This article originally appeared in the Chronicle of Social Change on May 23, 2014

By John Kelly

Democrats from the Senate Finance Committee said they planned to “play offense” on mental health services for foster youth, particularly in regard to the use of psychotropic medications.

“When you have one of these kids who is the victim of intense trauma, you’re not going to have the challenges just prescribed away,” said Senate Finance Committee Chairmen Ron Wyden (D-Ore.), at a press conference outside the Capitol Building today. “You need services where the youngster gets personal attention. The reality is we have programs that get that right, we just don’t have enough of them.”

President Obama has proposed a $750 million plan to curb psychotropic prescriptions to foster youths. It is included in his fiscal 2015 budget request, which was declared “dead on arrival” by House Republicans.

Wyden and Sen. Tom Carper (D-Del.) did not articulate specific legislation at the conference. But Wyden said the committee was “going to play offense” and “be serious about looking at fresh, creative ideas” to reduce the reliance on psych meds in addressing the mental health challenges of foster youths.

Carper repeatedly called psychotropics “mind-bending drugs,” and equated their use on foster youths with the protection of America’s southern border.

“What we do is build walls, have thousands of officers and drones” policing the borders, Carper said, while little attention is paid to the “hellacious lives” that prompt immigrants to chance those borders.

“It’s not enough to build walls at the border,” said Carper, who also serves on the Finance Committee.

Wyden did not mention Obama’s plan, which involves two main components: $250 million over five years to “encourage the use of evidence-based screening, assessment and treatment of trauma and mental health disorders” and $500 for a Medicaid demonstration project.

Carper voiced some support for the Obama plan, saying, “the administration has been good on this, they have a lot of money proposed on this.”

Last month, 116 national and local advocacy groups that signed a letter to Senate leadership supporting the Obama proposal in April.

“The Administration’s overmedication reform proposal responds with exactly the right approach – offer better alternatives and additional resources, but then reward states for what we all want – real improvements for kids,” said First Focus CEO Bruce Lesley, in a statement released after the conference.

The conference doubled as the release of a Government Accountability Office (GAO) report that identified some flaws in the documentation and monitoring of mental health drugs for foster youths.

The GAO suggested that stronger federal guidance could significantly improve state practices, particularly in states that rely on managed care organizations (MCO) to handle most of the Medicaid workload. It follows up on a 2011 report by the agency that examined the prescription rates of foster youths in five states: Florida, Massachusetts, Michigan, Oregon and Texas.

“Many states have, or are transitioning to, MCOs to administer prescription-drug benefits,” the report said, and the five states examined “have taken only lifted steps to plan for the oversight of drug prescribing for foster children receiving health care through MCOs.”

The 2011 report found significantly higher rates of psychotropic drug prescriptions to foster youths, with “hundreds” of youth prescribed more than four drugs at a time.

Today’s report is based on a review of 24 specific foster youth cases from those five states. The sample include one case from each state chosen to represent each of these scenarios:

  • A child prescribed any psychotropic during 2008 who was in foster care as of January 2010
  • A child with prescriptions in excess of the guidelines for the State of Texas, which based its guidelines on FDA recommendations
  • A child prescribed five or more medications at once in 2008, and still in care at the beginning of 2010
  • A child under the age of one who was prescribed a psychotropic medication

Experts reviewed the cases with an eye on whether medical documentation mostly supported, partially supported, or did not support that certain actions had taken place.

Among the potential problems identified by GAO:

  • In 18 of the 24 cases, documents only partially or did not support that doctors obtained informed consent to prescribe the drugs from anyone representing the child’s interest.
  • In only 13 of the 24 cases did documents “mostly support” that prescriptions were appropriately monitored.

John Kelly is the editor-in-chief of The Chronicle of Social Change.