In the Bronx, Pedro Maldonado’s story of diagnosis and prescription for Concerta and Seroquel — typically prescribed for ADHD and mood disorders like schizophrenia — started when he was in foster care at age 6.
“When I was younger I never really thought about it, I just took it. As I got older, I started speaking up for myself,” said Maldonado, who is now 22. “As I got older, it started to make me feel like a zombie and I guessed they upped the dosage.”
Ariel, another teen in New York City’s foster care system whose last name is being withheld, says that he was first prescribed Abilify, a powerful antipsychotic at age 13, for his ADHD diagnosis.
The drug made him feel so drowsy that he would fall asleep in class. So he wanted to get off it. But his foster mom had other ideas.
“She told me, ‘If you’re not on the medication you can’t live with me,’” Ariel said. “I wanted to stay, so I took it and I knew my other options were worse.”
The dosage kept getting increased without his consent, he said, and he started to have suicidal thoughts that “came out of nowhere.”
Interviews with dozens of current and former foster youth and children’s lawyers confirm that Ariel isn’t alone in being prescribed powerful, mood-altering drugs. But New York City’s foster care system says it has no data on youth prescription rates, despite federal guidelines that say they should have them.
The haphazard prescribing of psychotropic medications to foster children – some very young, and often medicated without appropriate talk therapy – was long a hidden problem. But despite grabbing newspaper headlines nationwide, foster children – some as young as 5 – are still routinely prescribed potent cocktails of psychotropics leaving them listless, obese or suicidal, all while doing little to improve the perceived mental health problems that the drugs aim to alleviate.
And after months of requests for information from both The Imprint and from New York City Council, the Administration for Children’s Services (ACS) repeatedly declined to share even basic facts about the percentage of kids who have been prescribed powerful drugs.
“[ACS] does not have access to data about the use of psychiatric medications in our foster care system, but we have been taking steps to try to access this information,” a spokesperson for ACS said. A source at the agency also explained the agency does not track data specific to “medication overrides” — instances where ACS allowed its foster care nonprofits to move ahead with a psychotropic prescription despite a parent declining to provide consent.
Monica Mahaffey, spokesperson for the state Office of Children and Families (OCFS), which regulates foster care agencies statewide, said via email the agency would need to look into “whether this is something we can get” when asked for the number of children younger than 6 in New York City and the state prescribed a psychotropic. Both Mahaffey for OCFS and the Department of Health, which manages the state’s Medicaid program, asked The Chronicle to submit a list of specific drugs, claiming they may be able to provide separate counts of prescriptions for each drug.
Children’s advocates are supporting a City Council bill proposed by General Welfare Committee Chair Stephen Levin that would require more systemic monitoring by ACS. “By collecting this data, ACS and City Council will be able to observe prescribing trends for each foster care agency, with the data disaggregated to show trends by gender and ethnicity,” read a statement by the Legal Aid Society, which represents most New York City foster youth in family court. “The data collected would allow ACS to track problematic prescribing practices on a systemic level and report on any corrective action taken to ameliorate these dangerous practices.”
Other states and cities make this data available publicly. Los Angeles County, for example, releases a quarterly report that details prescription rates. The last such report, from late October 2019, revealed that 1,363 children, or 7.3 percent of all foster children, were receiving psychotropic medications. Almost half of them were receiving more than one of these powerful drugs, and almost a quarter were receiving anti-psychotics.
Investigative reporting by The San Jose Mercury News in 2015 resulted in legislation ensuring that child welfare agencies across California track and mitigate the over-prescription of foster youth. The federal government has pushed for action on this issue running as far back as 2012, when the Administration for Children and Families recommended “effective [psychotropic] medication monitoring at both the client and agency level,” for child welfare agencies.
For Rosie Williams, who grew up in Brooklyn’s foster care system, the stream of psychotropic drugs began at 12 years old. “I was on at least three meds at a time. Seroquel, Wellbutrin and Zoloft, but those are the only ones I can pronounce,” Williams said.
Nigel, who asked his last name not be published, entered New York City’s foster care system at age 12. He is now 25 and said if he was drugged for a specific condition, it’s news to him. He was first prescribed an antipsychotic at age 14.
“They never really told me what I was diagnosed with but they put me on Seroquel,” he said. “I didn’t like how it made me feel, I was unresponsive, felt outside of myself. I felt like I was in a dream whenever I took it, it was sedation.”
Meanwhile, some members of the New York City Council would like to see more transparency from the agency on psychiatric medications. Earlier this year, four council members led by Levin introduced a bill that would require ACS to provide quarterly reports on the number and percentage of children prescribed three or more psychiatric medications, along with seven other related data points.
As youth who are drugged while in care age into adulthood, many say they are quick to leave the medications behind. Maldonado – the former foster youth from the Bronx, now 22 – said he stopped taking his prescriptions at 16.
Ariel, now 18, said he stopped taking the antipsychotic Abilify once he became an adult.
“I don’t know who I am ultimately yet but I entered a stage of growth,” said Ariel. “I knew about how they treated foster care kids and I wasn’t going to be their lab rat.”
Ericka Francois was the 2019 Brian Donovan Fellow for The Imprint.
This story was co-published by the Norwood News, which covers the Bronx.