Friday, December 4, 2015

Child welfare in California: A fix that recognizes “The GEICO principle"

Second of two parts

The previous post to this blog discussed an outstanding series of stories by Karen de Sa of the Bay Area News Group concerning the needless drugging of foster children, particularly those consigned to group homes and institutions.

There is a predictable pattern to what follows this kind of journalism – a response that isn’t nearly as good as the reporting.  There are declarations of outrage from politicians, public hearings and/or creation of an OBRC (Obligatory Blue-Ribbon Commission), and then some sort of legislation.

Sometimes, the legislation actually makes things worse – that’s usually what happens when the topic is child abuse deaths, for example, or in cases like the Jerry Sandusky sex abuse scandal at Penn State.  When it’s a topic such as children harmed in substitute care, the responses generally don’t do harm, but they don’t usually do much good either.  Typically they involve adding an extra layer of “review” and an extra form to fill out.

In fact, California tried that the last time the doping up of foster children in group homes and institutions was exposed – by the Los Angeles Times in 1998.  The next year the state enacted a law requiring juvenile courts to approve the prescriptions, with reviews every six months

But as the presiding judge of the Los Angeles Juvenile Court until last year, Michael Nash, told de Sa, that didn’t work too well:

A juvenile court authorizes each prescription, but the forms the courts use often lack critical details and a doctor’s expertise is rarely questioned. Nash, the Los Angeles judge, acknowledges the resulting challenges — even in Los Angeles, where mental health experts now review all applications for prescriptions and in 2013 officials created protocols to curb prescribing of multiple psych meds.
“The last time I looked around, there aren’t too many psychiatrists or psychologists on the bench,” the judge said. “So how in the heck are we able to make good decisions about these meds?”

This time around, it’s not clear if a lot of the solutions will be much better – indeed, the original proposals were weakened after lobbying by the group home industry and groups representing doctors.   

So it’s no wonder that Nash, for one, is cautious, telling de Sa:

"These bills are a step in the right direction for foster children in California who are being administered psych meds," he wrote in an email. "However, they are not a panacea and do not relieve anyone who is involved with foster children from giving them any less attention than they would give their own children."

But there is one exception. The exception actually is part of a plan unrelated to the other bills.  Indeed, it had been in development even before the news stories.

It should come as a shock to no one that the speed with which a caregiver will rush to demand that a child be medicated is inversely related to the extent that the caregiver gives a damn about that child.  So the rate of drugging in group homes and institutions in California is more than double the rate in foster homes.  In Florida, where the former leadership of the Department of Children and Families made it a mission to curb drugging foster kids, they broke down the data further and found that when children were placed in kinship foster homes with grandparents and other relatives, they were far less likely to be drugged than when they were placed with strangers – even when the strangers were foster parents.  (And, as in California, the rate of drugging was highest in group homes and institutions.)

As I’ve said before on this blog 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. 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.

Of course the group home industry has a different take.  They blame the kids.  By the time they get to us, they claim, the children are simply so troubled we have no choice but to drug them and drug them and then drug them some more.

But de Sa’s series shows that there are better options for these children.  See especially part four, in which she tells the story of a doctor at one institution who found that the kids didn’t need all those meds.  And check out the video below, in which Karl Dennis, who founded the nation’s first Wraparound program describes exactly the kind of youth the group home industry would write off as hopeless, and how Wraparound got him safely back home – without meds:

So, what is the plan California has to deal with this – the one that just might work?

A new law, set to take effect in January, is supposed to drastically curb the number of children put into group homes, and set strict limits on how long they stay.  In theory, most children won’t be allowed to stay more than six months, and, supposedly, the standards for the new institutions will be so high that many existing group homes will have to close.  The very name group home will be abandoned, to be replaced by a new category, “Short Term Residential Treatment Center” (STRTC).

The sponsor of the new law, Assemblyman Mark Stone told de Sa:

One of the biggest impacts that we're going to have on reducing the use of psychotropic drugs is getting kids out of group homes," said Stone. "Put a kid in a family, and that family is much, much less likely to resort to chemical restraints. It gets kids into situations where there is a commitment to their future."

In other words, Stone is applying what might be called the GEICO principle. To paraphrase the insurance company’s commercials: When you’re a group home you dope up the kids to keep 'em docile.  It’s what you do.

So the best way to stop overmedicating all those kids is to keep them out of group homes in the first place. 

But there are some problems with this plan.

For starters, the plan depends heavily on increasing the supply of foster parents – instead of taking the better approach: working to reduce the demand for foster parents, by doing much more to keep children out of foster care in the first place.  Get the children who don’t need to be in any form of foster care back into their own homes, and there will be plenty of good, safe family foster homes for the children now warehoused in group homes and institutions.

California has made real progress in reducing entries into care in recent years.  But Los Angeles County, for example, which has about one-third of the state’s foster care population takes away children at more than double the rate of New York City and more than triple the rate of metropolitan Chicago.

In addition, the bill seems to rely heavily on “accreditation” to ensure that the newly renamed STRTCs will do a decent job.  But in child welfare, accreditation is a sham.

But at least this law recognizes that you won’t solve the drugging-in-group-homes problem until you solve the group homes problem.  The law suggests some recognition of the fact that, in the overwhelming majority of cases, when you’re a family, you love your children.

It’s what you do.