Critical Look At The Foster Care System Medication of
to a nationwide study of runaway youths, more than one-third
had been in foster care in the year before they took to
than one out of five youths who arrive at a shelter come
directly from a foster or group home, with 38 percent
nationally saying they had been in foster care at some
time during the previous year, the study found. In a new
phenomenon compared with past surveys, almost 11 percent
of the youths said they were homeless and living on the
streets before coming to shelters.
findings were the most disturbing to emerge from a study
of 170 runaway shelters, said survey director Deborah
experts estimate that 45 percent of those leaving foster
care become homeless within a year.
A California study in Contra Costa County found that a
third of children placed in foster care eventually end
up homeless, and 35% are arrested while in foster care.
Lepak of the Contra Costa County Probation Department
explained to a 1988 Congressional subcommittee: "Children
are put in inappropriate placements, not designed to offer
family counseling, psychiatric treatment, or drug treatment.
Children are not prepared to return to families, nor are
they provided with a specialized educational and vocational
training they need to survive after they become 18." As
a result, says Lepak: "They become the new homeless."
North Carolina, a six-month investigation conducted by
the Charlotte Observer found that: "North Carolina's lack
of commitment to foster care is helping create a population
of throwaway children, many of whom go on to lives of
substance abuse, homelessness, crime."
McCaffrey, executive director of the Orphan Foundation
of America, explains:
federal funding guidelines encourage state-run foster
care programs to emphasize short-term, crisis-management
services, nongovernment players must concentrate on longer-range,
skill-development programs. Youngsters leaving foster-care
ill-equipped for life on their own often end up homeless
or permanently dependent on welfare services.
disproportionate representation of former foster care
children among the homeless population has long been documented.
According to the 1994 Green Book Overview of Entitlement
Programs: "Several surveys conducted during the mid-1980s
showed that a significant number of homeless shelter users
had been recently discharged from foster care."
such study conducted in the Minneapolis area found that
between 14 and 26 percent of homeless adults were former
foster care children.
subsequent study of the long-term homeless in Minneapolis
found that 39 percent had experienced foster care or institutional
care as children.
In New York City,
a study determined that between 25 and 50 percent of the
young men in the homeless shelters were former foster
Perhaps the most
distressing study of all, conducted in Calgary, consisted
of interviews with so-called "street kids." It was found
that an astounding 90 percent had been in foster care
prior to winding up living on the streets.
Even among the homeless,
the risks of continued family disruption are significantly
greater than among the general population.
An ongoing study
by the Institute for Children and Poverty reveals that
homeless families whose heads of households grew up in
foster care are at greatest risk of dissolution.
grew up in foster care are 30% more likely to be substance
abusers and 50% more likely to have a history of domestic
violence than the overall homeless population. Twice as
many of these heads of households have already lost at
least one child to foster care.
THE STREETS TO THE PRISONS
A 1991 federal study
of former foster care wards found that one-fourth had
been homeless, 40% were on public assistance and half
were unemployed. Connecticut officials estimate 75% of
youths in the state's criminal justice system were once
in foster care.
According to a survey
by the National Association of Social Workers, 20 percent
of children living in runaway shelters come directly from
foster care. Children placed in out-of-home care, regardless
of the reason, are at higher risk of developing alcohol
and drug problems. The survey also found that 80 percent
of prisoners in Illinois spent time in foster care as
Karl Dennis, executive
director of the Illinois based Kaleidoscope, the first
child welfare agency in the country to provide unconditional
care for children, says that in California, 80 percent
of the adults in in the correctional facilities "are graduates
of the state; the juvenile justice, the child welfare,
the mental health and the special education systems."
The outcomes many
former foster children may face are not limited to homelessness
and imprisonment. According to the Youth Law Center, which
has filed suits against several child welfare and foster
care systems on behalf of abused and neglected children
as well as foster care wards:
Lack of stability
and a permanent home are evident in the extraordinarily
high incidence of substance abuse, homelessness and psychological
problems among former foster children.
Under a contract
with the Department of Health and Human Services, Westat,
Inc. released the second phase of a two-phase report in
1992 as a follow up on youths who had been emancipated
from foster care during the period from January 1987 and
Westat found that
the status of older foster care youth 2 1/2 to 4 years
after discharge is "adequate at best" and that services
are needed for this population to improve their outcomes.
The 1994 Green Book describes the results of the second
that only 54 percent of the study population had completed
high school, 49 percent were employed at the time of the
interview, 38 percent maintained a job for at least 1
year, 40 percent were a cost to the community in some
way at the time of the interview (receiving public assistance,
incarcerated, etc.), 60 percent of the young women had
given birth to a child, 25 percent had been homeless for
at least one night, their median weekly salary was $205,
and only 17 percent were completely self-supporting.
The situation would
appear to be somewhat worse in the state of Florida with
respect to the percentage of high school graduations.
In 1996, a suit
was filed in Tallahassee Circuit Court that accused the
state of Florida of failing to adequately educate its
foster children. Miami attorney Karen Gievers filed the
suit claiming that while 73 percent of Florida children
graduate from high school or get an equivalent diploma,
less than half of the state's foster children do.
Jean Adnopoz, a
psychologist at the Yale Child Study Center, says children
who spend years drifting between foster care homes "can't
be expected to come out in any way that would appear to
be healthy." "If you have a child with no psychological
parents, essentially adrift in the world, you are headed
toward all sorts of bad outcomes," she said. "And we as
a society are going to pay and pay and pay for it."
Rights Project attorney Marcia Robinson Lowry: Foster
care systems established and funded to serve children
are failing, producing only more damaged graduates who
will go on to produce new generations of damaged children,
who will continue to lead unspeakably tragic lives and
who will increasingly tax our public resources.
In Washington state,
one out of every five children in the foster care system
is on potent mood-altering medications. Yet the state
has no safeguards in place regulating their use to protect
the children who swallow the potentially toxic pills.
The state does
not chronicle the problems children experience with these
drugs, nor are officials even certain how many of their
wards take behavioral medications. And the ranks of foster
children being given psychotropic drugs have swelled over
the years, experts say.
Says Aija Guedel,
former president of the School Nurses Organization of
Washington: "When I see foster children, most of them
are on a stimulant, anti-depressant or anti-psychotic
- or usually all three." What are the results on the children?
According to a six-month investigation conducted by the
A 4-year-old girl
was rushed to intensive care with an erratic heartbeat
after her foster parents accidentally doubled her daily
dose of anti-depressants - a dose already far above the
maximum recommended for her age and weight. The foster
parents said neither their doctor nor social worker had
warned them of the hazards of the drug, amitriptyline.
A 5-year-old boy
tried to kick out the windows in a bus, covered himself
with feces and tried to run naked down the street after
being given powerful anti-depressants. His foster mother
said she never was warned of the side effects.
A 13-year-old boy
sent into foster care in 1995 during the Wenatchee sex-ring
trials heard voices and suffered memory loss after being
put on high doses of the anti-depressant Zoloft. He later
tried to kill himself. Domico Presnell died. The wavy-haired
6-year-old failed to wake up in his Seattle foster home
last April 21. A toxic level of amitriptyline was found
in his blood.
drug most often prescribed to foster children in Washington
state over the past five years has been methylphenidate,
or Ritalin, which costs the state about 17 cents per pill,
according to the 1996 Formulary and Drug Use Guidelines
used at Western State Hospital.
The second most
commonly prescribed pill was the anti-depressant imipramine,
costing about 2 cents a dose. San Francisco youth activist
Lyn Duff, herself a former foster child, describes her
experience while in state care: "They put me on desipramine.
A week later they took all the kids in a van to the doctor.
He spent five minutes talking to us, with the other kids
in the room."
"It's not unusual
for me to have a child 9 years old on two or three psychotropic
medications at one time," says Dr. Sharon Collins of Mercy
Medical Center in Cedar Falls, Iowa.
The use of psychotropic
drugs to control foster children in state care has long
been documented. In a landmark suit filed against the
Illinois Department of Children and Family Services, the
American Civil Liberties Union blamed the child welfare
agency for much of the child abuse in the state.
One of four teenagers
named in the class-action suit had been in state custody
as long as he could remember. Although his mother and
grandmother had told him they wanted him back, the 13-year-old
had not received any services that might have helped to
reunite his family. In the meantime, he had been "warehoused"
for three months in the Henry Horner Children's Center,
where he was routinely drugged with psychotropic medication
and in danger of assault, according to the suit.
One of the numerous
terms of the consent decree stemming from the suit describes
the use of these agents to control foster children:
By January l, 1992,
DCFS shall convene a reform panel to review and make recommendations
regarding its policies and procedures concerning (i) the
use of restraint and seclusion on children in care and
(ii) the use of behavior controlling drugs including a
prohibition on the use of such medication for the punishment
of children, the convenience of caretakers or as a substitute
for programming for children's needs.
Has anything changed
as a result of the Illinois action? Pia Menon, a former
attorney with the Chicago Public Guardian's Office, was
assigned to investigate the Columbus-Maryville Children's
Reception Center operated by Catholic Charities. Her report,
suppressed by Public Guardian Patrick Murphy, was described
to author Renny Golden. Menon recounts her findings on
the use of drugs to control foster children:
are on psychotropic medications. Almost every child who
comes into the system ends up on some kind of psychotropic
medication--we're talking about four- and five-year-old
kids who are on Prozac and Ritalin..." "Give me a break--it's
to quiet them down," she adds. "Generally, psychotropic
medications take the place of nurturing."
But the use of medications
is not limited to group care facilities and the Children's
Reception Center. Menon explains: Caseworkers prefer that
the child is medicated. It helps the foster care parents,
who may not be qualified to deal with a disruptive child.
Staff often have no idea what a drug does to the child.
They dispense it like aspirin. There is absolutely no
one to monitor kids on multiple meds. What this all amounts
to is a systematic assault on children who've already
been removed from home, medicated, coded, misdiagnosed,
was a ward of the state. Both he and his sister endured
the difficulties of placement in residential group homes
and psychiatric facilities. "All you have to do is act
up and they give you drugs," says Prentis. "The drugs
were nice because they'd calm you down or put you to sleep
for days." Adds Prentis: "They gave me Thyroxine. Sometimes
your muscles twitch."
judicial approval is required for giving psychotropic
drugs to any foster child. Says Dr. Michael Malkin, who
reviews the drugs for Los Angeles County judges: "The
psychiatrist is usually beseeched by the group home operator
to medicate the kids."
Dr. Malkin tries
to substitute milder medications that don't cause permanent
facial tics, heavy sedation and other side effects. According
to Malkim, the Judicial approval required in California
deters doctors from dispensing risky anti-psychotic drugs
Oh, is that so?
A 1997 Los Angeles Grand Jury report indicates that foster
children are frequently medicated with psychotropic drugs.
Not only are the children excessively medicated, but the
conditions in group foster homes were found to be deplorable.
The Los Angeles Times describes the Grand Jury findings:
Many of the nearly
5,000 foster children housed in Los Angeles County group
homes are physically abused and drugged excessively while
being forced to live without proper food, clothing, education
and counseling, according to a blistering report by the
county grand jury. The Grand Jury found that children
were given a variety of medications without the proper
consent of a guardian or judge in nearly half of 158 audited
cases. In another instance, a group home withheld drugs
in hopes that a child would be ruled severely emotionally
disturbed--thus drawing a higher rate of government payments.
The Grand Jury also identified inadequate psychotherapy
for the children, with sessions of as little as five minutes
being held, although therapists were billing for full-length
Said Andrew Bridge,
executive director of the Alliance for Children's Rights:
"We need to have small homes of six beds or less to deal
with these kids in a therapeutic way and not simply put
them away or drug them."
The 1991-92 San
Diego County Grand Jury reached similar conclusions, extending
its examination of the foster care system in another direction.
Among its findings: Caseworkers, investigators and attorneys
believe that some foster parents routinely complain of
behavioral problems, insist that those behavioral problems
require mental health therapy and then seek additional
funds for regular transportation to the therapist and
special care needs. These claimed behavioral problems
are subjective and are not capable of being confirmed
by objective tests.
The Grand Jury
suggested that "foster parent claims of behavioral problems
in foster children not previously identified as having
the problems should be carefully investigated." In examining
the improper use of controlling medications, the Grand
Jury found that the medications in use ranged from mild
depressants and hypnotics to strong psychotropic drugs.
It determined that the lack of money for medical treatment,
the financial pressures on medical providers and a generalized
lack of medical records for foster children all contributed
to make it possible for unscrupulous foster parents to
obtain medication for children who did not need to be
A committee of
the U.S. House of Representatives examined many of these
problems years ago, concluding that the foster care and
child welfare systems were in dire need of reform.
A 1990 report issued
by the Select Committee on Children, Youth and Families
described the use of these mind-altering medications,
and the bizarre treatments to which children in state
care are frequently subjected: "In the state mental hospital
in South Carolina, children who attempted suicide were
stripped to their underwear, bound by their ankles and
wrists to the four corners of their beds, and injected
with psychotropic drugs."
Some critics charge
that psychotropic medications are not only routinely provided
as a method of controlling foster children, but as the
means to obtain disclosure of non-events.
In Wenatchee, Washington,
where allegations of a bizarre and highly improbable "sex
ring" involving several prominent citizens came to surface,
children alleged to be victims are apparently being provided
medications and therapy as a means to elicit disclosure,
critics charge. Melinda Everett, who was among the primary
witnesses for the prosecution, publicly recanted her testimony
on a televised broadcast, claiming that it had been coerced.
the heels of her public recantation, Melinda was seized
from her grandparents' home. Writes syndicated columnist
Paul Craig Roberts: "For the past several months the child
has been involuntarily locked away in a psychiatric facility
where she is under the exclusive control of 'recovered
memory' therapist Cindy Andrews. No one--not even elected
state representatives--has been permitted to see her."
Cindy Andrews, who
is under contract with the state, is among the defendants
in a civil suit in which Melinda Everett is a principal
Melinda is not alone
in her plight. More than a third of the alleged victims
of the so-called "child sex ring" in Wenatchee were placed
on psychotropic drugs paid for by the state once they
entered foster care. Are the Wenatchee children truly
victims of a sex ring that included dozens of people with
a local pastor as ringleader, or are they victims of a
state sanctioned machine determined to extract testimony
from them at any price?
Their stories include:
A 12-year-old boy taking the anti-depressant Zoloft who
heard voices telling him to hang himself by jumping off
a milk crate with a rope around his neck. His counselor
worried he was suffering from memory impairment as a side
effect of the drug. He originally was sent to Pine Crest,
but later was transferred to an institution in King County
where he tried to kill himself.
A 15-year-old developmentally
delayed boy who became a chief witness in several of the
cases after being sent to Pine Crest. He later attempted
suicide while on psychotropic drugs. A boy described in
medical records as "in denial" and "non-compliant" after
his parents were sentenced to prison on sex charges. At
age 9, in April 1995, he tried to run away from the foster
home he shared with two other alleged sex-ring children.
Doctors increased his dosage of Zoloft, and the fourth-grader
"tried to stick (a) metal object through his chest," according
to a DSHS episode report. He then entered a Seattle psychiatric
hospital, where he was prescribed the anti-depressant
In the case of one
13-year-old girl, her medical notes indicate that Andrews
"apparently would like her on medications." The girl later
was given Paxil.
The greatest irony
to be found among these tragic circumstances is that a
significant number of foster children have been removed
from their homes for reasons alleged to be related to
"neglect" stemming from substance abuse by their parents.
In Hawaii, an estimated 80% of cases involve substance
abuse by parents, says John Walters, an assistant program
administrator with its Department of Human Services.
people have thought of substance abuse as an adult problem,
substance abuse by parents has made it a children's problem,
as well," said a spokesperson for the Massachusetts Department
of Social Services.
Henderson and the ORRCF are calling for the support of a
push for corrective legislation, to find more sensitive
and effective solutions for monitoring and protecting children
that are at risk at home and in the custody the family courts
and foster care. For more information contact us via email
child protective system has gone to great lengths to ensure
that substance abuse is indeed "a children's problem,"
as its solution is all-too-often the traumatic removal
of children from their homes, and the systematic turning
of the children into drug-dependent wards of the state.