Bobby Jackson was 7 years old when he collapsed and died in a Eugene foster home in 1993 from a lethal dose of behavior modification drugs. His death prompted a law requiring parents, attorneys and others to be notified when a child in foster care has been prescribed certain drugs. Critics say that law was seldom followed.The most recent numbers provided by the state Department of Human Services show 14.3 percent of the children in state foster care last year were taking psychiatric medications. That was down from 2008, when 20 percent of children in Oregon foster care were prescribed mental health drugs, including Ritalin, prescribed for attention-deficit disorder, as well as anti-depressants such as Prozac and Zoloft.
State officials agree some data require further investigation. For example, 4 percent of the children placed in foster care with a relative, such as a grandparent, had mental health prescriptions last year. Meanwhile, 18 percent of children placed in a non-relative foster home were prescribed mental health drugs and 56 percent of those in residential treatment facilities had psychiatric prescriptions.
Mark McKechnie, executive director of Youth Rights & Justice, a non-profit law firm serving children and parents in Oregon's child welfare system, says he sees some progress.
"Overall, the sense is we're seeing fewer kids who are obviously being overmedicated," McKechnie said Wednesday, adding that Oregon child welfare officials are "taking their responsibility much more seriously than they used to."
Nationally, the practice of prescribing powerful drugs that weren't intended for kids has drawn increasing scrutiny.
Last week, the U.S. Government Accountability Office released a report showing children in foster care in five states, including Oregon, were more likely to be prescribed psychiatric medication than children in the general Medicaid population.
The findings, based on 2008 data, mirrored a 2007 investigation by The Oregonian, which found children in Oregon foster care were prescribed powerful psychiatric medications at four times the rate of other children covered by Medicaid.
The newspaper's investigation also noted that foster parents were paid more if children were on these medications.
The stories prompted the 2009 Legislature to require mandatory medication reviews for children younger than 6 and for older kids with more than two psychiatric prescriptions. The Department of Human Services also changed how it pays foster parents so that a prescription doesn't automatically trigger a higher rate.
Under the new law, children must have a mental health assessment before they are given any anti-psychotic drug or more than one of another type of psychiatric drug.
Yet there's been little progress in that area.
State data show 55.7 percent of the children entering Oregon foster care between July and October 2010 received a mental health assessment within 60 days. Between April and July this year, the results were essentially the same.
Officials blame staff shortages inside the agency and too few outside mental health evaluators.
On the positive side, state foster care manager Kevin George says "there's a lot more awareness" and discussion about children's mental health issues in state agencies and in Oregon's medical community.
For example, George says he now talks regularly with physicians, pharmacists and caseworkers about drugs prescribed to kids in state care. Those conversations didn't occur three or four years ago, he conceded.
An agency panel that includes physicians and a pharmacist reviews children's medication files.
As of July 2010, new psychiatric prescriptions require a signed consent from a state child welfare manager before a prescription can be filled.
George notes one sign that Oregon is headed in the right direction: "I've had supervisors call and say: 'Something doesn't look right.'"
--Michelle Cole