For Immediate Release: April 2, 2015
Washington – A letter sent today urges U.S. Senate Majority Leader Mitch McConnell and Minority Leader Harry Reid to support a budget initiative aimed at reducing the overmedication of children in foster care. The First Focus Campaign for Children, a bipartisan children’s advocacy organization, coordinated the letter in partnership with Voice for Adoption, a national organization advocating for children in foster care. The letter was signed by 128 national, state, and local organizations.
“When children have health problems, the right approach is a complete treatment plan that deals with the problems, not just drugs that make it easier to deal with the children,” said Bruce Lesley, president of the First Focus Campaign for Children.
A 2011 federal Government Accountability Office (GAO) analysis requested by a key Senate committee found that children in foster care are inappropriately prescribed psychotropic medications at a rate quadruple their peers. The same analysis found that children in foster care received larger and more frequent doses of these mind-altering drugs, including dosages exceeding the federal Food and Drug Administration’s recommendations.
Following up on its 2011 audit, GAO released a 2014 analysis based on reviews of foster children’s medical records to assess state oversight of prescribing practices. GAO found that prescribing decisions were not always fully supported by documentation in the medical records. Specifically, GAO found that documentation was sometimes incomplete in critical areas: screening, assessment, and treatment planning; medication monitoring; and informed and shared decision making.
Medication can be part of a treatment plan, but only if appropriately prescribed, monitored and used in combination with effective psychosocial therapy aimed at treating the underlying mental health condition. As the letter notes, advocates seek a comprehensive approach in which medications are administered to children only when necessary, and then only with effective monitoring and controls.
Inappropriately prescribed psychotropic drugs not only fail to address children’s real mental and behavioral health needs, but they often compound the challenges facing children in foster care. This can complicate efforts to help children reunify with birth parents or find permanent placement with relatives, an adoptive family or legal guardian.
A proposal included in President Barack Obama’s federal fiscal year 2016 budget would allocate $750 million ($150 a year for five years) to improve federal and state efforts to curb overmedication of children in foster care. The demonstration effort pairs two federal agencies: the Administration for Children and Families (ACF) and the Centers for Medicare and Medicaid Services (CMS). ACF would use $250 million to help states improve their capacity to oversee mental and behavior health care for children in foster care. States could use this funding to improve training, provide screening and assessment tools, evaluate care, and improve data collection. CMS would allocate $500 million as incentives to states that demonstrate reductions in inappropriate prescribing practices and over utilization of psychotropic medications, increased use of psychosocial treatments, and improved outcomes for foster children.
“There are best practices around treating children with mental and emotional health care needs, these include ensuring children have access to therapies that address their underlying issues. High dosages of medication alone is not the answer. This is an important collaborative between child welfare and Medicaid; we have a broad group of stakeholders in favor of this funding to invest in long term strategies to fix a system that is currently not getting the good outcomes that we know Congress is interested in seeing for our nation’s children in foster care,” said Nicole Dobbins, Executive Director, Voice for Adoption.
“This is exactly the right approach. Offer better alternatives and additional resources, but then reward states for what we all want – real improvements for kids,” said Lesley.
A similar initiative was also included in last year’s White House budget proposal. Though a key congressional committee held a hearing on the GAO’s 2014 report, Congress did not act on the overmedication reform initiative.
The 128 organizations signing the letter included national groups, as well as local advocates and child-serving agencies in 34 states, ranging from New Jersey to Arizona and Washington to Mississippi.
The First Focus Campaign for Children is a 501(c)(4) nonprofit organization affiliated with First Focus, a bipartisan children’s advocacy organization. The Campaign for Children advocates directly for legislative change in Congress to ensure children and families are the priority in federal policy and budget decisions. For more information, visit www.campaignforchildren.org.