Chuck Grassley

United States Senator from Iowa

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Grassley, Kaine Urge HHS to Move Forward on Recommendations to Help Foster Youth

Oct 15, 2018

WASHINGTON – U.S. Sen. Chuck Grassley of Iowa, along with Sen. Tim Kaine of Virginia, led a bipartisan group of senators in sending a letter to Assistant Secretary for Family Support Lynn Johnson, urging her to implement recommendations from a recent Health and Human Services (HHS) Office of Inspector General (OIG) report that would help foster children prescribed psychotropic medications. 

Iowa was one of five states studied by the OIG. More than 35 percent of Iowa’s foster youth are being treated with psychotropic medication, one of the highest rates in the country. The OIG found that 30 percent of these children did not receive a treatment plan, which is required by law in Iowa. Additionally, 48 percent of children in foster care did not receive medication monitoring by a prescribing professional.

“We are concerned to learn that the Department of Health and Human Services Office of Inspector General (OIG) determined that thirty-four percent of children in foster care who have been prescribed psychotropic medications did not receive treatment planning or medication monitoring.

“When children are removed from their homes and placed into foster care, the government is accepting, at minimum, the responsibility of providing a safe environment. It is critical that the Administration for Children and Families immediately take steps to ensure that states are providing treatment planning and monitoring to ensure that children are being prescribed psychotropic medications safely and appropriately.”

Grassley is the co-founder and co-chair of the Senate Caucus on Foster Youth and has been working to improve the lives of foster children and families for more than two decades. In 2008, Grassley introduced the Fostering Connections to Success and Increasing Adoptions Act, which provided additional federal incentives for states to move children from foster care to adoptive homes. That legislation also made it easier for foster children to be permanently cared for by their own relatives, and to stay in their home communities.

The Tax Cuts and Jobs Act, which passed late last year, preserved the Adoption Tax Credit, making it easier for families who want to adopt children in foster care to do so. Also last year, Grassley introduced the Strong Families Act of 2017, legislation to prevent child abuse and improve maternal and child health.

In 2011, Grassley worked to reauthorize grants that support families who struggle with substance abuse, and that improve the well-being of children who are not in their homes or are likely to be removed because of parental substance abuse. His bill, the Building Capacity for Family Focused Residential Treatment Act, was recently signed into law as part of a bipartisan, bicameral effort to reduce opioid addiction.

Text of the letter is available here and below.

 

The Honorable Lynn Johnson

Assistant Secretary for Family Support

Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

 

Dear Ms. Johnson,

We are concerned to learn that the Department of Health and Human Services Office of Inspector General (OIG) determined that thirty-four percent of children in foster care who have been prescribed psychotropic medications did not receive treatment planning or medication monitoring. Children in foster care are more susceptible to potentially inappropriate prescribing and treatment with psychotropic medications.

These children are often prescribed antipsychotic medications at far higher rates than non-foster care children. Side effects of psychotropic medications can be severe, and should be carefully considered against the benefits. Foster youth are more likely than the general population to have severe mental health conditions that may require the use of psychotropic medications. However, it is clear that treatment planning and monitoring are crucial to ensuring the safety and long-term health of these children.

In September 2018 the OIG published a report demonstrating that states do not have adequate processes in place to ensure children in foster care who are prescribed psychotropic medications have proper treatment planning and monitoring. The OIG report further found that twenty percent of children in foster care on psychotropic received no treatment planning. Of the children who did receive treatment planning, fifty-two percent did not have a complete treatment plan. As you know, treatment planning is imperative to ensure continuity of care and reduce the risk of harmful side effects, especially among foster youth who are subject to frequently changing caseworkers, foster parents, and health care providers. Without adequate treatment planning, it is difficult for a child’s caregivers to understand why medication has been prescribed, or the potential side effects or benefits of each medication.

Additionally, this report found that twenty-three percent of children in foster care who were prescribed psychotropic medications did not receive medication monitoring. It also found that professional practice guidelines were inconsistently incorporated in state monitoring requirements. Medication monitoring is crucial to preventing inappropriate dosing and adverse side effects from certain combinations of medications, and to ensuring successful longer-term management of the underlying condition.

The OIG report indicates that state-level officials recognize challenges in implementing state plans related to treatment planning and medication monitoring, and requested that the Administration for Children and Families (ACF) provide additional guidance and technical assistance, including national data for states to use as benchmarks, examples of successful strategies that other states have used, and assistance in improving communication between child welfare systems and Medicaid.

Accordingly, we request a response to the following questions:

 

  1. Does the ACF intend to implement all of the recommendations of the OIG report?
  2. If ACF does not intend to implement all recommendations, please provide a detailed explanation as to what recommendations ACF will implement and why. Please also provide a detailed explanation of what recommendations will not be implemented and why ACF has reached this decision.
  3. ACF noted that there is already a “well-established approach to program implementation.” However, the OIG report indicates that this approach is not sufficient to ensure state compliance with requirements related to treatment planning and medication monitoring. What steps does ACF intend to take to improve compliance with these requirements?
  4. ACF noted that the OIG’s recommendation would require statutory and regulatory changes to implement. What changes to law or regulation would be required to implement the OIG’s recommendations to improve states’ compliance with treatment planning and medication monitoring requirements?
  5. What additional statutory authorities or monetary resources does ACF need to implement all of the OIG’s recommendations?
  6. Are there other changes to law that would allow ACF to be more effective in improving states’ compliance with treatment planning and medication monitoring requirements?
  7. The recommendation to assist states in developing monitoring requirements that incorporate professional practice guidelines recommends publishing a memorandum with specific mechanisms for child-level treatment planning and monitoring. Does ACF intend to publish this memorandum, and if not what does ACF intend to do to assist states in implementing child-level monitoring consistent with professional practice guidelines?
  8. Does ACF intend to provide additional training or technical assistance for states related to incorporating professional practice guidelines beyond what is already available?

When children are removed from their homes and placed into foster care, the government is accepting, at minimum, the responsibility of providing a safe environment. It is critical that the Administration for Children and Families immediately take steps to ensure that states are providing treatment planning and monitoring to ensure that children are being prescribed psychotropic medications safely and appropriately.

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