Work Group and asked members to “take an independent look at this case and its implications on the way DCF does business throughout the state.”

Since June 5, the agency has been posting weekly reports, by region, detailing the number and percentages of foster children receiving one or more prescriptions. Additional reports have been posted outlining DCF’s drug-prescription policies and procedures.

Several of the reports have been highly critical of the agency. Case in point? The recent “Special Quality Assurance Review” of 268 6- and 7-year-olds in state foster care receiving psychotropic medications. The study found:

In 58 percent of the cases, the case manager did not attempt to engage the parent or legal guardian before requesting a court order to medicate the child.

In 70 percent of cases, supervisory reviews and discussions of the child’s behavioral health were not documented.

In 75 percent of the cases, the case manager did not provide the child’s medical information to the prescribing doctor.

In 86 percent of cases, prescribing physicians did not complete a treatment plan for the child.

Clearly, DCF is failing foster children and their families. However, if the agency continues to operate with the same level of unprecedented transparency it has exhibited the past three months — and implements much-needed reforms — it may save the lives of other foster children.

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Foster care fiasco – Agency’s grip on child care too loose

Bradenton Herald

News – Our Take
Foster care fiasco
Agency’s grip on child care too loose

Over the past few months, the track record of the Florida Department of Children and Families is one of a dysfunctional agency.

From losing track of hundreds of foster children taking powerful psychiatric drugs to discovering dozens of child-welfare workers had falsified reports, the department show signs calling for another overhaul.

This comes just seven years after the previous restructuring, in which the agency outsourced child-safety workers after a caseworker stopped visiting one foster child. The 5-year-old Miami girl went missing and has never been located.

After the April suicide of a 7-year-old on psychotropic medication, DCF reviewed files and found hundreds of previously uncounted foster children taking Risperdal and Adderall.

Furthermore, the agency failed to allow such medications only with a court order or parental approval in more than 400 cases. That violates a 2005 state law. With pediatric prescriptions of such antidepressant and antipsychotic drugs as Risperdal and Adderall, warnings of suicide have been on the rise. Yet hundreds of children slipped through the system.

DCF Secretary George Sheldon, on the job only since October, quickly clamped down on this problem by ordering judicial review of prescriptions and informed consent from parents.

But part of the quandary in the case of the 7-year-old boy who hanged himself is the caseworker repeatedly claimed the mother agreed to the medications, and that was not so.

Now comes the most recent fiasco — with more than 70 caseworkers submitting false reports over the past two years. That malfeasance caused 14 foster children to be left in unsafe homes and the agency to lose track of at least another six.

Uncovered in an Orlando Sentinel investigation published Sunday, this is disturbing news about caseworkers lacking in morality and responsibility.

One employee lied about making home visits to a child who ended up staying with an uncle facing child-rape charges — a monstrous scenario that should have resulted in felony charges against the worker for filing false reports about children in foster care, as state law allows.

Several other cases the Sentinel unearthed are just as unsettling. Half the falsified reports were filed by DCF employees and half by workers for private contractors. While outsourcing raises questions, tighter oversight of all caseworkers should be implemented.

While almost all of the 70 deceitful caseworkers got fired or quit, the newspaper also learned that half of them did face prosecution, a far more deserving outcome.

Sheldon pledges closer policing of foster care workers. That’s a must. The agency must weed out lazy and dishonest caseworkers.

To that end, the agency plans to provide hand-held global-positioning systems. While that will let caseworkers write reports in the field, more importantly, the agency will be able to verify home visits occurred. That’s one positive step.

Foster children are the most vulnerable among us, completely dependent on the state for protection and care. They deserve a strong agency and dedicated caseworkers.

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Don’t bend the law when giving foster kids drugs

Miami Herald

OUR OPINION: A new DCF study shows 2005 law ignored, endangering kids

untitled
Gabriel Myers was a 7-year-old boy whose world was collapsing when he hanged himself in a foster home in Margate. He was among 268 children between the ages of 6 and 7 medicated while in state care.

A new state study looking at whether these children were treated according to the law points to a total disregard of the law by a majority of case workers and medical professionals making life-and-death decisions. The irony is case workers now are employed by private firms under contract with the state. Weren’t they supposed to do better by Florida’s children than the old system of state workers?

In Gabriel’s case, the boy was getting an adult anti-depressant known by the medical community to be linked to suicides in children. A 2005 law requires more information sharing among case workers and medical and legal authorities, parental involvement and the review of doctors’ prescriptions to kids in state care.

Yet in 86 percent of the cases studied, the doctor prescribing the drugs didn’t complete a treatment plan so that case workers, legal guardians and judges could better determine a child’s mental health.

In 75 percent of cases, the case workers didn’t provide the doctor sufficient medical information about the child getting treatment.
Nor were parents informed about the psychotropic drugs their children were taking in 76 percent of the cases.

The Department of Children & Families’ study about the lackadaisical use of medication for children shows the agency is taking seriously its mission to protect kids. It should follow through with hefty sanctions for those who ignored the law.

One little boy already has paid the ultimate price for the disregard of those who were supposed to care for him.

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