Foster care failures

Published Friday, June 5, 2009

Two disturbing facts about the Florida foster care system have emerged following the suicide of a 7-year-old boy on psychiatric drugs. First is the extraordinary prescription rate for children under the supervision of the Department of Children and Families. Second is the alarming revelation that a 2005 law aimed at tackling that problem has been repeatedly and systemically ignored.

So far, DCF Secretary George Sheldon, eight months into the job, is to be commended for the openness and urgency he has brought to the agency's investigation. But his true challenge will be altering the culture of an agency that failed to implement the safeguards already in place.

Agency critics have long argued that too many foster children are being medicated for the convenience of caregivers. As of Friday, an ongoing review of DCF's foster care database found that at least 400 more children are taking psychiatric drugs than initially thought. That means at least 3,068 — or 15 percent of the 20,000 foster children — are receiving the drugs, compared to 5 percent of the state's children.

What's more, DCF acknowledges at least 14 percent of the children received the drugs without the informed consent of the parent or the court. Sheldon believes the percentage is higher, because he suspects many parents weren't adequately informed of potential side effects of such drugs or didn't speak to the physician.

Sadly, the revelations come four years after concerns about pediatric use of antipsychotics and antidepressants — few of which have been tested or approved by the FDA for use by children — prompted legislative action. A 2005 law requires that all foster children's prescriptions be approved by a parent, or if parental rights have been terminated, by the court. The law also made clear that DCF was to monitor children on such drugs.

In response, DCF included questions about medications and parental consent on its database software. Local providers use the program to create the official state record of each child. But time and again, Sheldon acknowledges, caseworkers have failed to fully complete the forms or lied about obtaining consent.

DCF's failure to follow the law was laid bare by the tragic death of Gabriel Myers, a 4-foot-tall, 67-pound boy who hanged himself from an extendable shower hose at a South Florida foster home in April shortly after having his medication changed. He was taking Vyvanse, an ADHD drug, and Symbyax, a combination of the antipsychotic Zyprexa and the antidepressant Prozac. Symbyax carries a "black box" warning that it might lead to suicidal behavior among children and adolescents, especially when first prescribed. Neither his parent nor a judge had approved the prescriptions. And his death came after 10 days of tumult: His mother had lost visitation rights. He had been in two foster homes, changed therapists, and been told he would be going back to Ohio, where he had been sexually abused.

Since his death, caseworkers across the state have been ordered to go through their files and remedy shortcomings — from updating the state database to reaching out to parents whose consent was never sought for their child's medications. DCF has also convened a panel of experts aimed at addressing what else might be done. Among the likely outcomes, Sheldon said, are new protocols before a child is given powerful psychotropic drugs, such as requiring a review by a second doctor.

Such changes will only work if Sheldon succeeds in changing a culture that ignored such safeguards. DCF relies heavily on nonprofit local providers to do its work. Those providers need to fully understand what is at stake, as do their employees. Four years after the Legislature thought it had addressed this problem, a 7-year-old's suicide is a stark reminder that the system is still terribly flawed. How long will it take to get it right?