WASHINGTON, D. C. - Ohio’s foster care system does not adequately track psychotropic and opioid medication prescriptions for children in its care who have painful injuries or conditions including attention deficit hyperactivity disorder, depression, schizophrenia, and anxiety disorders that require such drugs, according to an inspector general’s report released Thursday by the U.S. Department of Health and Human Services.
The report found more than 30% of the children in foster care in the state were prescribed one or more psychotropic or opioid medications and Ohio’s Statewide Automated Child Welfare Information System (SACWIS) often lacked accurate details about their prescriptions, increasing their likelihood of getting improper medication doses or combinations.
Medical problems of foster children who change residences during the year can be aggravated if the state doesn’t have correct details of their prescriptions on file and the information falls between the cracks, said HHS Senior Auditor Lisa Capuano.
Capuano said her office decided to examine how Ohio monitors foster kids’ prescription drugs after a past audit found the state’s foster care records didn’t always contain documentation that showed children received required health care services, and a third audit found an Ohio foster child experienced a severe reaction after taking multiple prescription medications that weren’t adequately monitored.
Past HHS research has found that up to 80% of children in foster care enter state custody with significant mental health needs. Unlike children from intact families, children in foster care often lack a consistent interested party to provide continuous oversight of their treatment. Because responsibility for children in foster care can be shared among multiple people such as foster parents, birth parents and caseworkers, there’s a greater risk of miscommunication, conflict and lack of follow-up, HHS says.
The HHS report released Thursday examined the case records of 70 Ohio foster children who were prescribed psychotropic medications, and 30 who were prescribed opioids. It found that Ohio’s SACWIS system didn’t contain proper information about the opioid medications taken by 28 of the 30 children who were taking them, and case records for 33 of the 70 children in the sample who were prescribed psychotropic medications weren’t accurately documented. It also found some county agencies didn’t correctly list medications as psychotropic when they put them into the system.
The HHS Inspector General’s report recommended that the Ohio Department of Job and Family Services improve monitoring to ensure that county agencies put the required prescription medication documentation into its SACWIS system, better train county agency workers who input medical and medication information, and to implement procedures to monitor opioid medications prescribed to children in its custody.
The state agency told HHS it would revise its requirements and conduct outreach to county agencies to address the deficiencies, better train county agencies to record drug information, and establish a data agreement with the Ohio Department of Medicaid to cross check prescription information with Medicaid claims and monitor opioid and psychotropic drug trends and usage among foster children.
“We recognize the corrective actions the State agency has implemented or plans to implement to address our recommendations,” the report said. “These corrective actions should provide improved monitoring and a reliable source of information for the coordination of health care for children in foster care that are prescribed psychotropic and opioid medications.”
A statement from ODJFS spokesman Bret Crow said that since receiving the report, ODJFS has taken steps to implement its recommendations.
“We are pleased that the OIG recognized our efforts as we strive to protect the health, safety, and wellbeing of all of Ohio’s foster youth,” Crow continued.
A May 27 letter from Ohio Department of Jobs and Family Services Director Kimberly Hall to the HHS Inspector General’s office said her agency is “committed to ensuring the continued compliance with state and federal regulations related to monitoring of psychotropic and opioid medication information for children in foster care,” but implementing some changes has been delayed as county agencies transitioned to remote working because of the COVID-19 coronavirus pandemic.
“ODJFS will remain vigilant in its mission to assure the accuracy and completeness of psychotropic and opioid medication information for children in foster care,” her letter said.