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.”