Psychotropic Medications and Foster Care

Psychotropic Medications

The parental struggle to help children coping with behaviors, trauma, or mental illness

This weekend one of our FACES members posed the question...what is FACES doing to help families understand psychotropic medication usage in child welfare? A fair question. We have not discussed this issue in any of our publications. It is a subject of grave concern, but is highly individualized and advocacy on the topic can be very delicate. FACES must be certain we provide you with information, but your individual utilization of the information must be measured and appropriate to your own unique situation...so that is our disclaimer for the information we will provide in this edition.

There are many organizations promoting information about psychotropic medications. In the media, you will find sensationalized versions of the issue, so that they are able to drive home a point. If the media were not to dramatize the issue of psychotropic medication and children in foster care, there might be less attention paid to the topic...and this is a topic that needs the light of day shone on it.

Much research has pointed to the fact that children in foster care are more likely than other children on Medicaid to receive psychotropic medications as the answers to their behavioral and emotional behaviors. This article by Children's Rights discusses this issue.

The American Psychological Association has studied this issue as well and points to an interesting fact. In Medicaid across this country, the reimbursement for psychotropic medications is most often the only reimbursable strategy for dealing with emotional and mental illnesses. Medicaid reimbursements for alternative or concurrent treatments such as psychotherapy or alternative approaches such as dietary support are lacking. This study published by the American Psychological Association can be overwhelming to review; however the conclusions and recommendations beginning on page 173 help to distill the many of the important facts and conclusions from the report.

So given these facts, what is a parent to do? WE have much to do to protect our children. As parents, our first priority is to care for and about the children in our home. As advocates, our first priority is to fight for a system that protects all children. And, yet in the midst of all of this we must also struggle with how to balance care and advocacy with daily responsibilities and the possibility that speaking out in the wrong way may risk the placement of the children in our homes. FACES can provide you with information and training to support your efforts, but only you can decide how best to apply the information in your unique situation.

Some sources for your consideration in determining your own next steps.

• Learn strategies from other families about how to get accurate diagnoses for children.
• Know the questions to ask and learn more about emotional and mental illnesses.
• Develop knowledge about psychotropic medications both their positive and adverse affects on developing children.
• Discover alternatives to or co-treatment options that may have positive impacts.
• Understand the reality of the lack of trained child and adolescent psychiatrist in Virginia who are trained on evidenced-based practices.
• Understand the potential benefits of psychiatric medication.
• Learn how other states have developed policies to protect children in foster care from inadequate or inappropriate psychotropic medication prescribing patterns.

 Advocating for the children in your home.

As a foster parent, you are ever mindful that the children in your home can be removed at any time, for any reason. You must keep this always in the forefront of your minds as you plan your advocacy strategy for the children in your home. Here are some of our top recommendations:

1. Document, document, document...and when you are done; document some more. It is important that you journal everyday about what behaviors you are seeing and what physical changes you might be noticing. Is the child becoming more withdrawn? Are you seeing a change in their eyes, their motor skills, tremors, or other physical characteristics? Keep track of dates and times. Sometimes behaviors can include sundowning (drastic behavior changes which occur after dusk).
2. Keep in touch with teachers and guidance counselors at school. Be sure they see you as a partner in managing and supporting the child's needs. Ask them questions on a regular basis. Establish a communications system...emails, notes, or phone calls. Work with them to find the best communication approach, and, document your interactions.
3. Socialization. Friendships are often healing. Help the child find ways to become socially engaged in their community based on their interests. Set up a communications approach, in advance, with the child so that he or she feels comfortable giving you clues about any discomfort or anxiety they may feel during activities. Keep in mind, regardless of medication choices, some of the best things we can do as parents is to provide children with positive role modeling, positive interactions, patience, and family/friend time.
4. When you are ready to talk to the child's worker, GAL, or CASA volunteer about the child's needs and your concerns regarding medication; be mindful that the best approach is to focus on the child in your communications. We advised families to start the conversation with "How can we best care for [insert child's name]?" or, "We need your help. We are observing the following changes. Is there anything we can do or anything you could help us with that might make things better for [insert child's name]?" This is an important strategy, because it creates a dialogue and not simply a response. It is important to avoid questions that will lead to "No, we can't do that." Sensitivity, also, to the worker, GAL, and CASA volunteers authority is important. Many would like to do anything to help the child, but often their hands are tied by lack of funding, authority, or information. Avoid emphatic or demanding statements ("This child must have a change in medications.") and lean toward empathic and inclusive questions (Is there anything that can be done to be sure we are properly treating [insert child's name]? I understand we all want what is best, and we thought it might help everyone involved to hear about some things we are observing. Do you think it could help all of us to have a meeting so we can all discuss [insert child's name]'s needs?
5. Realize that psychotropic medications may have their place in the treatment approach for some children. Most of the literature, however, also supports co-treating approaches if medication is used to eliminate symptoms. In addition, there are some families who have found that children were able to improve their behaviors by slowly eliminating the psychotropic medications from their system and utilizing alternative approaches such as psychosocial support and/or dietary changes. Most parents can expect that when psychotropic medications are reduced or eliminated there can be a return to the behaviors which prompted the prescription. This is why reducing or eliminating psychotropic medications needs to be a team decision with proper supports and services for managing behaviors and progressing children toward the elimination of destructive and harmful behaviors. Do NOT attempt to do this on your own. The impact of simply eliminating certain medications without professional and medical oversight can be dangerous to a child's health, also.

At this time, FACES is moving forward with developing partnerships with several organizations to bring more information to you through either webinars or regional trainings on the issues of mental health treatment for children in foster care. Please stay tuned for more information about what we are planning.

In addition, as we have previously reported, the passage of recent federal legislation now mandates that states report to the federal government what they are doing to monitor and manage psychotropic medication usage with children in foster care. Illinois has long had a system requiring that the foster care worker of any child prescribed more than one psychotropic medication phone into the University of Illinois-Chicago to get approval from the the authorized psychiatrist at the Institute for Juvenile Research prior to permitting the administration of the medications. Is it time for Virginia to develop this or some other type of model to protect children? Should we work to host a statewide summit to address this issue and develop strategies for our children? Email us at info@facesofvirginia.org or sign on Wednesday night to our on-line FACEBOOK chat to let us know your thoughts.

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Don't forget the FACES on-line chat Wednesdays at 9:00 PM. Log onto the FACES home page, click on the FACEBOOK icon, and ask to be invited to join the support group chat. Let us hear your voice!

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