Category Archives: Lakeland Ledger

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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Portrait Of a Young Man

Lakeland Ledger

Gabriel Myers had a charming little face with a big, toothy smile. In his photograph, he doesn’t look like a 7-year-old who would kill himself in the bathroom of a South Florida foster home.

His buoyant air offers no hint of a child who threw such major tantrums that one of his caregivers feared for the safety of a baby in the home, ultimately sending Gabriel to a different family.

His photo bears no inkling of a boy who frequently “acted out” – on other children – the sexual molestation he experienced in the past.

It doesn’t seem to be the face of a youngster whose short life was filled with the turmoil of a drug-addled mother and an absentee father – a boy overwhelmed with stress, upheaval and disappointment.

Nothing suggests that this beaming child was on powerful, psychotropic drugs prescribed to rein in his diagnosed “mood disorder.”

The photograph, in short, is a monument to the fact that appearances can be tragically deceiving – and that helpful interventions can hurt.

With his mother bound for jail in June 2008, Gabriel entered Florida’s child welfare system. There, documents indicate, he seemed to get responsive care, extensive counseling, frequent evaluations and medical supervision. But despite all this, his behavior began a downward spiral in October, generally worsened through the winter, and reached crisis stage by spring of this year.

A REGIMEN OF DRUGS

Many of the boy’s troubles paralleled the increased upheaval in his life, but his medication schedule is also of interest. In December he was prescribed Vyvanse, a stimulant for attention deficit issues, and initially showed improvement. But in early February, Lexapro – an antidepressant – was added; and in mid-March he was switched from Lexapro to Symbyax, an antidepressant/anti-psychotic.

About two weeks later, he yelled during an outburst at school that he “wanted to kill himself,” according to information from the state Department of Children and Families. But he apparently showed no signs that he would really do so, and was not deemed suicidal following the tantrum. After another evaluation by his board-certified psychiatrist, Gabriel was kept on the drug regimen.

On April 14, a therapist noted that Gabriel “demonstrates no active psychotic features or suicidal/homicidal ideation or plan.”

But two days later, Gabriel was dead. His apparent suicide – hanging himself in the shower after another outburst at a “respite” foster home – is still under investigation.

Given the frequent emotional dislocation in Gabriel’s life, it is not known what role, if any, his prescriptions played in his apparent suicide. But Symbyax carries a warning that “antidepressants may increase suicidal thoughts or behaviors in some children … especially within the first few months of treatment or when changing the dose.”

DOCUMENTATION LACKING

Vyvanse is approved for use in children 6 and over, but the manufacturer notes that the drug should not be taken by those in “agitated states.” Aggression and abnormal behaviors are sometimes associated with its use.

These risks are among the reasons why Florida law requires informed parental consent or judicial order before administering psychiatric medications to foster children. Paperwork in Gabriel’s case indicated consent had been given, but that was erroneous, DCF officials say. A statewide review of psychiatrically medicated foster children found consent documentation lacking in 16 percent of such cases – a serious gap in the safety net.

DCF seems to be treating its findings with genuine urgency, and is awaiting advice from a task force assigned to investigate other concerns, including medical, related to Gabriel’s case. The added layer of review is important and sends an encouraging signal that the agency is sincere about improving its once dismal record.

But the dilemma over psychotropic medications for children will not be easily resolved.

These drugs are a godsend to many people, enabling them to escape the prison of profound mental disability. However, the potential risks, combined with the challenge of monitoring doses and the difficulty of distinguishing side effects, present a double-edged sword. In the case of foster children, for whom frequent moves are common, the need for medical vigilance is paramount.

As Gabriel has sadly shown, a smile is not necessarily proof that the drugs – or the system – are working.

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psychiatric drugs – Usage Uncertain In Foster Children

Lakeland Ledger
BY KRIS HUNDLEY
and CONNIE HUMBURG

The agency in charge of Florida’s foster kids thinks it has finally gotten a handle on how many of its charges are on powerful psychiatric drugs.

But a closer look raises serious questions about the validity of the recently updated database.

While Florida’s Department of Children and Families said last week that a review of case files found 2,669 children on psychotropic medications, the supporting data are shaky.

DCF’s records include such unlikely scenarios as an eight-year delay between the time a court approved a drug and the date it was actually prescribed.

In another case, a child started taking a drug for attention deficit hyperactivity disorder nine years before the judge gave consent.

About 100 court approvals were signed on weekends.

And of more than 5,000 prescriptions, only one child was reportedly taking Symbyax, a combination antipsychotic and antidepressant that has been on the market since 2004. Symbyax was one of the psychotropic drugs being taken by a 7-year-old foster child who committed suicide in South Florida last month.

DCF is required by law to track foster children on psychiatric drugs because of potentially dangerous side effects. Previously, the department had reported that fewer than 2,000 kids were on such prescriptions.

In its review, DCF also admitted that one in six of those children did not have legally required approval by either a parent or a judge to have such a prescription.

But in hundreds of cases in which a judge’s consent reportedly was obtained, the date of that order came either long before or long after the prescription started.

For instance:

In 10 cases around the state, DCF’s records show judges signing consent orders for a variety of drugs in January 2001, but the children’s prescriptions did not start until 2009.

A 16-year-old in Marion County was approved for the antipsychotic Risperdal in August 2005, but the prescription didn’t begin until May 2009.

A 15-year-old in Duval County had a judge sign off on another antipsychotic, Abilify, in January 2007; state records show the prescription began in May 2009.

John Cooper, DCF’s acting assistant director of operations, acknowledged shortcomings in the state’s database but said the medication start date could simply reflect the most recent prescription for a long-standing medication.

Andrea Moore, a longtime advocate for foster children, said that’s no excuse. State law requires judges to regularly review the appropriateness of psychotropic prescriptions, she said, especially if the medication is changed.

“A consent signed two years earlier is not a valid consent,” said Moore, former executive director of Florida’s Children First. “That’s particularly important when you’re talking about atypical antipsychotics where serious questions have been raised about their long-term side effects.”

Conversely, in more than 100 cases, there was an unusually long delay between the medication start and the court order.

A 14-year-old in Brevard County reportedly on the ADHD drug Adderall since 1999 received court approval in November 2008.

A 16-year-old in Hillsborough County began taking Seroquel, an antipsychotic, in October 2005, with a judge’s consent received this January.

DCF Secretary George Sheldon ordered a thorough review of all kids on psychotropic drugs last month after the suicide of Gabriel Myers. Myers, who had been in state custody for 10 months, was on Symbyax, as well as Vyvanse, for ADHD.

The state’s database shows only one other foster child, a 14-year-old in Marion County, currently taking Symbyax. DCF’s Cooper declined to comment on why the drug did not appear more frequently.

Symbyax has not been approved for children, although the practice that employs Gabriel Myers’ psychiatrist is currently recruiting adolescents for a clinical trial of Symbyax for bipolar depression.

This story appeared in print on page B1

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