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California Approves Laws To Cut Use Of Antipsychotics In Foster Care

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Efforts to protect children in foster care from being inappropriately medicated with powerful antipsychotic drugs got a big boost forward on Tuesday, when California Gov. Jerry Brown signed three bills into law designed to reform prescribing.

Overprescribing of psychiatric meds for foster youth is a persistent problem nationwide, with children given the drugs at double or triple the rate of those not in foster care.

In 2011, the federal Government Accounting Office found nearly 1 in 4 children in foster care was taking psychotropic medications, which include antipsychotics, antidepressants, mood stabilizers and stimulants.

Source: California Approves Laws To Cut Use Of Antipsychotics In Foster Care

California Moves To Stop Misuse Of Psychiatric Meds In Foster Care

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By the time DeAngelo Cortijo was 14, he had been in more than a dozen foster homes. He had run away and lived on the streets for months, and he had been diagnosed with bipolar and anxiety disorders, attachment disorder, intermittent explosive disorder or posttraumatic stress disorder. He had been in and out of mental hospitals and heavily medicated.

Cortijo, who was born in San Francisco, was taken from his mother after she attempted suicide when he was 3.

After his later diagnoses, he was prescribed a combination of antipsychotics, antidepressants and stimulants, and was told that taking them was his only hope of being normal. Instead, he said, medication made him feel “doped up and completely lost.”

Source: California Moves To Stop Misuse Of Psychiatric Meds In Foster Care

Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses 

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The release in late March of an alarming new report by federal investigators has confirmed in shocking new detail what has been known for years: Poor and foster care kids covered by Medicaid are being prescribed too many dangerous antipsychotic drugs at young ages for far too long — mostly without any medical justification at all. The report by the U.S. Department of Health and Human Services (HHS) Inspector General examined in depth nearly 700 claims filed in 2011 in five of the biggest prescribing states — California, Florida, Illinois, Texas and New York — and discovered that two thirds of all the prescribing with these popular and costly “second generation antipsychotics” (SGAs) raised high-risk “quality of care” concerns.

Source: Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses | Art Levine

Office of Inspector General Podcast – Antipsychotic Drugs Prescribed for Children Enrolled in Medicaid

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Antipsychotic Drugs Prescribed for Children Enrolled in Medicaid

March 26, 2015

Michala Walker, a team leader for the Office of Evaluation and Inspections in Kansas City, is interviewed by Brian Whitley, Regional Inspector General for the Office of Evaluation and Inspections.

via Podcasts | Newsroom | Office of Inspector General | U.S. Department of Health and Human Services.

Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns Report (OEI-07-12-00320) 03-25-2015

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Second-generation antipsychotics (SGAs) are a class of drugs used to treat psychiatric disorders, such as schizophrenia, bipolar disorder, and psychotic depression. SGAs are widely used to treat children enrolled in Medicaid who have mental health conditions. However, SGAs can have serious side effects and little clinical research has been conducted on the safety of treating children with these drugs. Consequently, children’s treatment with SGAs needs careful management and monitoring. This evaluation examines the quality of care provided to children receiving SGAs that were paid for by Medicaid.

HOW WE DID THIS STUDY

We selected a sample of 687 claims for SGAs prescribed to children in California, Florida, Illinois, New York, and Texas. These States represented approximately 39 percent of total Medicaid payments for SGAs in 2011. Board-certified child and adolescent psychiatrists reviewed medical records related to the sampled claims using seven criteria related to quality-of-care concerns (see the chart below for the criteria). We established these criteria on the basis of information and guidelines issued by various Federal and State agencies and professional associations regarding the prescribing of psychotropic drugs to children.

via Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns Report (OEI-07-12-00320) 03-25-2015.

Foster care kids put on too many psych drugs, report says – CBS News

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Psychiatric drugsMany children in foster care are being overmedicated with antipsychotic drugs they may not really need, or the drugs are being given incorrectly, according to a government review obtained by CBS News.

The report by the Inspector General for the Department of Health and Human Services looked at concerns surrounding the use of these powerful drugs in children on Medicaid. Many children on Medicaid are in the foster care system.

“Psychotropic drugs are being used in these children, and we don’t really know what the side effects are in children this young,” said CBS News correspondent Anna Werner. “There’s not a lot of research because you can’t really test these drugs on children.”

via Foster care kids put on too many psych drugs, report says – CBS News.

Texas System Failure for Foster Children – Texas Comptroller of Public Accounts

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December 14, 2006

Fellow Texans:

Today, I am releasing this Texas Health Care Claims Study – Special Report on Foster Children.

Children are our most precious resource and the foster children of Texas need special attention because the state has taken either temporary or permanent guardianship of them in effect making the state and all of its citizens their parent.

This report reveals shocking evidence of the system’s failure regarding the care provided to our foster children. In addition, it raises many red flags pointing to areas of potential fraud and abuse that I am referring to the Office of Inspector General at the Health and Human Services
Commission to investigate. In a separate report, Review and Analysis of The Medicaid and Public Assistance Fraud Oversight Task Force, I am recommending the Office of Inspector General report directly to the Governor and become an independent office.

I am making 48 recommendations to the Medicaid and Public Assistance Fraud Oversight Task Force in this report.

For example, I am urging the Office of Inspector General to fully investigate potential fraud and abuse identified in this report.

The Department of Family and Protective Services should hire a physician to serve as a fulltime medical director responsible for health care for Texas’ foster children.

In April 2004, I recommended DFPS create a “medical passport” for each foster child, which would follow each child as they move from one placement to another. I again call upon DFPS to immediately implement this long-overdue recommendation that would dramatically improve health care for our forgotten children—which could be done by using a simple paper copy system until an electronic version is available.

The medical director should be responsible for ensuring that a foster child’s medical passport be received by the foster child’s caregiver within 48 hours of being placed in a foster home or facility.

HHSC should require prior authorization for prescriptions to address the dispensing of non-FDA approved psychotropic medications for children.
DFPS and the Department of State Health Services should seek lower-cost, less restrictive alternatives to psychiatric hospitalization and immediately develop rules for the psychiatric hospitalization of foster children.

The medical director and the Department of State Health Services should evaluate the case files of all medically fragile foster children and develop best practices for care.

DFPS in coordination with HHSC and the Department of State Health Services should study complementary treatments to psychotropic medications—such as therapy, diet, exercise, therapeutic activities and mentor programs. The Office of Inspector General at HHSC and the State Auditor should review the quality of the physical environments in which foster children live and make recommendations to improve standards for living conditions.

My first investigation into the Texas foster care system in 2004—Forgotten Children—documented the tragic failure of the system. Part of the report focused on psychotropic medications and care prescribed to our foster children. The findings caused me deep concern and led to my decision in November 2004, to look into this aspect of the system more closely.

Out of concern for the foster children of the state of Texas and pursuant to my statutory obligation to review Medicaid claims for fraud under the Government Code Section §403.028, I reviewed the Medicaid claims of foster children in fi scal 2004 in depth. I am disappointed to report that the findings confirmed the conclusions of the Forgotten Children report.

Given the distressing findings contained in this report, I hope that the state will not delay in adopting recommendations, which have been crafted to help mend this broken system. My hope is that the state leadership and the health and human service agencies will work to make things better for our state’s most vulnerable children. This report is available on the Texas Comptroller’s Web site at www.window.state.tx.us.

Texas is great, but we can do better. We have to—for the sake of our children.

Sincerely,
Carole Keeton Strayhorn
Texas Comptroller
Chairman, Medicaid and Public Assistance Fraud Oversight Task Force

Download here

Reports on the Overmedication of Texas Foster Children

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Initiated in 2004 by Comptroller Carole Keeton Strayhorn in a report called “Forgotten Children” investigations started into the overmedication of foster children in Texas.

Reporting date: 2004-04-01

Authorities involved: Department of Family and Protective Services

Case File Report Date

Forgotten Children 2004-04-00

Texas Comptroller Eyes Governor’s Race. 2004-11-12

Strayhorn to investigate alleged drug fraud in foster care 2004-11-12

Use of Psychoactive Medication in Texas Foster Children State Fiscal Year 2005 2006-06-00

Strayhorn: More dying in foster care 2006-06-24

Report finds foster care abuse, neglect 2006-06-25

Critics: States quick to drug foster kids 2007-03-14

Texas Foster Care: Current Issues, Reform Efforts and Remaining Problems 2007-09-00

Psychotropic Medication Patterns Among Youth in Foster Care 2007-12-31

News Tip:Texas Foster Care Scandal? 2008-05-15

Greater Psychotropic Medication Use in Foster Care Raises Concerns 2008-08-04

Some Texas foster kids’ doctors have drug firm ties 2008-08-17

via Psychotropic drug case Texas | Pound Pup Legacy.

U.S. GAO – Foster Care: HHS Needs to Improve Oversight of Fostering Connections Act Implementation

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US CongressWhat GAO Found

To implement the Fostering Connections to Success and Increasing Adoptions Act of 2008 (Fostering Connections Act), many states GAO surveyed (which included the District of Columbia and Puerto Rico) reported requiring caseworkers to employ multiple practices to improve outcomes for children in foster care; however, states continue to face challenges that can undermine progress. Among the practices that the Department of Health and Human Services (HHS) and others suggested states use, survey respondents reported requiring caseworkers to use group decision-making to maintain family connections, consult with schools, and facilitate adult connections for older youth. At the same time, a majority of surveyed states reported facing challenges, especially related to foster placements (see fig. below).

Major Challenges Reported by States in GAO Survey Regarding Foster Placements

Note: Responses do not sum to 52 if states selected “do not know/not applicable” or did not respond.

Further, the Fostering Connections Act made additional children eligible for federal adoption assistance payments thereby potentially freeing up state funds previously used for this purpose. Although states are required to spend any resulting savings on child welfare services, only 21 states reported calculating these savings for fiscal year 2012, and 20 states reported difficulties performing the calculations. HHS has not provided states guidance in this area, and without it states may continue to struggle with the calculations, leading to potential lost program funding.

HHS approved states’ plans to implement the Fostering Connections Act; however, the agency has not yet monitored states’ actions. HHS regulations specify that states must undergo a complete review of child welfare programs every 5 years, yet HHS’s last review cycle began in 2007—using a tool developed before the act was passed. Internal control standards emphasize using timely data for effective monitoring, but data collected by HHS do not reflect the act’s provisions. In March 2014, HHS announced plans to begin a review cycle in fiscal year 2015, but details about how it would address changes from the act were unavailable. Without adequate monitoring or updated data, HHS lacks information about the implementation of the act and the effectiveness of states’ actions.

via U.S. GAO – Foster Care: HHS Needs to Improve Oversight of Fostering Connections Act Implementation.