Child advocates say they are disturbed but not surprised by a new state auditor’s report on the Massachusetts Department of Children and Families (DCF).
The report, by state auditor Diana Dizoglio’s office, criticized the agency for poor medical oversight of many children in foster care – specifically over the prescribing of psychiatric medications.
Among the findings – that DCF did not always get court approval for prescriptions, nor did the agency properly document which medications were given, which raises the risk of unsafe medical care.
“This is removing the courts’ oversight of children in DCF protective custody, who are too young to consent to their treatment plans and need a neutral, third party to ensure any prescribed medications are in the children’s best interest,” Dizoglio’s office wrote.
The report also found that children in state custody were not always given therapy in addition to medication, without which “DCF cannot monitor the effectiveness of these medications and cannot identify and mitigate any side effects that these children may experience,” the auditor wrote.
Several child advocates said they are disturbed but not surprised by the findings.
Alexis Williams Torrey, an attorney for the Children’s Law Center of Massachusetts, represents children in state custody. She said she’s seen providers at state-funded residential programs prescribe medication as a means to control aggressive behavior and the symptoms of trauma. She said that may not be what’s best for a child’s medical care.
“These are obviously very heavy medications,” Williams Torrey said. “They can cause lifelong side effects and are impacting the brain of oftentimes very young children who are prescribed these antipsychotic medications.”
Daniel Mahoney is with the Committee for Public Counsel Services, the state’s public defender agency, which often represents children in foster care. He said the auditor’s report reflects longstanding problems with DCF.
“We have a system where there's issues around provision of services because of the limited capacity,” he said.
In response to the auditor’s findings, the Department of Children and Families said it is already addressing many of the problems.
“The documentation gaps identified in the report are being addressed by using updated technology to better track and manage dates of court approvals for children prescribed anti-psychotic medications,” the agency wrote in a statement.
“We also recognize the importance of consistently updating current medical information in the child’s electronic case record and are exploring adjustments to policy and practice,” the agency wrote, adding that “any time prescribers recommend anti-psychotics for a child, DCF conducts a medical review to assess the appropriateness of the medication.”
In addition, an agency spokesperson wrote that “DCF enhanced its multiple pathways for oversight to ensure safety and the judicious use of psychotropic medications for youth in state custody,” and listed a number of programs that DCF has implemented or taken part in to improve its systems since the audit period ended.
But Williams Torrey of the Children’s Law Center said over-prescribing of anti-psychotic medication remains a problem.
“It has not been my individual experience that things are getting better,” she said. “I think the fundamental problem is that DCF, by its nature, is a bureaucracy, and bureaucracies aren't particularly skilled at taking care of children.”
For that reason, Williams Torrey said it’s critical to address the underlying problems that lead to the removal of children from their families, even aside from how DCF handles their care.
“A lot of these children are having mental health issues. And that is actually the underpinning for why they're involved with the department,” she said. “So I think rather than diverting funds and auditing and oversight to the Department of Children and Families, I think the public needs to consider really answering the calls of families for more accessible mental health treatment, child care, stable and affordable housing – all of those supports that could prevent children from ending up being in the custody of the department to begin with.”
