A Critical Look At The Foster Care System Medication of Children

FOSTER CARE OUTCOMES

According to a nationwide study of runaway youths, more than one-third had been in foster care in the year before they took to the streets.

More than one out of five youths who arrive at a shelter come directly from a foster or group home, with 38 percent nationally saying they had been in foster care at some time during the previous year, the study found. In a new phenomenon compared with past surveys, almost 11 percent of the youths said they were homeless and living on the streets before coming to shelters.

These findings were the most disturbing to emerge from a study of 170 runaway shelters, said survey director Deborah Bass.

Some experts estimate that 45 percent of those leaving foster care become homeless within a year.

A California study in Contra Costa County found that a third of children placed in foster care eventually end up homeless, and 35% are arrested while in foster care.

Dennis Lepak of the Contra Costa County Probation Department explained to a 1988 Congressional subcommittee: "Children are put in inappropriate placements, not designed to offer family counseling, psychiatric treatment, or drug treatment. Children are not prepared to return to families, nor are they provided with a specialized educational and vocational training they need to survive after they become 18." As a result, says Lepak: "They become the new homeless."

In North Carolina, a six-month investigation conducted by the Charlotte Observer found that: "North Carolina's lack of commitment to foster care is helping create a population of throwaway children, many of whom go on to lives of substance abuse, homelessness, crime."

Eileen McCaffrey, executive director of the Orphan Foundation of America, explains:

Since federal funding guidelines encourage state-run foster care programs to emphasize short-term, crisis-management services, nongovernment players must concentrate on longer-range, skill-development programs. Youngsters leaving foster-care ill-equipped for life on their own often end up homeless or permanently dependent on welfare services.

The disproportionate representation of former foster care children among the homeless population has long been documented. According to the 1994 Green Book Overview of Entitlement Programs: "Several surveys conducted during the mid-1980s showed that a significant number of homeless shelter users had been recently discharged from foster care."

One such study conducted in the Minneapolis area found that between 14 and 26 percent of homeless adults were former foster care children.

A subsequent study of the long-term homeless in Minneapolis found that 39 percent had experienced foster care or institutional care as children.

In New York City, a study determined that between 25 and 50 percent of the young men in the homeless shelters were former foster care wards.

Perhaps the most distressing study of all, conducted in Calgary, consisted of interviews with so-called "street kids." It was found that an astounding 90 percent had been in foster care prior to winding up living on the streets.

Even among the homeless, the risks of continued family disruption are significantly greater than among the general population.

An ongoing study by the Institute for Children and Poverty reveals that homeless families whose heads of households grew up in foster care are at greatest risk of dissolution.

Individuals who grew up in foster care are 30% more likely to be substance abusers and 50% more likely to have a history of domestic violence than the overall homeless population. Twice as many of these heads of households have already lost at least one child to foster care.

GRADUATING FROM THE STREETS TO THE PRISONS

A 1991 federal study of former foster care wards found that one-fourth had been homeless, 40% were on public assistance and half were unemployed. Connecticut officials estimate 75% of youths in the state's criminal justice system were once in foster care.

According to a survey by the National Association of Social Workers, 20 percent of children living in runaway shelters come directly from foster care. Children placed in out-of-home care, regardless of the reason, are at higher risk of developing alcohol and drug problems. The survey also found that 80 percent of prisoners in Illinois spent time in foster care as children.

Karl Dennis, executive director of the Illinois based Kaleidoscope, the first child welfare agency in the country to provide unconditional care for children, says that in California, 80 percent of the adults in in the correctional facilities "are graduates of the state; the juvenile justice, the child welfare, the mental health and the special education systems."

OTHER OUTCOMES

The outcomes many former foster children may face are not limited to homelessness and imprisonment. According to the Youth Law Center, which has filed suits against several child welfare and foster care systems on behalf of abused and neglected children as well as foster care wards:

Lack of stability and a permanent home are evident in the extraordinarily high incidence of substance abuse, homelessness and psychological problems among former foster children.

Under a contract with the Department of Health and Human Services, Westat, Inc. released the second phase of a two-phase report in 1992 as a follow up on youths who had been emancipated from foster care during the period from January 1987 and July 1988.

Westat found that the status of older foster care youth 2 1/2 to 4 years after discharge is "adequate at best" and that services are needed for this population to improve their outcomes. The 1994 Green Book describes the results of the second survey:

Westat reported that only 54 percent of the study population had completed high school, 49 percent were employed at the time of the interview, 38 percent maintained a job for at least 1 year, 40 percent were a cost to the community in some way at the time of the interview (receiving public assistance, incarcerated, etc.), 60 percent of the young women had given birth to a child, 25 percent had been homeless for at least one night, their median weekly salary was $205, and only 17 percent were completely self-supporting.

The situation would appear to be somewhat worse in the state of Florida with respect to the percentage of high school graduations.

In 1996, a suit was filed in Tallahassee Circuit Court that accused the state of Florida of failing to adequately educate its foster children. Miami attorney Karen Gievers filed the suit claiming that while 73 percent of Florida children graduate from high school or get an equivalent diploma, less than half of the state's foster children do.

Jean Adnopoz, a psychologist at the Yale Child Study Center, says children who spend years drifting between foster care homes "can't be expected to come out in any way that would appear to be healthy." "If you have a child with no psychological parents, essentially adrift in the world, you are headed toward all sorts of bad outcomes," she said. "And we as a society are going to pay and pay and pay for it."

Says Children's Rights Project attorney Marcia Robinson Lowry: Foster care systems established and funded to serve children are failing, producing only more damaged graduates who will go on to produce new generations of damaged children, who will continue to lead unspeakably tragic lives and who will increasingly tax our public resources.

MEDICATION OF CHILDREN

In Washington state, one out of every five children in the foster care system is on potent mood-altering medications. Yet the state has no safeguards in place regulating their use to protect the children who swallow the potentially toxic pills.

The state does not chronicle the problems children experience with these drugs, nor are officials even certain how many of their wards take behavioral medications. And the ranks of foster children being given psychotropic drugs have swelled over the years, experts say.

Says Aija Guedel, former president of the School Nurses Organization of Washington: "When I see foster children, most of them are on a stimulant, anti-depressant or anti-psychotic - or usually all three." What are the results on the children? According to a six-month investigation conducted by the Seattle Post-Intelligencer:

A 4-year-old girl was rushed to intensive care with an erratic heartbeat after her foster parents accidentally doubled her daily dose of anti-depressants - a dose already far above the maximum recommended for her age and weight. The foster parents said neither their doctor nor social worker had warned them of the hazards of the drug, amitriptyline.

A 5-year-old boy tried to kick out the windows in a bus, covered himself with feces and tried to run naked down the street after being given powerful anti-depressants. His foster mother said she never was warned of the side effects.

A 13-year-old boy sent into foster care in 1995 during the Wenatchee sex-ring trials heard voices and suffered memory loss after being put on high doses of the anti-depressant Zoloft. He later tried to kill himself. Domico Presnell died. The wavy-haired 6-year-old failed to wake up in his Seattle foster home last April 21. A toxic level of amitriptyline was found in his blood.

The psychotropic drug most often prescribed to foster children in Washington state over the past five years has been methylphenidate, or Ritalin, which costs the state about 17 cents per pill, according to the 1996 Formulary and Drug Use Guidelines used at Western State Hospital.

The second most commonly prescribed pill was the anti-depressant imipramine, costing about 2 cents a dose. San Francisco youth activist Lyn Duff, herself a former foster child, describes her experience while in state care: "They put me on desipramine. A week later they took all the kids in a van to the doctor. He spent five minutes talking to us, with the other kids in the room."

"It's not unusual for me to have a child 9 years old on two or three psychotropic medications at one time," says Dr. Sharon Collins of Mercy Medical Center in Cedar Falls, Iowa.

The use of psychotropic drugs to control foster children in state care has long been documented. In a landmark suit filed against the Illinois Department of Children and Family Services, the American Civil Liberties Union blamed the child welfare agency for much of the child abuse in the state.

One of four teenagers named in the class-action suit had been in state custody as long as he could remember. Although his mother and grandmother had told him they wanted him back, the 13-year-old had not received any services that might have helped to reunite his family. In the meantime, he had been "warehoused" for three months in the Henry Horner Children's Center, where he was routinely drugged with psychotropic medication and in danger of assault, according to the suit.

One of the numerous terms of the consent decree stemming from the suit describes the use of these agents to control foster children:

By January l, 1992, DCFS shall convene a reform panel to review and make recommendations regarding its policies and procedures concerning (i) the use of restraint and seclusion on children in care and (ii) the use of behavior controlling drugs including a prohibition on the use of such medication for the punishment of children, the convenience of caretakers or as a substitute for programming for children's needs.

Has anything changed as a result of the Illinois action? Pia Menon, a former attorney with the Chicago Public Guardian's Office, was assigned to investigate the Columbus-Maryville Children's Reception Center operated by Catholic Charities. Her report, suppressed by Public Guardian Patrick Murphy, was described to author Renny Golden. Menon recounts her findings on the use of drugs to control foster children:

"Many teenagers are on psychotropic medications. Almost every child who comes into the system ends up on some kind of psychotropic medication--we're talking about four- and five-year-old kids who are on Prozac and Ritalin..." "Give me a break--it's to quiet them down," she adds. "Generally, psychotropic medications take the place of nurturing."

But the use of medications is not limited to group care facilities and the Children's Reception Center. Menon explains: Caseworkers prefer that the child is medicated. It helps the foster care parents, who may not be qualified to deal with a disruptive child. Staff often have no idea what a drug does to the child. They dispense it like aspirin. There is absolutely no one to monitor kids on multiple meds. What this all amounts to is a systematic assault on children who've already been removed from home, medicated, coded, misdiagnosed, therapized...

Prentis Caudill was a ward of the state. Both he and his sister endured the difficulties of placement in residential group homes and psychiatric facilities. "All you have to do is act up and they give you drugs," says Prentis. "The drugs were nice because they'd calm you down or put you to sleep for days." Adds Prentis: "They gave me Thyroxine. Sometimes your muscles twitch."

In California, judicial approval is required for giving psychotropic drugs to any foster child. Says Dr. Michael Malkin, who reviews the drugs for Los Angeles County judges: "The psychiatrist is usually beseeched by the group home operator to medicate the kids."

Dr. Malkin tries to substitute milder medications that don't cause permanent facial tics, heavy sedation and other side effects. According to Malkim, the Judicial approval required in California deters doctors from dispensing risky anti-psychotic drugs en masse.

Oh, is that so? A 1997 Los Angeles Grand Jury report indicates that foster children are frequently medicated with psychotropic drugs. Not only are the children excessively medicated, but the conditions in group foster homes were found to be deplorable. The Los Angeles Times describes the Grand Jury findings:

Many of the nearly 5,000 foster children housed in Los Angeles County group homes are physically abused and drugged excessively while being forced to live without proper food, clothing, education and counseling, according to a blistering report by the county grand jury. The Grand Jury found that children were given a variety of medications without the proper consent of a guardian or judge in nearly half of 158 audited cases. In another instance, a group home withheld drugs in hopes that a child would be ruled severely emotionally disturbed--thus drawing a higher rate of government payments. The Grand Jury also identified inadequate psychotherapy for the children, with sessions of as little as five minutes being held, although therapists were billing for full-length sessions.

Said Andrew Bridge, executive director of the Alliance for Children's Rights: "We need to have small homes of six beds or less to deal with these kids in a therapeutic way and not simply put them away or drug them."

The 1991-92 San Diego County Grand Jury reached similar conclusions, extending its examination of the foster care system in another direction. Among its findings: Caseworkers, investigators and attorneys believe that some foster parents routinely complain of behavioral problems, insist that those behavioral problems require mental health therapy and then seek additional funds for regular transportation to the therapist and special care needs. These claimed behavioral problems are subjective and are not capable of being confirmed by objective tests.

The Grand Jury suggested that "foster parent claims of behavioral problems in foster children not previously identified as having the problems should be carefully investigated." In examining the improper use of controlling medications, the Grand Jury found that the medications in use ranged from mild depressants and hypnotics to strong psychotropic drugs. It determined that the lack of money for medical treatment, the financial pressures on medical providers and a generalized lack of medical records for foster children all contributed to make it possible for unscrupulous foster parents to obtain medication for children who did not need to be medicated.

A committee of the U.S. House of Representatives examined many of these problems years ago, concluding that the foster care and child welfare systems were in dire need of reform.

A 1990 report issued by the Select Committee on Children, Youth and Families described the use of these mind-altering medications, and the bizarre treatments to which children in state care are frequently subjected: "In the state mental hospital in South Carolina, children who attempted suicide were stripped to their underwear, bound by their ankles and wrists to the four corners of their beds, and injected with psychotropic drugs."

ELICITING DISCLOSURE

Some critics charge that psychotropic medications are not only routinely provided as a method of controlling foster children, but as the means to obtain disclosure of non-events.

In Wenatchee, Washington, where allegations of a bizarre and highly improbable "sex ring" involving several prominent citizens came to surface, children alleged to be victims are apparently being provided medications and therapy as a means to elicit disclosure, critics charge. Melinda Everett, who was among the primary witnesses for the prosecution, publicly recanted her testimony on a televised broadcast, claiming that it had been coerced.

Immediately on the heels of her public recantation, Melinda was seized from her grandparents' home. Writes syndicated columnist Paul Craig Roberts: "For the past several months the child has been involuntarily locked away in a psychiatric facility where she is under the exclusive control of 'recovered memory' therapist Cindy Andrews. No one--not even elected state representatives--has been permitted to see her."

Cindy Andrews, who is under contract with the state, is among the defendants in a civil suit in which Melinda Everett is a principal witness.

Melinda is not alone in her plight. More than a third of the alleged victims of the so-called "child sex ring" in Wenatchee were placed on psychotropic drugs paid for by the state once they entered foster care. Are the Wenatchee children truly victims of a sex ring that included dozens of people with a local pastor as ringleader, or are they victims of a state sanctioned machine determined to extract testimony from them at any price?

Their stories include: A 12-year-old boy taking the anti-depressant Zoloft who heard voices telling him to hang himself by jumping off a milk crate with a rope around his neck. His counselor worried he was suffering from memory impairment as a side effect of the drug. He originally was sent to Pine Crest, but later was transferred to an institution in King County where he tried to kill himself.

A 15-year-old developmentally delayed boy who became a chief witness in several of the cases after being sent to Pine Crest. He later attempted suicide while on psychotropic drugs. A boy described in medical records as "in denial" and "non-compliant" after his parents were sentenced to prison on sex charges. At age 9, in April 1995, he tried to run away from the foster home he shared with two other alleged sex-ring children. Doctors increased his dosage of Zoloft, and the fourth-grader "tried to stick (a) metal object through his chest," according to a DSHS episode report. He then entered a Seattle psychiatric hospital, where he was prescribed the anti-depressant amitriptyline.

In the case of one 13-year-old girl, her medical notes indicate that Andrews "apparently would like her on medications." The girl later was given Paxil.

The greatest irony to be found among these tragic circumstances is that a significant number of foster children have been removed from their homes for reasons alleged to be related to "neglect" stemming from substance abuse by their parents. In Hawaii, an estimated 80% of cases involve substance abuse by parents, says John Walters, an assistant program administrator with its Department of Human Services.

While "historically, people have thought of substance abuse as an adult problem, substance abuse by parents has made it a children's problem, as well," said a spokesperson for the Massachusetts Department of Social Services.

Apparently, the child protective system has gone to great lengths to ensure that substance abuse is indeed "a children's problem," as its solution is all-too-often the traumatic removal of children from their homes, and the systematic turning of the children into drug-dependent wards of the state.