Wednesday, November 30, 2011

Administration Concerned About Psych Meds and Foster Youths

by John Kelly

No regulation from feds yet; just information sharing

Starting this summer, states will have to provide the federal government with details about how they control the use of psychotropic medications on youth in foster care.

The Obama administration said in a letter to state officials last week that it was concerned about the “safe, appropriate and effective use” of the drugs, which are most often prescribed to adolescents in connection with a diagnosis for mood or conduct disorders, though many child advocates believe they are frequently used as chemical restraints because of their numbing effect on kids.

“As we strengthen child welfare systems’ ability to safely and appropriately manage psychotropic medication use, it is necessary to recognize the corresponding need to…implement effective, non-pharmaceutical interventions,” says the letter, sent jointly by three different divisions of HHS.

States must present the Department of Health and Human Services’ Administration for Children and Families (ACF) with an Annual Progress and Services Report in June 2012. That report must now include “comprehensive descriptions of procedures and protocols planned or in place to ensure the safe and appropriate use of psychotropic medications,” the letter says.

The letter is signed by George Sheldon, acting assistant secretary for ACF; Donald Berwick, director of the Centers for Medicare and Medicaid Services (CMS); and Pamela Hyde, administrator of the Substance Abuse and Mental Health Administration (SAMHSA).

Sheldon presided over Florida’s Department of Children and Families when it became the lightning rod for this issue in 2009, the year that 7-year-old foster youth Gabriel Myers hung himself. Myers had been prescribed psychotropic drugs without informed parental consent or a judge's order while in the foster care system.

A DCF review of Myers death found that doctors, judges, lawyers and social workers are often poorly-informed and need education and training when it comes to giving psychotropic drugs to children. But state legislation aimed at better regulating use of the drugs on foster children was killed the following summer.

The HHS letter suggests particular alarm at the fact that nearly half of foster youth in group or residential homes “are taking at least one psychotropic,” and that the “majority of children in foster care receiving psychotropic medications have multiple prescriptions.”

There is a dearth of information about how effective psychotropics are for kids, the letter says, and there is “scant evidence of the effectiveness of treatment with multiple medications,” a practice that “increases the likelihood of drug interactions and other adverse effects.”

The three HHS divisions also outlined ways in which the federal government intends to help states address the issue. In advance of the annual report’s June deadline, ACF will publish a Program Instruction that specifies what information that will be requested. And at some point during the summer, the divisions plan to convene child welfare and health authorities for “peer learning and technical assistance.”

CMS is currently in the process of disseminating findings from a 16-state working group on best practices for use of psychotropics among children on Medicaid.


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