Medications in foster care

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Medications in foster care

Postby Marina » Sun Nov 25, 2007 1:12 pm

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Foster kids' meds get scant attention

Oregon's children - More than a fourth in state care get psychiatric drugs, with little training, oversight or review

Sunday, November 25, 2007BRENT WALTH and MICHELLE COLE The Oregonian Staff

An Albany foster mother recalls a 5-year-old boy medicated so heavily that he lived in an endless cycle of sleeping, rising for a meal, taking his pills and collapsing back into bed.

A Salem nurse who volunteered at a camp for Northwest foster kids last summer says she was shocked at the hundreds of psychiatric drugs she gave out to children every day.

A Multnomah County court officer tells of a teen in foster care who loved skateboarding but became so overwhelmed by his meds that he could barely hold his head up.

More than one in four Oregon children in foster care -- some as young as 2 -- are being given powerful psychiatric drugs developed to treat depression, anxiety, trauma and other mental health issues.

The medications include potent drugs such as Prozac and Zoloft. Many have not been approved for children, their side effects can be severe and there's little evidence about how they might act on developing brains and young bodies.

About 2,400 kids a year in foster care are on psychiatric drugs. The medications can help troubled children who suffer abuse, neglect or other trauma. Even so, The Oregonian found that children in foster care took psychiatric drugs at a much higher rate -- more than four times higher -- than other Oregon children.

The state's child welfare system creates incentives for foster parents that could encourage psychiatric drug use: The meds make the kids less trouble. And the foster parents can be paid double for the "special needs" of kids on psychiatric drugs.

The state, the legal guardian for children in foster care, does little to monitor the use of psychiatric drugs.

"Nobody is tracking it in a way that makes sense," says Judge Nan Waller, the chief family law judge in Multnomah County. "We need to make sure we have the level of oversight our children deserve."

Tannie Mowdy has eight children younger than 18 living in her tan, two-story house on a country acre six miles east of Albany.

Last edited by Marina on Sat Apr 25, 2009 7:53 am, edited 1 time in total.

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Postby Marina » Sun Nov 25, 2007 1:16 pm

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Other states have tighter rules for medication use

Some states require an official's consent, professional reviews and tracking of psychiatric prescriptions

Sunday, November 25, 2007BRENT WALTH and MICHELLE COLE The Oregonian Staff

Oregon is not alone in dealing with the use of psychiatric medications for children in foster care. Here's a comparison:


In Oregon, foster parents can begin giving a child a psychiatric drug without approval of a parent, caseworker or judge.

In Illinois, an administrator within the Department of Children and Family Services must give consent before a psychiatric drug is started or a prescription changed.

In Tennessee, biological parents must consent to the use of psychiatric medications when possible. If a parent cannot provide consent, a regional nurse reviews the file and consents to medically necessary medication. Tennessee officials say consent rules and other safeguards have helped lower the percentage of children in foster care on mental health drugs from 25 percent in 2004 to about 20 percent last year.

Tracking medications:

Oregon does not have a single database tracking psychiatric drugs. Foster parents are required to complete medication logs that are kept in children's files.

Tennessee developed a Web-based program to track mental health medication use by children who are on more than three psychotropic drugs; more than one drug from the same class of medications; children ages 5 and younger; and children lacking appropriate informed consent.

In Utah, every child who enters foster care is assigned a registered nurse stationed in a local child welfare office. The state also maintains a database with information about every medication prescribed.

Medical oversight:

Oregon's child welfare system has one registered nurse to consult on psychiatric medications.

In Illinois, before a child in foster care starts a psychiatric drug, every prescription is screened by a team of psychiatric nurses and reviewed by doctors at the University of Illinois at Chicago School of Psychiatry.

Second opinion:

In Oregon, a second opinion is optional and rare.

In Tennessee, experts under contract at three universities provide guidance in complex cases.

Washington required second opinions for hundreds of prescriptions for attention-deficit disorder drugs given to children in its Medicaid program. Reviewers found half the children were overmedicated or on the wrong drug.


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Postby Marina » Tue Nov 27, 2007 12:38 pm

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Law requires notification when meds are prescribed

Following through on the state's legal requirements is "a relatively rare phenomenon," an official says

Sunday, November 25, 2007BRENT WALTH and MICHELLE COLE The Oregonian Staff

Many of the adults responsible for children in foster care don't know about Oregon's Bobby Jackson law.

Jean Ettel, Bobby's first-grade teacher at Willard Elementary, says she remembers 7-year-old Bobby as a well-behaved boy who was small for his age.

Bobby still had his baby teeth, says Ettel, who also remembers that he liked to play ball.

She didn't know he was taking a drug to moderate his behavior.

Bobby was given imipramine, an antidepressant doctors had recommended to control his daytime tantrums and nighttime sleeping problems.

"Sometimes his little hands would shake when he would write," Ettel says.

On Jan. 5, 1993, Bobby collapsed at his Eugene foster home after running uphill from school. An autopsy found a lethal dose of imipramine in his body.

The law that the 1993 Legislature passed following Bobby's death requires foster parents to notify the Department of Human Services within one working day when a child in their care gets a mental health prescription.

Then, caseworkers must notify a child's parent, lawyer and court-appointed special advocate -- or CASA -- about why the drug is being given, the dosage and possible side effects.

But that doesn't always happen.


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Postby Marina » Wed Nov 28, 2007 7:19 pm

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Foster kids, meds merit exam

Oregon - Lawmakers say they are determined to fix the lack of oversight of psychiatric drugs

• Psychiatric drugs and children in foster care

Tuesday, November 27, 2007MICHELLE COLE and BRENT WALTH The Oregonian Staff

SALEM -- Oregon lawmakers said Monday that they're determined to fix problems with the state's oversight of psychiatric medications given to children in foster care.

Oregon Senate President Peter Courtney, D-Salem, said the Legislature will hold hearings when lawmakers reconvene in February to examine how well the Department of Human Services supervises the use of mental health medications.

"The state is responsible for the well-being of these children," Courtney said in a statement. "We need to determine if agency policies are putting the health and potentially the lives of some of our most vulnerable citizens in jeopardy."

Courtney's announcement follows a story in The Sunday Oregonian that found more than one in four children in foster care in Oregon take drugs to treat depression, anxiety and other mental health problems.

The newspaper found that 2,400 children in foster care received these drugs in a recent 12-month span -- a rate more than four times that of other Oregon kids.

Experts say the drugs can help troubled children in foster care, who often face higher rates of mental problems. The kids have faced grave abuse and neglect or were exposed to drugs and alcohol before they were born.

The newspaper found, however, that the state's child-welfare system does little to monitor the use of these medications. And state officials ignored warnings from a panel of experts who raised concerns about allowing foster parents to make decisions to medicate children without state consent or adequate medical review.

Dr. Bruce Goldberg, the director of the Department of Human Services, asked for a review of the rules governing the use of psychiatric drugs by children in foster care after The Oregonian raised questions about the practices.

Rep. Wayne Krieger, R-Gold Beach, spent the past two years working with a bipartisan group of legislators on ways to improve the state's child protection system. He said he welcomes hearings.

"There might be times I disagree with Senator Courtney, but I think he's right on," said Krieger, who also spent more than a decade as a foster parent.


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Postby Marina » Fri Dec 28, 2007 8:44 pm

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Potent Pills: More foster kids getting mood-altering drugs

Gary Craig
Staff writer

(December 9, 2007) — When Laticia Anderson's son entered foster care in 2005, a social worker described the 4-year-old as "an extremely smart little boy who loves school."

But over the next six months, as he was shuttled from an emergency foster-care placement to two foster homes, his personality changed.

The boy would explode in tantrums, gouge his own flesh, even consider killing himself. Social workers and pediatricians could not quell his outbursts.

Frustrated, they resorted to Depakote, an anti-seizure medication intended for adults but occasionally given to children to alter their moods.

And then her son's personality really changed, Anderson said. The boy she knew as playful and exuberant was, when she visited him, distant and withdrawn - "almost like a zombie."

Like Anderson's child, hundreds of foster children in Monroe County each year are placed on psychotropic, or mood-altering, drugs. Though questioned in some medical and psychiatric quarters because of long-term health risks, the use of the psychotropic medications on foster care children in Monroe County is on the rise, a Democrat and Chronicle investigation shows.

The investigation included analyzing data from county, state and federal agencies; interviewing experts locally and nationwide; interviewing families of some local foster children on medications; and reviewing public records of Monroe County Family Court cases in which the prescription of the drugs has been an issue.

The investigation reveals that:

In 2002, about a third of the county's foster care population, 327 children, were prescribed one or more common psychotropic drugs. By the end of 2006, the number had increased about 40 percent to 457 foster children, or almost half of the county foster care population.
In the five years from 2002 through 2006, according to state data, Medicaid expenditures for common psychotropic medications for Monroe County foster children nearly doubled - an increase almost four times the statewide rate.
Psychotropic medications are also more commonly used at residential foster care treatment centers than in the past, according to medical and psychiatric staff. At the nonprofit Hillside Children's Center, for instance, 55 percent of the foster children are prescribed one or more psychotropic drugs.
2006 records show that more than one of every eight foster children in Monroe County is on some kind of drug to combat psychosis, a severe form of mental illness characterized by lost contact with reality.
Very young children are also prescribed the psychotropic medications, according to county data.
Last year, a 1-year-old foster child was prescribed the antipsychotic drug Risperdal, and two 4-year-old foster children were prescribed Depakote. Pediatricians say Risperdal and Depakote, if properly monitored, can be safely prescribed for young children, but some medical experts worry about possible health effects. Risperdal has been associated with heart disease in older adults; Depakote has been linked to liver failure in children younger than 2.

Drugs a straitjacket?

Foster care advocates say children are a particularly vulnerable population, often invisible to the public and beset with higher rates of mental and emotional illness in large part because of the disruptive - and sometimes abusive - lives they've led.

This leads to a conundrum: Are foster children legitimately prescribed psychotropic drugs more commonly because they have so many needs? Or are the drugs used more as a convenient way to straitjacket troublesome behavior?

The use of such drugs "definitely has gone up, and I say that with much reluctance because I don't think these medications are necessarily safe medications," said Dr. Mohsen Emami, a staff psychiatrist at St. Joseph's Villa in Greece, a nonprofit residential facility for troubled youths.

Across the country, while the use of psychotropic medications for all children has increased, the rate of use for those in foster care has grown even faster. By some estimates, foster children receive psychotropic drugs at a rate two to three times that of other children.
"I have no doubt that many, many kids are overmedicated," said Dr. Martin Irwin, a Syracuse-area psychiatrist who has been contracted by counties and treatment centers around the state to help decrease the use of psychotropic drugs for foster children.

"It's out of control in general, but the worst problems are in foster care because there's basically nobody advocating for the kid."

Keeping tabs on drugs

Local psychiatrists and pediatricians who work with foster children say that although they worry about increased use of the medications, they can ward off bad health effects by keeping close tabs on reactions to the drugs. Many of the drugs require frequent monitoring of blood levels, lipid counts or liver function, depending on the particular side effects.

"We're always being as careful as we can because we want to know we're doing it safely," said Dr. Stuart Loeb, a child psychiatrist who is medical director at Hillside Children's Center.
Monroe County operates a nationally recognized clinic, called Starlight Pediatrics, for foster care children in home settings.

The clinic centralizes care for foster children to ensure they receive preventive and other necessary medical treatment.

Still, the clinic and Monroe County Department of Human Services, which manages foster care, have not been without controversy on the issue of psychotropic medications.

Last year, Monroe County Family Court Judge Marilyn O'Connor rebuked the clinic and county social service workers in two separate cases for what she declared to be the questionable prescription of drugs to foster children.

Both cases involved the prescription of Depakote - in one case to Laticia Anderson's 4-year-old son and in the other to a 2-year-old girl.

While both cases centered on whether the county received proper consent from a biological parent to prescribe drugs - parental consent is typically required for such a prescription - O'Connor in one ruling challenged whether the medication was even warranted and if the risk of side effects was sufficiently considered.

O'Connor ruled that "the decision to medicate this child was based on hearsay, limited information and without any complete evaluation of an existing mental health issue by a psychiatrist or psychologist," a contention the county has denied.

O'Connor, who will retire from the bench at the end of this year, said she grew concerned because of the number of foster children she sees in court on psychotropic medications.

While refusing to discuss specific cases, she said in an e-mail: "Anecdotally, many of the children who appear before me ... are on some form of medication and I believe it is higher than what is being prescribed to the general population of children. Other factors affect this, but I am alarmed by what I see in the reports I receive."

Laticia Anderson was also alarmed when she visited her son after he was put on Depakote. "He was real tired. He didn't act like a kid any more. He didn't have that play in him. He didn't have that 'go' in him."

Anderson no longer wanted him on the medication. She challenged whether she had given true consent. County attorneys argued at a hearing that the drugs were prescribed "in his best interest," but O'Connor ordered the medication halted unless Anderson consented.

Now 6 years old, the boy is in a compatible, loving foster home, said Anderson, who has three other children in foster care.

And he is no longer on Depakote. "Now he's a normal kid. He laughs. He plays. He can tell you what he thinks. He couldn't do that on the meds."

Children 'more disturbed'

There are about 800 children now in foster care in Monroe County, counting those in individual homes and in residential treatment centers such as Hillside and St. Joseph's Villa.

Many have been removed from the homes of drug-addicted parents. Many have been severely abused. Many don't know the benefits of a healthy diet or even the pleasure of a good meal.

The transition to foster care can add to their trauma.
"They're in a neglectful, intellectually and emotionally impoverished or abusive environment" at their parental home, said Dr. Michael Naylor, a Chicago child psychiatrist who is an expert on the use of psychotropic drugs for foster care children.

"Then it just gets worse. These kids are taken out of their home and there's a disruption of parental attachment. These kids are attached to their parents, even though they are not often particularly very good parents."

About 45 percent of the school-age children seen at Starlight Pediatrics are in special education programs, half of them for behavioral or emotional problems, said the clinic's pediatric director, Dr. Moira Szilagyi. Three of every 10 children using the clinic suffer from some form of chronic illness, ranging from asthma to seizures.

Szilagyi, a Mendon resident who is nationally recognized for her work with foster care children, said the clinic does not resort to psychotropic drugs without being convinced that other options, such as therapy and counseling, won't work alone.

Typically, the clinic won't prescribe psychotropic medications without consulting with mental health professionals, she said.

The clinic often works closely with the University of Rochester's Mount Hope Family Center to determine the best answer for a child's needs, she said. "We work very hard at getting them into services."

Still, medication may be necessary and beneficial when paired with therapy, she said.

Although state and local data show that Monroe County's use of psychotropic drugs for foster children has increased, the reason behind that increase is less clear. Szilagyi said that foster children in Monroe County have greater access to services, and that higher uses of medication may be evidence that the children are being diagnosed better than in other communities.

In Onondaga County, for instance, the use of common psychotropic drugs in the foster care population is even greater than in Monroe County, according to state data. Onondaga is known as a county that tries to rigorously evaluate the needs of foster children, Szilagyi and other experts said.

The use of psychotropic drugs at foster care residential programs has likely increased because the county is trying to route only the most demanding children there, said Cindy Lewis, director of the Child and Family Services Division of the county's Department of Human Services.

Officials at those programs agree that the needs of their children are even more dire than in the past. "I think in all of our services, we see children who are more disturbed and more dysfunctional," Loeb said.

About a third of the children at St. Joseph's Villa are on psychotropic drugs, Emami said, and many of them had been prescribed drugs before entering the program. "I would say at least a third of them arrive on two or three psychotropic medications. Some of them are so fragile that if you try to lower the dose, they really struggle."

Similarly, many children already have prescriptions for psychotropic drugs before they arrive at the foster care clinic, Szilagyi said.

Deciding if and when to prescribe psychotropic drugs often tears at him, Emami said. "These medications have benefits - I certainly have seen it in 30 years of practice. But they also have serious side effects."


The growing use of psychotropic drugs is not a trend unique to the foster care community. The prescription for all children has significantly increased in the past 15 years.
Between 1994 and 2001, the prescription of psychotropic drugs for teenagers increased by 3 1/2 times, with much of that gain coming after 1999, according to a Brandeis University study. Other studies show that pattern has continued.

"The Holy Grail here is we want to know what's appropriate (for prescription) and what's not," said Cindy Parks Thomas, a Brandeis University professor and expert on prescription drug trends who worked on the study.

"When you have a high growth in prescribing, it can mean things are being overprescribed. On the other hand, it can mean we are identifying things that need to be treated," Thomas said.

The prescription of Ritalin and other attention deficit disorder medication has exploded in the past three decades, and in the 1980s, the prescription of antidepressants for children became more common. Antipsychotic drugs are now also given to children and teens.

Irwin and other child psychiatrists worry that their colleagues are too quick to pin a "disorder" label on a child and turn to drugs when intensive counseling and therapy would be a safer, more effective approach. Many have challenged the recent surge in the diagnoses of adolescent bipolar disorders, for which Depakote is often prescribed.

A recent study funded in part by the National Institutes of Health determined that the number of doctor visits resulting in a diagnosis of bipolar disorder of a child or adolescent increased by 40 times over the past decade.

The increased use of psychotropic drugs among foster children has greatly outstripped the rate within the overall population, many studies show. This isn't surprising to those who work with foster children, given their needs.

"When you look at these youngsters, one can hardly imagine a group of children or adolescents that have more stacked against them," Naylor said. "Mental health issues. Abuse. Neglect."

But some psychiatrists say that many in the field too routinely use drugs as a remedy.

Irwin said: "Most medication for foster kids is given because they have behavior that adults don't like."

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Postby Marina » Fri Aug 15, 2008 6:41 pm ... /2688.html

Psychotropic Medications Overused Among Foster Children

By Rick Nauert, Ph.D.
Senior News Editor
Reviewed by John M. Grohol, Psy.D. on August 4, 2008

Monday, Aug 4 (Psych Central) -- New research finds that psychotropic medications are frequently used to treat youth in foster care. The pattern is disturbing because effectiveness and safety of the pharmaceuticals has not been established.

Psychotropic medication act on the central nervous system to alter emotion or behavior temporarily.

In a study of Texas children with Medicaid coverage, the latest in a series of analyses of state Medicaid records, foster care youth received at least three times more psychotropic drugs than comparable children in poor families.

But there is no clear treatment advantage to the foster children, according to Julie Zito PhD, professor of pharmacy and psychiatry at the says a University of Maryland, Baltimore researcher.

Of 32,135 Texas foster care children enrolled in Medicaid from September 2003 to August 2004, 12,189 (38 percent) were dispensed one or more psychotropic medications. Among those receiving psychotropic medications, 41.3 percent of a random sample of 472 youths received three or more psychotropic drugs daily.

The medicated children were most likely to be Caucasian males, and 10 to 14 years of age. This sizable proportion of youth receiving drug combinations poses questions about appropriateness, benefits and risks, says Zito.

The Texas study also indicated that decisions to give some children three or more psychotropic drugs may be largely based on behavioral and emotional symptoms rather than conclusive diagnosis of a specific mental condition.

“These data do not provide sufficient information to address questions of severity and impairment that might explain such complex drug regimens,” Zito suggests.

Emphasizing symptoms can lead to the diagnosis of more than one mental disorder in a patient, leading to greater use of combinations of drugs, said the study, which was published earlier this year in the journal Pediatrics.

Zito says, “There are serious behavioral and emotional problems with many foster children and we want to make sure they are medicated appropriately. These are our troubled children.”

Many foster children experience multiple family placements and such disruption poses real challenges for the developing child, caregivers, and treating clinicians.

She says the extensive use of such drugs in foster care youth is an indication of a trend of expanding use “in U.S. youth across the country. This [increase in psychotropic drug use] represents a sea change in the practice of child mental health treatment since 1990. Such trends in community treatment deserve further investigation. Let’s learn more about the medications being taken by children, the reasons for use, who benefits and who doesn’t.”

More than 75 percent of the psychotropic medication use for children is off-label, a practice of prescribing drugs for a purpose other than the approved use on its label.

“So we are generalizing our [knowledge] from adults to children without knowing enough about pharmacokinetics, dosing, or long-term safety in the pediatric population,” said Zito.

Zito has been leading studies of children’s use of medication in the Medicaid population for more than a decade, with funding for the past five years from the National Institutes of Health’s National Institute of Child Health and Human Development.

To enhance the work, the Maryland School of Pharmacy’s Pharmaceutical Research Computing (PRC) center has established state-of-the-science computing resources to analyze very large data sets.

As one of a new breed researchers called pharmacoepidemiologists, Zito studies community populations for the use and safety of medications already on the market. She says her work may be thought of as phase IV drug analysis, a logical continuation of the common three-phase clinical trials that a drug maker needs to complete before seeking federal approval to market the drug.

“This is a ‘post-marketing’ view of how a drug is doing,” she says.

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Postby Marina » Sat Apr 25, 2009 7:56 am

Apr 22, 2009 7:49 pm US/Eastern

Questions About Meds In Foster Child's Suicide
Prescribed Pills Are Not Approved For Kids

Reporting Gary Nelson


Gabriel Myers, the 7-year-old Broward boy who hanged himself in the shower of his foster home.
Miami Herald

CBS4 news partner The Miami Herald reports the boy who apparently hanged himself in his foster home in Margate last week, had been taking powerful, psychotropic medications. Some of the drugs are not approved for use in children by the Food & Drug Administration. Three of the drugs come with strong warnings that they can increase the risk of suicide in children.

While Gabriel had been given pills meant to treat mental illness, there is no indication he was psychotic.

"Apparently, he was a normal little boy who occasionally had tantrums and became difficult when he didn't get his way, but he was not diagnosed with schizophrenia or any other major mental illness," Herald reporter Carol Marbin Miller said.

Gabriel was being watched last Thursday by Miguel Gould, the 19-year-old son of the foster father in the home where he lived as a ward of the state. "He was just sick," Gould told CBS4's Gary Nelson Wednesday. "He had pills he had to take to get better. He would have to take like two or three pills per day."

In recent weeks, Gabriel was prescribed the drug Symbyax, which comes with the strongest warning the FDA issues regarding potential for suicide in children. Gould said the boy's behavior worsened after he began taking the latest drug. "It got worse. His behavior was just out of control. I couldn't control him, my parents couldn't control him."

Gould told CBS4 News the boy pitched a fit the day he died, angry about a lunch of soup and crackers he had been given. Gould said Gabriel had to eat something with the medication he was taking because it "could be rough on his stomach."

Dr. David Lustig, a child psychologist and director of the Koala Learning Center in Pembroke Pines, said some children may need to be treated with psychotropic drugs, but because of possible serious side effects they have to be watched closely, especially when starting on a new medication. "Someone has to be monitoring the child to make sure the medicine is doing what it's supposed to do and there are not adverse reactions," Lustig said. "In a foster setting, there may not have been anyone to do that adequately."

Jack Moss, the director of the Department of Children and Families in Broward County, said his agency is reviewing the medical history of the boy who died. "It's not only the drugs and the dosage we're concerned about," Moss said. "The department has a concern as to whether the drugs were appropriately prescribed in the first place."

Moss spoke after a hearing before Circuit Judge Thomas Lynch, who ordered that DCF's confidential records on Gabriel's history with the state be made public. DCF, citing a public interest and "desire for transparency," asked the judge to unseal the records. It's expected to take the department several days to compile the documents, an estimated 11-thousand pages.

Miller, the Herald reporter, previously authored an investigative series that revealed as many as one in four foster children in Florida was being given psychotropic drugs. "They didn't suffer from psychosis," Miller said. "They were just kids whose foster parents found it difficult to manage."

After the Herald's reports, the Florida legislature passed a measure intended to limit the practice, but it has met only limited success. Doctors are permitted to prescribe the powerful drugs "off label," despite the FDA's lack of approval for their use in children.

Gabriel Myer's manner of death has not been officially classified as a suicide by Margate police. "We want to exhaust every possible avenue and make sure we have done a thorough investigation before we make a determination," said Ofc. Vom Williams, a department spokesman.

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Postby Marina » Sat May 23, 2009 10:02 am

Investigative Reporter Colleen McCarty and Photojournalist Kyle Zuelke
I-Team: Young Foster Kids on Powerful Psychiatric Drugs

Updated: May 19, 2009 10:29 AM EDT

Remember that kid in school who had all the answers? In Mr. Moye's honors history class, her name is Saida Brown. The Coronado High School sophomore values education like first-time drivers cherish their wheels.

Born to a drug-addicted mom, Saida entered foster care at 14-years-old when a family member discovered she was cutting herself. Frequent admissions to mental health facilities followed, along with multiple psychiatric diagnoses. "I was on so many medications. They had me on medications that zoned me out. My grades in school mean so much to me and they would send me to school on Thorazine," she said.

She says she was on Seroquel, Haldol, and Depakote, just to name a few. They're powerful, mood-altering drugs and some of them are not approved for use on children. "The medicine was making it worse. I was like, ‘I don't need any pharmaceuticals to help me cope with life. I just need someone to sit down and talk to me,' you know," she said.

A review of state insurance records suggests Saida's experience is not unique. In 2007, one in five kids in the custody of state or county agencies was prescribed one or more psychotropic medications. More than 80 children 5-years-old or younger were taking powerful anti-psychotic drugs.

"We just don't know the long term effects of many of these pharmaceuticals on kids because it's not really measured -- the anti-psychotics in particular," said child psychiatrist Dr. Norton Roitman.

Roitman is among a growing chorus seeking more oversight of the process by which children in the system receive medication. A bill before the Nevada State Legislature would require parental consent, or court approval, before psychotropic drugs can be used on the youngest foster kids.

"It's just like grammar school; you have to show your work. You have to show you've gone through the necessary steps to not overprescribe. In order to put a kid at risk, you have to be able to justify that," he said.

Roitman acknowledges, of course, some children benefit from medication but insists a lack of resources contributes to overuse.

"I decided I wasn't going to be a guinea pig anymore," said Saida. With the support of her foster mom and a therapist, Saida stopped taking her pills. "That was kind of my turning point for when I started to get on track," she said.

Saida's fellow students recently elected her junior class president and her academic achievement puts her among the top of her class. At 17-years-old, she may not really have all the answers, but Saida will be the first to tell you that she has some of them. "Everything is not going to be ok unless you push yourself to keep going," she said.

Family Services Director Tom Morton has conducted his own research into this issue. His findings show 55 children in county custody under the age of six on psychotropic medications, including a 2-year-old diagnosed with three different disorders taking five different drugs.

Policy changes are underway to keep the agency more informed about what drugs kids in their care are taking and in the future, all requests will be reviewed by clinical staff.

Morton says he supports the latest legislation.

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