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Gabriel Myers Work Group ready to review final report, recommendations

Fort Myers News Press

The Gabriel Myers Work Group will meet Thursday to review its final report and recommendations.

Department of Children and Families Secretary George Sheldon established the group to review the use of psychotropic medication to treat children in foster care.

It came after the April death of a 7-year-old Broward County foster child, Gabriel Myers, who hanged himself.

The department had not obtained valid consent for his medication.

A draft of the report released earlier found that medicating children in state care is often an unregulated, haphazard process in which drugs are prescribed to help caregivers calm difficult children instead of treating them.

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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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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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DCF Report rips way kids get meds


Fort Myers News Press

Panel: Foster children drugged to calm them
By JANINE ZEITLIN

Medicating children in state care is often an unregulated, haphazard process in which drugs are prescribed to help caregivers calm difficult children instead of treating them, according to an initial state review.

“I’m not a happy camper with the way medications are being used,” said Stan Appelbaum, chairman of the Local Advocacy Council for mental health. “The first thing that I’d take away from this review is that it’s not a perfect system.”
The findings also point out state officials long knew of the child welfare system’s shortcomings in doling out psychotherapeutic drugs but failed to institute six-year-old recommendations to protect foster children.

“Until there is more information regarding the safety and efficiency of these drugs, Florida’s foster care children should be monitored closely,” read a 2003 Statewide Advocacy Council report to the governor quoted in the review. “The information in this report should be immediately incorporated.”

The issues were raised in a draft report from experts and state administrators convened by the Department of Children and Families to investigate the April death of a 7-year-old Broward County foster child, Gabriel Myers, who hanged himself.

Officials had not obtained valid consent for his medication. The report shows the system failed in providing supervision and oversight in his case.

Judi Spann, DCF deputy chief of staff, said the draft was “very preliminary” and a final report would likely be complete next week.

“We do know that in this case no one was stepping in to be Gabriel’s champion to ensure that his particular needs were being met.”

In Southwest Florida, about 13 percent, or 136, of abused, abandoned or neglected children in foster care are taking mind-altering drugs such as antidepressants and mood stabilizers.

About 70 percent are boys, almost the highest male percentage in the state, while the female percentage is the lowest.

Nadereh Salim, CEO of the Children’s Network of Southwest Florida, which runs foster care locally, said she doesn’t believe caregivers are able to get drugs prescribed simply to control behaviors.

After Gabriel’s death, the network has been involved in trainings, organizing one with a child psychiatrist, and a local work group on the drugs.

“Since the Gabriel Myers tragic event, there’s been a lot more emphasis on procedures,” she said. “It was not a topic that was high on the priority list statewide. There has been quite a bit of improvements.”

Frank Prado directs the regional Guardian ad Litem office, which connects children in the child welfare system with court advocates. He said the office is concerned if medication is used improperly but Gabriel’s death piqued local awareness surrounding the drugs.

“We do believe that is misuse of medication to calm children down,” he said. “There’s so much more you can do with children. We can give them other outlets to work out their energy.”

Spann said DCF hopes to use the findings to prevent further tragedies.

The review states children’s rights often seem to be ignored by child welfare officials, who appear to lack a good understanding of the medication.

It recommends children who are old enough be involved and allowed to participate in court hearings about treatment.

“There is no evidence that children are routinely provided notice of the proposed treatment with information on how to object in a timely fashion,” it states.

The draft highlights anecdotal evidence that youth stop using medication as adults “without suffering adverse effects.”

Appelbaum, who also sits on the Children’s Network board, would like to see more services to deal with behavior issues.

Drugs should be a last resort, he said.

“There are tools to use but the unfortunate part is that we’re not getting enough funding,” Appelbaum said.

Dr. John Ritrosky, a Fort Myers pediatrician who also is on the board, hopes to see efforts to deal with behaviors beefed up as well.

“Throwing more money at the system would help it,” he said. “We definitely need to work on that. That’s a little impoverished.”

He’d like to see children with attention deficit disorders sorted out from those with depression or bipolar disorders and may have more need for drugs.

Salim said she couldn’t estimate how much money goes to behavioral programs because it’s bundled with other services.

“Can we use more behavioral therapy? Absolutely,” she said, noting the network does spend “quite a bit.”

The review also recommends the department require all children coming into foster care receive a comprehensive behavioral health assessments.

Those who are not receiving them may be immigrant children who are not eligible for Medicaid or children placed with relatives.

Salim said all children removed from their homes receive the assessment and others get one if they demonstrate a need.

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Children in foster care taking psychotropic drugs higher than originally thought.

News Press
By JANINE ZEITLIN
jzeitlin@news-press.com

Department of Children and Families data released Friday showed that the number of Southwest Florida children in foster care taking psychotropic drugs was higher than originally thought.

Last week, DCF secretary, George Sheldon, released findings of a review of every foster child’s files to check for parental consent or a court order for such medications, as required by law.

The inquiry came after the April death of 7-year-old Gabriel Myers, a Broward County foster child who hanged himself in the shower.
The department had not obtained valid consent for medication.

The revised state data showed 13 percent of children served in out-of-home care by the Children’s Network of Southwest Florida were taking such drugs, which include mood stabilizers and antidepressants.

That number was up from 11 percent.

Judi Spann, a DCF spokeswoman, said the agency continues to updates its data.

Last week’s count did not include about 400 children of the 3,070 counted.

Numbers show a high percent of teenagers in foster care taking the drugs. In Southwest Florida, more than one in four teenagers in foster care are taking the medications.

Since the data was released, the department has obtained more consent or court orders, edging down to 14 percent statewide without consent compared to 16 percent last week.

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DCF vows better drug oversight

News Press
By JANINE ZEITLIN
jzeitlin@news-press.com

The head of the state’s child welfare agency vowed Thursday to improve oversight of the 13 percent of children in care who are prescribed psychotropic drugs, and also raised concerns about use of those drugs in children.

George Sheldon, Department of Children and Families’ secretary, released findings of a review of every foster child’s files to check for parental consent or a court order for such medications, as required by law.

The inquiry came after the April death of 7-year-old Gabriel Myers, a Broward County foster child who hanged himself in the shower. The department had not obtained valid consent for medication.

“Gabriel Myers couldn’t wait for a better system,” Sheldon said. “I don’t believe any of our children can. They need us right now.”

The Children’s Network of Southwest Florida, contracted by DCF to care for local children, counted 9 percent of its population taking such drugs, which include mood stabilizers and antidepressants.

No consent was obtained in 19 percent of the 111 local children with active prescriptions, according to the state report. Nadereh Salim, the network’s CEO, said its data reflects closer to 15 percent.

“That’s still not good,” Salim said. “What we’re going to do is take each of one those files and pursue the process.”

Statewide, the report found no record of consent or order in 16 percent of the almost 2,700 children receiving medication.

Dr. John Ritrosky, a pediatrician and network board member, said Gabriel’s death points to the need to drive local attention to monitoring foster children taking the drugs.

“I think this case is a wake-up call,” Ritrosky said. “We all need to focus on these kids more and see what their psychiatric care is and see what the local psychiatric manpower is to take care of these kids.”

Sheldon sounded alarm when a psychiatrist at Thursday’s press conference said about 5 percent of children in the general population take the drugs.

“That obviously raises some red flags,” Sheldon said. “I’m not anti-medication, but I have serious questions on the administration of psychotropic drugs for children.”

This is not the first time this issue has been raised. In 2005, a study found one in four foster children were being prescribed mood-altering drugs.

Sheldon seethed about his agency’s failings.

“It is inconceivable for me … that the system doesn’t have this right yet,” he said.

Salim said local case managers do know consent is legally required, but may have obtained verbal consent or had trouble contacting the parents.

Debate percolates about whether some of the potent drugs should be prescribed.

“There really is nothing satisfactory to do for these kids,” Ritrosky said. “It’s frequently flying by the seat of the pants.”

Local advocates are concerned that the proper parties be involved in the decision to medicate.

“It’s a matter of a really good relationship with parents, foster parents, and physicians and, when that doesn’t happen, that’s when I have a problem with it,” said Liz Givens, executive director for the Lee County chapter of the National Alliance on Mental Illness.

Some worry foster children may be overmedicated. Julie Pettit of Cape Coral is a court advocate for a foster child prescribed a handful of drugs.

“I’ve objected to that in court and said, ‘Why is a 16-year-old getting all this medication?'” Pettit said.

Pettit said the teenager can be angry, but has reasons to be after moving more than a dozen times in her nine years in care.

“When a child is taken away from their parents that trauma stays with them all of their lives,” Pettit said.

Mark Geisler, network board president, warned of the system becoming too involved in medication.

“How many people are you going to have second-guessing?” he asked. “At some point, you have to say, you have licensed physicians doing their best.”

Salim plans more oversight and will take part in weekly calls on medication as mandated by DCF. The department set a June 5 deadline to obtain missing consent.

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Study: 13 percent of children in DCF custody on medication

News Press, Fort Myers, Florida

More than 13 percent of children in Department of Children and Families custody are taking one or more psychotropic, or mind-altering drugs, according to a review released today.

The Children’s Network of Southwest Florida counted 9 percent of its total population taking the drugs, among which some are largely unproven for children, expert says.

DCF conducted the review in response to the suicide of Gabriel Myers, a 7-year-old foster child in Fort Lauderdale. In its review of the case, the department found that it had not obtained valid consent as required by law.

The report found no record of parental consent or judicial order authorizing the medication in 16 percent of the almost 2,700 children receiving such medications.

In Southwest Florida, there was no consent obtained in 19 percent of the 111 children with active prescriptions.

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