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    11.04.10 Treating Mental Disorders in Poor and Vulnerable Children
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    It’s an unfortunate, but true fact, that poor and vulnerable children in foster care, are misdiagnosed with mental disorders, and receive more psychotropic drugs than other children their age. Brooklyn Law School recently hosted a Theory Practice Seminar co-sponsored by the Center for Health, Science and Public Policy and the Hastings Center, a nonpartisan bioethics research institution to bring this issue to the forefront. Organized and moderated by Professor Karen Porter who serves as the Center’s Executive Director, the seminar brought together distinguished representatives from legal advocacy groups, psychiatrists, academic institutions, and local government agencies to discuss this issue.

    “The program was designed for participants to better understand the significance of this issue and provide a platform to identify changes in policy and practice that are likely to improve psychopharmacologic prescription practices among poor and vulnerable youth,” Professor Porter said.

    Josephine Johnston, Research Scholar for the Hastings Center, hoped the seminar would encourage further thought and ongoing dialogue about atypical children and legal advocacy questions. “The issue is complex, dire, and ongoing,” she said.

    The event’s keynote speaker, Julie Zito, Ph.D., explained that “one in three foster care youth are likely to receive psychotropic medication in a given year.” Even more problematic, prescription rates have increased dramatically. Compared to prescription rates in 1997, said Zito, in 2006, children were three times more likely to be prescribed at least three different types of psychotropic medication over a given 60-day period. Furthermore, a University of Chicago study revealed that only 30% of medications used by children were approved by the FDA. Zito also pointed out that the government has not invested enough talent, time or resources into this topic to present a solution or alternative to the status quo.

    Indeed, as Janice Cooper, Interim Director of the National Center for Children in Poverty later articulated, “It is our responsibility to track current legislative policies of mental health treatment of children in our society to make sure they are effective and to determine whether new policies are necessary.”

    A distinguished professor at the University of Maryland School of Pharmacy and Medicine, Zito’s research on psychotropic drug prescription rates and mental health diagnoses in poor and vulnerable children continues to contribute to society’s understanding of the current system of economic and social forces that favor hasty diagnoses and prescriptions for psychotropic medications to this population. Zito’s research reveals that the ideal solution of integrated psychosocial and pharmacological interventions along with continuity of care has been overlooked as an unrealistic and impractical dream. She explained, “safe, effective treatments are fewer than anyone would wish.” There was uniform agreement among the roundtable participants that much was wrong with the American system of prescribing mental health medication, particularly over-prescription of medication. This they said, was caused by an ever-increasing sense of desperation and pressure to devise an immediate response to the child’s bad behavior. They urged clinicians to work together to understand these behaviors and to develop long-term treatment plans.

    They also agreed that the economic pressure of Medicaid reimbursements is one of many factors that has contributed to the problem. Psychiatrists are only reimbursed when a child receives a diagnosis. Thus, misdiagnosis is common and treatment less effective. Furthermore, this pressure causes some psychiatrists to over-prescribe psychotropic medication without considering adverse side-effects.

    Informed consent issues, government regulation and safety concerns prevent foster children from participating in research studies on the very problems that these children face. As Dr. Joan Kaufman, Associate Professor of Psychiatry at Yale School of Medicine stated, “we have no database guiding what we’re doing with kids in foster care.”

    Tom Mackie, a Research Associate at Tufts’ Institute for Clinical Research and Health Policy Studies said that some helpful research was underway. Tufts Medical Center has been measuring each state’s response to medicating children. What they found is that four major components exist to begin to determine an alternative. Researchers have evaluated the foster care system, whether or not there is informed consent, what the case level monitoring process is, and they monitored the population data.

    Professor Angela Burton, of CUNY Law School found the seminar to be extremely helpful. “I’m so glad to hear from a legal standpoint what to do to mitigate this problem. I’m interested in cross-disciplinary approaches and this seminar allowed lawyers, clinicians, and academics to begin to discuss this important issue,” she said. “It’s obvious the foster care system is broken. We need to create preventative care and this seminar was one step closer to that goal.” Burton’s article, “‘They use it like candy’: How the Prescription of Psychotropic Drugs to State-involved Children Violates International Law,” was recently published in the Brooklyn Journal of International Law.

    Learn more about the Center for Health, Science and Public Policy.