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“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”
Universal Declaration of Human Rights
The Foster Care System Failing Children and the US Taxpayer
It has been estimated that 70% of the US prison population was once in foster care. Three in 10 of the nation's homeless adults report foster care history. This points to an obvious problem within our social service network. We must be failing these needy children. There are inadequacies in supervision of the placement of these children, clear indications of corruption within the system as well as neglect of the children’s needs. Child placement agencies, foster care parents and residential treatment centers get paid a daily sum for the care of a foster child. These allocated amounts are based on the Federal entitlement system IV-e and are based on the level of care the child needs. The more difficult the child is to care for the higher the daily payment for care. Thus it is in the interest of the state agencies, social service workers, foster parents, and therapeutic clinicians to make the child appear on paper to need the highest level of care possible. Many foster children are labeled with more than one psychological diagnosis in order to upgrade their status to a higher level. Foster care daily rates run from $17 per day to $1,000 per day. A child diagnosed with a mental disorder and placed on psychiatric drugs is worth more than a child without problems. Let us hear first hand from some of these foster children who were interviewed at a Foster Care Alumni meeting and asked about their experiences with child protective services while still wards of the state.
GAO Forensic Investigation -
Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, Thursday, December 1, 2011 at 10:30 AM
Dirksen Senate Office Building, room SD-342
• U.S. Senator Thomas R. Carper, view statement: http://www.psychsearch.net/federal/Senator-Thomas-R-Carper-Statement%20-.pdf
Financial and Societal Costs of Drugging Foster Children
Foster Care in the State of Texas
Jim Gottstein - Foster Children
Psychiatric Drugging of Foster Children
Children in foster care are a very vulnerable population having been removed from abusive or neglectful homes. These children are experiencing childhood trauma, grief at loss of their biological family, their home community and often having experienced severe abuse – physical, psychological, emotional and sexual. These are children who often have experienced years of trauma leaving them with complex post traumatic stress. Thus they are prone to show the symptoms of PTSD¸- which is often misunderstood and therefore is often treated as other mental health conditions instead.
PTSD is best handled by cognitive behavioral therapy – this is proven to be effective for victims of sexual assault and also combat trauma. These children have come from a home environment which is like a combat zone – domestic violence, drug dealers, drive by shooting, child sexual abuse by relatives, abusive punishments, parents with mental illness who act irrationally and arbitrarily, and other traumatic events. But rather than getting psychological care these traumatized children need these vulnerable children are instead refused the necessary psychological therapy and are instead sent to a psychiatrist who then in sometimes less than 15 minutes prescribes for them mind altering and sometimes life endangering drugs.
Thousands of foster children are routinely prescribed doses of psychotropic drugs that are higher than the maximum levels cited in guidelines based on FDA approved labels. This increases the potential for adverse side effects and does not typically increase the efficacy of the drugs to any appreciable extent. Even children as young as one year old were prescribed psychiatric drugs even though there were no mental health conditions in infants which would warrant their use. This certainly could result in serious adverse effects including metabolic and cardiovascular problems
The side effects of these drugs include suicidal thoughts, loss of coordination, hallucinations, kidney, thyroid, liver and pancreas damage, polycystic ovaries, weight gain, diabetes, tremors, potentially fatal neuroleptic malignant syndrome, rigidity, tardive dyskinesia, depression, agitation, sleeplessness or downiness, nightmares, blurred vision, decreased appetite, tics, and psychosis. When the children show these symptoms they are often given higher doses of the drugs or even additional drugs, rather than being given lower dosages or taken off these medications. So a spiral occurs of increasing dosages of more powerful drugs leading to great symptoms and decreasing function of the child. When the child becomes unmanageable, they are placed in a residential treatment facility at $700 or more a day for weeks sometimes much longer. If the psychiatrist wants to change their medication and get them “habituated” on a new medication the child might be hospitalized for half a year or more. This all happens at the US taxpayers’ expense.
In an effort to expand the market for psychiatric drugs, pharmaceutical companies capitalized on the use of foster children to test their products on this vulnerable population. These children were not given the right to informed consent, they were wards of the court in a judicial system that is overworked and understaffed and where even CASA volunteers have little time to carefully review FDA information or scientific literature about the safety or effectiveness of prescribed medications. The legal surrogate decision makers for the child are not medically trained and often accept blindly the advice of the treating psychiatrist. No information about the long term consequences of the use of these medications in children is given to these decision makers so crisis decision making is the norm with the pills looking like the perfect quick fix. In addition the pharmaceutical industry has for decades controlled the release of negative information about their products by controlling all the publicity of research findings (funded by the industry), using an aggressive legal campaign to shut down any malpractice law suit¸ out of court settlements with gag orders for silence and suppressing court documents from discovery by having them sealed by the judge.
Through aggressive marketing to medical professionals, teachers, CASA volunteers, welfare case managers, and guardians, the pharmaceutical companies have now pushed the treatment of children for such mental diseases as attention deficit hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia, often diagnosing them for these problems so as to use psychiatric medications “off label”. The Teen Screen program which pushed psychiatric drugs on school children is an example of this direct marketing by pharmaceutical companies. The pharmaceutical industry has placed industry representatives on major governmental panels and commissions order to influence policy to facilitate passing legislation that would approve the Medicaid payment of psychiatric medications for “off label” uses. But these drugs are not without risk, there are serious side-effects, including irreversible movement disorders, seizures, and increased risk of diabetes.
The prescription of these drugs is oftentimes very questionable and inappropriate prescribing of youth in state custody has lead to increased costs to the US taxpayer over the lifetime of the child. These children, who are often medicated with up to 5 drugs at the same time, have cognitive impairment, as well as physical dependency on the drugs. When they try to stop the medications they face severe withdrawal symptoms for up to 7 months and these symptoms can be misunderstood and the child instead re-drugged at high dosages. No study has been done to see if these foster children who were highly medicated were able to go on to productive independent lives after leaving foster care. Many have been in and out of residential treatment, leading to disruption in their schooling. In addition these drugs change the child’s ability to think, reason, and also dull emotional awareness and response. This makes it difficult to learn and to relate to peers and their foster/adoptive family.
When they age out of the foster care system, they find themselves thrown out into a world that labels them as mental misfits, treats them with disrespect and forces them into being repeat users of the psychiatric industry/medical complex. Many end up in prison and then are force drugged by court order in prison and when they are released court ordered medicated for life. The costs of the repeat hospitalizations – at $700 -$1,000 a day along with the cost of medications at tens of thousands of dollars a year, is a cost borne by the US taxpayer until the former foster child’s death. It is almost impossible to be taken off these medications once the child has taken them for years.
Death of a Foster Child
Medical Whistleblower letter to the United Nations November 2008
Jesse Jackson: "I am - Somebody. I may be poor, but I am - Somebody! I may be on welfare, but I am - Somebody! I may be uneducated, but I am - Somebody! I must be, I’m God’s child. I must be respected and protected. I am black and I am beautiful! I am - Somebody! Soul Power!" Address to Operation Breadbasket rally, 1966.
Foster Care Statistics
· 80% of the US prison inmate population was in the foster care system (US Dept. of Justice, 2005)
· 70% of California's inmates have been in the foster care system (Sacramento Bee article by John Burton [chairman of the CA Democratic Party and chairs the John Burton Foundation for Children Without Homes)
· Children are 11 times more likely to be abused in State care that they are in their own homes. (National Center on Child Abuse and Neglect [NCCAN])
· 90% increase of children and youth in the US foster care system since 1987. (Casey Family Programs National Center for Resource Family Support *CASEY FOUNDATION*)
· 3 out of 10 of the nations homeless are former foster children. (Casey Foundation*)
· Children in foster care are 3 to 6 times more likely to have emotional, behavioral, and developmental problems including:
· Conduct disorders
· Difficulties in school
· Impaired social relationships
· Approximately 30% of foster children have marked or severe emotional problems. (Casey Foundation*)
· Children and youth in foster care tend to have limited education and job skills and perform poorly in school compared to children NOT in care. (Casey Foundation*)
· Children in foster care lag behind their education by at LEAST one year and have lower educational attainment than the general population. (Casey Foundation*)
· Children in foster care are 5.25 times more like to die as a result of abuse than children in the general population. (CPS Watch Inc.)
· 2.1 % of ALL CHILD FATALITIES took place in foster care.
**Since "state care is supposed to be a 'safe-haven', the number of fatalities should have been less than the child fatalities of the general population (less than 0.4%). However, child fatalities that occurred while in foster care were 5.25 times greater than that amount." (CPS Watch Inc.)
Youth Voices - Life After Foster Care
News from PsychRights on Drugging of Foster Children
Briefing Paper: The Financial And Societal Costs Of Medicating America’s Foster Children: A Proposed Solution: Enforcement of Medicaid's Restriction of Covered Outpatient Drugs to Medically Accepted Indications, to Sen. Mark Begich, U.S. Senate Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, December 12, 2011.
“Get up, stand up, stand up for your rights."
Poor Children Likelier to Get Antipsychotics
Poor Children Likelier to Get Antipsychotics
By DUFF WILSON
[New York Times]
December 11, 2009
New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.
Those findings, by a team from Rutgers and Columbia, are almost certain to add fuel to a long-running debate. Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?
The questions go beyond the psychological impact on Medicaid children, serious as that may be. Antipsychotic drugs can also have severe physical side effects, causing drastic weight gain and metabolic changes resulting in lifelong physical problems.
On Tuesday, a pediatric advisory committee to the Food and Drug Administration met to discuss the health risks for all children who take antipsychotics. The panel will consider recommending new label warnings for the drugs, which are now used by an estimated 300,000 people under age 18 in this country, counting both Medicaid patients and those with private insurance.
Meanwhile, a group of Medicaid medical directors from 16 states, under a project they call Too Many, Too Much, Too Young, has been experimenting with ways to reduce prescriptions of antipsychotic drugs among Medicaid children.
They plan to publish a report early next year.
The Rutgers-Columbia study will also be published early next year, in the peer-reviewed journal Health Affairs. But the findings have already been posted on the Web, setting off discussion among experts who treat and study troubled young people.
Some experts say they are stunned by the disparity in prescribing patterns. But others say it reinforces previous indications, and their own experience, that children with diagnoses of mental or emotional problems in low-income families are more likely to be given drugs than receive family counseling or psychotherapy.
Part of the reason is insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do. Part of it may have to do with the challenges that families in poverty may have in consistently attending counseling or therapy sessions, even when such help is available.
“It’s easier for patients, and it’s easier for docs,” said Dr. Derek H. Suite, a psychiatrist in the Bronx whose pediatric cases include children and adolescents covered by Medicaid and who sometimes prescribes antipsychotics. “But the question is, ‘What are you prescribing it for?’ That’s where it gets a little fuzzy.”
Too often, Dr. Suite said, he sees young Medicaid patients to whom other doctors have given antipsychotics that the patients do not seem to need. Recently, for example, he met with a 15-year-old girl. She had stopped taking the antipsychotic medication that had been prescribed for her after a single examination, paid for by Medicaid, at a clinic where she received a diagnosis of bipolar disorder.
Why did she stop? Dr. Suite asked. “I can control my moods,” the girl said softly.
After evaluating her, Dr. Suite decided she was right. The girl had arguments with her mother and stepfather and some insomnia. But she was a good student and certainly not bipolar, in Dr. Suite’s opinion.
“Normal teenager,” Dr. Suite said, nodding. “No scrips for you.”
Because there can be long waits to see the psychiatrists accepting Medicaid, it is often a pediatrician or family doctor who prescribes an antipsychotic to a Medicaid patient — whether because the parent wants it or the doctor believes there are few other options.
Some experts even say Medicaid may provide better care for children than many covered by private insurance because the drugs — which can cost $400 a month — are provided free to patients, and families do not have to worry about the co-payments and other insurance restrictions.
“Maybe Medicaid kids are getting better treatment,” said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. “If it helps keep them in school, maybe it’s not so bad.”
In any case, as Congress works on health care legislation that could expand the nation’s Medicaid rolls by 15 million people — a 43 percent increase — the scope of the antipsychotics problem, and the expense, could grow in coming years.
Even though the drugs are typically cheaper than long-term therapy, they are the single biggest drug expenditure for Medicaid, costing the program $7.9 billion in 2006, the most recent year for which the data is available.
The Rutgers-Columbia research, based on millions of Medicaid and private insurance claims, is the most extensive analysis of its type yet on children’s antipsychotic drug use. It examined records for children in seven big states — including New York, Texas and California — selected to be representative of the nation’s Medicaid population, for the years 2001 and 2004.
The data indicated that more than 4 percent of patients ages 6 to 17 in Medicaid fee-for-service programs received antipsychotic drugs, compared with less than 1 percent of privately insured children and adolescents. More recent data through 2007 indicates that the disparity has remained, said Stephen Crystal, a Rutgers professor who led the study. Experts generally agree that some characteristics of the Medicaid population may contribute to psychological problems or psychiatric disorders. They include the stresses of poverty, single-parent homes, poorer schools, lack of access to preventive care and the fact that the Medicaid rolls include many adults who are themselves mentally ill.
As a result, studies have found that children in low-income families may have a higher rate of mental health problems — perhaps two to one — compared with children in better-off families. But that still does not explain the four-to-one disparity in prescribing antipsychotics.
Professor Crystal, who is the director of the Center for Pharmacotherapy at Rutgers, says his team’s data also indicates that poorer children are more likely to receive antipsychotics for less serious conditions than would typically prompt a prescription for a middle-class child.
But Professor Crystal said he did not have clear evidence to form an opinion on whether or not children on Medicaid were being overtreated.
“Medicaid kids are subject to a lot of stresses that lead to behavior issues which can be hard to distinguish from more serious psychiatric conditions,” he said. “It’s very hard to pin down.”
And yet Dr. Mark Olfson, a psychiatry professor at Columbia and a co-author of the study, said at least one thing was clear: “A lot of these kids are not getting other mental health services.”
The F.D.A. has approved antipsychotic drugs for children specifically to treat schizophrenia, autism and bipolar disorder. But they are more frequently prescribed to children for other, less extreme conditions, including attention deficit hyperactivity disorder, aggression, persistent defiance or other so-called conduct disorders — especially when the children are covered by Medicaid, the new study shows.
Although doctors may legally prescribe the drugs for these “off label” uses, there have been no long-term studies of their effects when used for such conditions.
The Rutgers-Columbia study found that Medicaid children were more likely than those with private insurance to be given the drugs for off-label uses like A.D.H.D. and conduct disorders. The privately insured children, in turn, were more likely than their Medicaid counterparts to receive the drugs for F.D.A.-approved uses like bipolar disorder.
Even if parents enrolled in Medicaid may be reluctant to put their children on drugs, some come to rely on them as the only thing that helps.
“They say it’s
impossible to stop now,” Evelyn Torres, 48, of the Bronx, said of her son’s use
of antipsychotics since he received a diagnosis of bipolar disorder at age 3.
Seven years later, the boy is now also afflicted with weight and heart problems.
But Ms. Torres credits Medicaid for making the boy’s mental and physical
conditions manageable. “They’re helping with everything,” she said.
Graphic – charts: http://www.nytimes.com/imagepages/2009/12/11/health/12medicaidg.html
Photo - Suzanne DeChillo/The New York Times - Dr. Derek H. Suite, a psychiatrist in the Bronx, says he sees many children on antipsychotic drugs who do not need them.
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A front page article in The New York Times raises the long-overdue alarms about the forced drugging of American children -- in particular poor children who are condemned to ingest toxic neuroleptics (a.k.a. 'atypical antipsychotics’) at a rate four times higher than children whose parents have private insurance. These drugs qualify under the definition of poison.
Wikepedia definition of poison: "In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism."
These drugs' toxic debilitating effects are clinically measurable and demonstrable in children's impaired biological functions (cardiovascular, hormonal, metabolic, gastrointestinal) and damaged organs (liver, heart, and brain) not to speak of their adverse effects on children's mental and psychological well-being.
The only unknown factor is how long it will take for these drugs' toxic effects to cause a particular child severe, irreversible damage.
"Some experts say they are stunned by the disparity in prescribing patterns. But others say it reinforces previous indications, and their own experience, that children with diagnoses of mental or emotional problems in low-income families are more likely to be given drugs than receive family counseling or psychotherapy."
Of note, as the Times reports, "Part of the reason is insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do."
This points to the (perhaps) unintended, but likely catastrophic consequences of a "public insurance option"--one that fails to rein in irresponsible clinicians who have financial ties to drug manufacturers. The FDA's failure to restrict the use of toxic, harm producing prescription drugs whose clinical efficacy is a matter of heated debate--coupled with the agency's recent irresponsible approval of these drugs for use in teens--without evidence of long-term safety usage--demonstrates a colossal disregard for America's vulnerable children who are relegated as sacrificial lambs.
The Times quotes one of the leading American child psychiatrists who suggests that children on Medicaid who are being prescribed poison at quadruple the rate that other American children are, "are getting better treatment."
"Maybe Medicaid kids are getting better treatment," said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. "If it helps keep them in school, maybe it's not so bad."
That encapsulates the perverse culture of psychiatry. Its leading “experts" maintain that disastrous treatment produced (iatrogenic) outcomes-- such as, drug-induced diabetes, cardiovascular disease, hyperprolactemia / gynecomastia (male enlarged breasts) *--are actually desirable outcomes from "better treatment." (* See: http://www.plasticsurgery4u.com/gynecomastia_gallery/teenage_gyno_gallery.htm)
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"Never impose on others what you would not choose for yourself." Confucius
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."
Roosevelt- Excerpt from the speech "Citizenship In A Republic",
delivered at the Sorbonne, in Paris, France on 23 April, 1910