Tuesday, December 6, 2011

Children in Foster Care and Psychotropic Medications … Monitoring Is Not Enough

By Darcy Gruttadaro, NAMI Director of Child & Adolescent Action Center

NAMI recently prepared a statement for a Senate hearing examining the use of psychotropic medication for children in foster care. NAMI is pleased that the Senate is looking closely at this issue and that the U.S. Government Accountability Office (GAO) recently released a report on the issue. The GAO report calls for states to more closely monitor the prescribing of psychotropic medications for children in foster care. This is a critical first step, but is not enough.

Expert prescribing guidelines for psychotropic medications should be developed and distributed by states to agencies and mental health professionals that serve children in foster care. Training, support and technical assistance are needed on an ongoing basis to help ensure that the guidelines are being used and followed.

Given the high prevalence of children in foster care with mental health care needs, these children should be screened and for those who screen positive, provided with a comprehensive psychiatric evaluation and a physical examination to rule out other physical health conditions that the child may be experiencing. All of this must be paid for by Medicaid and private insurers.

Our nation has a critical shortage of child mental health professionals, making access to care extremely difficult for all families, including those involved in the foster care system. States need to support access to scarce psychiatric care for children by supporting collaborative care and integrated care models that encourage the development of partnerships between families, primary care and mental health providers. NAMI recently released a family guide on integrated care that outlines the effective collaborative care and integrated care models that exist around the country and that benefit children and families.

Our nation must get serious about providing effective and evidence-based psychosocial interventions to all children with mental illness, including those in foster care. Many psychosocial interventions have been shown through research to work for children with mental illness, some as part of a comprehensive treatment plan along with medications and some on their own. These include cognitive behavioral therapy, parent-child interaction therapy, functional family therapy and more. Sadly, these interventions are often not available because providers are not trained in them and/or they are not paid for by private insurers or through Medicaid. The provider community, state Medicaid Directors, private insurers, federal agencies and others should work to ensure that there is a trained work force that understands how to deliver these effective interventions to children both within and outside of foster care. The availability of psychosocial interventions will impact the rate of psychotropic medications prescribed for children in foster care.

Finally, more research is needed to better understand the long-term safety and effectiveness of psychotropic medications for children, especially very young children. With the exception of stimulant medications for children with ADHD, there is very limited research. Although medications, when prescribed appropriately, can be lifesaving for children, more must be learned about their long-term impact on children’s health.

If we want to get serious about protecting the health and well-being of children in foster care, then we must look at all of these variables that directly impact the care provided to these children. These issues transcend the foster care system and pertain to all children and youth living with mental illness.


Anonymous said...

After years of taking psychotrophic medication that nearly destroyed my body, I call on NAMI to stop the insanity!!! Yes, NAMI ... kids in foster care have mental illness because of their situations. Lithium and other drugs will not teach them how to cope. They are a band aid!!! Wake up, people ... these kids need TLC and counseling if they are ever going to escape the vicious cycle of mental illness. They're not crazy, but they are overwhelmed. Sedatives mask the problems but only make things worst.

We give kids sedatives when they are so hurt, they stop functioning. We are fitting the symptoms into a book (DSM or Diagnostic and Statistical Manual ...whatever version we are on!) to try to create biological disorders to explain why people are so stressed and act crazy. They act crazy because they are overwhelmed and need love and understanding.

I was dx'd with bipolar in '94 and went through hell for years. When I stopped taking medication and found a support system, my life began to turn around but there are plenty of burned bridges behind me. Please don't do this to the kids.

Bring back the counselors. Give the kids love and see how that affects their mental health BEFORE you start dispensing all those chemicals into those little bodies.


Anonymous said...

You are pointing to long term use---the drugs used for ADHD are effective for some; but only for short term use, and after about a year, not so effective, ALL of them are addictive and have a risk of causing psychosis and sudden death. The SSRIs are not safe and only minimally effective for a small percentage of youth. The risk of suicide and homicide increased for youth and young adults.

The fact that NAMI has the entire nation covered with it's 'GRASSROOTS' could be a good thing But not if you're MISinforming people.

There is no valid use for
Neuroleptic drugs. They are not SAFE they have serious risks and are effective for 12% of children with a diagnosis of schizophrenia---this rate would NOT suggest using them for ANY other diagnosis,given the risk for permanent impairments 50% of kids who take them are expected to get Tardive Dyskenisia.

I have a son who was used in the TEOSS drug trials which helped these drugs gain approval for pediatric use---WITHOUT INFORMED CONSENT 2 children died, and I thought my son was going to, as well---he is severely disabled due to the NOT "safer and more effective" just much more expensive neuroleptic drugs called atypical antipsychotics. I have yet to meet a parent who has been told by a psychiatrist of the well known serious risks of any psychiatric drug prescribed to their child.

Informed Consent is not happening as a matter of course both children and adults---not just kids who are in foster care. These things could be more effectively addressed if NAMI were willing to honestly and ethically advocate for the people who access mental health services.

Truth, transparency and valid information is necessary for ethical treatment and to support recovery. Self Determination and Client and Family Directed care is and has been Federal Medicaid and Medicare policy for decades. The SAMHSA CMHI and Transformation grants are to transform the mental health system and are in fact to pay the states and communities to comply with the law! This will enable the people with a psychiatric diagnosis to be empowered and to recover. Self Determination means directing their own recovery---how they see fit. This requires honesty and integrity from those who support and advocate for them.

The one positive in your article is you said that more psycho-social services are needed---indeed they are! It is these treatments which actually aid recovery. However these treatments are not in PHarma's best interest and the bio-medical model is what is being funded and pushed by the TAC, the NIMH and by NAMI National. The services won't materialize without being supported and funded---but those who are bio-medical devotees do not want these services and so it is what it is.

If you are going to advocate for the people with mental illness, do that. If you are going to advocate for the corrupt drug industry, do that. There is a difference between collaborating with and being directed by. When the $, the information and educational materials, and the lobbying strategies and model legislation is coming from the a benefactor well that is who you are advocating for. No person or group can serve two masters whose interests are in conflict.

One more thing: you state, "Although medications, when prescribed appropriately, can be lifesaving for children, more must be learned about their long-term impact on children’s health." Medications prescribed appropriately and taken as directed have also killed children you know...Every parent that has buried a child was unaware it was in fact a known risk...They were never told. Informed Consent is NOT happening...

Anonymous said...

Who do you think will produce the expert guidelines? the same "doctors" whose fraud and corruption enabled this ongoing tragedy.

18,800 of kids who lived with parents and were given drugs in using high doses some of drugs was nlywho were that because of the

Anonymous said...

Psychotropic drugs given to children are extremely dangerous. The health care problems which many develop such as metabolic syndrome, diabetes, extrapyramidal side effects, further complicate their problems. The fact that children in foster care receive these drugs at a rate 2 to 3 times that of those in the general population is abhorring. The caregivers administering the medications need to know of all the side effects before dispensing. Do they? This needs to be stopped.

Imafoster said...

I feel like there is a lot of medication bashing. I agree that a lot of foster kids are over medicated but sometimes you have to way the factors. Therapy and counseling is needed but if you mind is not in the right place to take in what is being discussed then there is no point. I think some of the medication on help me process things more clearly. When you go through abuse and traumatic experiences sometimes your mind trains itself to survive whatever that may be. I think many time medication is needed to help re-train the mind back into a more "normal" state.

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