In wake of child’s suicide, Legislature moves to limit foster care’s reliance on psychiatric drugs

St. Petersburg Times
By Cristina Silva, Times Staff Writer

TALLAHASSEE — A year after a 7-year-old boy heavily medicated on powerful psychiatric drugs hanged himself in his Margate foster home, lawmakers are pushing to reform state medical requirements for foster children.

The Senate’s Children, Families, and Elder Affairs Committee unanimously approved a measure Thursday designed to curb the prescription of mental-health drugs to children in state care.

The proposed law would require the state Department of Children and Families to assign volunteer guardians to oversee each child’s mental health care. It prohibits foster children from being the subject of clinical drug trials and raises the age at which children are allowed to take these drugs from 6 to 11 in many cases.

The measure (SB2718 and HB1567) would also give children some say in the drugs they take.

“We are not just going to medicate them until they turn 18 and then dump them into adulthood,” said sponsor Sen. Ronda Storms, R-Brandon, chairwoman of the Children, Families, and Elder Affairs Committee.

The state’s growing use of adult medication on emotionally and mentally troubled children has sparked debate for years.

Multiple state studies show child-welfare doctors and case managers routinely failed to follow legally required treatment plans or properly document when and why drugs were given to foster children, creating a network of youth sedated by “chemical straitjackets,” Storms said.

The death of Gabriel Myers in April further revealed the shortcomings of 2005 legislation that required more information sharing, parental involvement and second-party review of doctors’ prescriptions for the youngest children.

Because foster children are often cared for by multiple service contractors, communication lapses and fragmented mental health care are still rampant, a recent state report on Myers’ death determined.
“Our response to him was to medicate him, and medicate him, and medicate him,” Storms said.

Under the bill, proposed medical treatment plans must be explained to a child and the child must consent to the treatment in many cases before taking the drugs.

“What this means is less medication and more behavior analysis so that they are not just sedated little zombies,” said Jan Montgomery, president of the Florida Association for Behavior Analysis, which would train legal guardians to observe and treat behavioral problems.

Still, Montgomery said she did not expect a sudden culture shift, given failed past efforts to track foster children’s medical records.

“It’s going to be a slow slide toward what we are hoping is the right way,” Montgomery said.

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Bills worry child advocates


Daytona Beach News Journal

By DEBORAH CIRCELLI

DAYTONA BEACH — While social service agencies brace for more cuts this legislative session, many are following dozens of bills dealing with everything from giving foster children psychotropic medications to better screening of employees who work with vulnerable children and adults.

Improvements in background screenings for state-regulated jobs passed the Florida House on Thursday, but will still need approval in the Senate and by the governor. Owning a gun also won’t prevent someone from adopting a child, based on a bill approved in both chambers Thursday.

Local child-welfare officials are also watching what new guidelines will be passed dealing with prescribing psychotropic medications to foster children after the April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers. Gabriel was prescribed several mind-altering drugs and hanged himself in his foster home. Locally, about 120 or 14.4 percent of foster children in out-of-home care such as foster homes, group homes or living with relatives are on psychotropic medications.

Former foster youth receiving a monthly stipend by the state for living expenses while they continue their education could also see their money cut in half.

A House bill (HB 5305) would place a cap of $675 on how much former foster youth could receive each month for living expenses while continuing their education. About 70 youth locally are receiving about $1,200 a month. Another committee bill (SB7066) would require an audit of the program to track how youth are doing and spending the funds.

State and local advocates fear cutting funds will lead to youth dropping out of high school or college and becoming homeless.

“I think it would be extremely difficult for them to make it,” said Bill Babiez, CEO of Community Partnership for Children, the local foster care agency for the state.

Some other bills being followed by social service agencies include:

• BACKGROUND SCREENINGS (SB1520/HB7069): Enhances screenings for groups working with vulnerable adults and children. Some areas would include Guardian Ad Litem, nursing homes, foster homes, mental health personnel, home health agency personnel and people working with the developmentally disabled. The bill passed unanimously in the House. Fingerprints for various groups would be submitted electronically and retained by the state Department of Law Enforcement.

• FIREARMS/ADOPTIONS (SB530/HB0315): Prohibits an agency from denying a person the ability to adopt because they lawfully possess a firearm. The Legislature adopted the bill Thursday — including a 112-0 vote in the House and 38-2 in the Senate — and Gov. Charlie Crist said he supports it.

• ADOPTION (SB102/HB0003): Repeals law that currently prohibits someone who is homosexual from adopting.

• ATTORNEY REPRESENTATION FOR FOSTER CHILDREN (SB1860/HB7075): Appoints attorneys for foster children in certain cases such as if they’ve been in care for 18 months and their parents’ rights have not been terminated, or if a child asks for an attorney and the court agrees. Also, in cases where psychotropic medications are prescribed and the child objects or the court is concerned.

• INCREASED SERVER PENALTIES/OPEN HOUSE PARTIES (SB1068/SB1066/HB0033): Enhances penalties for people serving alcohol to someone under 21, including someone hosting an open house party where drugs or alcohol are possessed or consumed by minors. As opposed to 60 days in jail and a fine not to exceed $500, a person could get a one-year sentence and $1,000 fine, which is a first-degree misdemeanor, for selling or delivering alcohol to a minor within one year of a prior conviction.

• MENTAL HEALTH, CRIME REDUCTION AND TREATMENT ACT (SB1140/HB 1189): Provides more substance abuse and mental health services in the community such as crisis intervention teams and mental health courts. The legislation would reduce the number of people with mental illnesses or substance abuse disorders from being in the criminal justice system. Chet Bell, CEO of Stewart-Marchman-Act Behavioral Healthcare, said, “We want mental illness among nonviolent offenders to be treated as a health issue, not a criminal justice issue,”

• INTELLECTUAL DISABILITIES (SB1388): Would replace the word “mental retardation” in current legislation to “intellectual disability.” Barry Pollack, president & CEO of United Cerebral Palsy of East Central Florida in Daytona Beach, said, “Our society has turned the word ‘retardation’ and variations of the word into a socially unacceptable label with very negative characterizations.” Other bills dealing with rights of people with disabilities include increased training requirements for people teaching children with disabilities.

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FDA warns psychiatrist who treated dead foster child

Miami Herald
BY CAROL MARBIN MILLER

MENTAL HEALTH
FDA warns psychiatrist who treated dead foster child
The psychiatrist who treated the Broward foster child who killed himself last year is now in hot water with the FDA.

A South Florida psychiatrist who was treating a 7-year-old foster child before the boy committed suicide last year has received a warning from federal drug regulators who say he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.

In a strongly worded letter dated Feb. 4, regulators at the U.S. Food and Drug Administration said Dr. Sohail Punjwani over-medicated children who were enrolled in clinical trials for undisclosed drugs. One girl, the letter said, slashed her wrists while hallucinating.

Another, a 13-year-old, “experienced sedation and dizziness during the study,” the letter said.

The warning letter, a harsh and rare form of discipline by the agency, says Punjwani failed to “adhere to the applicable statutory requirements and FDA regulations governing the conduct of clinical investigations.”

“Your failure to conduct the requisite safety measures contributed to the unnecessary exposure of pediatric subjects to significant overdoses, which jeopardized the subjects’ rights, safety and welfare,” the letter says.

Punjwani did not return calls from The Miami Herald seeking comment.

Punjwani, who practices in Tamarac and has offices elsewhere in South Florida, was treating 7-year-old Gabriel Myers when the boy hanged himself with a shower cord in a Margate foster home. The boy’s death prompted a yearlong probe by a Department of Children & Families task force, as well as proposed legislation before the Florida Senate.

Before Gabriel’s death, Punjwani had prescribed several powerful mental health drugs — some of which had not been approved by the FDA for use on children and had been linked to dangerous side effects, including an increased risk of suicide among children.

Punjwani also was sued last summer by a Tamarac mother who claims her son, 16-year-old Emilio Villamar, died after being over-medicated with a group of mental health drugs at a Fort Lauderdale psychiatric hospital.

The letter mailed to Punjwani does not specify the names or types of drugs the doctor was testing, and a spokeswoman for the FDA, Sandy Walsh, said such details are kept confidential to protect drug companies.

Walsh said the FDA does not send out such warning letters often, and the agency considers breaches of its regulations to be “very serious.” The letter was signed by Leslie K. Ball, a doctor who heads the compliance office of the Division of Scientific Investigations, and Constance Cullity, a doctor who is also a compliance officer.

For years, drug makers did not study most medications on children, largely due to ethical concerns over using kids as test subjects. More recently, however, Congress passed laws to encourage pharmaceutical companies to test their drugs for safety and efficacy with children by extending patents on drugs approved for adults.

In a trial for one drug that was not identified, Punjwani gave one child dosages “in excess of… specified limits,” the letter says.

The child was discontinued from the trial before it was completed, the letter says, “due to worsening auditory hallucinations that apparently caused the subject to lacerate her wrists.” The girl was “overdosed” on the drug for more than two weeks.

The letter says Punjwani submitted a corrective action plan to the FDA and revised his procedures to better protect his research subjects from dosing missteps. “However,” the letter says, “we are concerned that the response is not adequate to prevent future recurrence of the violation.”

The clinical trials for a different drug were to adhere to a series of protocols that specified what dosage of the drug was to be used, depending on the child’s weight, the letter states. But for six of seven children — chosen at random — who received one of the tested drugs in Punjwani’s study, the dosage exceeded what was spelled out in the protocol.

One child who weighed 103 pounds, for example, “was overdosed on study medication for 20 consecutive days while participating in the study,” the letter states. The child is identified only as “Subject 1001.”

A child identified as “Subject 1003,” who was 15 at the time of the trials, “was overdosed on study medication for 21 consecutive days while participating in the study,” the letter says. “Subject 1004,” a 16-year-old, “received doses in excess of the maximum target dose for 3 consecutive days while participating,” the letter says.

A 10-year-old, identified as “Subject 1007,” was “overdosed” for nearly two weeks while on the study, the letter states.

Department of Children & Families Secretary George Sheldon, who appointed a task force last year to study Gabriel’s death, said Monday he is asking the FDA to compare a list of Florida foster children with lists ofchildren enrolled in Punjwani’s clinical trials. Sheldon said he was acting on concerns that children in state care may have been involved in clinical trials, which is against state law.

The FDA letter, Sheldon said, “raises clear ethical issues and judgment issues that we need to clearly understand.” If foster kids were enrolled in clinical trials, he said, “we will need to take it to another level.”

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Regulations sought for foster kids prescribed psychiatric drugs

Miami Herald
FLORIDA LEGISLATURE

In the wake of a Broward child’s death, state lawmakers will consider a bill designed to make it harder for child welfare workers to use mental health drugs to control foster kids.
BY CAROL MARBIN MILLER

Florida lawmakers will once again consider a measure to rein in the use of psychiatric drugs among foster children in the wake of last year’s death of a 7-year-old Broward boy who was on a cocktail of mood-altering drugs.

A new bill, filed Friday by state Sen. Ronda Storms, a Brandon Republican, would, among other things, require that foster children assent to the use of psychiatric drugs. The proposed law would require caseworkers to explain to children, in a manner they can understand, why the drugs are necessary and what risks they carry.

“It’s a huge step forward for the children of Florida,” Robin Rosenberg, deputy director of Florida’s Children First, said of the provision. “It’s integral to effective treatment for children to be involved at a developmentally appropriate level.”

The requirement that foster kids be involved in their own treatment was one of scores of recommendations made by a child welfare work group of administrators from the Department of Children & Families, doctors and children’s advocates who studied the death of Gabriel Myers last April.

Gabriel, originally from Ohio, entered state care in June 2008 when his mother was found slumped in her car in a restaurant parking lot — with a narcotic pill bottles surrounding her. Gabriel hanged himself on April 16, using a retractable shower cord as a noose.

In the aftermath, The Miami Herald reported that the boy had been prescribed several anti-psychotic and anti-depressant drugs in the months before his death. Most of the drugs have not been approved for use with children, and some have been linked to serious side effects, including an increased risk of suicide.

While Storm’s bill tracks most of the work group’s findings, it differs in some respects. One major difference: The work group wanted each child being administered psychotropic drugs to have the benefit of a lawyer at all court appearances.

Storms’ bill requires the state to appoint guardians ad litem, or volunteer lay guardians. Storms said the guardians are qualified for the role because they already are involved in the children’s lives.

Rosenberg, who was a member of the Gabriel Myers Work Group, said “the work group concluded that attorneys are best suited to protect children’s interests when prescribing medication,” she said.

The bill would also:

• Prohibit children in state care from being involved in clinical trials designed to determine the safety or efficacy of drugs that have not yet been approved by the FDA.

• Require an independent medication review before psychiatric drugs can be administered to children 10 or younger.

• Require mental-health professionals to prepare an overall treatment plan, including the use of counseling and therapy, when children are prescribed psychiatric drugs.

“We want to give a preference to behavioral therapy,” said Storms, the bill’s sponsor. “We’re not going to just drug them through their childhood and adolescence.”

Storms said she thought the prescribing of such drugs has become a crutch for therapists, who are eschewing traditional couch chats with children. Research shows, she said, that some doctors are writing one prescription for a child every three minutes.

DCF administrators have supported the legislation, which marks the second time this decade that lawmakers have sought to crack down on mental-health drug use among kids in state care.

“With young kids, we really need to err on the side of caution,” said DCF Secretary George Sheldon, who has supported both the work group and the legislation.

State Sen. Nan Rich, a Sunrise Democrat who is vice chair of the children’s committee, said the bill will fail if lawmakers decline to set aside enough money to pay for it — especially the provision that requires guardians for foster kids who are prescribed drugs.

Miami Herald staff writer Robert Samuels contributed to this report from Tallahassee.

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Bill tightens rules for foster kids’ prescriptions

Associated Press

By KELLI KENNEDY

FORT LAUDERDALE, Fla. – Powerful mental health drugs dispensed to Florida foster care children would be more closely monitored under a bill introduced in the Florida legislature that comes after the death of a 7-year-old boy who was taking several psychiatric medications.

Sen. Ronda Storms, who filed the bill (SB 2718), said the drugs have replaced talk therapy and are over-prescribed to subdue unruly children. The measure requires an independent review before psychiatric drugs can be administered to children 10 or younger.

The bill, filed late last week, also expands the role of court-appointed guardians in overseeing children on mental health drugs and requires caseworkers to explain the possible side effects of such drugs to children in an age appropriate manner.

Mez Pierre, who entered the foster system at age 5, said he was given various medications, including one that caused diabetes, and said it’s crucial that children be involved in their own treatment.

“Its fair to know what it is you’re putting in your body,” said Pierre, 22.
The proposal is largely based on the findings of a task force formed after Gabriel Myers, who was on several psychotropic drugs, locked himself in a bathroom and hanged himself with a shower cord last April.

Gabriel was on Seroquel and other psychiatric drugs linked by federal regulators to potentially dangerous side effects, including suicide, but the risks may not have been adequately communicated to his foster parents. They are not approved for use with young children. But doctors often prescribe them ‘off-label,’ for purposes for which the drugs have not been approved.

“All you do is mask the behavioral problems by treating him psychotropically. All you’re doing is putting him in a chemical straight jacket so that he can’t act out so you can get him to 18 and dump him into adulthood and that’s not acceptable,” said Storms, R-Valrico.
A similar bill was filed in the House on Tuesday.

Gabriel’s death prompted a statewide investigation that found 13 percent, or 2,699, of all foster children are on such drugs, according to a Department of Children and Families study. That compares with only an estimated 4 percent to 5 percent of children in the general population.

“I think it’s an extremely important step forward,” DCF Secretary George Sheldon said Tuesday. “The key is going to be the ability of the department to implement and hold people’s feet to the fire. You can have the best statutes but if we don’t do our job it’s not going to make a difference.”

Child advocates say prescribing doctors often lack pertinent information on the child, including medical history and behavioral background. The bill requires caregivers and doctors to report any adverse side effects, which DCF must document.

“There was no record when a child had a bad reaction of any kind to the medication. There was no way to keep that information,” said child advocate and Broward County attorney Andrea Moore.

The bill also requires children to have a mental health treatment plan that includes counseling for children prescribed such drugs. Sheldon said he’s heard from too many foster children who were kept on mental health drugs until they turned 18. Treatment plans must include a time frame for discontinuing medications, he said.

Basic analysis of all medications for children in state care — such as what medication they were taking, why and when it was prescribed, and whether it worked — was supposed to be collected beginning in 2005, but that never happened.

A DCF review shows caseworkers failed to complete treatment plans, didn’t consult psychiatrists and failed to obtain consent for the drugs in many cases. The bill addresses each of those issues.

The bill says foster children often receive “fragmented medical and mental health care” and requires a court-appointed guardian to oversee mental health treatment plans for all foster children prescribed such medications. The Gabriel Myers’ work group recommended a lawyer instead for each child.

“We very often are the ones in the courtroom standing up expressing concern or disagreement when it comes to pyschotropic medications,” said Marcia Hilty, spokeswoman for the Florida statewide guardian ad litem office.

The increased role of the court-appointed guardian could require more funding for additional training as medications are constantly changing, she said.

Pierre said his court-appointed guardian was a wonderful mentor, but Pierre thinks it’s “ludicrous” for them to play such a large role in medical treatment plans. He said an attorney is better equipped to navigate those matters.

“Why would we ask people who are just volunteers to go through the court system and be a liason on the way medications are distributed to children?”

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Drugs for foster children

The Tampa Tribune
By CATHERINE WHITTENBURG

Drugs for foster children: GOP Sen. Ronda Storms of Valrico, who is chairwoman of a human services policy committee, has made restricting the use of psychotropic drugs to treat the state’s foster children a priority this session. The issue came to light last year after a 7-year-old foster child who was prescribed such medication hanged himself in Broward County.

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Child’s suicide raises medication questions


Daytona Beach News Journal

By DEBORAH CIRCELLI

DAYTONA BEACH — Little bodies sink into adult-sized conference chairs.

With crayons between their fingers, they color on a sheet of paper after writing promises to their parents — “to control my anger,” “to make good grades” and “to go to the good side” when deciding what path to take in life.

In a room at Halifax Health Behavioral Services on Jimmy Ann Drive, 10- and 11-year-olds are dealing with adult issues — depression and mood swings.

For Walter Grimes, 11, his quiet demeanor is a sharp contrast from court documents describing a child in a school summer program who bit a teacher on both of her arms and punched and kicked her in the face. Walter, who was 10 at the time, was taken to Halifax Health Behavioral Services under the state’s Baker Act as a threat to himself and others and charged with battery on a school official, records show.

Therapy and psychotropic medication — medicine used for psychiatric reasons such as mood stabilizers, stimulants and drugs for attention deficit hyperactivity disorder — are helping him stay calm and concentrate, his therapist and great aunt said.

The question of how much is too much and how young is too young when it comes to prescribing psychotropic medications — some that are not approved for children by the Food and Drug Administration — is a statewide and national debate.

In Florida, 81,961 children covered by Medicaid were on psychotropic medications from January to June 2009, compared to 76,358 from January to June 2008, according to the state Agency for Healthcare Administration. Numbers for private health insurance companies are not public.

Local agencies are seeing a rise in the number of children with psychiatric problems, from severe anxiety to depression. They’re also seeing more young children who are 5 or 6 years old. The concern is especially high in foster care, where a higher percentage of children are given psychotropic drugs than in the general population.

The April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers — who was prescribed several mind-altering drugs and hanged himself in his foster home — sparked a statewide review and recommendations in November that will result in new rules and legislation in the coming months for children under foster care.

“We must do better for our children,” said Alan Abramowitz, former local DCF administrator and state director of the DCF Family Safety Program Office. “Medication is not the cure-all.”

Adderall is the psychotropic medication prescribed statewide in foster care to the largest number of children for attention deficit hyperactivity disorder, DCF records show. Locally in foster care, the main psychotropic drug being prescribed is Seroquel for mental/mood conditions.

Some child advocates question whether medications — some of which have serious side effects such as suicidal thoughts — are being used as a quick fix to behavioral problems that children will grow out of because their brains are still growing.

“It shouldn’t take mind-altering medications to help children grow up,” said Karen A. Gievers, a child advocate and an attorney in Tallahassee. “It takes good parents to help children grow up.”

Others say some children need medications to help them concentrate and succeed in life. Some are being exposed to more violence at home and dealing with issues not seen a decade ago.

“We get children who haven’t giggled or laughed or smiled in years,” said Shirley Holland, department manager at Halifax Health Behavioral Services, the local community mental health provider for children. “Once we add medication, it’s like the light goes on. They experience life in a completely different way. It doesn’t mean the burdens go away, but life is not so heavy.”

MORE CHILDREN BAKER-ACTED

Halifax Health Behavioral Services has seen the number of children admitted under the Baker Act as a danger to themselves or others almost triple in Volusia and Flagler in a three-year period. The agency treats about 3,000 children in all its programs — more than half are on psychotropic medications.

The reasons behind the rise are unclear, but some point to children being subjected to more stress at home.

Holland said it would be unusual about 20 years ago to see a 12-year-old who was psychotic, hearing voices and hallucinating, but “they are younger than that now.”

She recalled a 5-year-old in 2009 who broke glass and swallowed it after stating he wanted to kill himself.

With a child or adolescent attempting suicide every 90 seconds in this country, Holland asked how can her staff not treat and help children have a better quality of life.

For Walter Grimes, he and his four siblings were adopted by their great aunt in 2008 after being removed from their parents by DCF. Carrie Hill, his great aunt, said the children dealt with issues of abuse and neglect, including sometimes sleeping on the floor when their cots broke. When he first came to live with her three years ago before he was adopted, Hill was often called to the school by police and administrators.

There were times he would “curse at me, hit me and spit on me,” she said.

Now, after being on medication for mood swings, Walter is making good grades and has certificates for scoring high on the FCAT in reading, but Hill said he still has more work to do.

“I was worried to put him on medicine, but I asked a lot of questions and talked to doctors and they helped me,” Hill said. “He has come a long way. He’s a sweet child and he’s very lovable and he has a beautiful smile. It’s just these issues he’s dealing with.”

At his Daytona Beach house recently, Walter was quiet and shy as he read his favorite book, “The Lion King,” to Hill, whom he calls “Auntie.” He said he loves to read because “it’s fun.”

The fourth-grader said he’s learned in therapy how to control his behavior by taking time to think about the situation, breathe or walk away if he is angry. He said the medicine “helps me stay calm. I don’t mind (taking it).”

Vanessa Harvey-Lents, program therapist at Halifax Health Behavioral Services, told children in the group recently they always have a choice to do the right thing. She told them that while the medicine they take calms them to think and make the right decision, they have to control their behavior.

“There is no cure to bad behavior,” she said.

UNKNOWN DRUG SIDE EFFECTS

Others worry children are being overmedicated and, in some cases, put on medications not approved for children, with unknown long-term side effects.

Dr. Christopher Bellonci, , a psychiatrist in Massachusetts and national expert who has testified before Congress and Florida child-welfare officials, said some psychotropic medications used for aggression in children can have serious side effects, from weight gain to diabetes and heart disease. He thinks there is “over-prescribing.”

He points to the diagnosis of bipolar disorder increasing 40-fold in the last decade. Part of the problem, he said, is the “societal viewpoint” that medications are the answer and will be easier than doing therapy and behavioral work.

“I don’t know that kids are any more ill than they were a decade ago,” Bellonci said. “But if you look at the diagnostic percentages, you are seeing huge increases in the way people are diagnosing these kids.”

Maryann Barry, CEO of the Children’s Advocacy Center in Daytona Beach, which provides therapy services to abused children, is concerned some children are being treated for mental illness when in truth “the problems are environmental or behavioral.” If there is a child in a violent, disruptive home, she said, the child will have violent or withdrawn behavior.

“Their body and mind is responding to that environment,” Barry said.

But Dr. Hilda Vega, a child and adolescent psychiatrist at Halifax Health Behavioral Services, said she looks at a variety of factors before deciding whether to place a child on medication, including the child’s pathology and his environment at home and school.

The youngest child she put on medication was 3 1/2 and was aggressive at home and in day care. But the family also saw a behavioral analyst.

In “an ideal world,” where there are no problems or illnesses, she said, she would not put any child on medicine. But she said, “we do not live in an ideal world.”

The brain is an organ, Vega said, and it also gets sick, which affects behavior and mood. Medicine, Vega said, helps regulate and stabilize. Many times children don’t have to stay on the medication into adulthood because, she said, they learn coping and organizational skills.

VIOLENCE AT HOME

“Our” Children First in Daytona Beach, which provides counseling and services to children and families, is seeing an increase in children who are depressed and making suicidal statements or threatening violent acts. In some cases, agency officials said, those children also have ADHD and their academics are impeded. Young children are being put on sleeping medication because of severe anxiety and post-traumatic stress, said Fran Moccia, the agency’s CEO.

“Children are seeing their mother shot and killed on the front lawn,” Moccia said, referring to a local Daytona Beach case and similar cases in West Volusia and Palm Coast where children were present when their mothers were shot. “There is so much violence every time you turn around..”

Crystal Knight, the agency’s clinical director, said while coping skills are taught in therapy, some children are not developmentally able to learn those skills and need medicine in conjunction with therapy.

“Sometimes counseling is just not enough,” Knight said.

Dr. Michael Bell, a DeLand pediatrician, said he’s shied away from prescribing psychotropic medication since the federal government issued warnings that some medications could cause suicidal thoughts in children. Instead, he refers children to a psychiatrist.

But Bell, who is also medical director of the child protection team at the Children’s Advocacy Center, also worries regulations and paperwork requirements are too strict for doctors and there is a risk more children will commit suicide if they are not treated with medication.

Still another concern is the use of off-label medications, which haven’t been properly tested for children, said Howard Talenfeld, president of Florida’s Children First, a statewide nonprofit children’s advocacy group, and chairman of a Florida Bar committee looking at children’s legal needs.

Ken Kramer, researcher for the Citizens Commission on Human Rights of Florida in Clearwater, which is associated with the Church of Scientology, agrees. He wants to see parents of all children fully informed about alternatives and risk and legislation requiring annual disclosures of gifts/payments by drug companies to physicians.

Walter Grimes’ aunt did her homework, and even though psychotropic medication is helping Walter and one of his brothers, she hopes they won’t have to take the medicine for very long.

“That is my prayer,” she said. “They said they can wean them away from it if they get better. I look forward to the day they can be off the medicine.”

State revamping children’s medication rules

Christina Pooley was used to the morning, noon and night ritual.

She’d open her mouth and move her tongue around so workers could see that the psychotropic medication she picked up in a little cup with her name on it was gone.

She tried “cheeking” her meds by hiding them in her cheek or partly swallowing them and coughing them up in her room at therapeutic foster homes throughout the state. When staff caught on and she refused to take the medicine, she said they’d give it to her through a shot or crush it up in apple sauce and watch her eat it.

The now 21-year-old Holly Hill woman said throughout almost her entire stay in foster care, from age 13 to 18, she was prescribed several medications at a time for mental health diagnoses, including depression, bipolar disorder, borderline personality disorder and oppositional defiant disorder.

Pooley’s story of being on psychotropic medications is not uncommon in foster care, state and national child welfare experts say. Nationally about 5 percent of all children are treated with psychotropic medications, but in foster care it ranges from 13 to 53 percent in states nationwide, experts say.

In Florida’s foster care system on Jan. 4, for example, about 14.5 percent of children — or 2,745 children — received one or more medications. The numbers locally were 13.5 percent or 112 children.

The April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers, who was prescribed several mind-altering drugs and hanged himself in his foster home, sparked a statewide review and new rules, and legislation is being developed.

Pooley admits she hit walls, threw things, cut herself on her inner arms and legs and ran from group and foster homes, spending days on the Boardwalk. But she also thinks she was overmedicated. She now receives individual therapy at Halifax Health Behavioral Services and said she’s only on two medications to help her sleep.

Officials with the state Department of Children & Families would not comment on Pooley’s time spent in foster care and her records are not public. But a work group has been studying the broader issue after the South Florida child’s death last year .

The group made 90 recommendations in November, including hiring a chief medical officer to monitor prescribing such medications and appointing attorneys for children. Some changes have already been made, such as obtaining proper court and parental consent. DCF is continuing to develop new rules.

DCF Secretary George Sheldon said the state needs to ensure it’s dealing with children’s behavioral needs appropriately and realize just the act of removing children from their home is traumatic.

“I’m not anti-medication, but I think it is a last resort,” Sheldon said.

Locally, child-welfare officials have trained caseworkers on new requirements, including ensuring parents understand the forms they sign, consenting to their children being placed on psychotropic medication.

Robin Rosenberg, who serves on a statewide DCF work group and is deputy director of Florida’s Children First, a child advocacy agency, said the issue is whether the “right kids are getting the right medications.”

“Before you say we are going to cure that problem with medicine, you need to address what is happening in that child’s life,” Rosenberg said.

Pooley said she was removed from her home and placed in the state’s care because of issues at home. She also said each time she moved from one group home to the next, new doctors would put her on different psychotropic medications, which child-welfare officials and Halifax Health Behavioral Services representatives said is not unusual when children move around and see new doctors.

But Pooley said sometimes the amount of medication she was on made her feel “like I wanted to die.” She said when she was 16, she tried overdosing on one of the medications — Seroquel, which DCF officials say is the most common psychotropic drug used on local foster children.

When she ran from foster care and was on the Boardwalk, she said, she felt better being off medication.

She said that at Halifax Health Behavioral Services — where she was taken by police under the state’s Baker Act as being a danger to herself or others — doctors took her off all her medications, evaluated her and put her on fewer medications. She believes the people there saved her life and are continuing to help her now with therapy since finding out two years ago she’s going blind from a brain malformation that also causes headaches and insomnia.

“It’s more depressing than being in foster care, but I don’t act out or cut myself and I’m able to deal with it,” Pooley said.

She’s planning to start back this month at Daytona State College after various surgeries. She wants to get a degree in psychology and work with children at Halifax Health Behavioral Services.

“A lot of (other) people gave up and said I wasn’t going to amount to anything,” Pooley said. “But people at (Halifax Health Behavioral Services) said, ‘We know you have it in you. This is what you have to work on and get it done.’ They kind of held me to it.”

BY THE NUMBERS

Here are the number of children prescribed psychotropic medications to deal with the top four diagnoses at Halifax Health Behavioral Services:*

1,350 Children who are prescribed drugs, such as Concerta or Adderall, for attention-deficit hyperactivity disorder/attention-deficit disorder. Possible side effects are: anxiety, nervousness, chest pain, high blood pressure, headache and mood changes.

471 Children who are prescribed drugs, such as Prozac or Lexapro, for major depression/depressive disorder. Possible side effects are: nervousness; loss of appetite; anxiety or trouble sleeping; and feelings of irritability. May increase risk of suicidal thoughts in children, teens and young adults.

241 Children who are prescribed drugs, such as Depakote/Depakene, for bipolar disorder. Possible side effects are: dizziness; increased or decreased appetite; trouble sleeping; fast or irregular heartbeat; and hallucinations. Severe and sometimes fatal liver problems have occurred.

159 Children who are prescribed drugs, such as Seroquel, for oppositional defiant disorder. Possible side effects are: fast or irregular heartbeat; increased hunger; seizures; and suicidal thoughts or mood changes.

NOTE: *Number of children as of Dec. 11, 2009

SOURCE: Halifax Health Behavioral Services and News-Journal research

BAKER ACT & CHILDREN

The number of children in Volusia and Flagler counties admitted to Halifax Behavioral Services involuntarily under the state’s Baker Act as a danger to themselves or others is on the rise:

2005/2006: 289

2006/2007: 662

2007/2008: 784

2008/2009: 845

SOURCE: Halifax Behavioral Services.

Fiscal year starts Oct. 1 and ends Sept. 30.

PSYCHOTROPIC MEDICATION IN FOSTER CARE

The number of children from birth to age 17 in foster care who are on one or more psychotropic medications:

• Florida: 2,745 children or 14.55 percent of all children in foster care.

• Volusia/Flagler/Putnam: 112 children or 13.58 percent of all children in foster care

SOURCE: Florida Department of Children & Families as of Jan. 4, 2010

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