Dec 15, 2016

Texas Foster Care System Faces Concerns About Overmedication of Children

Reporting Texas

Holding a scrapbook inches from his face, Jessy Dussetschleger flips through pages and pages of pictures from his childhood. Smiling and tapping his adoptive mother on her shoulder, he points to a photo of himself with his siblings at a birthday party.

Touching memories from early childhood are a rarity for him.

Jessy, 22, was born deaf. His mother, a single mom, also was deaf and raised him in an abusive household in Corpus Christi. He was just 4 years old when Child Protective Services removed him from the home.

Although it is unclear how much abuse he suffered, scars indicate it was extensive. The state declared that he was “severely traumatized.” He had six placements during his first three months in the foster care system before he was placed with Melody and Darrel Dussetschleger.

Jessy was unable to communicate and had severe behavioral problems due to his deafness and the abuse. He was holding the scrapbook so close to his face because he also is legally blind.

At 4, he was prescribed Focalin, Thorazine and BuSpar to manage his behavior. His sister, Shela, also was fostered by the Dussetschlegers and was on heavy psychotropic medication when she came to them at 3 years old.

“Every kid we had was so over-medicated. He was on medication most adults can’t even handle. She would just look hollow. It was horrible,” said Melody Dussetschleger, 56, a stay-at-home mom.

More than 30,000 children are in Texas’ foster care system, including more than 1,000 Travis County. In 2015, 15.5 percent of foster children were prescribed psychotropic medication by the state or contract physicians, down from 28 percent in 2002.

Psychotropic medication includes drugs that affect mental activity, which includes sedatives, tranquilizers, stimulants, antidepressants and anti-psychotics. Side effects can range from suicidal ideation and cardiac arrest to seizures and sudden death. There are few studies on the long-term effects of those medications. The drugs also can mask underlying problems that could be treated with therapy.

“The medications are not only approved, you have to give it to them. They are pushed by the state. We didn’t have a choice,” said Darrel Dussetschleger, 60, a self-employed contractor. His family has fostered 32 children over the past 25 years. Jessy was their first.

In December 2015, U.S. District Judge Janis Jack ruled that Texas’ foster care system was was unconstitutional. She found that the system subjected children to unreasonable risk of harm and that children left foster care more damaged than when they entered. The state is responsible for children “shuttled throughout a system where rape, abuse, psychotropic medication and instability are the norm,” Jack’s ruling said.

Jack ordered an expert review of the system, which found that psychotropic medication had been prescribed widely, often without evaluation and with missing medical records. The report, which was released in November, recommended that the state establish regular review of children’s diagnoses and medication dosages and create an informed consent protocol.

Marissa Gonzales, a spokeswoman for the Texas Department of Family and Protective Services, said it conducted an “extensive review” of prescription practices for children in foster care more than a decade ago. “In general, the use of psychotropic medication in foster children has declined significantly in recent years, even as the number of children entering the foster care system has continued to rise,” she said.

Concerns about the use of psychotropic medication in the foster care system date at least to 2008, when the federal Government Accountability Office compared Medicaid data from five states. The GAO found that in Texas, 32 percent of foster children were prescribed psychotropic drugs, compared to 7 percent of children outside of foster care. No other state had such a big disparity.

Tymothy Belseth said medication made it difficult to get to the root of the trauma he saw kids endure in foster care.

“You can’t get a pill to take away trauma,” said Belseth, 26, who entered Texas’ foster care system when he was 15. He is now a research coordinator at the Texas Institute for Child and Family Wellbeing in Austin. “It’s easier to deal with a doped-up kid than to deal with one that is constantly mouthing off,” Belseth said.

The Department of Family and Protective Services now revises its guidelines on psychotropic medication, which were introduced in 2005, every three years based on recommendations from the experts at the University of Texas at Austin’s College of Pharmacy and other medical professionals.

The guidelines set limits for dosages and designate “red flags” for mixing medications that trigger a review of the child’s treatment plan. However, scarce resources make it difficult to enforce the parameters.

“Certainly, kids need more psychotherapy than they’re getting,” said Dr. Steven Pliszka, a child and adolescent psychiatrist who helps DFPS develop the medication parameters. The goal is not to get children completely off medication but to reduce practices such as prescribing multiple drugs to treat the same behavioral disorder, he said.

“We know very little about childhood PTSD and really the best treatments. For the most part, we are extrapolating from the adult data, and that’s true in therapy as well as medication,” Pliszka said.

Jessy suffers from macular degeneration, a condition that causes blind spots to grow in his field of vision. The disease is caused by retinal deterioration, which typically manifests as adults age. Specialists said repeated head trauma could have damaged Jessy’s eye tissue, preventing it from developing correctly. Vision specialists told the Dussetschlegers there was no way to estimate when he would lose his sight completely.

When he was in second grade, Jessy’s blindness had worsened to the point where he could no longer see his teacher. The Dussetschlegers said his psychiatrist recommended Jessy get off psychotropic medications, including Thorazine, an anti-psychotic whose side effects include vision problems.

“We took him off, and it was amazing how much easier his behavior was, because he didn’t have all of those side effects,” said Melody. Jessy’s medications had caused drooling, insomnia and severe mood swings. “We called them ‘the afternoon nasties,’” she said.

Tyrone Obaseki understands the emotional side effects of psychotropic medication from his 18 years in the foster care system.

“I was living an environment where you are constantly being told that you are retarded,” said Obaseki, now a Houston-based therapist and advocate. “That begins to affect the self-esteem of the young person like it did with me, especially in adolescence.”

Obaseki was on and off psychotropic medication and was admitted to psychiatric hospitals during his time in the system. He believes he was misdiagnosed and pleaded with his foster parents to take him off all medication. After leaving the system, he went on to earn a master’s degree in counseling from Prairie View A&M University.

“I believe that I am a normal, functioning adult who was dealt a bad hand and is trying to make the best of it,” he said. “The solution was not drugs, it was love and support.”

After decades of working with the state, the Dussetschlegers haven’t fostered children since 2010. They said it became too difficult to work with DFPS and its prescriptions for how they should care for children. “It wasn’t our home anymore,” Melody said.

But heartened by the changes that Jack’s ruling might spur, the Dussetschlegers, parents of three biological and two adopted children, are thinking of becoming foster parents again.

Their house is about to empty. Jessy has a full-time job at a warehouse in Taylor and is eager to move out of his parents’ home, and his sister, Shela, is getting married in April.

“I have seen true evil in what has happened to these kids, but they are so resilient. Seeing how much they have overcome only strengthens my faith,” Melody said. “It makes me full of hope.”