Rep. Oliver
State Rep. Mary Margaret Oliver (D-Decatur)
What initially drew your interest to this issue?
There are a lot of people doing preliminary work on this issue. The recent report conducted by Karen Worthington (prepared for the Supreme Court of Georgia Committee on Justice for Children - view the report here) gives a lot of background and is quite helpful in getting a handle on this issue. The report is a national study of other state practices in the area of psychotropic drugs. The Department of Community Health (DCH) has provided their payment patterns and recommendations for drugs. I learned a lot from Georgia’s Cold Case Project, a project sponsored by the Supreme Court of Georgia’s Committee on Justice for Children. That effort was about improving the legal process for abused and neglected children in the courts. The committee did an intensive file review of those cases of children who have been in the foster care system long-term and learned a lot about high psychotropic drug use among them. There needs to be some independent clinical oversight in regards to this. These are children with no parents or other adults to advocate on their behalf. There are caseworkers who don’t have the skill set or knowledge, being asked to approve medications for these kids. These children move around a lot; there’s a lack of consistent medical record keeping. We need to have a more uniform process for prescribing these drugs and to assess whether they’re needed in some cases at all.
How serious is this issue in Georgia?
First off let me say that this problem is not unique to Georgia; this is a national issue too. What we do know is that our state spends $7.8 million annually on psychotropic drugs for many of our foster children. That’s a huge expense and one that we can’t afford not to look at more closely. We have a huge obligation to provide better care for our foster children. There is an obligation for us to create a rule-making process to help us find out what are the needs here and how to address the situation. We need to identify the red flag cases and look at private psychiatrists who can help caseworkers do some troubleshooting. When you see Medicaid payment records showing thousands of children receiving multiple psychotropic drugs at one time, you’ve really got to look at whether this is necessary for these children.
What exactly are you hoping to achieve with HB23?
I am pushing for better medical records management for these children. My bill calls for the Department of Family and Children Services (DFCS) to implement rules creating a process for an independent medical review of the mental health treatment programs for foster care children. Who should decide and oversee psychotropic medications for these foster kids? There is no loving or competent parent? We know that we need a clinical review, but how do we do it? That’s one of the many questions that have to be answered. We have to be a part of the solution for these children. Significant changes could result in us spending a lot less money.
Now that you’ve introduced the legislation, what’s the next step?
It is now before Sharon Cooper’s Health and Human Services Committee. I have not asked for a hearing yet because I am waiting to collect more data. I want to hear from some private funders about what they want to provide. There are still a lot of questions that have to get answered. What problems do we anticipate? What are the costs? What are the solutions? We have to get those questions answered. I’m seeing a lot of attention brought to this issue. People are really paying attention to this. With the amount of money being spent and the number of children being affected, it’s a huge issue. I’ve been pleased with the process. I believe that we are going to be able to make a lot of progress on this issue.
View Rep. Oliver’s op-ed published in The Atlanta Journal-Constitution
Here’s what some other local child advocates had to say about Rep. Oliver’s bill:
Rep. Glenn Baker
State Rep. Glenn Baker, (D-Jonesboro)
“We need to have something in place to monitor how these drugs are being administered to children. We need to educate our foster parents more about these drugs, but we can’t place the blame on these folks. It’s my understanding is that there is only one druggist in the state that supplies these medications.”
Gerald Bostock
Gerald Bostock, Child Welfare Services Coordinator, Clayton County Juvenile Court
“The problem with this psychotropic drug issue is that there is no oversight. These foster parents don’t understand the drugs that these children are on. You also have caseworkers who don’t understand these drugs either. Somebody has to take responsibility for these medications.”
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Got a juvenile justice story idea? Contact JJIE.org staff writer Chandra R. Thomas at cthom141@kennesaw.edu. Thomas, a former Rosalynn Carter Mental Health Journalism Fellow and Kiplinger Public Affairs Journalism Fellow, is an award-winning multimedia journalist who has worked for Fox 5 News in Atlanta and Atlanta, People and Essence magazines.
I recently worked at a group home for foster children in Arkansas, and am all too aware of the ridiculous overmedication of foster children – which is indeed a national problem. I would say 75% of the children aged 6 and up were on psychotropic drugs. The majority were standard drugs for ADD/ADHD or depression, but ranged upward to things like amphetamine salts and heavy drugs meant only for adults. I would estimate that about 5% of these drugs were actually necessary.
I saw the same process happen many times: A foster parent or houseparent has trouble with a child, they take them to a physician or psychiatrist to see how to “fix” them. The physician/psychiatrist asks the child a few questions, and nearly 100% of the time writes a prescription for at least one Medicaid-funded drug which “fixes” the adult’s complaint, but ignores the child’s actual problem (they need love and therapy). Subsequently, the child is moved around so much, future adults are either afraid to stop administering these drugs (“Well, I’m no doctor…”), or the child has developed some sort of psycho-dependency on them.
The result is totally non-beneficial for both child and the state. The cost is not just simply that of the medications; children who grow up taking drugs turn into adults who take other drugs that get them into more state-funded trouble. This is only exacerbated by the fact that most of these children were thrown into the foster care system in the first place because their parents took drugs. Are there any other ways we can think of to make this bad situation even worse?
I applaud Rep. Oliver’s efforts and insight, and I think she is on the right track. My suggestion would be to make these medications available only after a significant period of regular, frequent, and personal therapy, which I feel certain would actually reduce costs.