Foster children more likely to be prescribed psychotropic drugs than non-foster children, GAO study finds

By Tracy Jan, Globe Staff

WASHINGTON -- Foster children in Massachusetts are nearly four times as likely to be prescribed psychotropic drugs as non-foster children in the state, an alarming figure released in a report this morning by the Government Accountability Office during a congressional hearing.

The federal audit examined the rates of psychotropic prescriptions for foster and non-foster children insured by Medicaid in five states, including Florida, Michigan, Oregon, and Texas, using 2008 Medicaid data and found that foster children, including infants, were prescribed the drugs at rates 2.7 to 4.5 times higher than non-foster children.

While foster children tend to experience greater mental health needs and exposure to traumatic experiences, potential health risks can arise when patients are prescribed five or more drugs simultaneously, when prescriptions exceed recommended dosage guidelines, when children under 1 year old are given drugs, and when there are significant gaps in adhering to drug regimens, the report said.

Hundreds of children in the five states -- selected for their geographic diversity and large foster care population -- are on a regimen of five or more psychotropic drugs even though no evidence supports their concomitant use.

In Massachusetts, the audit found that foster children are being prescribed two or more psychotropic drugs concomitantly at a rate eight times that of non-foster children, and are almost four times as likely to be prescribed a medication exceeding FDA recommendations.

“The report we have received from GAO is both shocking and unacceptable,” said Massachusetts Senator Scott Brown, who fired off letters yesterday to the heads of the Massachusetts Department of Children and Families as well as MassHealth to express his concerns. “The very system that is supposed to be protecting these children is failing them.”

Brown is the ranking member of the Senate subcommittee on federal financial management, government information, federal services and international security, which held today’s hearing.

The monitoring programs for psychotropic drugs in the five states also fall short of the guidelines issued by the American Academy of Child and Adolescent Psychiatry, which states are not required to follow. According to the GAO analysis, Massachusetts has fully implemented just six out of 19 standards.

The GAO recommended that Health and Human Services issue guidance for states on how best to oversee psychotropic prescriptions for foster children. The drugs are used to treat mental disorders such as attention deficit hyperactivity disorder, bipolar disorder, depression, and schizophrenia.

In Massachusetts, 39 percent of foster children ages 0 to 17 are prescribed psychotropic drugs compared to just 10 percent of non-foster children. Among 13 to 17 year olds, 53 percent of foster children are given the drugs, compared to 15 percent of non-foster children.

But the state’s numbers may be skewed because the GAO only examined Medicaid fee-for-service data, which in Massachusetts includes most foster children, while other children insured by Medicaid are largely covered by managed-care plans.

And, the report said, higher levels of psychotropic drug prescriptions may be appropriate to deal with the increased prevalence and greater severity of mental health conditions among foster children. The study did not review appropriateness of the prescriptions because that would have required a case-by-case review of each child.