Working toward better foster care

Attendees at the most recent West Pine Bluff Rotary Club meeting were greeted with important facts about foster care in Arkansas. According to JoAnna Hale, director of the Jefferson County office of The Call (Children of Arkansas Loved for a Lifetime), a Christian-oriented foster care and adoption advocacy group, “There are 250 children from Jefferson County in foster care and only 27 foster homes here in Jefferson County. Children are being shipped all over the state to find them foster homes. Siblings are almost always separated and if we can’t find foster homes for them then they end up in group homes or emergency shelters.”

Separation from siblings and the persistent trauma of being perpetually uprooted further burden children who have already been through too much. While the efforts of groups like The Call are quite laudable, they highlight two deep chasms in modern society: a paucity of resources for foster child care; and cultural norms that spur an increased need for those services.

Foster care is the government-financed program that provides temporary living arrangements for 400,000 to 500,000 children and adolescents. When examined nationally, we see that foster care in America is not so much a safety net as it is a few ropes strung across a vast gorge. One of the most egregious lapses in foster care concerns the medical treatment given these children. A 2011 study in the journal, Pediatrics, found that doctors regularly treat foster children’s behavioral problems with the same powerful drugs given to adults with schizophrenia and severe bipolar disorder.

Susan dosReis, an associate professor in the University of Maryland School of Pharmacy and the lead author of the study, observes, “We simply don’t have evidence to support this kind of use, especially in young children.” The concern expressed by dosReis and her co-authors reflects that of other doctors and policy makers with regard to the high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. The Pediatrics study focuses on one of the most powerful classes of drugs, antipsychotics. DosReis and her co-authors found that about 2 percent of foster children took at least one such drug, in spite of the fact that schizophrenia and bipolar disorder — for which the drugs are approved — are extremely rare in young children. What is more alarming is that over 9 percent of foster children were prescribed more than one of these drugs.

According to the study, antipsychotic drugs can also cause rapid weight gain and increase the risk for metabolic problems, an effect that may be amplified by the use of two at once. DosReis notes that doctors who treat such children are cognizant of the side effects and often prescribe lower doses of the medications as a result. When doctors prescribe a second such drug, it is often to counteract side effects of the first medication.

Quoted by the New York Times, Dr. Ramesh Raghavan, a mental health services researcher at Washington University in St. Louis, put the problem in grim perspective: “There’s enormous anguish because everyone knows that this is not what we should be doing for these kids. We as a society simply haven’t made the investment in psychosocial treatments, and so we are forced to rely on psychotropic drugs to carry the burden.”

It might be argued that we as a society have not only failed to invest in the medical research surrounding child care in this population, but other venues as well. Given that foster children have few venues in which to communicate their needs, it is important that we reach out to them.