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Prevalence of drugs for DSS wards questioned

A lawmaker and some parents are calling on the Commonwealth to disclose how many children in state care are being given psychotropic drugs, and for government agencies to take a critical look at the procedures for allowing these medicines to be prescribed.

They cite what they call an alarming statistic about the number of children in the care of the state Department of Social Services who are being treated for mental illness.

Figures from the Massachusetts Behavioral Health Partnership, an organization contracted by DSS to coordinate mental health coverage for children in foster care, guardianship programs, and some adoption cases, show that almost two-thirds of children in DSS care received either inpatient or outpatient mental health counseling or treatment during the 2003 fiscal year.

According to the data, the partnership provided 12,722 of 19,856 DSS children with mental health counseling or treatment. The organization says it does not keep track of how many children are prescribed psychotropic medicines such as Ritalin, Adderall, and Prozac.

"We need to look into the use of these drugs on children," said state Representative Marie Parente, chairwoman of the state special committee on foster care. "We need a commission to examine the whole practice of administering these psychotropic drugs to children in foster care."

Parente said the two-thirds percentage demands a closer look because it is inordinately high, compared with the incidence of mental health disorders in the general population. For example, the National Institute of Mental Health estimates that up to 2.5 percent of children and up to 8.3 percent of adolescents in the United States suffer from depression, and 4.1 percent of 9- to 17-year-olds suffer from attention deficit hyperactivity disorder, two of the most common mental illnesses for which the young are treated.

"Many children come from problem homes, but the children are really fine," said Parente. But Dr. Elizabeth Childs, commissioner of the state's Department of Mental Health, said the high number of children in state care receiving mental health services is logical, given the children's tumultuous family histories.

"These numbers are absolutely high, but if anything we need a heightened awareness, since these children might have an increased need for mental health services," she said. "I would rather see that we did intervene with 64 percent of the children than have 50 percent of the children who need access not get it."

For the past two years, Parente has sponsored state budget amendments that would create a task force to study how many children in state care are prescribed psychotropic drugs. After her latest measure was approved by the House and the Senate, Governor Mitt Romney vetoed the amendment earlier this summer.

Richard Powers, spokesman for the state Executive Office of Health and Human Services, said the governor supported an investigation but opposed the creation of a task force.

"We don't oppose the study, but we didn't think a separate study was necessary," he said. "We also thought that a study might be expanded beyond the psychotropics to all medications that children in foster care are taking."

Others say they are skeptical of the state's current approach. Gail Wilson-Giarratano of Springfield, who adopted her son in 2002, said that Richard, now 12, came out of the state foster care system on more medications than she could count and that she and her husband have been trying to get him off the prescriptions ever since.

"He has been on meds for so long that nobody knows why they were issued," she said. "He has been labeled as having behaviors he doesn't show."

Parente also suggested that the state may be motivated to label children as mentally ill because of the reimbursement checks they receive from the federal government, which compensates Massachusetts for half of all Medicaid expenditures.

She said the state files a pre-expenditure report outlining expected costs and each patient's eligibility for Medicaid and other federal aid. While the state is not reimbursed until it submits a report of services actually provided, Parente said there is a lot of room for the state to fudge numbers and list services that were never delivered.

"I am very concerned that they not label these children as having mental health problems in order to receive federal reimbursement," she said.

Powers said that such suggestions are baseless. "DSS does not label children to get more money," he said, adding that the department depends on the assessment of mental health professionals for medical decisions.

While national statistics on the number of children in state care being treated for mental illness do not exist, a 2004 study by the Chapin Hall Center for Children at the University of Chicago found that only 37 percent of 17-year-old foster children surveyed in Illinois, Iowa, and Wisconsin had received psychological and emotional counseling in the last year and almost one-quarter had been prescribed psychiatric drugs. Those numbers are much lower than the two-thirds figure recorded by the Massachusetts Behavioral Health Partnership.

Loretta Kowal, a Massachusetts social worker on DSS's professional advisory committee, said Massachusetts doctors strongly endorse the use of psychotropic medicines.

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"We have seen them be successful over and over again," she said. "There probably is a belief in the Massachusetts community that when all else fails, you try what's in the cabinet."

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