Guest post by Joe Hoft at JoeHoft.com – published with permission
State Audit Reveals Psychotropic Drug Abuse in Children in State Care
Republished with permission from AbleChild
A recent audit conducted by the Massachusetts State Auditor’s Office shows that the Department of Children and Families (DCF) is apparently very bad at doing its job and the fact that the welfare of children is at stake makes the incompetence unfathomable.
DCF is tasked with providing services to children at risk and victims of abuse or neglect. State-responsible services include adoption, guardianship, foster care, home stabilization, and family support.
In particular, AbleChild is interested in the part of the audit that reviews the supervision of medication for children with serious psychiatric medications. The audit examines the period from July 2019 to December 2023.
During the audit period, 3,899 (22%) of the 17,891 children in DCF protective custody were prescribed at least one psychotropic medication. During the audit period, the number of prescriptions filled for each drug category included 1,065 prescriptions for anti-anxiety drugs, 21,585 Antidepressants, 10,564 Antipsychotics, 10,776 Mood Stabilizers, and 48,453 Stimulants. Clearly, chemical behavior modification is a common practice, and state DCF social workers must participate in, follow up on, and document the medication history of every child in their care.
To help caseworkers provide needed services, children are provided with a physical Medical Passport documenting health care services while in state custody. Social Workers are required to review these physical passports every six months to keep medical records related to children in the iFN (electronic information system) updated with the latest health information.
In Massachusetts, the Court must approve the use of antipsychotic drugs in children in state protective custody. The audit stated that “the Department of Children and Families does not always obtain or renew court approval before children in custody are prescribed antipsychotic drugs.” This is a problem because the court needs to know that the drug regimen is safe and effective. Furthermore, the court has supervision of children who are too young to consent to drug treatment and acts as a neutral party.
The audit also found that “the Department of Children and Families did not properly maintain health care records on iFamilyNet (iFN) for children in protective custody receiving psychotropic medication.” Keeping up-to-date records is important to ensure that the child is not overprescribed with toxic mind-altering drugs. No supervision, leaving children in custody at risk.
In addition, DCF does not record and / or update the psychotropic drugs given to children in the medical passport, which clearly can lead to the overprescribing of dangerous mind-altering drugs and adverse, if not fatal, events. And with the lack of documentation, DCF also failed to record doctor appointments and recommended psychosocial services. How can the deficit help children in state care?
Most egregiously, DCF “does not record consent on iFamilyNet for children in protective custody to receive psychotropic medication.” In fact, in 94% of children in the audit who were “prescribed at least one psychotropic medication from the MCO sample did not have the necessary documentation for DCF approval or court approval for psychotropic medication.” One must wonder, how can this recipe continue/change or improve without proper documentation? It is interesting to note that the Mass. DCF argues that it is not required “consent documents for routine health care (eg, psychotropic drugs, excluding antipsychotics).” “Routine” psychotropic medication? Simply because judges are not required to register all other mind-altering drugs given to children, the state’s case workers do not record the prescriptions. It doesn’t sound like a safe practice.
DCF also “does not ensure that children receive recommended psychosocial services along with prescriptions for psychotropic medications.” In other words, children in the state’s care are not only being exposed to serious mind-altering drugs but are not getting the necessary therapy recommended along with the drugs.
Of particular concern to AbleChild is the number of children receiving mind-altering drugs that exceed the dosages recommended by the Food and Drug Administration (FDA). “The Department of Children and Families should provide greater oversight of children in custody who receive psychotropic medications in amounts and doses that exceed the recommendations of the United States Food and Drug Administration.” Apparently 20% of the children in the audit received doses that exceeded FDA recommendations. Beyond the caseworker’s culpability, one must wonder what information the prescribing physician uses to determine which drug to prescribe and at what level.
So, let’s recap. Adults tasked with monitoring at-risk children in the country failed to document children’s health services, did not obtain court approval to administer/continue antipsychotic medications, did not record prescribed medications in medical passports and received mind-altering medications more than FDA recommendations. wow What exactly are caseworkers tracking if not this important drug information?
That there is a serious problem with the handling of psychiatric drug information for the country’s youth population at-risk, is not in question. However, one must wonder, what are the consequences of such an obvious failure? Will employees be independently reviewed and dealt with accordingly? What responsibilities do prescribing physicians have when it comes to supervision? What procedures are required to be followed when they are not currently in place? Are there any adverse events related to improper control and supervision of drug prescriptions?
The question was not asked by the auditor. A promise to “follow up in six months and track progress” was made by the auditor. It’s promising, but will the children of Massachusetts be safe until then? It should be noted that Massachusetts and Florida are the only two states that actually monitor the use of psychotropic drugs among at-risk youth populations. Unfortunately, based on news reports, Florida has also failed in its duty to protect children in state custody.
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