Oregon drug rules tighten for foster children

PORTLAND — Justin Snegirev mostly remembers feeling nauseous, tired and alone during the more than seven years he spent in state foster care.

Placed in a foster home when he was 8, Snegirev says it wasn't long before he was prescribed Ritalin, a drug used to treat attention deficit disorders. Next came an antidepressant and then a sleeping pill. Between ages 8 and 15, Snegirev says he was given at least seven different types of psychiatric drugs.

But he wasn't mentally ill, says Snegirev, now 20. "I was in an abusive situation and was a kid who simply was expressing symptoms of abuse — and nobody was listening to me."

As of July 1, Oregon will have a new law and new rules to ensure closer scrutiny of psychiatric drugs given to kids living in foster homes.

The change follows a November 2007 investigation by The Oregonian that found children in foster care were prescribed powerful psychiatric medications at four times the rate of other children covered by Medicaid. The investigation also noted that foster parents were paid more if children were on psychiatric medications.

A state audit the next year found one in five children in foster care was prescribed at least one psychiatric medication. The audit also found medication logs missing from child welfare files, poor communication between caseworkers and foster parents about medication and few children receiving timely mental health assessments as required by law.

New state data show those assessments still happen only half the time. Between October 2009 and January 2010, 55 percent of the children entering Oregon foster care had a mental health assessment within the first 60 days.

Officials say that will have to change under the new law. Children must have a mental health assessment before they are given any anti-psychotic drug or more than one of another type of psychiatric drug. There will also be mandatory medication reviews for children under age 6 who are taking psychiatric medications and for older kids with more than two psychiatric prescriptions.

In addition to the new law, the Department of Human Services has new rules on consent for psychiatric medications. In the past, the decision was left to the doctor and foster parents. Now, a child welfare manager must approve.

Changes made last year mean foster parents do not automatically get a higher rate simply because a child takes a psychiatric drug. Advocates for children support the shift of consent from the foster parent to child welfare manager.

"We thought there should be more oversight and that foster parents should not be the ones making that decision ... the trick will be whether they can do that efficiently," says Mark McKechnie, executive director of the Juvenile Rights Project, serving children and parents in the child welfare system.

Steve McCrea, a supervisor with the CASA program in Multnomah and Washington counties, says the new policy marks a "significant improvement."

"Kids were getting very inconsistent treatment," says McCrea, who supervises volunteers who advocate for children in foster care. "They'd be in one foster home with a whole bunch of medication and move to another foster home, where they didn't need it anymore. It was hard to determine why they were getting medication in one place and not in another."

It's too soon to know how the changes will affect doctors, said Dr. Nancy Winters, a child psychiatrist at Oregon Health & Science University, who consulted on the new rules.

But she notes that the new law simply asks for mental health assessments before certain drugs or multiple drugs are given: "I think most people would see that as pretty reasonable."

Foster parents are wary.

"There was some sort of assumption that foster parents were doping kids up so they had to change this. It was a knee-jerk reaction," says Don Darland, president of the Oregon Foster Parent Association.

Darland worries about the traumatized child who can't sleep. If it's a Friday night, he says, it could be Wednesday under the new rules before he can get medications.

The new rules include emergency language for such situations, counters Kevin George, state foster care manager.

"These are weighty decisions," he says, "it's important for foster parents to understand that we're shouldering the responsibility with them."

Snegirev ran away from his foster home at 15, in part he says, because he didn't want to take the drugs any longer.

He thinks the new state law doesn't go far enough. He'd like to see a mandatory waiting period, allowing a child to get used to a new foster home before he is given psychiatric drugs. And Snegirev wishes that teens coming out of foster care had more state support.

Living on his own and without the medications for five years, Snegirev wants to earn his GED, go to college and maybe become a lawyer. Recently he became president of the Oregon Foster Youth Connection, a group of young people between 14 and 25, who have personal experience with the Oregon foster care system.

His agenda includes raising awareness about the drugs prescribed to children in foster care.

"I feel my job as president is to advocate for other youths," he says. "I want to support them in meeting their goals."

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