DCF was failing to manage child mental health care regularly, new report says – The Boston Globe

The study examined the cases of 168 children who were given psychotropic medication while in protective custody and enrolled in one of two MassHealth benefit programs. In total, about 4,000 children, nearly a quarter of all in DCF’s protective care, had a prescription for at least one psychotropic medication during the survey period between 1 June 2019 and 31 December 2023.

The report states that medications for anxiety and depression, anti-depressants, stimulants and mood enhancers help children manage mood swings, anger and delusions. But they can have serious side effects, including confusion, seizures and suicidal thoughts.

DiZoglio emphasized how vulnerable children in DCF’s protective care can be.

“Most of these children are left without the help of their relatives and other supports, that’s why they end up in detention,” he said.

Daniel Mahoney, deputy chief counsel for the child and family law division in the public defender’s office, described DCF’s handling of children’s pills as a long-standing issue in the state.

“The review shows a lack of court approval and documentation of potentially harmful medications given to children in DCF custody,” he said in an emailed statement, “which undermines legal and medical protections designed to protect these children.”

As far back as 2009, the Office of the Children’s Advocate expressed concern about the agency’s use of psychotropic drugs, according to its 2015 annual report. The agency needed to do more than just treat children, according to a children’s advocate, who works for the DCF watchdog. The guidelines should be part of a larger behavioral health plan that is regularly reviewed and evaluated, the report said.

A spokeswoman for the child advocate said her office and DCF recognize the importance of keeping accurate records.

However the audit found that although the children’s advocate gave earlier warnings, the children who were given the medicine were still not receiving the additional treatment. Among the cases made, 25 children did not receive treatment at all and 34 did not receive treatment for more than four months. The study group included 28 children who had shown suicidal thoughts and were taking psychotropic medication.

DCF did not respond to a request for comment Thursday but issued a statement saying it strongly agrees with the audit’s findings and is working on them. see. The center has a team of professionals, including a child psychiatrist, a psychiatric nurse consultant, and a psychiatric social worker, who provide guidance on prescribing psychotropic medications for of children. A psychiatrist also oversees a monitoring program that reviews applications for antipsychotics for children.

The agency relies heavily on records from MassHealth to track proper prescriptions, and now conducts a medical review whenever a child is prescribed an antipsychotic, according to the statement.

Keeping accurate and up-to-date medical records is a challenge throughout the child welfare field, said Dr. Christopher Bellonci, a psychiatrist and chief medical officer at Judge Baker Children’s Center, which provides services and training related to children’s behavioral health. Digital data systems may lack control, foster parents and staff may not share complete information about medical care, and accurate record keeping is often time-consuming.

“There are a lot of places where this could go wrong,” Bellonci said. “That’s not an excuse by any means, but it’s the truth.”

There were 36 children who had received antipsychotic medication, but four were treated without court approval, the review found. That’s a violation of state laws that require the agency to get court approval, called a Rogers Order, before giving antipsychotic drugs to children too young to give legal consent. Six children were given antipsychotic medication after the court order expired. In one case, a child was still taking medication eight months after the court order expired.

In many cases, DCF did not maintain proper records of authorization or court approval for psychotropic medications, according to the audit.

DCF offered several explanations for its failure to obtain the necessary court approval. In one case, the agency told investigators that the child was not in protective custody and had been given medication before interacting with DCF. In one case, a prescription was filled but not picked up. In one case, the COVID-19 pandemic caused a delay in a court hearing.

The review noted that DCF reports contradicted or failed to verify the agency’s claims. It also stated that even if the child was not taking medication, the prescription should not be filled without a judge’s order.

Additionally, the auditor found that DCF did not need to monitor Rogers’ operations to ensure compliance.

The agency responded in the auditor’s report that it would do a better job following the court’s actions.

The review revealed all but two of the 168 children given psychotropic medication had gaps in their digital medical records. Those records are important in pediatric care, DiZoglio said, and if a child needs emergency care a doctor will rely on them to find a safe treatment option. Of the cases reviewed from the two MassHealth plans, about 88 percent did not have information about the children’s orders related to mental health or behavioral treatment, or incomplete information.

Keeping records for contact with doctors and mental health services was also in the same situation.

“DCF may create an unsafe or ineffective treatment plan for a child, because there is important information missing that could affect the child’s health care,” the auditor’s report said.

The department also does not have the means to provide additional care to enrolled children doses that exceed the recommendations of the Food and Drug Administration.

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Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.