August 27, 2012 - Because Minds Matter: Psychotropic Medications Collaboration

August 27, 2012

Washington, D.C.

Because Minds Matter: Psychotropic Medications Collaboration

Thank you all for coming to this conference.

Your presence here demonstrates how serious your state is about coming together to address the use of psychotropic medications with children in foster care.

Every one of you can probably share a story or two about how the lack of oversight and monitoring of these drugs resulted in harm to children in your state’s care.

Just such a thing happened in Florida when I was secretary of the Florida Department of Children and Families.

The child’s name is Gabriel Myers. And though I never met him, I will remember him forever.

Gabriel had to be removed from his mother’s care following several child protective investigations involving drug use and extreme neglect. Gabriel’s father was in prison.

When the protective investigators were called to remove Gabriel he was in the back seat of his mother’s car. She was in the front seat passed out from a night of drinking and using drugs. It wasn’t the first time.

Gabriel was six at the time he came into care. Gabriel needed love, support and stability.

At a time when most six year old boys are learning how to catch fly ball and field grounders, Gabriel was moving from placement to placement. And he was placed on three different psychotropic medications.

All with Black Box warnings….including suicidal ideation. I don’t know about you, but I find it almost impossible to believe that a 7-year-old boy, any 7-year-old, could contemplate suicide.

During Gabriel’s year in care he experienced four placements in addition to the removal, one was kinship care and the other three were licensed foster parents.

While in one placement, Gabriel experienced further maltreatments and began to sexually act out, causing him to be kicked out of school. As the traumas began to pile up, Gabriel began to slip further and further away.

His sexual acting out soon became violent, causing one experienced foster parent to declare he’d had enough. That foster father asked DCF to remove Gabriel after Gabriel threatened to kill his two-year-old son.

One treating therapist noted in Gabriel’s file that, “it is clear that this child is overwhelmed with change and possibly re-experiencing trauma.”

In removal after removal and placement after placement, no one person “owned” Gabriel’s case. No one person was solely concerned about Gabriel’s well-being.

On the day that Gabriel died, he’d stayed home from school with an upset stomach. He had been fighting with his 18-year-old foster brother, his caregiver for the day, and had been sent to his room. When he locked himself in the bathroom and threatened to kill himself, his foster brother didn’t believe him.

In the subsequent police investigation and review by the FBI’s Behavioral Analysis Unit, it was determined that Gabriel’s death, though an accident, was indeed by his own hand. It was inconceivable, the FBI’s lead forensic psychologist concluded, that Gabriel could’ve comprehended what he was doing at the time. How could he? He was seven.

His actions were meant to get attention and gain sympathy from his brother who was disciplining him according to his parents’ instructions.

After Gabriel’s shocking death, I ordered a full investigation of the case and how it was handled. Were the drugs to blame? Was the system to blame? Were we doing enough?

A team comprising child advocates, child welfare experts, dependency judges, law enforcement officials, substance abuse experts, psychiatrists and pharmacologists was empanelled to look at every aspect of the case, including Florida’s protocols for psychotropic use in foster care. Their findings were shocking.

Half of all the children who were prescribed psychotropics weren’t even listed as such in the state’s foster care database. Moreover, for the ones who were properly recorded as being on psychotropics, we lacked proper consent forms or court and/or court orders.

We vowed that Gabriel’s death would not be in vain.  Even though there were many factors that contributed to this terrible event, we focused on strengthening Florida’s systems for psychotropic drug use in foster care.

We addressed the database issues immediately as well as many others regarding the monitoring, tracking and prescribing of these medications. I think it goes without saying that every child who enters the foster care system has experienced significant, life-altering trauma.

Not many, not most… but every single child who comes into care.  Each has suffered his or her own personal hell to arrive at our doorstep in need of shelter and care. So, as we go about the early screenings and assessments—all designed with what we think are their best interests at heart—we still forget sometimes that they are experiencing great pain and anguish.

Theirs may not have been the perfect home. There were probably drugs, most likely violence and neglect.

But that’s the only home they’ve ever known, and they very likely still loved their mommy and daddy. Removal, in terms of trauma, is much like the loss of a loved one, or some other event causing great mental anguish. What follows is profound sadness and depression.

As a result we may seek medical attention and our doctor may prescribe medications to help us deal with the overwhelming anxiety or grief.

Generally, though, the prescription runs out as we begin to come to terms with our loss or the situation. This may last weeks or maybe months. A foster child may be on psychotropics the entire time he or she is in care…this can be 10 or more years for some.

At intake we may diagnose an underlying mental health or psychotic condition. But in reality these are oftentimes just the acute symptoms of trauma and stress working themselves to the surface. Wouldn’t it be better for these children if we were to combine medication with other treatments that have been proven effective?

Treatments like cognitive-behavioral therapy, family skills training and conduct management?

Sometimes the talking therapies are all that’s really needed for children with mild to moderate symptoms.  Unless the science says otherwise, these should be tried before committing to a medication regimen. The medications that get prescribed may be appropriate, but we need better guidelines based on verified trials and scientific evidence.

That is the reason behind the comprehensive, multi-agency approach. Working together with the states and other appropriate arms of the federal government, like the Food and Drug Administration we can create the roadmap leading to evidence-based guidelines. Together we must insist on more comprehensive monitoring and oversight. In the process we will refine our protocols to ensure safety and well-being, with checks and balances and follow up assessments.

And, we must include foster youth in the discussion and development of protocols. Many of the foster children I’ve spoken with told me they didn’t understand why they had to take the drugs they were on and didn’t believe the medications were helping them.

Many said how much better they felt once they stopped taking the powerful tranquilizers, anti-depressants and mood-altering drugs they were on. Every foster child I’ve spoken with said we need to do something to address this issue and find a solution that includes their voices, and their concerns.

We have made great strides in this area. There are tools now for foster youth, explaining how to discuss these medications with their doctors, empowering them in their own health care decisions.

This conference is proof that this administration and your states are listening and responding to the needs of children in care. There are promising developments from many of your states that are being reviewed and discussed. There are some examples of great, innovative practices out there that are ensuring that young people get the treatment they need, safeguarding their health, and really making them better off.

And I want to thank each and every one of you for participating. This issue is not just about quality of life for kids in care, it is literally about life and death.

I would be remiss if I didn’t commend Commissioner Bryan Samuels and his dedicated team for their groundbreaking work in this area. Addressing and fixing this problem is a passion Bryan and I share. His efforts on behalf of foster children are an inspiration.

Commissioner Samuels and his team have created an inclusive space in which all parties, foster children included, have come to the table to work out solutions in the best interests of children. Thank you, Bryan.

I also want to thank Pam Hyde from SAMHSA, and Marilynn Tavenner from the Centers for Medicare and Medicaid Services. They too have been instrumental in really pushing this initiative forward.

And, thank you ladies and gentlemen. I wish you good luck and Godspeed.