Current Initiatives, continued

Advocating for improved monitoring of the administration of psychotropic medications to youth in foster care 

During 2011 the Barton Center has been working collaboratively with Casey Family Programs, the nationís largest operating foundation focused entirely on foster care and improving the child welfare system, and other child advocacy partners to develop strategies to improve the systemic oversight of the administration of psychotropic medications to youth in foster care.  Psychotropic medications are those that act upon the central nervous system to affect brain function, resulting in changes in the childís mood, behavior, consciousness, perception and cognitive function. 

Inappropriate treatment is particularly a problem for children in foster care who do not have a loving family member who advocates for, or is connected to, the child and to his or her future.  Children in foster care are at extremely high risk for emotional and behavioral disturbances, arising from the initial trauma of abuse or neglect and compounded by the experience of family disruption and loss of support.  Multiple placement changes, overreliance on emergency room care, lack of proper psychiatric assessment and reassessment, and gaps in the system of care create challenges to longitudinal health care coordination for children in foster care and further increase the risk of poor health outcomes for this vulnerable population.  Consequently, these youth often accumulate multiple psychiatric diagnoses and evidence patterns of increased medication use. Recently published national studies report that the use of psychotropic medications is 3-4 times higher in the foster care population than in a comparable population of low-income, Medicaid-eligible youth. 

The Barton Centerís collaborative project provides children like Tommy with an independent medical evaluation by a child psychiatrist, who assesses the childís current diagnoses, recommended treatment, and prognosis for functioning well within a family.  To date, 75 children have received this additional level of service, and reviews conducted by the independent psychiatrist document disturbing trends including multiple prescriptions targeting the same cognitive and behavioral difficulties, the steady addition of new drugs and dosage increases without efforts to taper or discontinue the existing medication burden, a failure to adhere to recommended medication laboratory monitoring, and an absence of any evidence of informed consent in the medical records.

In addition to psychiatric review and consultation, the Barton Centerís project provides training to DFCS case workers, foster parents, Court Appointed Special Advocates, attorneys and judges to increase their knowledge about psychotropic medications and provide them with advocacy strategies to ensure appropriate oversight of behavioral health treatment at the individual case-level.  Additionally, child psychiatrists and other interested professionals are convened through the project to develop appropriate prescribing guidelines that are in line with professional standards of care.  Students have conducted research to examine oversight models in other states, conducted legal analyses of related legislation pending in Georgia, and are developing recommendations for changes in state law and child welfare agency policy.