Psychotropic medications

Oregon House passes bill on foster kids' medication

by Michelle Cole,, 6/17/09, SALEM -- Children in state foster care -- even kids younger than 4 -- are being prescribed powerful antidepressant and antipsychotic drugs. State lawmakers want to make sure those kids get more attention. On Wednesday, the Oregon House unanimously endorsed a bill that will require oversight of the children and their psychiatric medications. "Oregon should not be part of the problem of over-medicating anymore," said Rep. Tina Kotek, a Portland Democrat and sponsor of House Bill 3114. The bill, which passed by unanimous vote, requires the Oregon Department of Human Services to ensure that children in foster care have a mental health assessment before they are prescribed certain psychiatric medications, including antipsychotics. The bill also requires annual review of children's psychiatric medications when they are on more than two drugs or are younger than 6. The bill next moves to the Senate, where it is expected to pass. The governor has indicated he'll sign it. A November 2007 investigation by The Oregonian found children in foster care were prescribed psychiatric medications at four times the rate of other children covered by Medicaid.

The newspaper also found that state laws and rules governing the use of psychiatric medications by kids in foster care were often ignored, and that hundreds of children were taking several prescription drugs with little or no state scrutiny. More recent numbers show 1,461 children, about 20 percent of the kids in foster care last October, were prescribed at least one psychiatric drug. Those drugs include Ritalin, prescribed for attention-deficit disorder, as well as antidepressants such as Prozac and Zoloft. Experts say the drugs can help troubled kids in foster care, who often have higher rates of mental problems. These children often have suffered abuse or neglect, or were exposed to drugs and alcohol before they were born. But the state's own reports indicate five of every six children placed in foster care between October 2003 and June 2008 did not receive a mental health assessment within 60 days as required. Child welfare officials promised to do better. Last year, the state's Human Services director assembled a group of physicians and other experts to recommend improvements. The agency also requested a full-time medical director to focus on child welfare cases.

The full-time medical director won't be hired anytime soon because of a lack of money. But Erinn Kelley-Siel, head of the state Children, Adults and Families Division, said she has tapped a pediatrician and child psychiatrist who already work for Human Services to consult on foster care cases. The state's drug review board has also agreed to help with second opinions, she said. The bill that passed the House ensures that other promised improvements will occur by writing them into law. "There's an incredible increase of awareness," Kelley-Siel said. For example, agency rules encourage second medical opinions in cases where the children are younger than 6 or where kids are taking several psychiatric drugs at once. In May 2008, Kelley-Siel said the child welfare nurse reviewed 11 cases. In May 2009, the nurse reviewed 55. "We have more eyes and ears, better information and better practice." According to the state, there were 8,775 children on average in state foster care on any given day last year. "The children in foster care in this state are our children," Kotek said. "They deserve our care and protection." Original article by Michelle Cole, retrieved on June 18, 2009

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