A federal report released in September found Indiana failed to comply with its own requirements for documenting the use of psychotropic and opioid medications prescribed to foster children, following concerns earlier this year about overmedicating foster children.
The review of 115 children in state custody, 95% of whom had improperly stored healthcare information, confirms part of the testimony shared by foster parent Allison Missler earlier this year. She said she received children with little medical documentation from the Indiana Department of Child Services (DCS).
“It has been my overwhelming experience that the state prefers to medicate children then find non-pharmacological, trauma-informed treatment,” Missler told the Ways and Means committee in August.“Most children arrive at my home with a Ziploc bag of medications: medications to wake them up, to help them focus, to stabilize their moods and then to make them sleepy.”
The Indiana Capital Chronicle explored the issue in earlier story detailing the state’s history of issuing psychotropic drugs to more than one in four foster children, which the OIG reported in 2018.
The Office of Inspector General with the U.S. Department of Health and Human Services performed the audit because the state receives federal funding for child welfare services. The 115 children represents a small sample of the 18,593 children DCS cared for between 2019 and 2020. Of the total number of children, 6,334 (34%) were prescribed psychotropic or opioid medications.
The findings of the report
The federal agency expressed a concern about the serious side effects of the medications when given to children, especially when ineffectively monitored. Foster children, who may have greater mental and physical health needs than their peers, may get the prescriptions to treat anxiety or depression. However, without a consistent parent or guardian overseeing the medication, the state must fill the role by tracking and monitoring the medications.
The report found the overwhelming majority of children, 109 out of 115 analyzed, did not have medical passports in their health care records. In MaGIK — a portal used by DCS to track foster children and share their important documents — two-thirds of the children, 76, didn’t have their psychotropic or opioid medications recorded.
Of the 85 children prescribed psychotropic medication, 49 children didn’t have authorizations uploaded to the portal. Additionally, the health care records for 13 of the 21 children living in residential facilities with prescribed psychotropic medications didn’t have the required written reports and medical reviews from their prescribing provider.
Rep. Rita Fleming, D-Jeffersonville, said in a statement that she was “very concerned” about the report’s finding.
Rep. Rita Fleming (Photo from Indiana House Democrats)
“Children in foster care are some of the most vulnerable people in the state, and we need to be doing all we can to ensure their safety. Making sure that foster parents know a child’s medical history, as well as having a thorough understanding of what medications they are on – including possible side effects – is of utmost importance,” Fleming said.
Fleming said her daughter was a foster parent and thus knew the challenges of improperly documented medical records firsthand.
“As we are expecting a large influx of children entering our foster care system due to the near-total ban on abortion, we must act now to strengthen the Department of Child Services to ensure workers have the resources necessary to do their jobs to the best of their ability. The safety and health of Hoosier children depend on it,” Fleming said.
DCS declined to comment on the report, referring questions to their response included in the federal audit.
In that response, the state acknowledged receiving the report in late July, saying DCS was “pleased the OIG found no instances of harm or inappropriate medication distribution to any children.”
Indiana told auditors it was developing a new child welfare information system, called I-KIDS, that would better track and document healthcare information for foster children, including prescription authorizations.
“The State agency acknowledged that it was unable to produce required authorizations for medications prescribed to children in our sample,” the report said. “However, the State agency confirmed that the authorizations were provided to prescribers, and no children were unsafely prescribed medications.”
The OIG recommended that Indiana take efforts to better track health care records for foster children, obtain
Proposals for Indiana to fix its system
medical authorizations for children currently using psychotropic medication and coordinate with the Indiana Family and Social Services Administration (FSSA) to obtain access to Medicaid claims.
Indiana concurred with all of the recommendations, noting that its current policy required case managers to duplicate work by creating hard copies along with a profile in MaGIK. The policy “causes confusion,” DCS admitted, saying it would update internally and retrain staff.
The new child welfare information management system, I-KIDS, will connect a lookup table for psychotropic medications to FSSA’s Medicaid claims. The agency has drafted legislation it hopes to present during the 2023 session to the General Assembly to conform state statute with the new policy.
“Indiana DCS affirms that a robust monitoring system of psychotropic and opioid medications for foster children is critical to ensuring the safety and well-being of children in care and agrees there are opportunities to improve record keeping of these medications,” said DCS Director Terry Stigdon in a response to OIG.
“Indiana’s child-welfare system has made incredible strides in the past five years, and making these changes will build on that progress, bringing us closer to our vision of seeing children grow up in stable, supportive homes and communities.”