Monthly Archives: August 2009

Doping up our children

Orlando Sentinel
Editorial
Doping up our children

The state’s Department of Children and Families is under fire again, and rightly so.

Recently, a task force issued its final report documenting how weak oversight and lax compliance with guidelines fostered a culture where officials often blindly doled out powerful drugs as chemical pacifiers to help caregivers manage difficult children.

These troubling concerns aren’t new to DCF. But in the wake of the withering report, DCF Secretary George Sheldon concedes lapses and vows to heed and fund task-force proposals.

Such accountability is encouraging. But we expected reform before. In 2003, the Statewide Advocacy Council report made similar findings, and concluded, “…unnecessary dispensing of psychotropic medication remains a threat to [foster children]. Until there is more information regarding the safety and efficiency of these drugs, Florida’s foster care children should be monitored closely.”

That report’s proposals were largely ignored. Now, six years later, only swift reforms and a strong mandate to comply with existing rules that govern psychotropic drugs will shelve suspicions that this is déjà vu all over again.

Gabriel Myers becomes the latest Florida foster child whose tragic end led to familiar calls for DCF reform. The boy was removed from his drug-addled mother and turned over to state custody on June 29, 2008. Gabriel hopscotched between a relative and a foster home over the next 10 months. While in state care, he received several psychotropic drugs without valid parental or court consent, as state law requires. One of the drugs, Symbyax, an adult antidepressant, can lead to suicidal thoughts or actions.

On April 16, Gabriel put a shower cord around his neck in the bathroom of his Margate foster home.

Shortly afterward, Mr. Sheldon convened the Gabriel Myers Work Group to investigate the tragedy. The group’s 26-page report outlined 148 systemic breakdowns in Gabriel’s death.

It notes the egregious disregard of safeguards for foster children that are well “articulated in statute, administrative rule, and operating procedures.” Breakdowns in communication, advocacy, supervision, monitoring and oversight only exacerbated matters.

Gabriel was repeatedly evaluated while in care, and often saw therapists, including one who noted, “It is clear that this child is overwhelmed with change and possibly re-experiencing trauma.” Somehow, though, caregivers missed the red flags.

And the report backs child advocates who long have insisted the state overmedicates kids: “Psychotropic medications are at times being used to help parents, teachers, and other caregivers calm and manage, rather than treat, children.”

In Florida, 15.2 percent of foster kids take at least one psychotropic drug, compared with a 5 percent rate among the general population.

DCF must junk the “fix-it with pharmaceuticals” mentality that, for the sake of expediency, often skirts safer avenues for taming disorderly behavior. Adopting the task force’s call for “a higher requirement for due diligence prior to seeking approval for administering these drugs” would be a step forward.

The task force outlines a raft of reforms that include beefing up therapeutic services, adding court-appointed guardians, and bringing on a medical director to direct the use of psychotropic drugs.

Mr. Sheldon says he’ll free up resources within DCF to act on the suggestions. And despite austere budgets, he vows to cajole the Legislature to fund such options as behavioral therapy as an alternative to drug therapy. But a will to change must follow words.

Mr. Sheldon told the Fort Myers News-Press that in the past, “Regrettably, I’m afraid people said, ‘We dodged a bullet’ and it [reforms] never got out into the field. That cannot be the case this time.”

It better not. Or DCF almost assuredly in the months to come will experience another tragic case of déjà vu.

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DCF needs better tools to monitor psychotropic drug use

Sun Sentinel

Editorial Board

The working group brought together by the tragic death of Gabriel Myers has finished its work. Unfortunately, its final report comes as no surprise: Simply put, the 7-year-old foster child who committed suicide died at the hands of a neglectful bureaucracy.

Gabriel’s lifeless body was found hanging in his Margate foster home on April 16. The death shone a troubling spotlight on the boy’s medical history and — once again — resurrected the controversy over prescribing psychotropic medications to children. Nationally, about 5 percent of all children are treated with psychotropic drugs. In Florida’s foster care system, roughly 15 percent of its children receive at least one of these powerful drugs.

The working group’s findings are replete with all-too-familiar instances of red flags and missed opportunities. One finding, however, stands out and is a testimony to the failure of a major reform to the state’s child welfare system: “There was inadequate oversight of the involved agencies by the [Florida] Department of Children & Families.”

Community-based care was designed to take care of that. The initiative, dating back to the days of Gov. Jeb Bush, took the responsibility for operating foster care services away from what was then a dysfunctional state agency and turned those duties over to local, “community-based” organizations, such as Child-Net, the group responsible for Gabriel’s care. DCF, under this reform, would concentrate its bureaucratic resources on oversight.

At least that’s how it was supposed to work.

Instead, DCF has had a tough go of it. State lawmakers earlier this year considered a bill to limit the department and other health and human services agencies’ ability to monitor these contracts, despite a recommendation by OPPAGA, the Legislature’s watchdog agency, against such limits.

Fortunately, cooler heads prevailed, and the legislation failed to get real traction. Lawmakers should instead find ways to improve monitoring to ensure quality services without strangling contractors’ operations. As Gabriel’s case shows, it’s needed.

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DCF looks to fix drug problem


News Press (Fort Myers)

By Janine Zeitlin

The head of Florida’s child welfare agency vowed to carry out and put dollars behind recommendations in a recent report that shows officials have often ignored years-old guidelines on medicating children in state care.

Last week, the Department of Children and Families released a final report from a panel that investigated the death of a 7-year-old Broward County foster child, who hanged himself, and the system’s use of psychotropic medications.

“Before you can solve a problem, you’ve got to own to it and identify it,” said DCF Secretary George Sheldon. “I think they’ve done a very good job of doing that.”

The report concludes it’s essential all officials treat foster children like their own.

Sheldon said officials will first try to carve out resources internally to act on suggestions such as bringing on a medical director to oversee the use of mind-altering drugs.

He’s also considering requiring an additional review before any child is given such drugs. The report highlights the need for training, court advocates for all foster children and attorneys for those taking such medication.

“There might be some financial resources that are needed,” Sheldon said.

He said he’ll have a budget recommendation by October but has yet to determine how much more the agency might need.

“I want to present a responsible request to the Legislature, and we will look at these recommendations and price them out.”

In Southwest Florida, almost 13 percent of children in state care — 129 — are taking drugs such as antidepressants and mood stabilizers. Medications range from Adderall to Zoloft.

Statewide, it’s about 15 percent.

Education for judges and a bench reference on the medication were some recommendations made by Judge James Seals that were included in the report.

He presides over Lee County’s court for abused, neglected and abandoned children.

Also the president of the Florida Council of Juvenile and Family Court Judges, Seals testified before the panel.

“Much of our concerns flow from the fact that we know less than we ought to know,” Seals told the group earlier this month.

The law requires parental consent or a court order before doling out such medications. Seals said heading to a judge must be the last resort. He worried parents weren’t fully included or informed.

“I have doubts that parents really understand what they’re doing, and I fear that parents may even be pressured into signing consent forms.”

Seals later said he doesn’t know that for certain but is concerned the urgency in some cases might cause corner-cutting.

The informed-consent form used locally did not include American Medical Association guidelines such as looking at the risks and benefits of alternatives to treatment and of doing nothing, Seals said.

Sherman McDade, a Fort Myers father whose 6-year-old is in foster care, believes his son was on psychotropic drugs for attention deficit hyperactivity disorder without his consent.

He said he later argued in dependency court for him not to take the drugs.

McDade believed his son’s behavior related to the trauma of moving between multiple foster homes.

“The children get frustrated because they want to come home,” he said.

Trauma may be one factor leading to the over-medicating of foster children some advocates believe is happening.

Currently, a child is given a behavioral assessment within 30 days of coming into care, Sheldon said, noting that is when the child is most traumatized.

“I don’t think we should be making a long-term diagnosis at that point.”

Sheldon said the report shows the need for ongoing follow-up, which is not typically done, according to report findings.

It notes physicians often lack medical history and basics about the child when prescribing.

Among their next steps, administrators say, is working to develop a simple, straightforward policy.

On Aug. 10, a legislative committee sent a letter to DCF indicating an existing rule may not conform to the law on gaining consent for all psychotropic medication.

Children’s advocate and Coral Springs attorney Andrea Moore fought for existing legislation to protect foster children taking psychotropic medication.

“It’s very hard for people who work on this to see it come back again and after all this hard work, it’s ignored anyway,” Moore said.
She’s hopeful, noting Sheldon is showing a respect for the law.

He pledged to gain compliance on systemic failures that were identified.

“Regrettably, I’m afraid people said, ‘We dodged a bullet’ and it never got out into the field,” Sheldon said of past reviews on the issue. “That cannot be the case this time.”

For his part, Seals said he’ll be further questioning the consent that comes before him.

“I think the judiciary will be watching these motions for psychotropic medications more carefully.”

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Foster care task force created after 7-year-old Margate boy killed himself wants changes

Miami Herald

A work group assigned to study the death of a Broward youngster released its final report. But advocates ask: Who will pay for the reforms the group recommends
By CAROL MARBIN MILLER

More lawyers and court-appointed guardians, more therapy, second medical opinions, and the security of long-term foster homes where caregivers treat kids “as we would our own children.”

Those are some of the wish-list items of a state task force that studied the April death of a Broward foster child and recommended a host of reforms for Florida’s chronically troubled foster-care system.

But will they work? Not, children’s advocates say, if state child welfare administrators can’t fix the one thing that has hampered the work of perhaps a dozen previous child-welfare task forces: a perennial lack of money.

Thursday, the Gabriel Myers Work Group released its final, 26-page report on failures of the state’s child-welfare system that were linked to the April 16 death of 7-year-old Gabriel, who hanged himself with a detachable shower cord in the bathroom of his Margate foster home.

Some of the recommendations require little more than tweaking internal rules and policies or having better compliance with existing rules — such as following state laws requiring informed consent from a parent or judge before giving a child powerful psychiatric drugs.

But a host of other recommendations will require millions of taxpayer dollars — at a time of shrinking state revenues and contracting budgets.

“This won’t be the first report or plan — and certainly won’t be the last — that runs into the reality of how much and where’s the money,” said Jack Levine, a longtime children’s and family advocate in Tallahassee.

Added state Sen. Nan Rich, a Weston Democrat who is vice chair of the Senate’s Children & Families Committee: “You can’t fix this problem without more financial resources. … We still have a long way to go to protect children.”

Department of Children & Families Secretary George Sheldon commended the work group, saying members “held nothing back” in issuing a blueprint for reform.

“Now,” he said, “it’s incumbent on me to carry the torch both from an internal standpoint, in terms of changing our culture, and from the external standpoint of getting the resources necessary to do it.”

`LEGACY’

Gabriel’s death — and the attention it received nationwide — will help provide lawmakers with the sense of urgency needed to resolve issues that long have plagued the agency, Sheldon said. “If any good comes out of this — if there will be a legacy for Gabriel — it will be a legislative initiative, both substantively and dollar-wise,” he said.

Gabriel, who was born in Ohio, was taken in by the Department of Children & Families on June 29, 2008, after his mother was found slumped in her car surrounded by narcotics. In the next 10 months, Gabriel was moved four times between a relative and foster parents.

In the weeks following the youngster’s death, authorities acknowledged Gabriel had been given several mental-health drugs — some linked to dangerous side effects in children — without the required parental or judicial consent. Though Gabriel had been seen by therapists and a psychiatrist, DCF admitted the agency missed key “red flags” that his condition was becoming critical.

KEY FINDINGS

Sheldon appointed five members to the work group, which held six meetings throughout the state in an effort to identify measures that could improve the care of children like Gabriel.

Among the work group’s key findings:

• DCF expects the work load to more than double — from 761 calls in budget year 2008 to 2,000 in 2009 — for a University of Florida program, called the Behavioral Health Network, that provides information on psychiatric drugs to parents, foster parents, court-appointed guardians and caseworkers for foster kids.

• Children with mental illnesses fare better when they receive psychological or behavioral therapy in addition to medication. Therapeutic services for foster children have remained stagnant in recent years along with state dollars for mental-health care.

• Court-appointed guardians ad litem should be reporting children’s wishes regarding medication to judges who oversee their time in foster care, the report said. But only about 6 out of 10 foster kids have access to a guardian, advocates say.

ATTORNEY FEES

• “Any child who objects to the administration of medication, at any point in time, should be appointed counsel to directly represent his or her position,” the group wrote. Some advocates, the report added, insist that every child in foster care — especially those taking psychotropic drugs — should have a lawyer.

The state now pays $1,000 in attorney’s fees for lawyers who represent parents accused of abusing or neglecting their children, said Judi Spann, DCF’s deputy chief of staff. The state pays another $1,000 in cases where parents might lose their rights permanently, and $1,000 more if there is an appeal.

`PRIORITIES’

And Florida law already requires that children in state care be appointed a guardian ad litem, said state Sen. Rich. Nevertheless, cuts in spending in the current state budget eliminated court-appointed guardians for 2,000 Florida children.

“It’s about priorities,” said Rich, a longtime children’s advocate. “There could have been funding for the Guardian ad Litem Program, but the Legislature did not determine it to be one of its top priorities. I disagree with that.”

`ACCOUNTABILITY’

Task force members acknowledged the difficulty in implementing the group’s proposals, though Thursday’s report suggests the greatest challenges lie in “accountability” and “responsibility” — not funding.

The last sentence of the report says concerns over “management and funding for the recommendations emerging from these findings remain, and must be addressed by appropriate executive and legislative branch agencies.”

FAMILIAR FINDINGS

Some of the work group’s recommendations have been around the block a few times.

Last April, for example, a Florida Bar committee on the legal needs of children recommended both lay guardians and attorneys for foster kids at key moments in their care — including when mental-health drugs are to be used. Legislation proposed by the Bar committee could cost as much as $15 million, said lawyer and children’s advocate Howard Talenfeld, who chairs the committee.

And in 2003, a task force studying the disappearance of then-5-year-old Rilya Wilson, a Miami foster child, said the judge overseeing Rilya’s case might have been alerted sooner that Rilya was missing if the child had been given a lay guardian.

A CHALLENGE

Sheldon acknowledged the concerns of some advocates that the Gabriel Myers report will end up on an agency bookshelf gathering dust along with prior studies.

“That’s a legacy I want to leave behind,” Sheldon said.

“I want to prove the cynics wrong.”

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DCF failed to follow guidelines on medicating children, report says


News-Press (Fort Myers)

Florida’s child welfare system has a detailed framework to protect foster children taking psychotropic medications, but officials often don’t follow it, concluded a state review released today.

The Department of Children and Families issued a final report by the Gabriel Myers Work Group, which looked into the death of a Broward County foster child and the use of psychotropic medications.

“The core failures in the system, however, stem from lack of compliance with this framework and with failures in communication, advocacy, supervision, monitoring, and oversight,” it reads.

The report found that the system failed Myers and that the medicating children in state care is an often haphazard process lacking oversight and sometimes done to help caregivers calm the child rather than treat them.

The report recommends that the DCF and its related agencies develop an action plan to carry out its recommendations.

It also suggested that Governor Charlie Crist and DCF Secretary George Sheldon take a leading role “in raising this to national prominence in order to develop a comprehensive nationwide approach to the use of medication to treat our children.”

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Panel says foster care workers ignored drug policies for kids

St. Petersburg Times
By Kris Hundley

Foster care workers at all levels routinely ignored policies designed to protect children in their care from being given psychotropic drugs without proper consent or monitoring. That was the conclusion of a panel looking into the suicide of Gabriel Myers, a 7-year-old foster child who killed himself in April while taking two psychotropic medications.

The 26-page report, released Thursday, highlighted a lack of communication, inadequate supervision and inaccurate information in the Department of Children and Families’ handling of Myers’ case. About 15 percent of foster children in out of home care are on at least one psychotropic medication.

DCF’s secretary, George Sheldon, said he looks forward to hearing the work group’s recommendations. Among the options: a second-party review of all foster children on psychotropic drugs regardless of the diagnosis.

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Task force issues final report on boy’s suicide in Margate foster home

Orlando Sentinel

The Associated Press

FORT LAUDERDALE – A Florida task force has issued its final report on the suicide of a 7-year-old boy who hung himself in a Margate foster home, determining proper procedures existed to prevent such problems but aren’t always followed.

The report says “core failures in the system…stem from lack of compliance with this framework and with failures in communication, advocacy, supervision, monitoring, and oversight.”

Gabriel Myers was on several powerful psychotropic medications with side effects including suicide when he used a shower hose to hang himself on April 16.

He was in three different foster homes, switched therapists, touched his classmates inappropriately and tried to strangle himself.

The panel found psychotropic medications should be better monitored, so children are not on them endlessly.

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