CCHR, a mental health industry watchdog, praises OIG report highlighting states’ failed oversight of foster children’s treatment and calls for immediate action to address ongoing drugging concerns.

By Jan Eastgate
President CCHR International
July 5, 2024

The Office of the Inspector General (OIG) under the U.S. Department of Health and Human Services delivered a critical report on the inadequate protection of foster care children in residential behavioral treatment centers. The Citizens Commission on Human Rights International (CCHR), which has long exposed the mistreatment and psychotropic drugging of foster children, commended the OIG report titled “Many States Lack Information To Monitor Maltreatment in Residential Facilities for Children in Foster Care.”[1] The report’s candid assessment of the poor state of oversight and stressed the urgency of implementing its recommendations to prevent the failures of past reform efforts.

The report says, “Policymakers, news media, and advocacy groups have raised concerns about the effectiveness of oversight efforts to protect children in these settings.” It surveyed each state child welfare agency to determine how they monitor child maltreatment that occurs in residential facilities. This is because “States oversee residential facilities, and ACF [Administration for Children and Families] provides funding and oversight to States for children in foster care who meet certain eligibility requirements.”

The OIG’s findings show a failure to meet these requirements. Nearly one-third of states could not identify patterns of maltreatment in residential facilities within their state. States also had limited awareness of maltreatment that occurred across chains of residential facilities operating in multiple states.

Instances of abuse and neglect (collectively referred to as maltreatment) have been reported as occurring in residential facilities, including cases of physical violence, sexual assault, and improper restraints across nationwide chains of facilities,[2] sometimes referred to as congregate care.[3]

This should include the number of children in foster care or other Medicaid beneficiaries who are prescribed psychotropic drugs, which could be considered maltreatment due to severe side effects ranging from addiction, heart disease, and kidney failure, to suicidal behavior and death.

CCHR filed Freedom of Information Act requests to each state asking for the numbers of Medicaid/Children’s Health Insurance Program (CHIP) child beneficiaries who were drugged in 2023. To date, 28 states have responded, revealing that 2.3 million underprivileged children and teens ages 0-17 were prescribed psychiatric drugs under Medicaid at a cost of $1.4 billion.

Stimulants are the predominant class of psychiatric drugs prescribed to them, followed by anti-anxiety drugs for 0-5 year-olds, both of which are documented to cause addiction and other dangerous adverse effects.

In 2011, the U.S. Government Accounting Office (GAO) found that foster children aged 0-17 in Medicaid were drugged at rates 2.7-4.5 times higher than non-foster children in Medicaid. A sample of five states revealed the following percentages of foster children on psychotropic drugs:

• Massachusetts 39.1%
• Texas 32.2%.
• Florida 22%,
• Michigan 21%,
• Oregon 19.7%[4]

While the two statistics are not comparable data, CCHR’s FOIA requests indicated:

• Florida: 185,428 0-17 year-olds (at a cost of $178.45 million), of which 18,938 were 0-5 years old (with drug costs of $2.78 million)
• Michigan: 100,364 0-17 year-olds ($73.37 million), of which 6,839 were 0-5 ($2.27 million)
• Massachusetts 59,169 0-17 year-olds ($68.81 million) of which 1,890 were ages 0-5 ($557,827)  

Oregon and Texas have not yet provided statistics, but the Texas, “Update on the Use of Psychotropic Medications for Children in Texas Foster Care: State Fiscal Years 2002-2022 Data Report” reported that in 2022, 21.4% (11,160) of 0-17-year-old foster children were still receiving psychiatric drugs, of which, 2% (300) were ages 0-2.

Some of the past attempts at curbing this and promises of oversight include:

2008-2010: The Congressional Research Service found that nearly one out of every four children in foster care was using a psychiatric drug.[5] 

2011, November: The GAO reported the federal government had not done enough to oversee the treatment of foster children with powerful mind-altering drugs.[6] Further, “no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and non-foster children in the five states had such a drug regimen.”[7]

Sen. Thomas Carper, the lead requestor of the 2011 GAO report said, “I was almost despondent to believe that the kids under the age of one, babies under the age of one were receiving this kind of medication.” In some parts of the country, as many as half of foster kids are on one or more psychiatric medications. This is compared to just 4 percent of kids in the general population.[8] 

Carper held a congressional hearing on Dec. 1, 2011, demanding changes in the foster care system. “In my judgment, no children in this country should be taking at the same time five different kinds of psychotropic drugs,” he said. “None.”[9]

2011, November: ABC News’ year-long investigation into the use of mind-altering drugs on foster children, titled, “Generation Meds,” revealed these children were more than nine times more likely than non-foster children to be prescribed drugs for which there was no FDA-recommended dose for their age.[10] Diane Sawyer and Sharyn Alfonsi uncovered that many foster children, even as young as one-year-old, were being prescribed powerful mind-altering drugs at alarming rates—up to 13 times higher than that of other children.[11]

2012: Senator Charles Grassley sent letters to 34 states asking what steps they had taken to investigate doctors whose prescribing of antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients far exceeds that of their peers. “These types of drugs have addictive properties, and the potential for fraud and abuse by prescribers and patients is extremely high,” Grassley wrote.[12]

2014: During a Congressional hearing, lawmakers acknowledged that foster kids were still being prescribed dangerous psychiatric drugs at disproportionately higher rates compared to other children. This time, the GAO estimated numbers as high as 20 to 39%.[13]

2015: An HHS Inspector General report flagged 67% of those being drugged as problematic, including prescriptions to children who were too young and prescriptions for the wrong dose or as a wrong treatment.[14]

2017: The GAO reported that HHS had taken steps to support oversight of psychotropic drugs, but said additional assistance to and collaboration with states was needed. It claimed to be working with states to implement voluntary measures to track medication use. GAO recommended that HHS consider cost-effective ways to convene state child welfare, Medicaid, and other stakeholders to promote collaboration and information sharing on psychotropic drug oversight use and other mental health treatments.[15]

2018: JAMA Pediatrics study found  20% of a cohort of medicated children from birth to 8 years old insured by Medicaid, received two or more drug classes concurrently for 60 days or more. Further, “At age 7 years, half or more of the medicated children had more than 200 days of drug exposure.”[16]

2021: The American Bar Association addressed the ongoing failure to protect foster care children. “Every day, thousands of children in foster care are administered powerful psychotropic medications. The federal government has coined this phrase with respect to the use of psychotropic medications for children in foster care—‘too much, too many, too young’—acknowledging a variety of ways in which the lack of oversight of psychotropic medications harms children. On any given day, up to 33 percent of children in out-of-home care may be administered a psychotropic medication, as compared to only about 6 percent of children in the general population. This large class of pharmaceuticals includes antipsychotics, stimulants, amphetamines, antidepressants, and other drugs known to cause adverse effects, including weight gain, tics, suicidal thoughts, and diabetes.” The ABA pointed to a 2018 decision in M.B. v. Corsi, a first-of-its-kind class action challenging the state of Missouri’s failure to safely oversee the administration of psychotropic medication to children in foster care, the Court followed these and other precedents to conclude that the plaintiff children indeed possessed “a strong liberty interest in not being unnecessarily administered psychotropic drugs.” As such, Missouri guarantees 7 rights to children, including the right to refuse psychotropic drugs after consultation with their doctor.[17]

In a 2020 study published in Psychiatric Services, the effects of the reliance upon drugging were telling, “Psychoactive medications are the most expensive and fastest-growing class of pharmaceutical agents for children. The cost, side effects, and unprecedented growth rate at which these drugs are prescribed have raised alarms from health care clinicians, patient advocates, and agencies about the appropriateness of how these drugs are distributed to parents and their children.”[18]

Far greater oversight of congregate mental health and behavioral facilities is needed, especially in identifying the drug and treatment practices that foster care and Medicaid/CHIP child beneficiaries receive. This oversight must include the prescribing practices and trends of psychiatrists and doctors treating foster care children, to flag malpractice. Regulations are needed to properly warn of psychotropic drug risks and tough penalties need to be implemented for child maltreatment involving psychotropic drugs or other so-called psychotherapeutic practices.

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[1] Many States Lack Information To Monitor Maltreatment in Residential Facilities for Children in Foster Care, June 2024, https://oig.hhs.gov/documents/evaluation/9920/OEI-07-22-00530.pdf

[2] Ibid., Highlights and p. 1

[3] Ibid., p. 1

[4] Kelly Patricia O’Meara, “National Child Abuse Prevention Month: Stop Mass Drugging of Foster Care Kids,” CCHR International, 28 Apr. 2015, https://www.cchrint.org/2015/04/28/national-child-abuse-prevention-month-stop-mass-drugging-of-foster-care-kids/  

[5] Kelly Patricia O’Meara, “Congress Saying Foster Kids are ‘Over-drugged’ is Like Saying Nuclear Waste is ‘Overly-toxic,’ CCHR International, 3 June 2014, https://www.cchrint.org/2014/06/03/congress-saying-foster-kids-are-over-drugged-is-like-saying-nuclear-waste-is-overly-toxic/

[6] “New Study Shows U.S. Government Fails to Oversee Treatment of Foster Children With Mind-Altering Drugs: GAO report released today caps off year-long investigation by ABC News,” ABC News, 30 Nov. 2011, https://abcnews.go.com/US/study-shows-foster-children-high-rates-prescription-psychiatric/story?id=15058380

[7] Kelly Patricia O’Meara, “National Child Abuse Prevention Month: Stop Mass Drugging of Foster Care Kids,” CCHR International, 28 Apr. 2015, https://www.cchrint.org/2015/04/28/national-child-abuse-prevention-month-stop-mass-drugging-of-foster-care-kids/

[8] Op. cit., ABC News, 30 Nov. 2011

[9] “Mind-Altering Psych Drugs for a 7-Year-Old.” ABC News. 1 Dec. 2011, https://abcnews.go.com/Health/mind-altering-psych-drugs-year/story?id=15066848#.TtlR7HrXpWn

[10] Op. cit., ABC News, 30 Nov. 2011

[11] “ABC News Investigation: Diane Sawyer and Sharyn Alfonsi to Report on the Overmedication of Children in the U.S. Foster Care System,” ABC News, 20 Nov. 2011, https://abcnews.go.com/blogs/headlines/2011/11/abc-news-investigation-diane-sawyer-and-sharyn-alfonsi-to-report-on-the-overmedication-of-children-in-the-u-s-foster-care-system

[12] https://www.cchrint.org/2012/01/24/grassley-senate-watchdog-target-doctors-prescribing-mass-amounts-of-dangerous-drugs/ citing: “Senate Watchdog Targets High-Prescribing Medicaid Docs,” ProPublica, 24 Jan. 2012, https://www.propublica.org/article/senate-watchdog-targets-high-prescribing-medicaid-docs

[13] Op. cit., Kelly Patricia O’Meara, CCHR International, 3 June 2014

[14] https://www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; Nidhi Subbaraman, “Missouri Has 23% Of Its Foster Kids On Strong Psychoactive Drugs. A Lawsuit Claims The State Isn’t Keeping Records,” Buzz Feed News, 2 August 2018, https://www.buzzfeednews.com/article/nidhisubbaraman/missouri-foster-kids-psychotropic-drugs

[15] “HHS Has Taken Steps to Support States’ Oversight of Psychotropic Medications, but Additional Assistance Could Further Collaboration,” GAO, 6 Feb. 2007, https://www.gao.gov/products/gao-17-129

[16] https://www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; Pennap, D., Zito, J. M., et al., “Patterns of early mental health diagnosis and medication treatment in a Medicaid-insured birth cohort,” Jama Pediatrics, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137539/

[17] Elizabeth Pitman Gretter, “Too Much, Too Many, Too Young: Youth Assent to Psychotropic Medication in Foster Care Is a Basic Human Right,” American Bar Association, 12 October 2021, https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/empowering-youth-at-risk/too-much-too-many-too-young/

[18] Kelly J. Kelleher, M.D., “Policy and Practice Innovations to Improve Prescribing of Psychoactive Medications for Children,” Psychiatric Services, 19 Mar. 2020