The popular television host known by millions as “Dr. Phil” testified last Thursday before the Committee on Ways and Means. During his testimony, Dr. Phil McGraw told the committee that these drugs are too often misused as “chemical straight jackets,” in what he desribed as “a haphazard attempt to simply control and suppress undesirable behavior, rather than treat, nurture and develop these treasured young people.”
Dr. McGraw further submitted that:
Approximately 20 percent of children in the general population are diagnosed with a mental disorder. In the foster care population, estimates are as high as 80 percent. We would certainly expect to see more of these children for whom psychotropic medication is appropriate, if not essential, but even then, there are grave concerns the evidence does not support the excessive prescribing pattern we see.
The reality is medication cannot put the psycho-social horse back in the barn. These kids deserve to live in safe environments where healthy behaviors are observed and modeled. A rush to medication creates a more manageable world for caregivers, teachers, and courts, but have we really helped these under-served children? Throwing drugs at the problem may make them “less inconvenient” in the moment, but is convenience a justification for higher rates of psychotropic drug therapy? I pray to God the answer is no, no, no. Looking for a drug just because it is calming and constrictive is wrong on so many levels. Long-term solutions cannot and will not be found in a pill bottle. So how do we determine the appropriate and necessary use of prescription psychotropic drugs with these children?
To answer this question, we must ask several more. When psychotropic drugs are used, is the use supported by evidence-based research? Has there been an appropriate diagnostic formulation reached by a qualified health care professional using well-established criteria? Once prescribed, is there appropriate monitoring of these medications for efficacy and side effects? Are medications used in conjunction with psychological and behavioral interventions?
If the answer to any or all of these questions is no, and I fear too often this is the case, then the bottom line is we stand by as these children are actually sabotaged in two very significant ways. First, they may be getting inappropriate and over-prescribed psychotropic drugs. Secondly, they are not receiving the evidenced-based treatments they actually need.
Dr. McGraw continued on to tell legislators that: “The worst thing we can do is throw money at the thing we have now. I think that would be disastrous, it would be like throwing gas on a fire.”
McGraw was a signatory to a letter signed by 117 national and state organizations, urging Congressional leadership to support President Obama’s budget proposal to allocate $750 million over a 5 year period to a joint Administration for Children and Families and Centers for Medicare and Medicaid Services initiative intended to reduce the over-prescription of psychotropic medication to foster children.
That letter specifically called for the inclusion of minority populations who are frequently under-served by the child welfare system. The letter explains:
We also encourage the inclusion of tribal governments in this collaborative demonstration to address issues related to American Indian and Alaska Native children who are affected by the inappropriate or over use of psychotropic medication. American Indian and Alaska Native children can be in either state or tribal foster care systems with medications being provided by agencies that are sometimes in different jurisdictions. Improving coordination between these jurisdictions is critical to effectively addressing medication issues with this population. This funding could be used to better train stakeholders (including foster parents and adoptive parents, judges, etc.), provide reliable screening and assessment tools, implement evaluation procedures and improve data collection. These efforts will better help children in foster care who sometimes fall through the cracks of a fragmented health planning process.
The letter references a 2011 Government Accountability Office report, which revealed that 20 – 39 percent of children in state foster care received prescriptions for psychotropic medication in 2008, compared with only 5 – 10 percent of children on Medicaid that were not in foster care. That report also found that children in foster care were prescribed dosages at far higher rates than their peers served by Medicaid, and often in amounts that exceed guidelines issued by the Federal Food and Drug Administration.
The GAO report was the centerpiece in a congressional hearing that was held previously, and presided over at the time by Sen. Carper. Gregory D. Kutz, Director Forensic Audits and Investigative Service with the GAO explained during his prepared testimony, that Congress had passed the Child and Family Services Improvement and Innovation Act, in September 2011, requiring states that apply for certain federal child welfare grants to establish protocols for the appropriate use and monitoring of psychotropic drugs prescribed to foster children.
The GAO report found that in Texas, foster children were 53 times more likely to be prescribed five or more psychiatric medications at the same time than non-foster children. In Massachusetts, they were 19 times more likely to be so prescribed. In Michigan, the number was 15 times. It was 13 times in Oregon. And in Florida, foster children were nearly four times as likely to be given five or more psychotropic medications at the same time compared to non-foster children.
Link to Committee on Ways and Means Calendar Item.