An article in the Los Angeles Times this week addressed what some suggest is the over medication of children in the Los Angeles County foster care system. Certainly this is a significant issue, and indeed, if children are being overmedicated, it must be addressed. Before rushing to any conclusions, it is important to consider why any child would be prescribed a psychotropic medication.
Children in the foster care system have been traumatized in some way, if for no other reason that they have been removed from their families. The reasons for the removal point to another layer of experiences that have further affected them. In addition, many of these children have experienced delays in their education, and in some instances, have been diagnosed with special learning challenges. Often for children in these kinds of situations medication is recommended to address impulsive behavior, an inability to sustain focus, depression, and anxiety. As helpful as some medication may be to address these issues, it is nevertheless a risk to prescribe medication without any assurances that there will not be any long-term negative effects.
As a result, it is with some reluctance medication is prescribed. However, often the nature of a child’s disturbance and a sense of urgency to maintain the child’s emotional well-being contribute to introducing medication into the regimen of care. For a child in the foster care system, this is often complicated because of inconsistencies in a child’s care such as multiple living placements, several school enrollments, and changing social workers and consulting psychiatrist. All these are factors that contribute to the overmedicating of children in care. Overmedication is a symptom of a system that is haphazard, uncoordinated, and driven by the need to safeguard its own interests rather than that of the children it serves.
Virtually all the children referred to Hillsides arrive having been prescribed some medication. The first thing that we do is a review of medications and dosages to determine the appropriateness while engaging family and responsible authorities in re-examining the need for each prescription. One of the many benefits of a highly structured and supervised environment like Hillsides is to determine if there may be a way to lessen the use of medication. The introduction of positive behavior reinforcement, an engaging individualized routine, strengthening of social skills, and cognitive therapies usually result in lessening the need for medication and equipping the child to be better prepared for a return to home and community.
Some effective medications have a profound impact on children and youth, enabling them to lead healthy lives. Mental illness is like any other illness; it requires constant attention and appropriate care to allow for improved functioning and a restoration of well-being. We certainly would not deny a child with juvenile diabetes insulin. Then we should not deny a child experiencing an episode of mental illness the appropriate care needed to get better.
Abuses can occur whenever medication is prescribed. What is required is a system of care that assures vigilance and seamless care focused on the long-term best interests of the child.