House Hearing On Psychotropic Medication In Foster Care

On Thursday, May 29, the House Subcommittee on Human Resources of the Ways and Means Committee focused additional attention on the issue of the over-use of psychotropic medication for children in foster care. The hearing coincided with the annual “Shadow Day” a House event that arranges to have youth in or formerly in foster care to follow their member of Congress for the day. The issue of over-medication has attracted increasing attention over the past several years with a series of GAO reports, congressional hearings and a new Obama Administration proposal that would target the over medication issue through a coordinated incentive fund with Medicaid and the Children’s Bureau.

Witnesses before the panel included: Joo Yeun Chang, Associate Commissioner of the Children’s Bureau, Dawna Zender Hovenier, The Mockingbird Society, Phil McGraw, Talk Show Host, Dr. Phil, Michael Naylor, Associate Professor of Psychiatry, University of Illinois at Chicago, and Stephen Lord, Director, Forensic Audits and Investigative Services, Government Accountability Office. The star power of Dr Phil helped to draw a big hearing crowd including several of the foster youth as well as several members of the Subcommittee. The consensus was that there is an over-reliance on the use of medication and an agreement that much of it occurs due to a lack of proper health care screening for children and youth in foster care and then a lack of access to proper therapies for patients. As a result, the over-use of medication becomes a fall-back positions in many instances.
Commissioner Chang, highlighted the need for the Administration’s proposal based on current practice which fails to provide the needed therapies and screening for children in foster care. She said, “The existing strong evidence-base in the area of trauma-informed psychosocial interventions warrants a large initial investment to expand access to effective interventions. The ACF proposal for $250 million over five years would fund infrastructure and capacity building, while the CMS investment of $500 million over five years would provide incentive payments to states that demonstrate measured improvement.”

Ms Hovenier discussed her experiences in foster care and what led to her medical treatment and the overuse of psychotropic medications. She testified that she “was ordered into the psychiatric hospital after my social worker told the court I had Borderline Personality Disorder, Major Depressive Disorder and suicidal ideation. I was forced to take strong doses of psychiatric medications and told I could probably never live on my own. Only my CASA and the man who became my father agreed with me that I didn’t need the drugs. The seven months I was locked up and forced to take drugs against my will felt like being in jail.” Ms Hovenier also suggested that youth in care have a right to request a second medical opinion regarding their care.

Dr Phil repeated some of his remarks delivered earlier that afternoon before a luncheon of foster youth and members of Congress when he said, “Prescription psychotropic drugs can change and even save lives, but when it comes to these vulnerable children, these drugs are too often misused as ‘chemical straight jackets.’ This is a haphazard attempt to simply control and suppress undesirable behavior, rather than treat, nurture and develop these treasured young people.” He said it would be wrong to pour more money into the same system but that investment into a system that would provide better health care would be worthwhile and that we had to make a greater effort at supporting these children including making a better effort at reunification.

Michael Naylor, discussed some of the recent efforts and successes of the state of Illinois to monitor and reduce the overuse of medication for the foster care population in the state. Dr Naylor said, “The Illinois model of providing consent for psychotropic medications for foster children and monitoring the use of these medications is widely regarded as a pioneer and leader in this arena and has received considerable attention…a well-designed and implemented medication consent and oversight program that provides effective longitudinal oversight of a youth’s care and monitoring of prescribing patterns can improve the continuity and quality and increase the cost-effectiveness of care provided to foster children.” The GAO witness reiterated some of the findings of last week’s GAO report.

Dr Phil also indicated that he had signed onto a letter signed by more than 100 organizations in support of the Administration’s budget request for the joint ACF-Medicaid proposal.

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