Category Archives: Research

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.

Senate Hearing on Impact of Federal Budget Decisions on Children

Today the Senate Budget Committee held a hearing on the impact of budget decisions on children. Chairwoman Patty Murray (D-WA) opened the hearing by saying there’s one group in particular whose voices are not often heard when it comes to the federal budget process – and that is our nation’s children. They may not be walking the halls of Congress, or calling up their Senators, or strategizing with lobbyists about how to protect funding for their programs. But they deserve a seat at the table. She stated that we cannot and should not solve our debt and deficit problems on the backs of our children. This is wrong for our kids and is not good economic policy.

Witnesses included Bruce Lesley, President of First Focus. He said since a peak in 2010 total federal spending on children has fallen by $35 billion, a 16 percent drop. Total spending for children has now fallen for three years in a row. First Focus compared the Senate budget to the House budget and found the Senate budget clearly places a much higher value on children and protecting investments critical to them.

Margaret Nimmo Crow is Acting Executive Director of Voices for Virginia’s Children. Her comments focused on the impact of decreasing budget revenues on children at the state level. In Virginia the number of children living in poverty has increased every year since 2005. She testified that in Virginia Head Start will cut 647 children this fall, as well as 112 jobs. In Prince George County, VA, 41 instructional, administrative and support personnel have been lost since 2009 while they have gained 150 new students.

Taking a much different perspective Dr. David Muhlhausen, Research Fellow at the Heritage Foundation, criticized federal funding for Head Start and other support programs. His research shows little evidence that they are providing positive results. His testimony offered a challenge to the Committee to make sure federal funds are spent in ways that can demonstrate positive results.

Shavon Collier is a Head Start parent who testified along with her daughter, Sakhia Whitehead, who is a Head Start alum. Their testimony was a positive account of their experiences with Head Start. Ms. Collier described how the program provided her children a strong academic foundation and an ability to focus. Ms. Whitehead testified how Head Start helped her prepare for kindergarten and to be on the Honor Roll in elementary school.

Senate Hearing on Ways to Prevent Sex Trafficking of Youth

Today the Senate Finance Committee held a hearing on sex trafficking and the role of child welfare in the prevention and intervention of such abuse. Chairman Max Baucus (D-MT) opened the hearing by comparing trafficking and exploitation to modern day slavery. He pointed out the need for his committee, which has jurisdiction over the nation’s foster care and adoption system, to explore such a topic noting that the children most vulnerable to trafficking predators are often foster youth (with some statistics suggesting that 50-80% of the children that are exploited and sold each year in America are connected to the foster care system).

Ranking Member Orrin Hatch (R-UT) took issue with the labeling of some of these at-risk children as “thrown away” children and stated that while their parents may have kicked them out of the home or abandoned them to the state, no child is a throw away and they all deserve to be protected, not treated like a criminal when they come to the attention of local law enforcement.

The witnesses for today’s hearing included a sex trafficking survivor turned advocate, a probation director with LA County, a Children’s Advocacy Center Director, and a judge with the Connecticut Department of Children and Families. They all shared stories of how they came to work with such a marginalized population, unique experiences that have shaped their work, programs that have shown proven results, and recommendations for Congress to address and provide federal support for preventing children from falling into the hands of sex traffickers.

Some of the common challenges that the witnesses expressed when working with this population are the fact that child welfare often does not intervene on behalf of these children due primarily to the fact that the traffickers are not their primary caregivers. In fact in many instances the victims are often charged with prostitution and unfortunately end up going back to the traffickers due to the lack housing and other resources that would keep them off of the streets. Another challenge is the fact that teachers, social workers, and law enforcement don’t have the training and/or education to see the signs and intervene on behalf of these children in a timely matter.

The recommendations that were presented before the Senate Finance Committee included the need for funding for specialized foster homes for at-risk youth, training for teachers, social workers, and law enforcement to see the signs and assist youth who are victims of sex trafficking, education for young women on how to stay safe and avoid falling into the trap of sex trafficking, and housing for young women who may be on the street and/or on the run from their trafficker. The witnesses also added that there is an underlying need to recognize sex trafficking as a form of child abuse regardless of the trafficker’s relationship to the victim. Consequently, professionals who interact with children must have the obligation to report this form of abuse. In the end, there was a general consensus that child welfare agencies have to be at the center of this work and own these children as victims of abuse if it is to be successful at preventing further abuse.

Symposium Addresses Domestic Child Sex Trafficking

The Johns Hopkins Bloomberg School of Public Health is hosting a symposium this week to address the needs of victims of child sex trafficking in the U.S. The symposium is part of a White House initiative, first announced by President Obama at the 2012 Clinton Global Initiative, to bring together leading researchers, bipartisan policy makers and advocates to identify gaps in research, best practices, and evidence to improve the lives of sexually exploited children.

The symposium will address how mental health research, law enforcement, survivor advocacy, disruptive technology, epidemiology, criminal justice, and public policy can all inform the treatment of victims of domestic sex trafficking. Much of the discussion will focus on using the power of technology to address these needs including equipping law enforcement with the technology and information needed to help rescue girls and put traffickers behind bars, reach out to girls where they are, online and on their mobile phones, to link them with critical services in their communities, and fostering information-sharing among academia, law enforcement and the private sector.