Colorado responds slowly to psychotropic drug use among foster kids — (The Denver Post)

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The Denver Post

By Jennifer Brown and Christopher N. Osher, The Denver Post

But Colorado stood out in two notable areas.

Low-income children in Colorado were more likely than children in any of the eight other states to take antipsychotics at two or more times the maximum recommended dose. Also, Colorado had the highest rate of children prescribed two or more antipsychotics at the same time. Foster children were the most likely to fall into this category.

“Whose needs is this medication addressing? The reality is, for the most part, it helps foster parents, schools, therapists, caseworkers — the adults,” said Steve McCrea, a supervisor with Court Appointed Special Advocates for Children in Portland, Ore.

More than medication, foster youths need long-term relationships with adults who they trust will not send them away for expressing their grief and anger. “If they are traumatized, they need secure relationships with adults,” McCrea said. “They need to know people care about them and aren’t going to abandon them.”

Foster mother Christi Beach, who takes in up to six teenage boys at once in her Arvada group home, has made it her mission to help foster youths wean themselves off medication, and most of them arrive on meds — for depression, for anxiety, for sleeping.

This is what she tells them: “Yes, you are going to be sad. Yes, you are going to be angry. Yes, you might have some sleep issues. But I’m willing to walk the miles with you to see what that looks like, as you stabilize, as you are in a nurturing environment, as you learn to have hope. Let’s go outside and hit the punching bag, or run around the block.”

But other families who have taken in children with extreme anger issues view psychotropic drugs as a matter of survival.

Colleen Tarket adopted four foster children who were siblings, survivors of severe abuse and neglect. The oldest, who was 10 when she was adopted, had violent fits and attempted suicide. She was diagnosed with bipolar disorder and prescribed psychotropic medication but refused to take it consistently. Her behavior became so extreme that her parents sent her to a residential treatment center.

But the girl’s youngest sibling, who was 5 when she was adopted, improved dramatically on psychotropic medication. Her grades and her mood got better, and she no longer spoke in nonsensical phrases. Still, Tarket said, weighing the positive outcomes with the side effects was “incredibly difficult.”

“Is weight gain and high cholesterol a good trade-off for being able to communicate with her peers?” she said. “Will the weight gain then hurt her self-esteem, which is already suffering, and make her more depressed? It’s a constant struggle to figure out what the right answer is, and that answer seems to be a moving target.”

Just the two of them

Diego’s mother moved to the United States from Colombia, settled in Aurora and started her own cleaning business. As a boy, Diego helped her put advertising fliers around town. They were happy, just the two of them.

Then she was struck with gastrointestinal cancer. Diego became her caregiver, cooking their meals, cleaning and caring for her. For months, he held it together on his own — until his middle school guidance counselor pulled him out of class to ask what was going on at home.

Diego’s mother, Isabel Rengifo, went to a hospice and he moved in with a teacher, bringing his Pomeranian with him. His mother died in April 2008 while he was living with the teacher. “I remember stumbling down the hallway and seeing my mom in a casket,” he said.

Her name and a cross are tattooed on his left arm.

“The dog helped me out,” he said. “I would cry every night, and my dog would come be with me.”

When his dog died, Diego cracked. Talking about Littlefoot upsets him still.

Diego’s official diagnosis was chronic depression and anxiety. He recalls occasional meetings with a psychiatrist. As he neared the end of his time in foster care, working two fast-food jobs and taking advanced classes to graduate early from Smoky Hill High School, he says he lied to his psychiatrist about his true emotions in order to get off medication.

At first, he felt like his mind was in heavy fog, like he couldn’t think straight. But he was “free to feel,” Diego remembered. To deal with his sadness, and to rid his body of the chemicals, he worked out twice a day.

Diego, who left foster care last year, is living with a friend while he searches for an apartment that will accept his low-income federal housing voucher. He took a few classes at CU Denver and is employed at a job-training program that helps people find work in the tech industry.

“I had to grow up young,” he said.

A dramatic rise

Graphic: Antipsychotic drug use among Colorado children

As early as 2007, psychotropic drug prescriptions were rising dramatically for Colorado kids on Medicaid, data uncovered by an independent researcher shows.

Among children ages 6-12, the number taking three or more psychotropic medications for at least three months jumped from 68 in 2006 to 108 in 2007, according to data received by Ben Hansen, a mental health researcher and advocate in Michigan, and provided to The Post. The state Medicaid office said in response to a recent open-records request from the newspaper that it could not release the data.

State officials attributed the rapid rise in prescriptions for such drugs to improved antipsychotics coming on the market, adding they were prohibited from restricting them by a state order meant to protect consumers’ access to medications.

Hansen’s data also found that the percentage of teenagers on Medicaid who were taking four or more psychotropics at once for at least 90 days jumped 130 percent from 2006 to 2007.

The data was produced by a research firm that received it from the Colorado Medicaid office, in cooperation with Eli Lilly, maker of the antipsychotic Zyprexa.

The two-year monitoring program, initiated in 2006, found Colorado’s Medicaid program was spending more than $1.4 million every two months on “high-risk” prescribing of antipsychotics to children. Kids were taking higher-than-recommended doses or multiple antipsychotics for long stretches.

After new federal requirements, state officials in 2013 convened a panel to examine the high rates of psychotropic prescriptions for children. The panel included psychiatrists, social workers and child welfare experts.

As recommended by the panel, the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid program, began requiring prior authorization for children prescribed psychotropic medications for any dosage above the FDA-approved maximum. The state also requires prior approval before paying for antipsychotics for children under 5.

But other recommendations from the panel are not in place. The group wanted Colorado to monitor whether foster children are taking three or more psychotropics at once, and to identify doctors who are prescribing the medications at higher-than-recommended doses.

State Medicaid officials said they hope within the next six months to have a plan that would lead to regular analysis of insurance claims identifying which patients are taking three or more such medications at a time. The CU pharmacy school has not had the money or staff to do such regular analysis for the state, Medicaid officials said.

The panel also recommended that Colorado require prior approval or monitoring of children receiving psychotropic medications for off-label reasons — such as when children have no diagnosis of bipolar disorder, schizophrenia or other psychosis. State officials said they are working to resolve out-of-date technology issues that make it difficult to tell whether patients have a diagnosis. Also, officials plan to require prior approval for off-label prescriptions “in the very near future.”

“This is a high-priority item, but it is too early in the process to state with certainty when this will be resolved,” said Medicaid department spokesman Marc Williams.

Along with re-evaluating medication policy, Colorado has increased spending in recent years on therapies that focus on children’s trauma, including at places such as Mount Saint Vincent home in northwest Denver.

Addressing the high prevalence of foster children on medications will take major change in doctors’ habits and government health care, which are more complex issues in some ways than an attack on pharmaceutical companies, experts said.

“It’s easy to point fingers at the pharmaceutical industry, but it didn’t take a lot for them to ignite this epidemic,” said Dr. Dave Rubin, a researcher at the Children’s Hospital of Philadelphia. Most states lack sufficient therapy programs as alternatives to medication, and government insurance typically reimburses psychiatry visits at much higher rates than other therapy visits, he said.

“We are probably using medications at rates that far surpass what we instinctively feel comfortable with because there are no other options,” he said. “And to some degree, we need to acknowledge that, in the short term, medication settles a kid down. It works. The problem is, is that the best way to treat that child? It’s sort of a chemical restraint. These are very potent, powerful medications that can have very serious side effects, and we don’t know the effects on a developing brain.”

Jennifer Brown: 303-954-1593, or

Graphic: Growth of sales of antipsychotic drugs

About the drugs

Psychotropics: A broad class of medications made of chemicals that alter brain function, including mood and behavior; these include antidepressants, anti-anxiety drugs and attention-deficit-disorder drugs.
Antipsychotics: The most powerful drugs in the broader class of psychotropics; have been linked to diabetes and weight gain in children, and growth of breasts in boys.
Atypicals: The latest generation of antipsychotic medications, with brand names such as Abilify, Zyprexa and Risperdal.

About the series

This investigation by The Denver Post into psychotropic drug use by foster children stems from The Post’s “Failed to Death” series on Colorado’s child-welfare system that ran in 2012.
The overprescription of powerful psychotropic medication to foster children is a national epidemic — yet in Colorado, efforts to curb the problem lag some states.
The Post obtained unpublished state data and reports, interviewed foster families and children, reviewed other states’ efforts and examined promising new therapies.


Sunday: Foster kids are prescribed powerful drugs that alter brain function at rates far higher than other children. A growing number of experts say this is not only unnecessary, but harmful.

Monday: Over decades, the pharmaceutical industry pushed aggressively to market psychotropics to children and tap into the lucrative Medicaid system.

Tuesday: New therapies to repair developmental delays in children’s brains caused by abuse and neglect are taking hold. Proponents advocate for more therapy and fewer medications.

Wednesday: Other states have been more aggressive and more effective than Colorado in establishing policies to reduce prescriptions of psychotropics to foster children.

Graphic: Most common drugs taken by Colorado children on Medicaid