Friday, April 23, 2010

Worse than foster care: Why can’t orphanages just say ‘no’ to drugs?

Yesterday's post to this Blog discussed stories in the Atlanta Journal-Constitution about widespread abuse in Georgia's privately-run publicly "regulated" orphanages – the assortment of group homes, shelters and "residential treatment centers" that are typical of most states.

At about the same time, The Miami Herald ran two stories that illustrate both the tragedy of relying on orphanages and the power of the orphanage industry. Both stories, by reporter Carol Marbin Miller, revolve around an issue the Herald has focused on for nearly a decade, the misuse and overuse of psychiatric medications on foster children.

One story is about Denis Maltez, who was institutionalized at age 8. Four years later he died, and the Miami-Dade medical examiner says the cause of death was a side effect of being overmedicated.

Much of the story focuses on the psychiatrist who prescribed the medications.

But the biggest failing in this case occurred before the doctor ever was involved.

No one so much as accused Denis' mother of abusing or neglecting him. But this also was not a case in which the Florida Department of Children and Families took away the child. DCF wasn't even involved in that decision.

Rather, this case is more like the kinds of cases at the heart of the "Safe Haven" debacle in Nebraska. Denis' mother couldn't cope with her autistic son's "volatility and violent outbursts." Another Florida agency, the Agency for Persons with Disabilities (APD), apparently had only one suggestion: Institutionalize him.

So technically, this was a voluntary placement. But it wasn't really voluntary at all.


When the mother of this boy went to APD, at the end of her rope, here's what APD should have said:

You don't have to deal with these problems alone, and you don't have to institutionalize your child to get him help. We have a program called Wraparound which brings everything a group home can offer right into your own home. We will give you all the help you need to take care of your son, without you ever having to surrender custody, and without him ever having to be institutionalized.

Such programs really do exist; I'm sure there is some of it in Florida, probably more now than before the state's recent child welfare reforms, which began after Denis was institutionalized.

This approach costs less than group homes and institutions, and it has succeeded with young people who have far more serious problems than this boy. This previous post includes a link to a video of a wonderful presentation by the "father of Wraparound," Karl Dennis.

But Denis Maltez' mother apparently wasn't offered that option. So, according to the Herald, she followed the recommendation of APD and decided

to move him into a sparkling new Miami group home called Rainbow Ranch. Administrators for the Agency for Persons with Disabilities had recommended the home, run by a man who had once pleaded guilty to practicing medicine without a license.

The group home discontinued Denis' treatment by a team from a local hospital and instead handed over his care to the same psychiatrist who "treated" all the other residents – and I do mean all of them. After Denis died, APD discovered that 99 percent of the residents were on psychiatric medication. The psychiatrist never met with Denis' mother, and described the boy as ``hyper, needy, pesty.''

According to Herald columnist Fred Grimm, after Denis died:

A dossier was compiled [by state regulators] against the three licensed Rainbow Ranch group homes, listing grotesque incidents in which disabled children in the homes were haphazardly fed, neglected, overmedicated and so under-supervised that the kids physically abused one another.

Except for the absence of either a full-scale riot or an exorcism, that sounds remarkably like what the Atlanta Journal-Constitution kept finding in orphanages in Georgia.

But none of this should come as a surprise. All over the country, newspapers have exposed the misuse and overuse of psychiatric medication on foster children.

The Herald began reporting on the topic in earnest in 2003. That led to a law intended to make it harder to use the medications just to keep kids docile for overwhelmed caretakers. But DCF ignored the law.

Then the Herald reported that psychiatric medication may have caused the death of a foster child, Gabriel Myers.

This time the response has been different. Reform-minded leadership is in charge at DCF, and they've probably responded more forcefully, and more candidly to the problem than any other state. They've set up a special section of the DCF website to post results of investigations and committee meetings, recommendations and what's being done about them, and they even include links to news coverage critical of DCF.

In other words, this time, there is a serious effort to curb these practices, not because of a new law, but because of new leadership.


But there is only so much government can do when it is trying to substitute for family. That lesson is driven home by the data DCF uncovered while investigating the Myers case.

It found that when foster children are institutionalized, 26 percent of them are medicated. When they're placed with strangers, it's 21. But when foster children are placed in kinship care, with extended family, usually a grandparent, only four percent are prescribed psychiatric meds.

It's not hard to figure out why: Grandparents and other relatives are more likely to love these children, and so will tolerate more difficult behavior before demanding a prescription. And that's just one indication that the best solution to the misuse and overuse of meds on foster children is not a new law – it's grandma; or, better yet, keeping more children out of the system in the first place.

Still another indication came from another Herald story. It described how, apparently with no difficulty at all, residential treatment providers got the sponsor of such a proposed law to weaken it so drastically it might actually be worse than existing law. Under the proposal, as amended, once a child is in an orphanage, the people running the place would have what amounts to a three-day free pass to dope up any child, no questions asked.

Here again we see what we see in Georgia: the enormous power of the foster care-industrial complex to put its interests ahead of those of children.

And that's what the Herald itself still doesn't get. Even as it runs stories about the terrible things the foster care system does to children once it gets hold of them, the same reporter has been writing misleading stories attacking the reforms - reforms which, according to independent evaluations, have safely reduced the number of children taken from their parents. And some of the same people are sources for both sets of stories. It's a bit like sounding the alarm about a fire and then throwing up barricades in front of the fire engines.