I thought I'd bring this important Denver Post series, "Prescription Kids," to the group's attention. The articles focus on the rate at which antipsychotic and antidepressant medications are prescribed to foster children in Colorado.


The articles raise a compelling question: Are these children, many of whom have been traumatized, receiving the appropriate treatment for their symptoms and conditions when they are prescribed multiple medications to help control their behavior? The medication may surely help in some cases, but the reporters who authored this series look at how Colorado is trying to adopt a trauma-informed approach to identifying and treating trauma in foster children. This may include prescription medication, but it increasingly includes different types of play and talk therapy to help reduce chronic stress and anxiety in these children. 

The third piece in the series, "New thinking on brain-science therapies could help foster kids," outlines the concerns and solutions in Colorado quite well. 

We'd like to hear from you on this topic. Are you troubled by the rate at which foster children are medicated? Do you see a shift in other foster care systems across the country from a medication model to a therapy model that includes different types of interventions? How do you feel the system can maintain a healthy balance between medication and other therapies? Please share your thoughts!

Rebecca Ruiz
Community Manager, ACEs Connection 

Series link: http://www.denverpost.com/fostercare/

Article link: http://www.denverpost.com/fostercare/ci_25567075/new-thinking-brain-science-therapies-could-help-foster

Original Post

Many are or maybe are.

I believe the issue is very complex, but a key staring point is that children needing psychotropic medications should be in therapeutic foster care, not 'traditional' foster care. Also, administration of any psychotropic should be done concomitantly with psychotherapy from a licensed mental health professional. Evidence-based treatment, evidence informed treatment, and/or promising practices should also be required. It behavioral health providers are not training in these levels of intervention due to geography, etc., consultations should be arranged with other such professionals. 

This really has been an ongoing issue for several years. I see the biggest problem here being time for appropriate assessments, time with the right people involved with the child(ren) to get adequate history, and then payment for the services of the professionals who conduct the evaluations. The current modus operandi is that anyone (even a driver) can deposit a child at a clinic for an evaluation by a psychiatrist who is given very little time. Yes, I had a 3 y.o. brought in by a driver for a psychiatric evaluation. Needless to say, I spent my time holding and consoling the poor child who was traumatized for the third time in a matter of days being taken from one place to another by strangers. My feedback to the child welfare agency was highly critical of this practice.  So this becomes what I call "checklist" medicine which does our foster kids a disservice. Foster parents have to be educated about the brain behavior of the kids and why that is so, and how best to intervene behaviorally. Medications can be useful when used judiciously, but we must allow more time for assessment, education and behavioral training, even when meds are used. Marilyn benoit, M.D. Child & Adolescent Psychiatrist

Hi, Rebecca--

 

My contact with foster children is primarily throgh in-home behaviroal health services in Southern, NJ.  I cannot comment on the use/over/under use of medication.  What I can comment on is severely inadequate trauma recognition and trauma-informed treatment and interventions across systems--lack of recognition of trauma symptoms/trauma effects and punitive responses to them; lack of preparation by the child welfare system for foster families for the level of severity of behavioral problems, often trauma induced, and lack of education about trauma-effects and trauma-informed, trauma-spfecific interventions in the home environment.  These failures lead to foster partents terminating the care and further traumatizing the child with yet another placement.  The courts are grossly trauma-uninformed and repeatedly retraumatize children with trauma-uninformed custody, visitation, and reunification.   Betty Lee Davis, Ph.D., LCSW

Thanks to everyone who has commented so far. These posts are really helpful in understanding the dynamic of the problem when it comes to foster care youth and mental health. Are there any resources you might recommend for a social worker or clinician or even adoptive parent who is trying to deal with these issues? I know that trauma-informed training requires a lot of time and practice, but if there's a primer or background material that others might benefit from, maybe we can share it here. 

Agreed. The field is doing a lot to try and train therapists; however, as in all of child welfare, there is so much turnover. Also, evidence-based trauma training is expensive and typically involves a follow up of 9+ monthly supervision sessions. But it is where we must go!

Likewise, this is where I recommend that all foster youth be screened at intake for trauma experienced/level of...and that treatment clearly involve a response to PTSD appropriately and/or mental illness as may or may not be present.

Here is report in the Providence Journal about efforts by the Rhode Island's Department of Children, Youth and Families to tighten rules for prescribing drugs to foster children:  http://ireader.olivesoftware.com/Olive/iReader/ProvidenceJournalPress/SharedArticle.ashx?document=TPJ%5C2014%5C06%5C05&article=Ar00105

Elizabeth Prewitt

Community Manager/Policy Analyst, ACEs Connection

Yes is all I have to say and inappropriately so. Pharmaceuticals push their shotgun drugs and don't look at the cause... Docs have 15 min to see you and "do something". Folks get direct to consumer ads on TV. As a doc I see it all the time esp in foster lids, kids from poverty, and stressed parents with little education and even the docs are only educated by the drug companies coming into your office providing free pens and lunches along with free samples it is really unfortunate... But primary care docs who care for most of these kids usually have neither the time or the training to do much more..... Just what I have seen

I would recommend the blog talk radio that I put on the aces in peds group from Dr. Bruce Perry who discusses how to deal with these kid.   Also the Foster Care AAP pdf has a section in the last pages about signs/symptoms kids can present with and how to respond to them.  With these kids sensitivity is the key.   Anything negative - a small look, a tone of voice that suggests even the slightest possibility of disappointment in the child can produce internal feelings of "I am terrible, I should have never been born, I am worthless, I am unloved" and can produce extreme outbursts or dissociation and disengagement.  Also the National Child Traumatic Stress Network has lots of stuff that is always useful. You have to join but everything is available free of cost.  But it truly is like emotionally, many of these kids can seem as if "they lack skin" because anything can hurt them.  A touch that would be loving to you or I may trigger an intense re-experience of a forceful blow or slap across the cheek.  The entire brain system is wired to detect threat and there is a negative bias to see threat. 

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