Florida Times Union
Consent for foster kids' psychiatric drugs on rise
More parents, courts approve medication; some fear they aren't informed decisions.
By Brandon Larrabee
Jul. 6, 2009
TALLAHASSEE - As a task force examining the use of psychiatric drugs by foster children draws nearer to issuing its report, caseworkers across the state are working to get parents or courts to approve the use of the medications to treat hundreds of children.
And while the number of foster children reported to be taking the medicines has risen from 2,669 in early June to 3,100 in numbers released Thursday, the proportion doing so without consent has dropped steeply, from 16.2 percent to 6.1 percent.
Even so, some advocates are worried that the rush to generate a paper trail for children already taking the medicines might mean some permission is being given without a full understanding of the drug's purpose and possible side-effects.
"They've been working very hard to get paper files that reflect consent," said Robin Rosenberg, interim director of Florida's Children First and a member of the state's Gabriel Myers Work Group. "But that is different than informed consent."
The work group began its investigation in the wake of the death of 7-year-old Gabriel Myers, a foster child in South Florida who police say hanged himself April 16.
Myers was taking psychiatric medicines, and the Department of Children and Families later found that local caseworkers had not obtained proper consent for him to use the drugs.
Psychiatric drugs, particularly antidepressants, have become controversial because of worries that they might increase thoughts of suicide in children, prompting the FDA to put a "black box" warning on the medications.
State figures show 488 children in the agency's 19-county Northeast Region - which includes Duval, Clay, Nassau, St. Johns, Flagler and Baker counties - are taking the medicines. In June, about 22 children - about 5 percent of those taking the drugs at the time - did not have consent; that number is now 18 children, about 3.7 percent.
Consent from courts
Much of the shift, though, has taken place by obtaining consent from courts. For example, 46 percent of children in the Northeast Region taking the drugs in June had consent from parents, with 44.8 percent taking the medicines under a court order.
According to Thursday's figures, 42.3 percent of children using the drugs are now doing so with parental consent, with court orders now accounting for about 53.1 percent of children being treated.
Statewide, the proportion of children taking drugs under court order has risen from 43.4 percent in June to 51.1 percent now.
Jim Sewell, former assistant commissioner of the Florida Department of Law Enforcement and head of the work group, said caseworkers were probably headed to court more often because some parents are difficult to find or have had their rights terminated.
"My speculation is that it's probably the safe way right now because there's so much attention on it. ... With the attention given this, there's a whole lot of pressure on these local organizations to get the paperwork right," he said.
Rosenberg pointed out that many foster children are in the system for a reason.
"The child was removed because of the parent's conduct," she said.
She also said that the child should also have an age-appropriate influence on treatment.
"They know what's happening to their bodies," she said.
Sewell said his group is closely monitoring even the cases where consent has already been obtained, to make sure that parents and courts are getting enough information to make the right decision. The panel is hoping to complete its report by Aug. 20 and present it to state officials six days later.
It's also wrestling with the loaded question of how many drugs are being prescribed. Sewell said the focus isn't on whether the department and physicians are underprescribing or overprescribing drugs.
"The issue really is, are we properly prescribing drugs," he said.
Rosenberg said some children do need to take the medicines.
"But if they're angry or depressed or misbehaving to get attention," she said, "a lot of things could be going on that have nothing to do with a psychological diagnosis."