'Cadillac' Plan New Foster Kid Approach
Program aims at drug treatment
By Carol Marbin Miller
Originally published in The Miami Herald, June 2, 2001
TALLAHASSEE — A panel of doctors, social workers and advocates is developing what they call the Cadillac or Mercedes of mental health programs for foster children, with hopes the new plan will largely eliminate the need for psychotropic drugs.
The Department of Children & Families' Advisory Panel on the use of psychotropic medications met for the first time Thursday and began to flesh out a new system for treating foster kids whose mental illness or unruly behavior require treatments such as the use of powerful mind-altering drugs.
The centerpiece of the model is the creation of teams of psychiatrists, case managers, behavior analysts, teachers and parents who would design treatment plans for hard-to-manage children in state care. Ideally, the teams would meet regularly to discuss a child's stability and progress while in treatment.
"What we're talking about is a Cadillac/Mercedes model of care," said Daniel Armstrong, a member of the panel and director of the Mailman Center for Child Development in Miami.
The new model may alleviate some concerns about the possible misuse of psychotropic medications because it will build in monitoring systems, Armstrong said.
"One reason we used [the drugs] was because we had no alternative," he said.
Despite its enthusiasm for the proposal, the panel acknowledged an enormous roadblock: money.
In recent years, DCF has said lawmakers were paying for only a small fraction of the mental health needs of Florida children. And some of the services the panel is backing, such as frequent consultations with psychiatrists, would be costly—and almost certainly not billable under Medicaid, a federal program for the needy.
"One way to look at it is quality; another way to look at it is expense," Armstrong said. "I suspect cost will be lower because it will be a much more efficient system."
In recent weeks, advocates for foster children have complained that some psychiatrists have been using powerful antipsychotic drugs to control the behavior of hard-to-manage children. One particular drug, Risperdal, has been widely prescribed though it has not been proven safe or effective for children and has produced some serious side effects.
Thursday's panel discussion, for the most part, never directly addressed the concerns of advocates that some drugs were being used as inappropriate "chemical restraints." The panel's leader, Children & Families' mental health chief, Celeste Putnam, said it was not the group's place to second-guess the decisions of medical professionals.
"The purpose of our meeting is not to try to define practice guidelines," Putnam said. "The use of psychotropic drugs by physicians with children is part of their practice. They are licensed and we are going to leave that to the physicians."
"What this is about is the department's role in taking care of children, and that we are consistent across the state in how we approach physicians and how we work with physicians."
Herald reporter Steve Bousquet contributed to this story.
