Audit finds Human Services falls short monitoring foster children’s prescriptions

Erin Kelley-Siel

Erin Kelley-Siel, Assistant Director for Children, Adults and Families

From the Oregonian, April 2 2009

More than one year ago, child welfare officials pledged better oversight of the psychiatric drugs given to one in five foster children, but an internal state audit shows that isn’t happening.

The audit, dated December 2008, found medication logs missing from child welfare files and almost none of the children’s psychiatric prescriptions getting a required second review. It also found poor communication between caseworkers and foster parents concerning children’s medications.

A November 2007 investigation by The Oregonian found children in foster care were prescribed psychiatric medications at four times the rate of other children covered by Medicaid. Most children come into foster care after being neglected or abused and often have mental health or behavioral issues.

The newspaper also found that state laws and rules governing the use of psychiatric medications in foster care were often ignored and that hundreds of children were taking multiple prescriptions with little or no state scrutiny.

Managers at the state Department of Human Services say they are committed to improving the system.

Today, child welfare officials will appear before a state House committee to discuss their progress. Lawmakers are turning up the heat with a bill requiring regular review of the psychiatric drugs administered to children in state custody.

Children are being prescribed two, three or more drugs, said Rep. Tina Kotek, a Portland Democrat and sponsor of House Bill 3114.

“It’s the state’s responsibility to treat children in foster care like they’re our kids,” Kotek said. “And I want to have better oversight of the drugs those kids are taking, especially if they’re young.”


The most recent numbers show 1,461 children, about 20 percent of the kids in foster care last October, were prescribed at least one psychiatric drug. Those drugs include Ritalin, prescribed for attention deficit disorder, as well as antidepressants such as Prozac and Zoloft.

Since the newspaper’s 2007 report, child welfare officials have convened a medical advisory committee to look at prescribing practices and sought opinions from the state Drug Use Review Board and the attorney general.

The agency also requested a full-time medical director to focus on child welfare cases. But that request was turned down for lack of money.

Instead, officials arranged early this year to share a pediatrician and a psychiatrist with another division in the agency.

“We have made progress, and there is still more to be done,” Erinn Kelley-Siel, the state’s child welfare director, said Thursday. “We are strongly committed to making every effort to ensure that children get the care they need.”

Two recent reports point to some of the work still to be done.


A March 10 report from the state Addictions and Mental Health Division concludes that five of every six children placed in foster care between October 2003 and June 2008 did not receive a mental health assessment within 60 days as required by state and federal rules.

The December 2008 audit, obtained by The Oregonian through a public records request, examined files from 50 children who were in foster care in July 2008.

All had been prescribed at least one psychiatric drug. Almost 80 percent of those children received mental health assessments at some point. But case files contained detailed medication logs only 20 percent of the time.

Auditors made sure to include children they considered the most “vulnerable”: young children and kids on three or more drugs. They found those children received the least oversight of their medications.

The audit also found that state caseworkers communicated a child’s health information to the foster care provider roughly half the time. Foster parents told caseworkers about new medications or changes in medications about a quarter of the time.

On March 25, Kelley-Siel ordered field supervisors to review files for all children on psychiatric medications. She has asked that the review be completed by the middle of May.

“It will give me assurance that our policy is being followed,” Kelley-Siel said.

If the budget allows, the agency said, mandatory training for staff and foster parents could begin later this year.

READ – Psychotropic Medications Compliance Review – December 2008

READ – Foster kids’ meds get scant attention, Oregonian, November 25 2007.