By Dianne Anderson

Years of over-medicating foster kids have raised more than a few professional eyebrows in recent times.

Legislative and policy coordinator Chantel Johnson said there are still a lot of holes on both sides of the issue. Over-medication and under-medication are system-wide, with not enough oversight to go around.

“From our standpoint, we are definitely in favor of

anything that would limit over-medication,” she said, but added she realizes medication is sometimes necessary.

“We recognize that post-traumatic stress disorder in foster youth is almost double that of war veterans. Sometimes, just to function there is some necessity,” she said.

Johnson is with California Youth Connection, a nonprofit in 30 counties statewide that is written into state law as a voice of the foster children. Made up of foster youth, its members, ages 14 through 24, have all worked directly to help craft legislation and push the system for something workable.

Hoping to shed more light on the problem, this year Assemblymember Noreen Evans reintroduced another bill calling for tighter oversight of psychotropic and hazardous medications with AB 1655. The bill calls for a pilot project in three counties to safeguard psychotropic medication to foster kids, provide better medical exams before giving meds and properly monitor side effects. It also extends caretakers’ right to a hearing before any meds are assigned.

The bill is sponsored by Children’s Law Center of Los Angeles, a partner with the California Youth Connection, a foster youth advocacy established 22 year ago.

For many years, Johnson said, their organization has offered legislative recommendations for group home care reform.

Last year, she said, a lawsuit following state cuts of $80 million from child welfare sent a lot of money going directly to group homes.

“They got about 241 million more dollars,” she said. “Group home care ranges about $9,000 per youth per month, sometimes more. And they don't even do anything,” she said.

Often, kids are kept in the house, and are not provided social or academic activities that could help them grow, heal, and learn emotional coping skills.

In AB1655, the bill text notes testimony that shows over-medication in the system a problem.

The problem is not new. In 2008, Dr. Julie Zito, a professor of pharmacy and psychiatry at the University of Maryland, Baltimore School of Pharmacy, showed her research of one year, that 38 percent of 32,000 foster kids on Medicaid in Texas received more psychotropic meds, with 41% of a sampling given three or more drugs daily.

She questions a trend that’s been developing in child mental health treatment since 1990 -- heavy medication without a conclusive mental health diagnosis. The study also showed 64% of kids over ten years old received medication that was not sufficiently justified.

Her research went international with a  three-country comparison of psychotropic medication prevalence in youth, finding that American kids three times more likely than European kids to be medicated.

Another issue is inadequate medication.

Locally, Dr. Cynthia Powell said one problem is most kids on Medi-Cal are prescribed off brand psychotropics, which may not be as effective as name-brand pharmaceuticals.

At group homes, chances are that foster kids at Level 12 through Level 14 need heavy drugs just to stabilize their emotions. Many high risk children are a step away from mental institutions.

Dr. Powell said that many more children are lately dealing with dual or multiple diagnoses, probably born to drug addicted moms. Medications are less effective when drugs are born into their system.

The good news is that counties are starting to exercise stronger compliance in issuing medications, which now requires court approval, she added.

“Some of the children I’m seeing now, the medications are [ineffective],” she said. “They're assaulting staff. We even have some children who are cutters.”

In her experience, Level 14 requires close attention in monitoring dosage. They are schizophrenic, bipolar, suicidal or self mutilating. For them, the next phase is a psychiatric ward.

However, she stressed medication by itself is not the cure. There needs to be a full range of programs to teach coping skills for children to heal.

“If you're really trying to mainstream people into regular society--and that's the goal with group homes--or just get them basic social skills, there has to be a whole 360, including the social, academic and emotional side,” she said.

Some kids eventually may be weaned off, but maybe not for decades. Others will need more medication as their emotional problems resurface later on.

But because of complaints of misdiagnosis within the overall system, Powell said she won’t treat a child without first getting a full physical, including eyes and ears.

For all of the problems in the system, some kids manage to do well despite the odds.

Not long ago she and professional associate Tina Robinson took a dozen foster teens to Atlanta, Georgia for the National Alliance of Faith and Justice where they participated in several events.  Some were Level 10 teens, most from group homes, and many had never been on an airplane or outside of the state. They were all perfectly behaved and had a blast.

“It was a beautiful experience,” she said. “My mistress and master of ceremony were just phenomenal. They were speaking before judges, speaking before attorneys and faith based community.”

Mentored over the past year, they attended packed events with gospel Hall of Famer Tramaine Hawkins. And the following night, met up with Susan Taylor from Essence Magazine.

“It was a rich, rich experience,” she said. “There was not one issue or one problem. They did very, very well.”

Dr. Brandon Gamble, professor at Cal State Long Beach, said that the problem is not so much that the anti-depressants or anti-psychotic medications can’t help a child’s mental illness, but the challenge is the fast growing needs of the child.

“For psychiatrists and the other mental health professionals assigned to the case, it is like hitting a moving target,” he said. “For children in foster care, the degree of difficulty raises in regards to finding the right medication, counseling therapy, and environment that can lead to improvements.”

Still, the current system is challenged with getting the right diagnosis, dosage, counseling therapy, measured against potential side effects, such as increased suicidal thoughts.

The best answer, he said, to help heal or maintain mental health is that foster kids need to be taught how to advocate for their health themselves, learning from someone they can trust. At the same time, he said that child advocates who really understand the obstacles are rare.

There are hardworking school psychologists, social workers, who advocate for foster kids, but he notes that they are up against the massive system of private, state, and “psycho-economic dynamic.”

“The sad part is that some children are told they cannot learn to control their emotions without the meds. It is especially sad for those youth who are misdiagnosed but given a label to move them through  the system, i.e. Big Pharma, the psychiatrist, private group home, insurance company. [They] all get paid,” he said.