Sunday, February 20, 2011

Review of Psych Drugs on Foster Children will Save Millions of Dollars

 

http://www.ajc.com/news/concern-over-high-medication-846324.html

 

Atlanta Journal-Constitution

Concern over high medication rate among foster kids

Review of kids' psych drugs urged

The Atlanta Journal-Constitution

 

While in foster care, Giovan Bazan, now 20, says he was put on Ritalin,

anti-depressants and sleeping pills. At 18, he elected to stop all drugs,

and says he learned he didn't need them.

 

Giovan Bazan was 6 when a doctor first gave him medicine to treat his diagnosis of hyperactivity.

Bazan admits he was unruly at the time. Perhaps it was because the only parent he had ever known, his foster mother since he was an infant, had just died.

No one asked about that. Nor did anyone check years later to see that he was on a double dose of Ritalin when another physician, seeing a boy so mellowed out that he barely reacted, prescribed an antidepressant. "They start you on one thing for a problem, then the side effects mean you need a new medicine," Bazan said. "As a foster kid, I'd go between all these doctors, caseworkers, therapists, and [it] seemed like every time there was a new drug to try me on."

When he turned 18, Bazan elected to stop all medications. It turned out he didn't need any of them.

Now, the Georgia House is weighing an idea to better track the psychotropic drugs foster children take at a far greater rate than other kids.

House Bill 23 hits a rare political sweet spot. The proposal to create an independent clinic review of the drugs foster children are given has support from Democrats and Republicans because of its efforts to protect the vulnerable — and projections that it will save the state millions of dollars. The state spends $7.87 million per year in Medicaid funds on those mind-altering drugs for foster kids. "This is an idea I'm very open and willing to have a discussion about," said Speaker David Ralston, R-Blue Ridge, adding his main concern is the cost of the review.

The issue is a national one. Only half of state child welfare systems — not including Georgia — have a policy to review usage of mind-altering drugs, even though as many as 52 percent of kids in foster care are taking them.

By comparison, about 4 percent of the general youth population is on the medications, according to a 2010 Tufts Clinical and Translational Science Institute study.

"These drugs are not something you take like an aspirin," said state Rep. Judy Manning, a Marietta Republican and chairwoman of the House Children & Youth Committee who is co-sponsoring HB 23 with Rep. Mary Margaret Oliver, D-Decatur.

"We want to monitor it and make sure the treatment is correct," she said. "You don't want a tragedy."

Lack of oversight can prove deadly. Gabriel Myers, a 7-year-old foster child in Florida, hanged himself in 2009 while taking three powerful psychotropic medications, none of which had been approved for use in children.

There have been no similar high-profile cases in Georgia. Still, one in three foster children on Medicaid was prescribed mind-altering psychotropic drugs last year, according to a January report from the state Department of Community Health. More than half of them were on a daily cocktail of more than two of the drugs — some of which lack approval for treatment in children.

Oliver argues that both the cost and number of foster children on such drugs will drop if her proposal succeeds.

Her plan calls for an independent review to kick in on red-flag cases in the system, such as when a very young child is prescribed drugs for mental health or when a youngster is on multiple medications at once.

It would be up to the Human Services or Behavioral Health departments to decide what would flag cases and how to best manage the independent psychiatrists who would monitor them.

Oliver said private foundations have expressed interest in funding the idea as a national pilot program.

"Foster children are more traumatized, for horrible reasons, and that's why their medical care has to be better," Oliver said. "I am excited about the number of stakeholders who want to work on solving this problem with us."

The issue may extend to lack of oversight on what drugs foster kids are being prescribed and taking. A 2010 investigation by The Atlanta Journal-Constitution revealed several companies operating foster care homes in the state had repeatedly used psychotropic medications to "subdue" children.

"Medications dispersed often aren't to help the child with their problems but to make the child more docile for the caregivers," said Richard Wexler, who heads the National Coalition for Child Protection and Reform. "And the paradox of child welfare care has always been the worst thing for the kids is what costs the most."

That seems to have been the case for Bazan. Now 20, he can recall a brief period in high school when prescriptions had run out and his foster mother didn't keep him on the stew of mind-altering drugs.

Fellow students noticed the no-nonsense boy was suddenly joking around and friendly.

"When I was off the medicines, everyone kept asking me why I was so happy," Bazan said. "There was a real difference."

The medications quickly returned, however. But Bazan said they didn't help with the loss he felt over the death of his first foster mother or his feelings of being unwanted and under attack in the foster home he repeatedly ran away from.

He spent time in Department of Juvenile Justice facilities, where the medications kept coming, sometimes provoking seizures because some of them didn't mix.

No one, he said, ever asked about his feelings. "They would have gotten a better response if someone had just taken a look at what was really going on in my life," he said.

Bazan did that himself when he quit all medications cold turkey at age 18. But the years of medication already have hurt his future: His plan to enter the military to pay for college is blocked by the diagnosis of hyperactivity. He is ineligible to serve.

Bazan now works part time at the Division of Family and Children Services, acting as a liaison with community organizations and state agencies.

He also has started his own security company to provide nighttime patrols at his church in DeKalb County and others.

His goal is to get a full-time job with DFCS and persuade Gov. Nathan Deal to appoint him to the Georgia National Guard. With that, he could pay for college.

First, though, he is sharing his story in the hope that lawmakers and others will see him as a cautionary tale for what can happen when someone isn't monitoring care of foster kids.

"I ask them, 'Would you give all these people carte blanche with your kids, without any scrutiny of their medical history and a review of their life?'" Bazan said. "We're just children. Someone has to look out for us. We need the same care and attention you give your own children."

 

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