Overmedicated: How the US Foster Care System Is Failing Our Children

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On Jan. 17, a federal class action lawsuit was filed against the state of Maryland Department of Human Services (DHS) over inadequate prescription oversight in the foster care system of psychotropic drugs for children, which puts them in danger of overdoses and serious side effects.

At least 72.1 percent of children in Maryland foster care who are taking psychotropic drugs “do not have a documented psychiatric diagnosis,” according to the lawsuit, which cites recent data from the agency.

The lawsuit states that “this could suggest that psychotropic drugs are not administered in response to a diagnosed mental health condition but instead are administered as a form of chemical restraint,“ and ”at minimum, it evidences inadequate medical record-keeping.”

Per the suit, more than 53 percent of children in the custody of Maryland DHS who take psychotropic drugs are administered multiple drugs at once, a “potentially dangerous practice known as polypharmacy.”

Children administered these medications face a greater risk of harmful physical and emotional side effects than adults, the filing explains. Harmful physical and emotional side effects may include—but aren’t limited to—seizures, suicidal thinking and behavior, irreversible movement disorders, adverse cardiovascular and respiratory effects, severe liver disease, excessive weight gain, and unexpected death.

For more than a decade now, the inadequate oversight of safety or effectiveness around the use of psychotropic medication among foster youth has been a topic of national concern.

There’s a large body of research citing questionable prescribing practices including polypharmacy, alarming dosages, use of psychotropics in treating infants, lack of adequate monitoring or appropriate therapeutic interventions, and “off-label” use of antipsychotics for children in foster care.

In a 2011 report, the U.S. Government Accountability Office (GAO) outlined significant concerns around the use of psychotropic drugs prescribed to foster care children and the strong recommendation that the U.S. Department of Health and Human Services help provide effective oversight of psychotropic medications prescribed to children in foster care.

According to the report:

“... thousands of foster and nonfoster children were prescribed doses higher than the maximum levels cited in guidelines ... which GAO’s experts said increases the risk of adverse side effects and does not typically increase the efficacy of the drugs to any significant extent.”

This report was followed up by a 2014 report, again urging leadership for better oversight of psychotropic medications administered to children in the foster care system.

Advocates say the necessary improvements haven’t been made, leaving vulnerable children at risk.

A Broken System

The 2011 review analyzed foster children in five states who were prescribed psychotropic drugs.

The study authors noted that although foster children may be “prescribed psychotropic drugs at higher rates than non-foster children in Medicaid” because of “foster children’s greater mental health needs, greater exposure to traumatic experiences, and the challenges of coordinating their medical care.”

The following concerns were found in the study relating to psychotropic medication treatment for youth in foster care:

• Polypharmacy (being on multiple psychotropic drugs at the same time).
• Prescribed doses at higher than the maximum levels cited in guidelines.
•  Use of psychotropics in treating infants.
•  Lack of adequate monitoring.

The report also states “no evidence supports the concomitant use of five or more psychotropic drugs in adults or children.” Yet hundreds of foster children have such a drug regimen.

GAO experts state that  “foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which GAO’s experts said have no established use for mental health conditions in infants; providing them these drugs could result in serious adverse effects.”

Studies point out that there’s much unknown about the use of psychotropic medications and their effects on children and that the risks aren’t well understood.

GAO authors warn that “while psychotropic drugs can have significant benefits for those with mental illnesses, they can also have side effects ranging from mild to serious.”

A study referenced in the American Academy of Pediatrics found that more than 41 percent of children in foster care who were prescribed psychotropic medications received three or more different psychotropic medications during the same month.

A more recent study from October 2021 titled “Psychotropic Medication Usage Among Foster and Non-Foster Youth on Medicaid,” which was presented during the American Academy of Pediatrics 2021 National Conference and Exhibition found that more than one-third (35 percent) of children in foster care are prescribed psychotropic medications in comparison to 8 percent not in foster care under Medicaid.

The study also indicated that the children in foster care receiving psychotropic medications were younger than children in the Medicaid group.

Fighting for Change

Actress Angela Featherstone, who appeared on popular TV shows such as “Friends” and “Seinfeld” over the past two decades knows firsthand how the atrocities of the broken foster care system can deepen trauma in already traumatized children. At the age of 16, she was put into the foster care system, and the experience, in many ways, deepened her trauma.

Today, Featherstone is an outspoken advocate for children in the foster care system and founder of Fostering Care, a nonprofit organization committed to healing young adults who are aging out of the foster care system.

Ten years ago, Featherstone mentored a child in foster care through Kidsave. Chanton Johnson was 11 at the time and had been in the foster care system since the age of 7.

“When I met him, he was on eight psychotropic drugs with numerous diagnoses from multiple doctors. He was also under a lot of stress from numerous changes in foster homes due to his status as special needs from these diagnoses,” Featherstone recalled in a recent phone interview with The Epoch Times.

“He had a massive break from reality due to overdosing on the prescribed drugs,” she said. “Sadly, he was immediately put into a horrible lockdown psychiatric hospital far from the people who were stable connections in his life. They also immediately changed his LCSW (Licensed Clinical Social Worker) leaving him with no familiar surroundings.”

Luckily, Featherstone took action and advocated on his behalf.

“The only good thing about the situation was that the doctor was willing to take him off all but one medication; a low dosage of anti-anxiety medication. His condition immediately improved and within a year he was off all medication and never again needed them and never had any psychiatric issues,” she said.

Featherstone warns that “this is a problem that’s happening nationwide, we can do better.”

After her recent talks with the Substance Abuse and Mental Health Services Administration and mental health advocates, Featherstone said that there’s positive feedback.

“I believe there’s an incentive to change the way things are done. But nothing changes if nothing changes. It’s time to truly heal trauma—not overmedicate children into complacency.”

Johnson is now 21 and has aged out of the system. He’s determined to overcome the bleak statistics that say only 1 out of every 2 foster kids who age out of the system will have some form of gainful employment by the age of 24, with 20 percent becoming immediately homeless.

In a recent phone interview with The Epoch Times, Johnson offered insight into some core issues he experienced while in the foster care system.

“So many times, a hug was all I needed,” Johnson said when reflecting on the horrific chain of events that ended with him on eight psychotropic drugs concomitantly before the age of 11.

But the “rules and regulations” and the “constant moving” from one facility to the next and from one doctor to the next prevented him from being able to “form meaningful bonds” with adults who could advocate on his behalf. “You can’t have a revolving door of therapists,” he said.

Nobody was paying attention. Nobody knew him well enough or paid attention to how the drugs were affecting him and when he tried to let the adults in charge know the medications were making him feel unwell, he said he was “forced” to take them.

The state of Maryland Department of Human Services hasn’t responded to a request for comment on the case.