Social worker now missing for 18 days (Either she must have really pissed someone off, or she's sick of stealing children and ran away.)
Jan 5, 2010 10:12 PM | By JUDY LELLIOTT
--------------------------------------------------------------------------------
A frantic father has been searching for his missing social worker daughter for 18 days.
--------------------------------------------------------------------------------
Vuyelwa Phangwana, 40, disappeared on the morning of December 18, after leaving the offices of Johannesburg Child Welfare in Marshalltown, downtown Johannesburg, where she works.
"I don't know whether I am coming or going. I have been really miserable since my daughter disappeared," her 90-year-old father, Vincent Phangwana, told The Times.
"Vuyelwa left [work] with no explanation an hour after she arrived - at about 8.30am. She left her wallet and ID lying carelessly on the desk," said Child Welfare director Aileen Langley, who has been helping the family search for the mother of three.
Phangwana's sisters, Phakama, Ruth and Ellen, have taken in her three children, aged 17, 14 and two-and-a-half.
"We have been really miserable since she disappeared," said her father.
Vuyelwa's family, together with her co-workers, have been combing Johannesburg mortuaries, hospitals, police stations, jails, parks and public places for her.
No one close to her had any reason to believe she was in trouble at the time of her disappearance. Colleagues and her family do not believe that her disappearance was voluntary, as she had just landed her "dream job", after qualifying as a social worker in October, and would not leave it without cause. They also say she would never leave her children.
Ruth Mabuya, 50, a nurse at Chris Hani Baragwanath hospital, says she has "no idea" why her younger sister left.
"We have found nothing at this stage. I've been visiting hospitals once a week and I have not found anything yet," said the investigating officer, Constable PM Mashala.
Phangwana was last seen wearing brown pants and a white shirt with brown spots. She is dark-skinned and wears her hair short.
Anyone with information on her disappearance should call Mashala on 011-497-4072.
http://www.timeslive.co.za/news/article250040.ece
Isabella Brooke Knightly and Austin Gamez-Knightly
In Memory of my Loving Husband, William F. Knightly Jr. Murdered by ILLEGAL Palliative Care at a Nashua, NH Hospital
Wednesday, January 6, 2010
Court hears arguments in RI foster care lawsuit
Tuesday, January 5, 2010 Court hears arguments in RI foster care lawsuit
BC-RI — Foster Care Lawsuit,0133
Court hears arguments in RI foster care lawsuit
Eds: APNewsNow.
BOSTON (AP) — A federal appeals court has heard arguments on whether to reinstate a lawsuit that alleges major problems with Rhode Island’s foster care system.
The lawsuit from the child advocate’s office alleged widespread abuse and neglect of children in the state’s legal custody. But a federal judge dismissed it last spring, saying he didn’t believe the children’s interests were being adequately represented in the lawsuit.
A lawyer for Children’s Rights, a national watchdog and advocacy group, urged the 1st U.S. Circuit Court of Appeals in Boston to reverse that decision and reinstate the case. The attorney general’s office urged the court to uphold the dismissal.
Retired U.S. Supreme Court Justice David Souter was part of a three-judge panel that heard the arguments.
Comments from unverified accounts will be reviewed twice daily. Details here. Please verify your email address to allow immediate posting of comments.
http://www.nashuatelegraph.com/news/statenewengland/517986-227/court-hears-arguments-in-ri-foster-care.html
BC-RI — Foster Care Lawsuit,0133
Court hears arguments in RI foster care lawsuit
Eds: APNewsNow.
BOSTON (AP) — A federal appeals court has heard arguments on whether to reinstate a lawsuit that alleges major problems with Rhode Island’s foster care system.
The lawsuit from the child advocate’s office alleged widespread abuse and neglect of children in the state’s legal custody. But a federal judge dismissed it last spring, saying he didn’t believe the children’s interests were being adequately represented in the lawsuit.
A lawyer for Children’s Rights, a national watchdog and advocacy group, urged the 1st U.S. Circuit Court of Appeals in Boston to reverse that decision and reinstate the case. The attorney general’s office urged the court to uphold the dismissal.
Retired U.S. Supreme Court Justice David Souter was part of a three-judge panel that heard the arguments.
Comments from unverified accounts will be reviewed twice daily. Details here. Please verify your email address to allow immediate posting of comments.
http://www.nashuatelegraph.com/news/statenewengland/517986-227/court-hears-arguments-in-ri-foster-care.html
Tuesday, January 5, 2010
An Admission that Court-Appointed Defense Attorneys in CPS Cases Are in Bed with CPS - Right Out of the Horse's Mouth
Tuesday, January 5, 2010 From CPS-A System Out of Control
An Admission that Court-Appointed Defense Attorneys in CPS Cases Are in Bed with CPS - Right Out of the Horse's Mouth
The paragraph highlighted in bold is very scary, in that DFCS is allowed to use heresay in the hearing. This is what causes most of the parents problems. The fact that the hearsay is allowed as fact in a hearing. Also it plainly states that all the lawyers, judges etc are in bed together to see that the parent is the guilty party. Just another piece of proof that the State is buying and selling our children illegally.
Barton Clinic Summer 2008 Intern Report
Intern: Natalece Washington
Assignment: Jackson County Juvenile Court Attorney GAL Division
School: University of Georgia School of Law
As an intern in the Juvenile Court of Banks, Barrow, and Jackson Counties I worked with a Child Advocate Attorney who is appointed by the court pursuant to statute O.C.G.A. §15-11-6 (b) that requires that all children in Juvenile Court be represented by council and § 15-11-9 (b) that requires a Guardian ad litem to be appointed in order to protect the interest of the children whose interests may be in conflict with their parents’ interests. The Judge presiding over the Piedmont Judicial Circuit has enacted a standing order that requires a staff attorney who is assigned to the court’s Child Advocate Division to serve as an attorney- Guardian ad litem in all deprivation actions of the Juvenile Courts of Banks, Barrow, and Jackson Counties. At the start of the internship I identified the main goals of the Child Advocate Attorney. First, we investigate the child’s or sibling group’s situation. Next, we advocate in court hearings for what we have found to be in the best interest of the child. Finally, we monitor the child’s ongoing best interest for as long as they remain in care or as long as they are in a placement that must be reviewed by the court periodically.
Generally, in our office the child advocate attorneys follows the Best Interest model. This means that it is our strategic goal to always secure outcomes that are in the child’s best interest. During my internship, I only experienced one instance of conflicting roles. A teenager’s desires were in conflict with the Child Advocate Attorney’s best interest recommendation. Because of this conflict another attorney was appointed to follow the client-directed model of representation and represent the child’s wishes. I learned that this happens rarely and that this situation was unique because of the child’s age and competence.
Early into the summer I learned the models of representation to achieve the goals of the child advocate. However, there were many practical aspects of the task of child representation that could only be gained from work in the field. Efficiency, camaraderie among professionals in the Juvenile Court, and lawyering skill and savvy to work with an ever-changing group of babies, toddlers, pre-teens, and teenagers are the essential practical components of child advocacy.
The Juvenile Court’s efficiency is a top priority in the Piedmont Judicial Circuit. One method the judge uses to ensure efficiency is the Pre-Trial Conference. This is a time for all parties to come together to decide on the particulars of an Adjudicatory hearing. Another effort to maintain court efficiency is timely appointment of council. Parents who are a part of deprivation actions have the legal right to an attorney. If they are without the state requisite income to hire an attorney, the Public Defender’s office will have one appointed for them. In the Piedmont Judicial Circuit, parents often decide that they can use an attorney’s services only after the original shelter care proceeding. Unbeknownst to a pro se parent, the shelter care hearing allows hearsay and can be damaging because the judge hears this information when he is first introduced to the case. I have learned that skilled parent attorneys, when appointed before the shelter care hearing, often consent to waive the shelter care hearing- stipulating deprivation- and make plans to advocate for their client in the Adjudicatory hearing that is governed by the rules of evidence. Often after experiencing the damaging effects of a shelter care without legal representation, parents opt to have council in subsequent proceedings. This creates backlog and the judge will have to continue any case scheduled prior to appointment of council. In this circuit, the judge never neglects to tell the parents of their right to an attorney early, at the start of a shelter care hearing. Unfortunately, despite his good effort, their change of heart is often unavoidable.
Surprisingly, there is high level of camaraderie among the attorneys, service providers, DFCS, DJJ, and placement representatives in our deprivation proceedings. The child advocates are frequently in friendly negotiations with parent’s attorneys and the SAAG to achieve the best interest outcome. Although all attorneys involved have a distinct agenda, there is no embittered power struggle among them. Perhaps it is simply professional courtesy. Whatever the cause, I believe it is their relationships and discussion that clarify the issues of a case and each party’s desired outcome. I think this is the best environment for a child client who is often present in the courtroom during proceedings that directly effect his or her welfare. This camaraderie may not exist in a metropolitan environment. I have heard that there is more hostility between parties. I believe this may be do to the greater number of players involved. In this circuit, we deal with the same parent’s attorneys, private attorneys, SAAGs, and Child Advocates. There are not any surprises. We know who and what to expect and they are all familiar with the culture of the court. This probably differs from more populated counties.
Finally, a high level of technique and savvy is required to deal with child clients. Getting documented information from agencies, placements, schools, and doctors is relatively easy since we are equipped with a court order that requires that all reasonable requests be granted. Any requests found to be unreasonable must be challenged in writing before the court. What seems to be more difficult is getting information from a child. Child advocates interview children frequently. As an intern testing my interview skills I found myself often quite uncomfortable. I would often stutter and choose my words all too carefully. This only confused the child and discredited me as a professional. Children seemed to respond best when the interviewer is comfortable. So as the summer progressed I felt more at ease talking to kids about their home situations and desires and made more progress in that manner. When I watch my supervisor interview children it is as if she is working from a checklist of the perfect questions to ask. She does this all while playing with the child or casually speaking to a teenager, never note taking. Her casual nature seems to help the interviewee put their guard down just long enough for her to uncover the information that she needs. My supervisor assures me that interviewing skills are developed with time and practice.
I have notably learned this summer that the Attorney Child Advocates are expected to be much more than attorneys. They are social workers, counselors, therapists, pharmacology students, and friends to their clients. They perform each of these roles as they advocate for their clients best interest. Throughout the internship we’d visit clients’ homes, schools, relatives, and service providers and conduct social worker-like investigations. Child Advocates often act as a check on DFCS personnel. I appreciate the work of the Child Advocate for this reason. The leg work and time put into investigation are our own “reasonable efforts” to ensure the child’s best interest are being met. If you are advocating for a child to go live in their grandmother’s home and you have never met grandmother, visited her home, or spoken with her to learn of her consent to this plan, then you are advocating blindly.
Child advocates often are skilled in identifying a need for counseling or specialized treatment. They see problems and often know when a child is at their breaking point needing someone to talk to or therapy to keep them from harming themselves or others. As lay pharmacology students, child advocates often know just what a child’s diagnoses are just by viewing their list of prescribed medications. I have also learned that if parents are on certain mood regulating drugs, then children are potentially suffering from the same mental health issues. In what might be considered their most important role, child advocates are the familiar friendly face that a child can see consistently in and out of court. In our court, children sit by their attorney when present. Unless it is a shelter care hearing, they have already talked to their attorney and had an opportunity to develop a relationship with someone not involved with DFCS who represents them. Unfortunately, a child’s tears dampen many court proceedings. The child’s attorney, not only represents them, but also helps them through this period of fear or frustration. Because this attorney wears so many hats the job is a little overwhelming. However, looking forward to the end result makes the multi-tasking worthwhile.
Because of the court’s expectation that every child be effectively served and the heavy case loads that come along with that expectation there is a need to check that everyone’s job is being completed adequately. There are means to review cases periodically, outside the setting of a hearing to ensure that kids are having all of their needs met. The Citizens Panel Reviews provide a way to review cases that hadn’t been to court for a while. It makes the child advocate review the file and have a chance to meet with and discuss issues with other agencies. The community gets to participate to observe their tax dollars at work or to identify when some child is getting short changed.
Posted by Divotdawg at 12:18 AM
http://cpsasystemoutofcontrol.blogspot.com/2010/01/admission-that-court-appointed-defense.html
An Admission that Court-Appointed Defense Attorneys in CPS Cases Are in Bed with CPS - Right Out of the Horse's Mouth
The paragraph highlighted in bold is very scary, in that DFCS is allowed to use heresay in the hearing. This is what causes most of the parents problems. The fact that the hearsay is allowed as fact in a hearing. Also it plainly states that all the lawyers, judges etc are in bed together to see that the parent is the guilty party. Just another piece of proof that the State is buying and selling our children illegally.
Barton Clinic Summer 2008 Intern Report
Intern: Natalece Washington
Assignment: Jackson County Juvenile Court Attorney GAL Division
School: University of Georgia School of Law
As an intern in the Juvenile Court of Banks, Barrow, and Jackson Counties I worked with a Child Advocate Attorney who is appointed by the court pursuant to statute O.C.G.A. §15-11-6 (b) that requires that all children in Juvenile Court be represented by council and § 15-11-9 (b) that requires a Guardian ad litem to be appointed in order to protect the interest of the children whose interests may be in conflict with their parents’ interests. The Judge presiding over the Piedmont Judicial Circuit has enacted a standing order that requires a staff attorney who is assigned to the court’s Child Advocate Division to serve as an attorney- Guardian ad litem in all deprivation actions of the Juvenile Courts of Banks, Barrow, and Jackson Counties. At the start of the internship I identified the main goals of the Child Advocate Attorney. First, we investigate the child’s or sibling group’s situation. Next, we advocate in court hearings for what we have found to be in the best interest of the child. Finally, we monitor the child’s ongoing best interest for as long as they remain in care or as long as they are in a placement that must be reviewed by the court periodically.
Generally, in our office the child advocate attorneys follows the Best Interest model. This means that it is our strategic goal to always secure outcomes that are in the child’s best interest. During my internship, I only experienced one instance of conflicting roles. A teenager’s desires were in conflict with the Child Advocate Attorney’s best interest recommendation. Because of this conflict another attorney was appointed to follow the client-directed model of representation and represent the child’s wishes. I learned that this happens rarely and that this situation was unique because of the child’s age and competence.
Early into the summer I learned the models of representation to achieve the goals of the child advocate. However, there were many practical aspects of the task of child representation that could only be gained from work in the field. Efficiency, camaraderie among professionals in the Juvenile Court, and lawyering skill and savvy to work with an ever-changing group of babies, toddlers, pre-teens, and teenagers are the essential practical components of child advocacy.
The Juvenile Court’s efficiency is a top priority in the Piedmont Judicial Circuit. One method the judge uses to ensure efficiency is the Pre-Trial Conference. This is a time for all parties to come together to decide on the particulars of an Adjudicatory hearing. Another effort to maintain court efficiency is timely appointment of council. Parents who are a part of deprivation actions have the legal right to an attorney. If they are without the state requisite income to hire an attorney, the Public Defender’s office will have one appointed for them. In the Piedmont Judicial Circuit, parents often decide that they can use an attorney’s services only after the original shelter care proceeding. Unbeknownst to a pro se parent, the shelter care hearing allows hearsay and can be damaging because the judge hears this information when he is first introduced to the case. I have learned that skilled parent attorneys, when appointed before the shelter care hearing, often consent to waive the shelter care hearing- stipulating deprivation- and make plans to advocate for their client in the Adjudicatory hearing that is governed by the rules of evidence. Often after experiencing the damaging effects of a shelter care without legal representation, parents opt to have council in subsequent proceedings. This creates backlog and the judge will have to continue any case scheduled prior to appointment of council. In this circuit, the judge never neglects to tell the parents of their right to an attorney early, at the start of a shelter care hearing. Unfortunately, despite his good effort, their change of heart is often unavoidable.
Surprisingly, there is high level of camaraderie among the attorneys, service providers, DFCS, DJJ, and placement representatives in our deprivation proceedings. The child advocates are frequently in friendly negotiations with parent’s attorneys and the SAAG to achieve the best interest outcome. Although all attorneys involved have a distinct agenda, there is no embittered power struggle among them. Perhaps it is simply professional courtesy. Whatever the cause, I believe it is their relationships and discussion that clarify the issues of a case and each party’s desired outcome. I think this is the best environment for a child client who is often present in the courtroom during proceedings that directly effect his or her welfare. This camaraderie may not exist in a metropolitan environment. I have heard that there is more hostility between parties. I believe this may be do to the greater number of players involved. In this circuit, we deal with the same parent’s attorneys, private attorneys, SAAGs, and Child Advocates. There are not any surprises. We know who and what to expect and they are all familiar with the culture of the court. This probably differs from more populated counties.
Finally, a high level of technique and savvy is required to deal with child clients. Getting documented information from agencies, placements, schools, and doctors is relatively easy since we are equipped with a court order that requires that all reasonable requests be granted. Any requests found to be unreasonable must be challenged in writing before the court. What seems to be more difficult is getting information from a child. Child advocates interview children frequently. As an intern testing my interview skills I found myself often quite uncomfortable. I would often stutter and choose my words all too carefully. This only confused the child and discredited me as a professional. Children seemed to respond best when the interviewer is comfortable. So as the summer progressed I felt more at ease talking to kids about their home situations and desires and made more progress in that manner. When I watch my supervisor interview children it is as if she is working from a checklist of the perfect questions to ask. She does this all while playing with the child or casually speaking to a teenager, never note taking. Her casual nature seems to help the interviewee put their guard down just long enough for her to uncover the information that she needs. My supervisor assures me that interviewing skills are developed with time and practice.
I have notably learned this summer that the Attorney Child Advocates are expected to be much more than attorneys. They are social workers, counselors, therapists, pharmacology students, and friends to their clients. They perform each of these roles as they advocate for their clients best interest. Throughout the internship we’d visit clients’ homes, schools, relatives, and service providers and conduct social worker-like investigations. Child Advocates often act as a check on DFCS personnel. I appreciate the work of the Child Advocate for this reason. The leg work and time put into investigation are our own “reasonable efforts” to ensure the child’s best interest are being met. If you are advocating for a child to go live in their grandmother’s home and you have never met grandmother, visited her home, or spoken with her to learn of her consent to this plan, then you are advocating blindly.
Child advocates often are skilled in identifying a need for counseling or specialized treatment. They see problems and often know when a child is at their breaking point needing someone to talk to or therapy to keep them from harming themselves or others. As lay pharmacology students, child advocates often know just what a child’s diagnoses are just by viewing their list of prescribed medications. I have also learned that if parents are on certain mood regulating drugs, then children are potentially suffering from the same mental health issues. In what might be considered their most important role, child advocates are the familiar friendly face that a child can see consistently in and out of court. In our court, children sit by their attorney when present. Unless it is a shelter care hearing, they have already talked to their attorney and had an opportunity to develop a relationship with someone not involved with DFCS who represents them. Unfortunately, a child’s tears dampen many court proceedings. The child’s attorney, not only represents them, but also helps them through this period of fear or frustration. Because this attorney wears so many hats the job is a little overwhelming. However, looking forward to the end result makes the multi-tasking worthwhile.
Because of the court’s expectation that every child be effectively served and the heavy case loads that come along with that expectation there is a need to check that everyone’s job is being completed adequately. There are means to review cases periodically, outside the setting of a hearing to ensure that kids are having all of their needs met. The Citizens Panel Reviews provide a way to review cases that hadn’t been to court for a while. It makes the child advocate review the file and have a chance to meet with and discuss issues with other agencies. The community gets to participate to observe their tax dollars at work or to identify when some child is getting short changed.
Posted by Divotdawg at 12:18 AM
http://cpsasystemoutofcontrol.blogspot.com/2010/01/admission-that-court-appointed-defense.html
Parental Drug Abuse as Child Abuse
Current Through May 2009
You may wish to review this introductory text to better understand the information contained in your State's statute. To see how your State addresses this issue, visit the State Statutes Search.
Abuse of drugs or alcohol by parents and other caregivers can have negative effects on the health, safety, and well-being of children. Approximately 47 States, the District of Columbia, Guam, and the U.S Virgin Islands have laws within their child protection statutes that address the issue of substance abuse by parents.1 Two areas of concern are the harm caused by prenatal drug exposure and the harm caused to children of any age by exposure to illegal drug activity in their homes or environment.
Prenatal Drug Exposure
The Child Abuse Prevention and Treatment Act (CAPTA) requires States to have policies and procedures in place to notify child protective services (CPS) agencies of substance-exposed newborns (SENs) and to establish a plan of safe care for newborns identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.2 Several States currently address this requirement in their statutes. Approximately 16 States and the District of Columbia have specific reporting procedures for infants who show evidence at birth of having been exposed to drugs, alcohol, or other controlled substances; 12 States and the District of Columbia include this type of exposure in their definitions of child abuse or neglect.3
Some States specify in their statutes the response the CPS agency must make to reports of SENs. Hawaii and Maine require the State agency to develop a plan of safe care for the infant. California, Maryland, Minnesota, Missouri, Nevada, and the District of Columbia require the agency to complete an assessment of needs for the infant and for the infant's family and make a referral to appropriate services. Illinois and Minnesota require mandated reporters to report when they suspect that pregnant women are substance abusers so that the women can be referred for treatment.
Children Exposed to Illegal Drug Activity
There is increasing concern about the negative effects on children when parents or other members of their households abuse alcohol or drugs or engage in other illegal drug-related activity, such as the manufacture of methamphetamines in home-based laboratories. Many States have responded to this problem by expanding the civil definition of child abuse or neglect to include this concern. Specific circumstances that are considered child abuse or neglect in some States include:
Manufacturing a controlled substance in the presence of a child or on premises occupied by a child4
Exposing a child to, or allowing a child to be present where, chemicals or equipment for the manufacture of controlled substances are used or stored5
Selling, distributing, or giving drugs or alcohol to a child6
Using a controlled substance that impairs the caregiver's ability to adequately care for the child7
Exposing a child to the criminal sale or distribution of drugs8
Approximately 25 States and the U.S. Virgin Islands address in their criminal statutes the issue of exposing children to illegal drug activity.9 For example, in 14 States the manufacture or possession of methamphetamine in the presence of a child is a felony,10 and in four States, the manufacture or possession of any controlled substance in the presence of a child is considered a felony.11 California, Mississippi, Montana, North Carolina, Ohio, and Washington State have enacted enhanced penalties for any conviction for the manufacture of methamphetamine when a child was on the premises where the crime occurred.
Exposing children to the manufacture, possession, or distribution of illegal drugs is considered child endangerment in seven States.12 The exposure of a child to drugs or drug paraphernalia is a crime in North Dakota, Utah, and the Virgin Islands. In North Carolina and Wyoming, selling or giving an illegal drug to a child by any person is a felony.
To see how your State addresses this issue, visit the State Statutes Search.
To find information on all of the States and territories, view the complete printable PDF, Parental Drug Use as Child Abuse: Summary of State Laws (PDF - 324 KB).
--------------------------------------------------------------------------------
1 The word approximately is used to stress the fact that States frequently amend their laws. This information is current through May 2009. The statutes in American Samoa, Connecticut, New Jersey, Northern Mariana Islands, Puerto Rico, and Vermont do not currently address the issue of children exposed to illegal drug activity. back
2 42 U.S.C. 5101 et seq., as amended by the Keeping Children and Families Safe Act of 2003 (P.L. 108-36). For more information on these issues, as well as training resources and technical assistance, visit the website of the National Center on Substance Abuse and Child Welfare. back
3 Arizona, California, Hawaii, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, Oklahoma, Texas, and Utah have enacted specific reporting procedures for drug-exposed infants. Arkansas, Colorado, Florida, Illinois, Indiana, Minnesota, North Dakota, South Carolina, South Dakota, Texas, Virginia, and Wisconsin include exposure of infants to drugs in their definitions of child abuse or neglect. back
4 Colorado, Illinois, Indiana, Iowa, Montana, New Mexico, Oregon, South Dakota, Tennessee, Washington, Wisconsin, and the District of Columbia. back
5 Arizona, Arkansas, Iowa, New Mexico, North Dakota, and Oregon. back
6 Arkansas, Florida, Hawaii, Illinois, Iowa, Minnesota, Texas, and Guam. back
7 Iowa, Kentucky, Minnesota, New York, Rhode Island, and Texas. back
8 Montana, South Dakota, Virginia, and the District of Columbia. back
9 Alabama, Alaska, California, Delaware, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Utah, Virginia, Washington, West Virginia, and Wyoming currently address the issue in their criminal statutes. back
10 Georgia, Illinois, Iowa, Kansas, Louisiana, Montana, Nebraska, New Hampshire, Pennsylvania, South Carolina, Virginia, Washington, West Virginia, and Wyoming. back
11 Alabama, Idaho, Louisiana, and Ohio. back
12 Alaska, Delaware, Illinois, Iowa, Kansas, Missouri, and Montana. back
This publication is a product of the State Statutes Series prepared by Child Welfare Information Gateway. While every attempt has been made to be as complete as possible, additional information on these topics may be in other sections of a State's code as well as agency regulations, case law, and informal practices and procedures.
--------------------------------------------------------------------------------
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.
http://www.childwelfare.gov/systemwide/laws_policies/statutes/drugexposed.cfm
You may wish to review this introductory text to better understand the information contained in your State's statute. To see how your State addresses this issue, visit the State Statutes Search.
Abuse of drugs or alcohol by parents and other caregivers can have negative effects on the health, safety, and well-being of children. Approximately 47 States, the District of Columbia, Guam, and the U.S Virgin Islands have laws within their child protection statutes that address the issue of substance abuse by parents.1 Two areas of concern are the harm caused by prenatal drug exposure and the harm caused to children of any age by exposure to illegal drug activity in their homes or environment.
Prenatal Drug Exposure
The Child Abuse Prevention and Treatment Act (CAPTA) requires States to have policies and procedures in place to notify child protective services (CPS) agencies of substance-exposed newborns (SENs) and to establish a plan of safe care for newborns identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.2 Several States currently address this requirement in their statutes. Approximately 16 States and the District of Columbia have specific reporting procedures for infants who show evidence at birth of having been exposed to drugs, alcohol, or other controlled substances; 12 States and the District of Columbia include this type of exposure in their definitions of child abuse or neglect.3
Some States specify in their statutes the response the CPS agency must make to reports of SENs. Hawaii and Maine require the State agency to develop a plan of safe care for the infant. California, Maryland, Minnesota, Missouri, Nevada, and the District of Columbia require the agency to complete an assessment of needs for the infant and for the infant's family and make a referral to appropriate services. Illinois and Minnesota require mandated reporters to report when they suspect that pregnant women are substance abusers so that the women can be referred for treatment.
Children Exposed to Illegal Drug Activity
There is increasing concern about the negative effects on children when parents or other members of their households abuse alcohol or drugs or engage in other illegal drug-related activity, such as the manufacture of methamphetamines in home-based laboratories. Many States have responded to this problem by expanding the civil definition of child abuse or neglect to include this concern. Specific circumstances that are considered child abuse or neglect in some States include:
Manufacturing a controlled substance in the presence of a child or on premises occupied by a child4
Exposing a child to, or allowing a child to be present where, chemicals or equipment for the manufacture of controlled substances are used or stored5
Selling, distributing, or giving drugs or alcohol to a child6
Using a controlled substance that impairs the caregiver's ability to adequately care for the child7
Exposing a child to the criminal sale or distribution of drugs8
Approximately 25 States and the U.S. Virgin Islands address in their criminal statutes the issue of exposing children to illegal drug activity.9 For example, in 14 States the manufacture or possession of methamphetamine in the presence of a child is a felony,10 and in four States, the manufacture or possession of any controlled substance in the presence of a child is considered a felony.11 California, Mississippi, Montana, North Carolina, Ohio, and Washington State have enacted enhanced penalties for any conviction for the manufacture of methamphetamine when a child was on the premises where the crime occurred.
Exposing children to the manufacture, possession, or distribution of illegal drugs is considered child endangerment in seven States.12 The exposure of a child to drugs or drug paraphernalia is a crime in North Dakota, Utah, and the Virgin Islands. In North Carolina and Wyoming, selling or giving an illegal drug to a child by any person is a felony.
To see how your State addresses this issue, visit the State Statutes Search.
To find information on all of the States and territories, view the complete printable PDF, Parental Drug Use as Child Abuse: Summary of State Laws (PDF - 324 KB).
--------------------------------------------------------------------------------
1 The word approximately is used to stress the fact that States frequently amend their laws. This information is current through May 2009. The statutes in American Samoa, Connecticut, New Jersey, Northern Mariana Islands, Puerto Rico, and Vermont do not currently address the issue of children exposed to illegal drug activity. back
2 42 U.S.C. 5101 et seq., as amended by the Keeping Children and Families Safe Act of 2003 (P.L. 108-36). For more information on these issues, as well as training resources and technical assistance, visit the website of the National Center on Substance Abuse and Child Welfare. back
3 Arizona, California, Hawaii, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, Oklahoma, Texas, and Utah have enacted specific reporting procedures for drug-exposed infants. Arkansas, Colorado, Florida, Illinois, Indiana, Minnesota, North Dakota, South Carolina, South Dakota, Texas, Virginia, and Wisconsin include exposure of infants to drugs in their definitions of child abuse or neglect. back
4 Colorado, Illinois, Indiana, Iowa, Montana, New Mexico, Oregon, South Dakota, Tennessee, Washington, Wisconsin, and the District of Columbia. back
5 Arizona, Arkansas, Iowa, New Mexico, North Dakota, and Oregon. back
6 Arkansas, Florida, Hawaii, Illinois, Iowa, Minnesota, Texas, and Guam. back
7 Iowa, Kentucky, Minnesota, New York, Rhode Island, and Texas. back
8 Montana, South Dakota, Virginia, and the District of Columbia. back
9 Alabama, Alaska, California, Delaware, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Utah, Virginia, Washington, West Virginia, and Wyoming currently address the issue in their criminal statutes. back
10 Georgia, Illinois, Iowa, Kansas, Louisiana, Montana, Nebraska, New Hampshire, Pennsylvania, South Carolina, Virginia, Washington, West Virginia, and Wyoming. back
11 Alabama, Idaho, Louisiana, and Ohio. back
12 Alaska, Delaware, Illinois, Iowa, Kansas, Missouri, and Montana. back
This publication is a product of the State Statutes Series prepared by Child Welfare Information Gateway. While every attempt has been made to be as complete as possible, additional information on these topics may be in other sections of a State's code as well as agency regulations, case law, and informal practices and procedures.
--------------------------------------------------------------------------------
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.
http://www.childwelfare.gov/systemwide/laws_policies/statutes/drugexposed.cfm
Grounds for Termination of Parental Rights New Hampshire
Grounds for Termination of Parental Rights New Hampshire
Statute: §§ 170-C:5; 169-C:24-a
Circumstances That Are Grounds for Termination
Abandonment or Extreme Parental Disinterest
Abuse/Neglect
Mental Illness or Deficiency
Felony Conviction/Incarceration
Failure of Reasonable Efforts
Sexual Abuse
Failure to Provide Support
Child Judged in Need of Services/Dependent
Child's Best Interest
Child in care 15 of 22 months (or less)
Felony assault of child or sibling
Murder/Manslaughter of sibling child
Circumstances That Are Not Grounds for Termination
Alcohol or Drug Induced Incapacity
Abuse/Neglect or Loss of Rights of Another Child
Failure to Maintain Contact
Failure to Establish Paternity
N.H. Rev. Stat. Ann. § 169-C:24-a (Lexis, WESTLAW through 1999 Reg. Sess.)
The State, through an authorized agency, or if required by a district court, shall file a petition for termination of parental rights or, if such a petition has been filed by another party, the State shall seek to be joined as a party to such petition, where any one of the following circumstances exist:
Where a child has been an out-of-home placement pursuant to a finding of child neglect or abuse, under the responsibility of the State, for 12 of the most recent 22 months;
Where a court of competent jurisdiction has determined that a child has been abandoned;
Where a court of competent jurisdiction has made any one or more of the following determinations: That the parent has been convicted of murder or manslaughter of another child of the parent; the parent has been convicted of attempt, solicitation, or conspiracy to commit any of the offenses above; or the parent has been convicted of a felony assault that resulted in serious bodily injury to the child or another child of the parent.
The State may not be required to file a petition for termination of parental rights, or seek to be joined as a party to such a petition, if one or more of the following conditions exist:
The child is being appropriately cared for by a relative;
A State agency has documented in the case file a compelling reason for determining that filing a petition for termination of parental rights would not be in the best interests of the child; or
The State has not provided to the family of the child such services and reasonable efforts as the State deems necessary for the safe return of the child to the child's home. In determining whether the State has made reasonable efforts to prevent placement and reunify the family, the district court shall consider whether services to the family have been accessible, available, and appropriate.
N.H. Rev. Stat. Ann. § 170-C:5 (Lexis, WESTLAW through N.H. 2003 Legis. Serv., Ch. 79)
The petition may be granted where the court finds that one or more of the following conditions exist:
The parent has abandoned the child. It shall be presumed that the parent intended to abandon the child if the parent left the child without provision for his identification or left the child in the care and custody of another without any provision for his support or without communication from such parent for a period of six months. If, in the opinion of the court, the evidence indicates that such parent has made only minimal efforts to support or communicate with the child, the court may declare the child to be abandoned;
Although the parents are financially able, they have substantially and continuously neglected to provide the child with necessary subsistence, education, or other care necessary for his mental, emotional, or physical health or have substantially and continuously neglected to pay for such subsistence, education, or other care when legal custody is lodged with others. However, it shall not be grounds for the termination of the parent-child relationship for the sole reason that the parent relied upon spiritual means through prayer in accordance with a recognized religious method of healing in lieu of medical treatment for the healing of the child;
The parents, subsequent to a finding of child neglect or abuse, have failed to correct the conditions leading to such a finding within 12 months of the finding, despite reasonable efforts under the direction of the district court to rectify the conditions;
Because of mental deficiency or mental illness, the parent is, and will continue to be, incapable of giving the child proper parental care and protection for a longer period of time than would be wise or prudent to leave the child in an unstable or impermanent environment;
The parent knowingly or willfully caused or permitted another to cause severe sexual, physical, emotional or mental abuse of the child. Subsequent to a finding of such abuse, the parent-child relationship may be terminated if return of the child to the parent would result in a substantial possibility of harm to the child. A substantial possibility of harm to the child shall be established by testimony of at least two of the following factors:
The parent's conduct toward the child has
resulted in severe harm to the child;
The parent's conduct toward the child has continued despite the reasonable efforts of authorized agencies in obtaining or providing services for the parent to reduce or alleviate such conduct;
The parent's conduct has continued to occur either over a period of time, or many times, or to such a degree so as to indicate a pattern of behavior on the part of the parent which indicates a complete disregard for the child's health and welfare;
Such conduct is likely to continue with no change in parental behavior, attitude, or actions.
Testimony shall be provided by any combination of at least two of the following people: a licensed psychiatrist, a clinical psychologist, a physician, or social worker who possesses a master's degree in social work and is a member of the Academy of Certified Social Workers.
If the parent or guardian is, as a result of incarceration for a felony offense, unable to discharge his responsibilities to and for the child, and in addition, has been found to have abused or neglected his child or children, the court may review the conviction of the parent or guardian to determine whether the felony offense is of such nature, and the period of incarceration imposed such duration, that the child would be deprived of proper parental care and left in an unstable or impermanent environment for a longer period of time than would be prudent. Placement of the child in foster care shall not be considered proper parental care and protection. Incarceration, in and of itself, shall not be grounds for termination of parental rights;
The parent has been convicted of one or more of the following offenses: Murder or manslaughter of another child of the parent or of the child's other parent; attempt, solicitation, or conspiracy to commit any of the above offenses; or a felony assault which resulted in serious bodily injury to the child or to another child of the parent, or of the child's other parent.
http://library.adoption.com/articles/grounds-for-termination-of-parental-rights-new-hampshire.html
Statute: §§ 170-C:5; 169-C:24-a
Circumstances That Are Grounds for Termination
Abandonment or Extreme Parental Disinterest
Abuse/Neglect
Mental Illness or Deficiency
Felony Conviction/Incarceration
Failure of Reasonable Efforts
Sexual Abuse
Failure to Provide Support
Child Judged in Need of Services/Dependent
Child's Best Interest
Child in care 15 of 22 months (or less)
Felony assault of child or sibling
Murder/Manslaughter of sibling child
Circumstances That Are Not Grounds for Termination
Alcohol or Drug Induced Incapacity
Abuse/Neglect or Loss of Rights of Another Child
Failure to Maintain Contact
Failure to Establish Paternity
N.H. Rev. Stat. Ann. § 169-C:24-a (Lexis, WESTLAW through 1999 Reg. Sess.)
The State, through an authorized agency, or if required by a district court, shall file a petition for termination of parental rights or, if such a petition has been filed by another party, the State shall seek to be joined as a party to such petition, where any one of the following circumstances exist:
Where a child has been an out-of-home placement pursuant to a finding of child neglect or abuse, under the responsibility of the State, for 12 of the most recent 22 months;
Where a court of competent jurisdiction has determined that a child has been abandoned;
Where a court of competent jurisdiction has made any one or more of the following determinations: That the parent has been convicted of murder or manslaughter of another child of the parent; the parent has been convicted of attempt, solicitation, or conspiracy to commit any of the offenses above; or the parent has been convicted of a felony assault that resulted in serious bodily injury to the child or another child of the parent.
The State may not be required to file a petition for termination of parental rights, or seek to be joined as a party to such a petition, if one or more of the following conditions exist:
The child is being appropriately cared for by a relative;
A State agency has documented in the case file a compelling reason for determining that filing a petition for termination of parental rights would not be in the best interests of the child; or
The State has not provided to the family of the child such services and reasonable efforts as the State deems necessary for the safe return of the child to the child's home. In determining whether the State has made reasonable efforts to prevent placement and reunify the family, the district court shall consider whether services to the family have been accessible, available, and appropriate.
N.H. Rev. Stat. Ann. § 170-C:5 (Lexis, WESTLAW through N.H. 2003 Legis. Serv., Ch. 79)
The petition may be granted where the court finds that one or more of the following conditions exist:
The parent has abandoned the child. It shall be presumed that the parent intended to abandon the child if the parent left the child without provision for his identification or left the child in the care and custody of another without any provision for his support or without communication from such parent for a period of six months. If, in the opinion of the court, the evidence indicates that such parent has made only minimal efforts to support or communicate with the child, the court may declare the child to be abandoned;
Although the parents are financially able, they have substantially and continuously neglected to provide the child with necessary subsistence, education, or other care necessary for his mental, emotional, or physical health or have substantially and continuously neglected to pay for such subsistence, education, or other care when legal custody is lodged with others. However, it shall not be grounds for the termination of the parent-child relationship for the sole reason that the parent relied upon spiritual means through prayer in accordance with a recognized religious method of healing in lieu of medical treatment for the healing of the child;
The parents, subsequent to a finding of child neglect or abuse, have failed to correct the conditions leading to such a finding within 12 months of the finding, despite reasonable efforts under the direction of the district court to rectify the conditions;
Because of mental deficiency or mental illness, the parent is, and will continue to be, incapable of giving the child proper parental care and protection for a longer period of time than would be wise or prudent to leave the child in an unstable or impermanent environment;
The parent knowingly or willfully caused or permitted another to cause severe sexual, physical, emotional or mental abuse of the child. Subsequent to a finding of such abuse, the parent-child relationship may be terminated if return of the child to the parent would result in a substantial possibility of harm to the child. A substantial possibility of harm to the child shall be established by testimony of at least two of the following factors:
The parent's conduct toward the child has
resulted in severe harm to the child;
The parent's conduct toward the child has continued despite the reasonable efforts of authorized agencies in obtaining or providing services for the parent to reduce or alleviate such conduct;
The parent's conduct has continued to occur either over a period of time, or many times, or to such a degree so as to indicate a pattern of behavior on the part of the parent which indicates a complete disregard for the child's health and welfare;
Such conduct is likely to continue with no change in parental behavior, attitude, or actions.
Testimony shall be provided by any combination of at least two of the following people: a licensed psychiatrist, a clinical psychologist, a physician, or social worker who possesses a master's degree in social work and is a member of the Academy of Certified Social Workers.
If the parent or guardian is, as a result of incarceration for a felony offense, unable to discharge his responsibilities to and for the child, and in addition, has been found to have abused or neglected his child or children, the court may review the conviction of the parent or guardian to determine whether the felony offense is of such nature, and the period of incarceration imposed such duration, that the child would be deprived of proper parental care and left in an unstable or impermanent environment for a longer period of time than would be prudent. Placement of the child in foster care shall not be considered proper parental care and protection. Incarceration, in and of itself, shall not be grounds for termination of parental rights;
The parent has been convicted of one or more of the following offenses: Murder or manslaughter of another child of the parent or of the child's other parent; attempt, solicitation, or conspiracy to commit any of the above offenses; or a felony assault which resulted in serious bodily injury to the child or to another child of the parent, or of the child's other parent.
http://library.adoption.com/articles/grounds-for-termination-of-parental-rights-new-hampshire.html
Illegal Child Drugging Scandal: Alarming Revelations
Illegal Child Drugging Scandal: Alarming Revelations
The number of foster children on powerful psychiatric drugs was badly underreported, child-welfare bosses reveal.
The shocking numbers emerging from Florida’s investigation into psychiatric intervention in its foster care service represent a virtual pandemic of child drugging.
Nearly thirty percent of teenage Florida foster children have been prescribed a mental-health drug, and no less than 73 foster kids younger than 6 are taking mind-altering drugs, according to a study released on Thursday. In all, 2,669 children of Florida foster children are being given powerful psychiatric drugs.
This represents roughly a third more kids than a Department of Children and Families (DCF) database had reported as taking mental-health drugs: state records had seriously underreported the use of such drugs. Many of the drugs being illegally given to kids have never been approved by the Food and Drug Administration for use on children, and many are linked to serious side effects.
Investigation
The figures are the result of an investigation launched in response to the suicide of a seven year old foster child who was taking such medications. The child who took his own life, Gabriel Myers, had been given psychiatric drugs in the weeks leading up to his suicide. The drugs included anti-depressants that are linked to a high risk of suicide among children.
In violation of the law, neither Gabriel's parents nor a judge had consented to the use of such drugs.
''Normally, a 7-year-old boy is learning how to read and tie his shoes,'' said the DCF director. "It is incomprehensible to me even now that a child so young may have deliberately and consciously made a decision to end his life.''
Certainly one can but wonder what kind of distress the boy must have been suffering and why nothing effective was done to help him and, echoing the outrage of many observers and concerned citizens, he added that he had ''serious questions'' about the use of mental-health drugs on children.
Chemical Restraints
Worse even than the numbers involved in the abuse, are the possible motives behind the child drugging.
It has emerged that for almost a decade, Florida child advocates have complained that mental-health drugs are being used as ''chemical restraints'' to control some foster kids but their legitimate concerns appear to have been disregarded.
Andrea Moore, a former head of Florida's Children First who first suggested child-welfare workers were relying on mental-health drugs to control behavior, said, ''The shift-care workers at group homes are much more likely to report sadness and crying as depression, or anxiousness as some sort of mental-health problem,'' Ms Moore said.
Reporting "depression" and thus labeling the child mentally ill provides justification for drugging in an effort to render the child more malleable and, sadly, is in line with the common psychiatric practice of labeling normal human behavior an "illness" requiring psychiatric intervention.
But as Ms Moore pointed out: "You'd be sad and anxious, too, if you didn't know where you were going to live from day to day.''
Can any of us imagine what such a situation must be like for a small and helpless child? Certainly labeling a normal reaction to a distressing situation as a mental illness and using this as an excuse to drug with particularly dangerous chemicals that can set in train lifelong damage, appears to be the height not only of irresponsibility but of cruelty too.
It has emerged that caregivers were once told they did not need consents for mental-health drugs in certain cases -- meaning there may be significant numbers of incidences of drugging not listed at all!
Among the 20,235 children whose case files were studied, investigators found no parental or judicial consent on record for 16 percent of the children, the report said.
The report produced by the DCF outlines steps administrators will take.
These include:
• State child-welfare lawyers will seek permission to drug their children from parents who still have authority to make decisions on their children's behalf, or go to court to seek approval from a judge to start drugging.
• Administrators are launching an ''immediate'' review to determine how reliable the state's child-welfare database is. It is not clear to this writer what steps will be take to ensure that database becomes one hundred percent accurate.
• DCF administrators and the heads of private foster-care agencies throughout the state will discuss the use of psychiatric drugs by foster children weekly by telephone.
''The purpose of these calls is to ensure effective communication on improvements that must take place,'' the report said.
It is as yet unclear what precisely will be discussed and whether the discussion will include valid and highly workable alternatives to drugging or if those involved are even aware that such alternatives exist.
''This report is an important first step in closely examining not only this case -- but to help ensure this type of tragedy never happens again,'' the DCF Director said at a Thursday news conference.
Unfortunately, psychiatric drugs being what they are and having the side effects they are known to have, while their use continues there can be no guarantees the tragedy will not happen again.
Concern
There appears to be no news yet as to what will be done about psychiatrists and other care workers who broke the law relating to child drugging.
Equally cause for concern, the undertakings listed above seem to indicate a determination to go on drugging foster kids as long as the letter of the law is adhered to, whereas the whole concept of psychiatric involvement, particularly as this invariably means drugging, in the care of children is in urgent need of a rethink.
Several matters need to be urgently examined:
The scientific validity of the "disorders" or "mental illnesses" with which children are labeled as an excuse to drug them.
The number of people labeled "mentally ill" who are "cured" by the drugs they are given as opposed to the numbers who are merely drugged indefinitely without cure.
The number of children thus drugged who develop mental health "complications" including later addiction to street drugs.
The deterioration in performance in areas of life at local, state and national level, such as education, mental health and drug rehabilitation where psychiatry has been allowed to intervene.
The ineffectiveness of drugging in curing anything and its tendency to produce serious side effects and complications and the connection between serious crimes such as murders by youngsters and their medication by psychiatrists in the period preceding their crimes.
The percentage of drugged children who go on to become criminals at considerably exacerbated cost to both society and the state.
Why government is wasting taxpayers dollars on psychiatric methods when they are rendered outmoded by advances in knowledge of diet, nutrition and medicine is not clear. The state would not waste money on having leeches administered to sick children instead of antibiotics so why does it waste money on equally stone-age treatments for those emotionally troubled?
Whether it would be safer, healthier, kinder and more cost effective to spend money, not on psychiatry, but on ensuring effective nutrition and a safe, caring environment for foster kids.
Future
A race that fails to love and care for its children has abandoned its future. Most of us would like to think we do right by our young and that some kind of future is being ensured for our civilization.
We would appreciate our governments’ help in the matter.
About The Author
For more information about psychiatry at Citizens Commission and addiction at Narconon.
http://www.buzzle.com/articles/illegal-child-drugging-scandal-alarming-revelations.html
The number of foster children on powerful psychiatric drugs was badly underreported, child-welfare bosses reveal.
The shocking numbers emerging from Florida’s investigation into psychiatric intervention in its foster care service represent a virtual pandemic of child drugging.
Nearly thirty percent of teenage Florida foster children have been prescribed a mental-health drug, and no less than 73 foster kids younger than 6 are taking mind-altering drugs, according to a study released on Thursday. In all, 2,669 children of Florida foster children are being given powerful psychiatric drugs.
This represents roughly a third more kids than a Department of Children and Families (DCF) database had reported as taking mental-health drugs: state records had seriously underreported the use of such drugs. Many of the drugs being illegally given to kids have never been approved by the Food and Drug Administration for use on children, and many are linked to serious side effects.
Investigation
The figures are the result of an investigation launched in response to the suicide of a seven year old foster child who was taking such medications. The child who took his own life, Gabriel Myers, had been given psychiatric drugs in the weeks leading up to his suicide. The drugs included anti-depressants that are linked to a high risk of suicide among children.
In violation of the law, neither Gabriel's parents nor a judge had consented to the use of such drugs.
''Normally, a 7-year-old boy is learning how to read and tie his shoes,'' said the DCF director. "It is incomprehensible to me even now that a child so young may have deliberately and consciously made a decision to end his life.''
Certainly one can but wonder what kind of distress the boy must have been suffering and why nothing effective was done to help him and, echoing the outrage of many observers and concerned citizens, he added that he had ''serious questions'' about the use of mental-health drugs on children.
Chemical Restraints
Worse even than the numbers involved in the abuse, are the possible motives behind the child drugging.
It has emerged that for almost a decade, Florida child advocates have complained that mental-health drugs are being used as ''chemical restraints'' to control some foster kids but their legitimate concerns appear to have been disregarded.
Andrea Moore, a former head of Florida's Children First who first suggested child-welfare workers were relying on mental-health drugs to control behavior, said, ''The shift-care workers at group homes are much more likely to report sadness and crying as depression, or anxiousness as some sort of mental-health problem,'' Ms Moore said.
Reporting "depression" and thus labeling the child mentally ill provides justification for drugging in an effort to render the child more malleable and, sadly, is in line with the common psychiatric practice of labeling normal human behavior an "illness" requiring psychiatric intervention.
But as Ms Moore pointed out: "You'd be sad and anxious, too, if you didn't know where you were going to live from day to day.''
Can any of us imagine what such a situation must be like for a small and helpless child? Certainly labeling a normal reaction to a distressing situation as a mental illness and using this as an excuse to drug with particularly dangerous chemicals that can set in train lifelong damage, appears to be the height not only of irresponsibility but of cruelty too.
It has emerged that caregivers were once told they did not need consents for mental-health drugs in certain cases -- meaning there may be significant numbers of incidences of drugging not listed at all!
Among the 20,235 children whose case files were studied, investigators found no parental or judicial consent on record for 16 percent of the children, the report said.
The report produced by the DCF outlines steps administrators will take.
These include:
• State child-welfare lawyers will seek permission to drug their children from parents who still have authority to make decisions on their children's behalf, or go to court to seek approval from a judge to start drugging.
• Administrators are launching an ''immediate'' review to determine how reliable the state's child-welfare database is. It is not clear to this writer what steps will be take to ensure that database becomes one hundred percent accurate.
• DCF administrators and the heads of private foster-care agencies throughout the state will discuss the use of psychiatric drugs by foster children weekly by telephone.
''The purpose of these calls is to ensure effective communication on improvements that must take place,'' the report said.
It is as yet unclear what precisely will be discussed and whether the discussion will include valid and highly workable alternatives to drugging or if those involved are even aware that such alternatives exist.
''This report is an important first step in closely examining not only this case -- but to help ensure this type of tragedy never happens again,'' the DCF Director said at a Thursday news conference.
Unfortunately, psychiatric drugs being what they are and having the side effects they are known to have, while their use continues there can be no guarantees the tragedy will not happen again.
Concern
There appears to be no news yet as to what will be done about psychiatrists and other care workers who broke the law relating to child drugging.
Equally cause for concern, the undertakings listed above seem to indicate a determination to go on drugging foster kids as long as the letter of the law is adhered to, whereas the whole concept of psychiatric involvement, particularly as this invariably means drugging, in the care of children is in urgent need of a rethink.
Several matters need to be urgently examined:
The scientific validity of the "disorders" or "mental illnesses" with which children are labeled as an excuse to drug them.
The number of people labeled "mentally ill" who are "cured" by the drugs they are given as opposed to the numbers who are merely drugged indefinitely without cure.
The number of children thus drugged who develop mental health "complications" including later addiction to street drugs.
The deterioration in performance in areas of life at local, state and national level, such as education, mental health and drug rehabilitation where psychiatry has been allowed to intervene.
The ineffectiveness of drugging in curing anything and its tendency to produce serious side effects and complications and the connection between serious crimes such as murders by youngsters and their medication by psychiatrists in the period preceding their crimes.
The percentage of drugged children who go on to become criminals at considerably exacerbated cost to both society and the state.
Why government is wasting taxpayers dollars on psychiatric methods when they are rendered outmoded by advances in knowledge of diet, nutrition and medicine is not clear. The state would not waste money on having leeches administered to sick children instead of antibiotics so why does it waste money on equally stone-age treatments for those emotionally troubled?
Whether it would be safer, healthier, kinder and more cost effective to spend money, not on psychiatry, but on ensuring effective nutrition and a safe, caring environment for foster kids.
Future
A race that fails to love and care for its children has abandoned its future. Most of us would like to think we do right by our young and that some kind of future is being ensured for our civilization.
We would appreciate our governments’ help in the matter.
About The Author
For more information about psychiatry at Citizens Commission and addiction at Narconon.
http://www.buzzle.com/articles/illegal-child-drugging-scandal-alarming-revelations.html
Congressional hearing held on psychiatric drugging of USA foster care kids
Congressional hearing held on psychiatric drugging of USA foster care kids
by David W. Oaks — last modified 2008-05-15 12:27
The US Congress held a public hearing about the way youth in foster care are often given large amounts of powerful psychiatric drugs, without adequate oversight, accountability, information, alternatives and advocacy. Vera Sharav of Alliance for Human Research Protection issued this report.
Rep. McDermott announced the US congressional hearing on foster care psychiatric drugging.
May 15, 2008
Hearing: Drugging of Foster Children
ALLIANCE FOR HUMAN RESEARCH PROTECTION:
http://www.ahrp.org
A hearing held by The House Ways and Means Committee, May 8, focused on the use of psychotropic drugs for children in foster care.
Report by Vera Sharav
A riveting testimony was delivered by Misty Stenslie, Deputy Director, Foster Care Alumni of America (below).
She represents one of 12 million adults in this country who grew up in foster care, the government served as my parents. She spent 12 years in approximately 30 placements.
"My time in care resulted in a long list of diagnoses, including Post Traumatic Stress Disorder, Oppositional Defiant Disorder, Depression, and a sleep disorder. Because of the instability in my living situation, it seemed that the only option the professionals in my life were able to take for treating all of the diagnosed conditions was prescribing medication. Over the years I was on more medications than I can count--usually without my knowing what the meds were for, how I should expect to feel, side effects to watch out for, or any plan for follow up."
"The rates of post-traumatic stress disorder (PTSD) among foster care alumni are about twice as high as PTSD rates in war veterans and nearly 5 times the rates of the general public. Alumni experience panic disorder at rates more than three times that of the general population. People in and from foster care have particularly high rates of ADHD, chemical dependency, conduct disorder and depression and other mood disorders."
"Because of the insight and creativity of [my last] foster parents, I was able to see my world in a brand new way. I was able to ask that my medications be decreased and eventually discontinued, and they supported me in getting the kind of treatment that would make a sustainable difference in my life--learning new ways to cope, recognizing what is good and right in myself so that I could do more of it, identifying ways to keep myself safe without having to hide or fight. By the time I went off to college, I was no longer on any medications and I actually had the skills and knowledge I needed to take the place of the medications."
Not all children misprescribed psychotropic drugs, in and out of foster care, are as lucky as Misty Stenslie.
She offered some recommendations from the foster care alumni community.
Expert testimony by Dr. Julie Zito, professor of Pharmacy and Psychiatry at the University of Maryland, testified about the what the Medicaid data shows about psychotropic drug prescriptions for under 18 year olds. Dr. Zito has done numerous state Medicaid data analyses. Here is a snippet of her testimony:
High Foster Care-specific Prevalence of Psychotropic Medication Use.
Among community-based populations, foster care youth tend to receive psychotropic medication as much as or more than disabled youth and 3-4 times the rate among children with Medicaid coverage based on family income [temporary assistance for needy families (TANF) or state-Children's Health Insurance Program, (s-CHIP)]. For example, in 2004, 38% of the 32,000+ Texas foster care youth less than 19 years of age received a psychotropic prescription (Zito et al., 2008). When 2005 data were disaggregated by age group the 2005 annual prevalence of psychotropic medication was: 12.4% in 0-5 year olds; 55% in 6-12 year olds; and 66.5% in 13-17 year olds. When two-thirds of foster care adolescents receive treatment for emotional and behavioral problems, far in excess of the proportion in non-foster care population, we should have assurances that the youth are benefiting from such treatment.
. Poverty, social deprivation, and unsafe living environments do not necessarily justify complex, poorly evidenced psychopharmacologic drug regimens.
. Concomitant Psychotropic Medication Patterns in Foster Care with Little Evidence of Effectiveness or Safety.
Combinations of medication are prescribed in order to address multiple symptoms. The sparse data on such practice patterns suggest that it is increasing (Safer, Zito, & dosReis, 2003). To assess concomitant psychotropic classes in the Texas foster care data, we selected a one month cohort of youth in July 2004 and found 29% (n=429) received one or more classes of these medications.
Of these psychotropic-medicated youth, 72.5% received two or more psychotropic medication classes and 41.3% received 3 or more such classes. In such combinations, more than half the medicated youth had an antidepressant (56.8%); a similar proportion (55.6%) had an ADHD medication (a stimulant or atomoxetine) dispensed, and 53.2% had an antipsychotic dispensed. Most psychotropic combinations lack adequate evidence of effectiveness or safety in youth.
Typically, they are adopted based on knowledge generalized from adult studies or assume that the combination is as safe and effective as each component of the regimen. Such assumptions, however, are not warranted because data reveal that children and adolescents differ from adults in adverse drug reactions to psychotropic medications (Safer, 2004; Safer & Zito, 2006).
In addition, pediatric research shows that increasing the number of concomitant medications increases the likelihood of adverse drug reactions (Turner, Nunn, Fielding, & Choonara, 1999; Martinez-Mir et al., 1999). Long-term safety and drug-drug interactions are also more problematic. Data show that poorly evidenced regimens tend to increase in complexity over the age span suggesting that polypharmacy is not effective in managing the multiplicity of problems of foster care youth and others with serious social, behavioral and mental health problems who are often referred to as treatment-resistant or difficult to treat (Lader & Naber, 1999). This is particularly true when observing youth with repeated hospitalizations.
In the Texas cohort, 13% had a psychiatric hospitalization in the study year and 42% of these had a psychiatric hospital diagnosis of bipolar disorder. As younger age youth receive psychotropic medications, the early introduction of medications to the developing youth (12% of preschoolers in these data from Texas), suggests the need for drug safety studies. Drug safety studies require access to large community-based data sets, formation of cohorts for longitudinal assessment over successive years and epidemiologic methods for conducting observational safety studies. Yet, funding and training of clinical scientists for this type of research is quite modest (Klein, 1993; Klein, 2006) while the FDA is largely focused on the pre-marketing assessment of new drugs (APHA Joint Policy Committee, 2006).
Concomitant medication with antipsychotics and anticonvulsant-mood stabilizers is referred to as "off-label' usage, i.e., lacking FDA approved labeling for either the age group or the indication for treatment, e.g. an antipsychotic for ADHD or disruptive disorders. In the Texas foster care data, most antidepressant use was also off-label. Moreover, when the drug class use was compared among the leading diagnostic groups, there was little evidence of specificity. In youth with 3 or more medication classes, antipsychotic medications were used in 76.1% of those with an ADHD diagnosis; 75.8% of those with adjustment or anxiety diagnoses; and 84.1% of those with a depression diagnosis.
***If medication regimens increase the risk of adverse events without robust evidence of benefits (outcomes), prudence suggests that oversight programs monitor and review therapeutic interventions in professionally competent, individualized, and caring assessments.
Contact: Vera Hassner Sharav
212-595-8974
Subcommittee on Income Security and Family Support Hearing on the Utilization of Psychotropic Medication for Children in Foster Care Thursday, May 08, 2008
Hearing Advisory
McDermott Announces Hearing on the Utilization of Psychotropic Medication for Children in Foster Care Witness List
Julie M. Zito, Ph. D., Professor of Pharmacy and Psychiatry, Pharmaceutical Health Services Research, University of Maryland, Baltimore
Jeffrey Thompson, M.D., Medical Director, Washington State Department of Social and Health Services, Olympia, Washington
Tricia Lea, Ph.D., Director of Medical and Behavioral Services, Department of Children's Services, State of Tennessee
Misty Stenslie, Deputy Director, Foster Care Alumni of America
Laurel K. Leslie, Developmental-Behavioral Pediatrician, Center on Child and Family Outcomes, Tufts-New England Medical Center Institute for Clinical Research and Health Policy Studies
Christopher Bellonci, M.D., Medical Director, The Walker School, Needham, Massachusetts ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Public Hearing on Prescription Psychotropic Drug Use Among Children in Foster Care Response by Misty Stenslie, MSW Foster Care Alumni of America Deputy Director May 8, 2008
INTRODUCTION AND SUMMARY
Thank you, Chairman McDermott and members of the sub-committee for holding this important hearing today. As one of 12 million adults in this country who grew up in foster care, the government served as my parents. This committee and your colleagues in congress have stood in the places where our mothers and fathers belong for generations of foster youth, including the more than 500,000 children who live in care right now.
I am the Deputy Director of Foster Care Alumni of America. We are a national non-profit association that brings together those of us who share that foster care experience in order to be the permanent extended-family community for each other, something that many of us growing up never had. We also work with others-foster parents, social workers, policy makers, community members-to influence foster care practice and policy. Our goal is to erase the differences, the stigmas, the disparate outcomes that are faced by our brothers and sisters from care compared to the general public.
In addition to having grown up in foster care, I am a master's level social worker and have spent the last 19 years working in the child welfare system. I have worked in group home facilities, as a child protection worker, as a clinical social worker for young people in treatment foster care and their families. I now live in Minnesota and work around the country to improve the lives of those who come after me in foster care.
I am also proud to have been the licensed foster mother for three young people-Chris, Sean, and Tomikia. They came to me in their teen age years and are now 23, 24 and 26 years old.
The thing I know the most about in this world is foster care, having experienced it from so many different sides. On the topic of the use of prescription psychotropic medications with youth in foster care-and nearly any other topic related to child welfare-I have to start by acknowledging that there is simply no one right answer. But I do want to make sure that you hear from many different perspectives about what we, as the community of alumni, ask you to consider on this topic. Remember, you have taken on the very real role of parents for people in and from foster care and your careful deliberations-both as law makers and as mothers and fathers-is what we need.
In my childhood, I spent 12 years in approximately 30 placements. I lived in placement in MN, ND, SD, ID, UT, MT, WY, and NE. I experienced foster homes, group homes, shelter facilities, detention and correctional institutions, kinship care, and psychiatric/residential treatment. Through those unstable years, I probably had a couple hundred people who were responsible for me-yet no family. I emancipated with no permanent connections and very few resources. My time in care resulted in a long list of diagnoses, including Post Traumatic Stress Disorder, Oppositional Defiant Disorder, Depression, and a sleep disorder. Because of the instability in my living situation, it seemed that the only option the professionals in my life were able to take for treating all of the diagnosed conditions was prescribing medication. Over the years I was on more medications than I can count--usually without my knowing what the meds were for, how I should expect to feel, side effects to watch out for, or any plan for follow up.
It was not until I was a senior in high school and in my last foster home that I even knew that I could question the medications or challenge the diagnoses. In that home, the foster parents dutifully gave me my handful of pills each night for the first week or two and finally asked what they were for. I said I didn't really know, other than that they were supposed to help me sleep. My foster father asked me why I don't sleep well without them and I told him that I get so anxious at night when I hear noises that I can't get any rest. These foster parents did something incredible.
They skipped the medication one night, made cocoa, and sat around playing cards with me late into the evening. As we got into the deepest part of the night, we sat together and listened to all of the noises in the house. I could feel the familiar anxiety--but my foster dad patiently helped me figure out what all those noises were. It was the dog getting a drink of water upstairs. It was the furnace turning on. It was the water softener regenerating. My foster parents reassured me of my safety. They listened to my stories about how unsafe I had been in the home I came from. They acknowledged that I was actually very smart to be so vigilant and protective of myself that I didn't fall into such deep sleep that I could be hurt at my home. They helped me make sense of my reaction--which on paper looked like a disorder, but in the reality of my life had been the very best thing I could do for myself. They helped me to learn and believe that I didn't have the same reality anymore and I could let go of some of that vigilance. Because of the insight and creativity of those foster parents, I was able to see my world in a brand new way. I was able to ask that my medications be decreased and eventually discontinued, and they supported me in getting the kind of treatment that would make a sustainable difference in my life--learning new ways to cope, recognizing what is good and right in myself so that I could do more of it, identifying ways to keep myself safe without having to hide or fight.
By the time I went off to college, I was no longer on any medications and I actually had the skills and knowledge I needed to take the place of the medications. As you'll see in my testimony, we know from alumni that it is a common occurrence for youth in care to have an experience like this--receiving diagnoses and medications in response to their disordered lives. We know that sometimes that medication serves as a lifeline--it makes it possible for the young person to get through a particular crisis. They then have the opportunity to come out on the other side of the crisis to develop healthy strategies for coping. We also know that medications often are given as a substitute for what young people really need--stability, love, power, hope, and someone who sees them and hears them.
What is known about the mental health of people in and from foster care is that many of us have psychiatric needs due to the trauma of abuse and neglect. It is also true that youth in care face the additional trauma of removal from their homes and all of the people and places that are familiar and placement in the system. When youth experience placement instability, these traumas are compounded. The best treatment for this trauma is stability, patience, compassion, and safety.
We also know that young people in foster care are often coming from families of origin that are facing significant mental health issues. Whether as a result of trauma, a matter of genetic predisposition or a collision of those factors, many youth in care do have valid mental health disorders and do require treatment, sometimes including medication. Research conducted by Casey Family Programs1 has shown that mental health outcomes for adult alumni of foster care are disproportionately poor compared to the general population. Among the findings:
The rates of post-traumatic stress disorder (PTSD) among foster care alumni are about twice as high as PTSD rates in war veterans and nearly 5 times the rates of the general public.
Alumni experience panic disorder at rates more than three times that of the general population.
People in and from foster care have particularly high rates of ADHD, chemical dependency, conduct disorder and depression and other mood disorders.
There are no easy answers, but there are some recommendations we'd like to share as a community of alumni.
Pecora, P. J., Williams, J., Kessler, R. C., Downs, A. C., O'Brien, K., Hiripi, E., & Morello, S. (2003).
Assessing the effects of foster care: Early results from the Casey National Alumni Study. Seattle, WA: Casey Family Programs. Available at http://www.casey.org. Revised January 20, 2004.
Recommendations from alumni of foster care about the use of psychotropic medications:
1. Consistency is the key to adequate and appropriate mental health care. We need stable placements, we need a 'medical home', and we need professionals who know us and our circumstances-and who care about us enough to be effective advocates.
2. Medication should not be the first option considered and should never be the only mode of support we receive. Pills cannot change the experiences we've faced or the life situations we've been put into.
3. We need access to well-trained and supported professionals who can provide culturally competent services. The culture of foster care includes both challenges and victories that need to be recognized and supported by the people responsible for our care.
4. We need ongoing access to health care even after we've been adopted, reunified, or emancipated. Our needs don't change just because the court order or case plan does.
5. We need to know about our own lives, and need to be the primary voice in planning and decision-making. We need access to our records, information about our diagnoses and medications, and the power to seek or refuse treatment based on an educated and supported knowledge about our own lives. What alumni of foster care want you to know:
Foster Care Alumni of America is proud to be a member of the national Task Force on Foster Care through the American Academy of Pediatrics. As part of our work with the AAP, we've been conducting a survey of our members about their experiences and recommendations regarding health and mental health care access and services. In addition, we have a national community art project where people in and from foster care have submitted postcard art about what they've learned, what they want to share in connection to their foster care experiences. Here are some of the insights we've gathered.
"I was over-diagnosed and over-medicated. I was depressed and emotional when I first entered care and I did not respond to antidepressants. So they thought I had something more serious, but what I had was a life problem." --Alumna of care, mid-20s, Ohio
"Don't assume that foster children are "damaged" and need to be "fixed". Do your homework and learn as much as you can about the culture of foster care. Often individuals who are privileged in our society overlook even the simplest of things that foster children must deal with every day (e.g., who loves me? where do I belong?). Society continues to send messages to foster children about the value of family (e.g., home is where the heart is - family is the key to happiness) however, those who live outside of secure committed families feel marginalized and disempowered." --Alumnus of foster care
"Scary things in my case file made people assume that there were scary things inside my head. I really was struggling, but I needed time with people, attention, someone who loved me, somebody to talk with who wasn't there for a paycheck."
--Alumna of care, late 30s, Virginia
"I was put on medication as soon as I entered the system. Did they understand I was grieving, scared, confused about my life? No, they figured let's give her a pill. All I ever wanted was for someone to listen." --Alumna of care, California
"Once I left the system I became homeless and without money to afford medication I was left to my own devices: self-medicating with drugs. Luckily, the law "helped" me to learn my lesson. As an adult, my own children are in foster care. I don't think this would have happened if I'd gotten what I needed as a child and I'm working so hard to make it different"
--Alumnus of care
"Pills can't take away what happened to me." --Alumna of care
"The system enabled me to become chemically dependant to my meds. I sought out ways to feel numb once the system was gone, once my medical was cut off ---- alcohol and drugs."
--Alumnus of care
"The best care I got was people accepting me where I was at...not trying to change me as though I was broken/damaged, but being allowing me the room to express my experiences without judgment from the doctor or counselor. The most helpful experience was one in which the counselor or doctor did not assume they knew me based on a file."
--Alumnus of care
"My case file made me look very oppositional--I had a long criminal history as well as chemical abuse issues. What seemed to escape the notice of the system was the fact that any criminal or using behaviors were all connected to my biological family--either activities done WITH them or as a method of coping with them. I think because of that, I wasn't taken seriously. I wasn't respected or heard."
--Alumnus of care
"I had 8 diagnoses. I wish they would have had compassion and realized group homes were tough...and so was my childhood...and just given it time....or provided me with an adjustment disorder diagnosis." --Alumnus of care
On behalf of all of us in and from foster care, thank you for standing in the place where our parents belong. Thank you for considering the expertise we have to offer as people who have learned about foster care from the inside. Know that our organization, Foster Care Alumni of America, is available any time policy related to foster care is being considered. We have members from all 50 states, with our youngest members being 18 and our eldest in their 80s. It matters to us that the youth who come after us in foster care have the best that the system has to offer-stability, love, safety, and peace-and we want to help you make that happen.
Hugh Massengill, psychiatric survivor and MFI member, addresses opening session of City of Eugene, Oregon, USA conference on Choice in Mental Health Care as a Human Right at the University of Oregon.
MindFreedom International - 454 Willamette, Suite 216 - PO Box 11284 - Eugene, OR 97440-3484 USA
phone: 541-345-9106 USA toll free 1-877-MAD-PRID[e] fax: 480-287-8833
http://www.mindfreedom.org/kb/youth-mental-health/foster-care-psychiatric-drugs/psychotropic-medication-hearing/
by David W. Oaks — last modified 2008-05-15 12:27
The US Congress held a public hearing about the way youth in foster care are often given large amounts of powerful psychiatric drugs, without adequate oversight, accountability, information, alternatives and advocacy. Vera Sharav of Alliance for Human Research Protection issued this report.
Rep. McDermott announced the US congressional hearing on foster care psychiatric drugging.
May 15, 2008
Hearing: Drugging of Foster Children
ALLIANCE FOR HUMAN RESEARCH PROTECTION:
http://www.ahrp.org
A hearing held by The House Ways and Means Committee, May 8, focused on the use of psychotropic drugs for children in foster care.
Report by Vera Sharav
A riveting testimony was delivered by Misty Stenslie, Deputy Director, Foster Care Alumni of America (below).
She represents one of 12 million adults in this country who grew up in foster care, the government served as my parents. She spent 12 years in approximately 30 placements.
"My time in care resulted in a long list of diagnoses, including Post Traumatic Stress Disorder, Oppositional Defiant Disorder, Depression, and a sleep disorder. Because of the instability in my living situation, it seemed that the only option the professionals in my life were able to take for treating all of the diagnosed conditions was prescribing medication. Over the years I was on more medications than I can count--usually without my knowing what the meds were for, how I should expect to feel, side effects to watch out for, or any plan for follow up."
"The rates of post-traumatic stress disorder (PTSD) among foster care alumni are about twice as high as PTSD rates in war veterans and nearly 5 times the rates of the general public. Alumni experience panic disorder at rates more than three times that of the general population. People in and from foster care have particularly high rates of ADHD, chemical dependency, conduct disorder and depression and other mood disorders."
"Because of the insight and creativity of [my last] foster parents, I was able to see my world in a brand new way. I was able to ask that my medications be decreased and eventually discontinued, and they supported me in getting the kind of treatment that would make a sustainable difference in my life--learning new ways to cope, recognizing what is good and right in myself so that I could do more of it, identifying ways to keep myself safe without having to hide or fight. By the time I went off to college, I was no longer on any medications and I actually had the skills and knowledge I needed to take the place of the medications."
Not all children misprescribed psychotropic drugs, in and out of foster care, are as lucky as Misty Stenslie.
She offered some recommendations from the foster care alumni community.
Expert testimony by Dr. Julie Zito, professor of Pharmacy and Psychiatry at the University of Maryland, testified about the what the Medicaid data shows about psychotropic drug prescriptions for under 18 year olds. Dr. Zito has done numerous state Medicaid data analyses. Here is a snippet of her testimony:
High Foster Care-specific Prevalence of Psychotropic Medication Use.
Among community-based populations, foster care youth tend to receive psychotropic medication as much as or more than disabled youth and 3-4 times the rate among children with Medicaid coverage based on family income [temporary assistance for needy families (TANF) or state-Children's Health Insurance Program, (s-CHIP)]. For example, in 2004, 38% of the 32,000+ Texas foster care youth less than 19 years of age received a psychotropic prescription (Zito et al., 2008). When 2005 data were disaggregated by age group the 2005 annual prevalence of psychotropic medication was: 12.4% in 0-5 year olds; 55% in 6-12 year olds; and 66.5% in 13-17 year olds. When two-thirds of foster care adolescents receive treatment for emotional and behavioral problems, far in excess of the proportion in non-foster care population, we should have assurances that the youth are benefiting from such treatment.
. Poverty, social deprivation, and unsafe living environments do not necessarily justify complex, poorly evidenced psychopharmacologic drug regimens.
. Concomitant Psychotropic Medication Patterns in Foster Care with Little Evidence of Effectiveness or Safety.
Combinations of medication are prescribed in order to address multiple symptoms. The sparse data on such practice patterns suggest that it is increasing (Safer, Zito, & dosReis, 2003). To assess concomitant psychotropic classes in the Texas foster care data, we selected a one month cohort of youth in July 2004 and found 29% (n=429) received one or more classes of these medications.
Of these psychotropic-medicated youth, 72.5% received two or more psychotropic medication classes and 41.3% received 3 or more such classes. In such combinations, more than half the medicated youth had an antidepressant (56.8%); a similar proportion (55.6%) had an ADHD medication (a stimulant or atomoxetine) dispensed, and 53.2% had an antipsychotic dispensed. Most psychotropic combinations lack adequate evidence of effectiveness or safety in youth.
Typically, they are adopted based on knowledge generalized from adult studies or assume that the combination is as safe and effective as each component of the regimen. Such assumptions, however, are not warranted because data reveal that children and adolescents differ from adults in adverse drug reactions to psychotropic medications (Safer, 2004; Safer & Zito, 2006).
In addition, pediatric research shows that increasing the number of concomitant medications increases the likelihood of adverse drug reactions (Turner, Nunn, Fielding, & Choonara, 1999; Martinez-Mir et al., 1999). Long-term safety and drug-drug interactions are also more problematic. Data show that poorly evidenced regimens tend to increase in complexity over the age span suggesting that polypharmacy is not effective in managing the multiplicity of problems of foster care youth and others with serious social, behavioral and mental health problems who are often referred to as treatment-resistant or difficult to treat (Lader & Naber, 1999). This is particularly true when observing youth with repeated hospitalizations.
In the Texas cohort, 13% had a psychiatric hospitalization in the study year and 42% of these had a psychiatric hospital diagnosis of bipolar disorder. As younger age youth receive psychotropic medications, the early introduction of medications to the developing youth (12% of preschoolers in these data from Texas), suggests the need for drug safety studies. Drug safety studies require access to large community-based data sets, formation of cohorts for longitudinal assessment over successive years and epidemiologic methods for conducting observational safety studies. Yet, funding and training of clinical scientists for this type of research is quite modest (Klein, 1993; Klein, 2006) while the FDA is largely focused on the pre-marketing assessment of new drugs (APHA Joint Policy Committee, 2006).
Concomitant medication with antipsychotics and anticonvulsant-mood stabilizers is referred to as "off-label' usage, i.e., lacking FDA approved labeling for either the age group or the indication for treatment, e.g. an antipsychotic for ADHD or disruptive disorders. In the Texas foster care data, most antidepressant use was also off-label. Moreover, when the drug class use was compared among the leading diagnostic groups, there was little evidence of specificity. In youth with 3 or more medication classes, antipsychotic medications were used in 76.1% of those with an ADHD diagnosis; 75.8% of those with adjustment or anxiety diagnoses; and 84.1% of those with a depression diagnosis.
***If medication regimens increase the risk of adverse events without robust evidence of benefits (outcomes), prudence suggests that oversight programs monitor and review therapeutic interventions in professionally competent, individualized, and caring assessments.
Contact: Vera Hassner Sharav
212-595-8974
Subcommittee on Income Security and Family Support Hearing on the Utilization of Psychotropic Medication for Children in Foster Care Thursday, May 08, 2008
Hearing Advisory
McDermott Announces Hearing on the Utilization of Psychotropic Medication for Children in Foster Care Witness List
Julie M. Zito, Ph. D., Professor of Pharmacy and Psychiatry, Pharmaceutical Health Services Research, University of Maryland, Baltimore
Jeffrey Thompson, M.D., Medical Director, Washington State Department of Social and Health Services, Olympia, Washington
Tricia Lea, Ph.D., Director of Medical and Behavioral Services, Department of Children's Services, State of Tennessee
Misty Stenslie, Deputy Director, Foster Care Alumni of America
Laurel K. Leslie, Developmental-Behavioral Pediatrician, Center on Child and Family Outcomes, Tufts-New England Medical Center Institute for Clinical Research and Health Policy Studies
Christopher Bellonci, M.D., Medical Director, The Walker School, Needham, Massachusetts ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Public Hearing on Prescription Psychotropic Drug Use Among Children in Foster Care Response by Misty Stenslie, MSW Foster Care Alumni of America Deputy Director May 8, 2008
INTRODUCTION AND SUMMARY
Thank you, Chairman McDermott and members of the sub-committee for holding this important hearing today. As one of 12 million adults in this country who grew up in foster care, the government served as my parents. This committee and your colleagues in congress have stood in the places where our mothers and fathers belong for generations of foster youth, including the more than 500,000 children who live in care right now.
I am the Deputy Director of Foster Care Alumni of America. We are a national non-profit association that brings together those of us who share that foster care experience in order to be the permanent extended-family community for each other, something that many of us growing up never had. We also work with others-foster parents, social workers, policy makers, community members-to influence foster care practice and policy. Our goal is to erase the differences, the stigmas, the disparate outcomes that are faced by our brothers and sisters from care compared to the general public.
In addition to having grown up in foster care, I am a master's level social worker and have spent the last 19 years working in the child welfare system. I have worked in group home facilities, as a child protection worker, as a clinical social worker for young people in treatment foster care and their families. I now live in Minnesota and work around the country to improve the lives of those who come after me in foster care.
I am also proud to have been the licensed foster mother for three young people-Chris, Sean, and Tomikia. They came to me in their teen age years and are now 23, 24 and 26 years old.
The thing I know the most about in this world is foster care, having experienced it from so many different sides. On the topic of the use of prescription psychotropic medications with youth in foster care-and nearly any other topic related to child welfare-I have to start by acknowledging that there is simply no one right answer. But I do want to make sure that you hear from many different perspectives about what we, as the community of alumni, ask you to consider on this topic. Remember, you have taken on the very real role of parents for people in and from foster care and your careful deliberations-both as law makers and as mothers and fathers-is what we need.
In my childhood, I spent 12 years in approximately 30 placements. I lived in placement in MN, ND, SD, ID, UT, MT, WY, and NE. I experienced foster homes, group homes, shelter facilities, detention and correctional institutions, kinship care, and psychiatric/residential treatment. Through those unstable years, I probably had a couple hundred people who were responsible for me-yet no family. I emancipated with no permanent connections and very few resources. My time in care resulted in a long list of diagnoses, including Post Traumatic Stress Disorder, Oppositional Defiant Disorder, Depression, and a sleep disorder. Because of the instability in my living situation, it seemed that the only option the professionals in my life were able to take for treating all of the diagnosed conditions was prescribing medication. Over the years I was on more medications than I can count--usually without my knowing what the meds were for, how I should expect to feel, side effects to watch out for, or any plan for follow up.
It was not until I was a senior in high school and in my last foster home that I even knew that I could question the medications or challenge the diagnoses. In that home, the foster parents dutifully gave me my handful of pills each night for the first week or two and finally asked what they were for. I said I didn't really know, other than that they were supposed to help me sleep. My foster father asked me why I don't sleep well without them and I told him that I get so anxious at night when I hear noises that I can't get any rest. These foster parents did something incredible.
They skipped the medication one night, made cocoa, and sat around playing cards with me late into the evening. As we got into the deepest part of the night, we sat together and listened to all of the noises in the house. I could feel the familiar anxiety--but my foster dad patiently helped me figure out what all those noises were. It was the dog getting a drink of water upstairs. It was the furnace turning on. It was the water softener regenerating. My foster parents reassured me of my safety. They listened to my stories about how unsafe I had been in the home I came from. They acknowledged that I was actually very smart to be so vigilant and protective of myself that I didn't fall into such deep sleep that I could be hurt at my home. They helped me make sense of my reaction--which on paper looked like a disorder, but in the reality of my life had been the very best thing I could do for myself. They helped me to learn and believe that I didn't have the same reality anymore and I could let go of some of that vigilance. Because of the insight and creativity of those foster parents, I was able to see my world in a brand new way. I was able to ask that my medications be decreased and eventually discontinued, and they supported me in getting the kind of treatment that would make a sustainable difference in my life--learning new ways to cope, recognizing what is good and right in myself so that I could do more of it, identifying ways to keep myself safe without having to hide or fight.
By the time I went off to college, I was no longer on any medications and I actually had the skills and knowledge I needed to take the place of the medications. As you'll see in my testimony, we know from alumni that it is a common occurrence for youth in care to have an experience like this--receiving diagnoses and medications in response to their disordered lives. We know that sometimes that medication serves as a lifeline--it makes it possible for the young person to get through a particular crisis. They then have the opportunity to come out on the other side of the crisis to develop healthy strategies for coping. We also know that medications often are given as a substitute for what young people really need--stability, love, power, hope, and someone who sees them and hears them.
What is known about the mental health of people in and from foster care is that many of us have psychiatric needs due to the trauma of abuse and neglect. It is also true that youth in care face the additional trauma of removal from their homes and all of the people and places that are familiar and placement in the system. When youth experience placement instability, these traumas are compounded. The best treatment for this trauma is stability, patience, compassion, and safety.
We also know that young people in foster care are often coming from families of origin that are facing significant mental health issues. Whether as a result of trauma, a matter of genetic predisposition or a collision of those factors, many youth in care do have valid mental health disorders and do require treatment, sometimes including medication. Research conducted by Casey Family Programs1 has shown that mental health outcomes for adult alumni of foster care are disproportionately poor compared to the general population. Among the findings:
The rates of post-traumatic stress disorder (PTSD) among foster care alumni are about twice as high as PTSD rates in war veterans and nearly 5 times the rates of the general public.
Alumni experience panic disorder at rates more than three times that of the general population.
People in and from foster care have particularly high rates of ADHD, chemical dependency, conduct disorder and depression and other mood disorders.
There are no easy answers, but there are some recommendations we'd like to share as a community of alumni.
Pecora, P. J., Williams, J., Kessler, R. C., Downs, A. C., O'Brien, K., Hiripi, E., & Morello, S. (2003).
Assessing the effects of foster care: Early results from the Casey National Alumni Study. Seattle, WA: Casey Family Programs. Available at http://www.casey.org. Revised January 20, 2004.
Recommendations from alumni of foster care about the use of psychotropic medications:
1. Consistency is the key to adequate and appropriate mental health care. We need stable placements, we need a 'medical home', and we need professionals who know us and our circumstances-and who care about us enough to be effective advocates.
2. Medication should not be the first option considered and should never be the only mode of support we receive. Pills cannot change the experiences we've faced or the life situations we've been put into.
3. We need access to well-trained and supported professionals who can provide culturally competent services. The culture of foster care includes both challenges and victories that need to be recognized and supported by the people responsible for our care.
4. We need ongoing access to health care even after we've been adopted, reunified, or emancipated. Our needs don't change just because the court order or case plan does.
5. We need to know about our own lives, and need to be the primary voice in planning and decision-making. We need access to our records, information about our diagnoses and medications, and the power to seek or refuse treatment based on an educated and supported knowledge about our own lives. What alumni of foster care want you to know:
Foster Care Alumni of America is proud to be a member of the national Task Force on Foster Care through the American Academy of Pediatrics. As part of our work with the AAP, we've been conducting a survey of our members about their experiences and recommendations regarding health and mental health care access and services. In addition, we have a national community art project where people in and from foster care have submitted postcard art about what they've learned, what they want to share in connection to their foster care experiences. Here are some of the insights we've gathered.
"I was over-diagnosed and over-medicated. I was depressed and emotional when I first entered care and I did not respond to antidepressants. So they thought I had something more serious, but what I had was a life problem." --Alumna of care, mid-20s, Ohio
"Don't assume that foster children are "damaged" and need to be "fixed". Do your homework and learn as much as you can about the culture of foster care. Often individuals who are privileged in our society overlook even the simplest of things that foster children must deal with every day (e.g., who loves me? where do I belong?). Society continues to send messages to foster children about the value of family (e.g., home is where the heart is - family is the key to happiness) however, those who live outside of secure committed families feel marginalized and disempowered." --Alumnus of foster care
"Scary things in my case file made people assume that there were scary things inside my head. I really was struggling, but I needed time with people, attention, someone who loved me, somebody to talk with who wasn't there for a paycheck."
--Alumna of care, late 30s, Virginia
"I was put on medication as soon as I entered the system. Did they understand I was grieving, scared, confused about my life? No, they figured let's give her a pill. All I ever wanted was for someone to listen." --Alumna of care, California
"Once I left the system I became homeless and without money to afford medication I was left to my own devices: self-medicating with drugs. Luckily, the law "helped" me to learn my lesson. As an adult, my own children are in foster care. I don't think this would have happened if I'd gotten what I needed as a child and I'm working so hard to make it different"
--Alumnus of care
"Pills can't take away what happened to me." --Alumna of care
"The system enabled me to become chemically dependant to my meds. I sought out ways to feel numb once the system was gone, once my medical was cut off ---- alcohol and drugs."
--Alumnus of care
"The best care I got was people accepting me where I was at...not trying to change me as though I was broken/damaged, but being allowing me the room to express my experiences without judgment from the doctor or counselor. The most helpful experience was one in which the counselor or doctor did not assume they knew me based on a file."
--Alumnus of care
"My case file made me look very oppositional--I had a long criminal history as well as chemical abuse issues. What seemed to escape the notice of the system was the fact that any criminal or using behaviors were all connected to my biological family--either activities done WITH them or as a method of coping with them. I think because of that, I wasn't taken seriously. I wasn't respected or heard."
--Alumnus of care
"I had 8 diagnoses. I wish they would have had compassion and realized group homes were tough...and so was my childhood...and just given it time....or provided me with an adjustment disorder diagnosis." --Alumnus of care
On behalf of all of us in and from foster care, thank you for standing in the place where our parents belong. Thank you for considering the expertise we have to offer as people who have learned about foster care from the inside. Know that our organization, Foster Care Alumni of America, is available any time policy related to foster care is being considered. We have members from all 50 states, with our youngest members being 18 and our eldest in their 80s. It matters to us that the youth who come after us in foster care have the best that the system has to offer-stability, love, safety, and peace-and we want to help you make that happen.
Hugh Massengill, psychiatric survivor and MFI member, addresses opening session of City of Eugene, Oregon, USA conference on Choice in Mental Health Care as a Human Right at the University of Oregon.
MindFreedom International - 454 Willamette, Suite 216 - PO Box 11284 - Eugene, OR 97440-3484 USA
phone: 541-345-9106 USA toll free 1-877-MAD-PRID[e] fax: 480-287-8833
http://www.mindfreedom.org/kb/youth-mental-health/foster-care-psychiatric-drugs/psychotropic-medication-hearing/
Subscribe to:
Comments (Atom)