Category Archives: Sarasota Herald Tribune

Struggle to fix foster system

Sarasota Herald Tribune
TRACKING PROBLEMS: Changes prompted by suicide of 7-year-old
By KELLI KENNEDY The Associated Press

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 8, Foster said her actions were easy to explain: She was sad she could not 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 so quick to put these diagnoses on children,” Foster, 25, 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 caseworkers 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 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 fell short. Forty percent of the 112 foster children whose files were studied were not accompanied to their appointment. Many were dropped off by medical transport, making it harder for an adult to communicate crucial details about 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.

Leave a comment

Filed under Sarasota Herald Tribune

Portrait of a child at risk

Sarasota Herald Tribune
Opinion

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.

George Sheldon, secretary of Florida's Department of Children and Families, speaks at a news conference on the use of psychotropic drugs by foster children. In the background is a picture of Gabriel Myers. AP PHOTO / PHIL COALE

George Sheldon, secretary of Florida's Department of Children and Families, speaks at a news conference on the use of psychotropic drugs by foster children. In the background is a picture of Gabriel Myers. AP PHOTO / PHIL COALE

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, an absentee father and too frequent shuffling among distant relatives, schools and foster homes.

His eyes don’t reveal a boy overwhelmed with stress, upheaval and disappointment.

And nothing in the photo 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 interventions designed to help can hurt.

A downward spiral begins

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.

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.

Drugs carried warnings

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.”

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 potentially 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 instability and 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.

Leave a comment

Filed under Sarasota Herald Tribune

Tom Lyons: System doesn’t always foster good parenting

Sarasota Herald
By Tom Lyons
Herald-Tribune Columnist

A foster mother wrote a long criticism of a column about so many foster kids being put on prescribed psychiatric drugs without the required documentation and approval.

In short, she bristled at my suggestion that many of Florida’s foster parents may be too quick to embrace medication of children as the answer to behavior and emotional problems.

Most foster parents are dedicated and caring and not inclined to drug kids just to make their jobs easier, she informed me. And, she said, my column could scare away good potential foster parents.

Actually, I never said anything critical of most foster parents. I’ve written in the past about the importance of having enough good ones. Kids taken into state custody are usually in dire need of good parenting and should not be saddled with a set of substandard adults they aren’t even related to.

So, as I explained to my critic, if she’s one of the really good ones, I sincerely applaud her. Please keep up the good work.

But the system never has enough good ones. And she can’t possibly know enough foster parents to dismiss the implications of the Department of Children and Family’s own statistics on psychotropic drug prescriptions for foster kids.

The foster mom had another issue, too. It is related to my view that the system might be responding better of late to studies that show children fare better when more effort is made to keep them with relatives. She is afraid it goes too far.

She is worried that her foster child might become a victim of that effort, because the child might soon be given back to the birth mother despite the woman’s mental problems and behaviors that make this seem like a bad idea.

But she couldn’t give me names or details, because of rules and confidentiality issues.

I understand that, and I’m sorry she’s in that spot, but it highlights another issue: Confidentiality means outsiders rarely know beans about the system’s decision making, good or bad. And, some of the most caring foster parents get the boot because they are often the ones least able to keep quiet when they think the system is failing a child.

Speaking out isn’t just likely to break a rule. It also tends to anger decision makers who don’t want their judgments questioned.

And so, the system tends to become well stocked with foster parents good at keeping quiet about problems, a skill that doesn’t make my top 10 list of favorite parenting traits.

Tom Lyons can be contacted at tom.lyons@heraldtribune.com or (941) 361-4964.

Leave a comment

Filed under Sarasota Herald Tribune

In another tragic death, another lesson for DCF

Sarasota Herald Tribune
By Tom Lyons
Herald-Tribune Columnist

The photo of Gabriel Myers on the Department of Children and Families Web site shows a smiling 7-year-old looking happy and well-cared for.

He was anything but that when he died in April, in the bathroom of a foster home in Margate.

That a child so young would hang himself after the state took custody is terrible enough. Worse, one factor might have been psychotropic drugs prescribed under DCF care.

What careful consideration went into the decision to give that boy Symbyax, an anti-psychotic and anti-depressant, combined with another drug for ADHD? I have no idea. Despite strict reporting and permission requirements to make sure indifferent foster parents don’t drug troubled kids just to make handling them easier, DCF Secretary George Sheldon says his agency’s database didn’t even show the boy was prescribed the drugs. Nor did DCF have a parental permission form or judge’s order, as required.

Worse still, Sheldon says his own investigation has already determined this is not unusual. DCF thought 1,950 kids under its supervision were on similar medications. The actual number is more than 2,600. One in six have no approval forms from a judge or parent.

“That is unacceptable,” Sheldon said.

Richard Wexler — a man I often quote as a thoughtful watchdog on child welfare agencies — could once again jump all over Florida’s system now. But Wexler says he has seen things to praise as well as criticize of late.

Yes, he says, the drug stats indicate “a lot of kids are being given these drugs not because they need them but because some group home workers and stranger-care parents want them doped up and docile.”

It is too easy for foster parents to decide an upset, unhappy child needs drugs, never mind that he has reason to be freaked out while being forced to live among strangers.

That underscores one of his themes: Kids usually fare better when placed with relatives, even imperfect ones, “because Grandma loves that child,” he said.

But DCF has put more emphasis on relative placement, and Wexler likes Sheldon’s response to Gabriel’s death. He says Sheldon seems to mean it when he says his aim now is making sure kids get drugs only when needed, and that a permission form would not have saved Gabriel.

In fact, Sheldon said what Wexler and I both think about that: Parents will often sign whatever DCF says to sign, out of fear, “and that’s not informed consent.”

So when DCF wants psychiatric drugs for foster kids, it had better have a good reason.

Tom Lyons can be contacted at tom.lyons@heraldtribune.com or (941) 361-4964.

Leave a comment

Filed under Sarasota Herald Tribune