A damning report from the Massachusetts Office of the State Auditor has exposed severe lapses in the Department of Children and Families’ (DCF) oversight of psychotropic drug use on children in state custody. The audit, which reviewed data from July 2019 to December 2023, highlights widespread failures in documentation, court approvals, and healthcare management, leaving some of the state’s most vulnerable children at risk.
The audit revealed that out of the 17,891 children in DCF’s protective custody during the review period, 22%—or 3,899 children—were prescribed at least one psychotropic medication. These prescriptions included 1,065 for anti-anxiety medications, 21,585 for antidepressants, 10,564 for antipsychotics, 10,776 for mood stabilizers, and a staggering 48,453 for stimulants.
Psychotropic drugs are often prescribed to manage behavioral and emotional issues, but their use comes with significant risks, especially for children. For this reason, oversight is critical. However, the audit found DCF consistently failed to meet even basic standards for safeguarding the health and well-being of children under its care.
One of the most serious findings was that DCF often failed to obtain or renew court approval before administering antipsychotic medications to children, as required by law. Court oversight is meant to ensure that these powerful medications are safe, necessary, and in the child’s best interest, particularly when the child is too young to provide informed consent. Yet, the audit discovered numerous instances where children were given these medications without proper judicial authorization.
The state mandates that children in DCF custody have a “Medical Passport,” a physical record of their healthcare services, which caseworkers are required to review and update every six months. However, the audit found glaring deficiencies in maintaining these records:
- Medication Records: Psychotropic drugs were often not listed or updated in the children’s Medical Passports. This lack of documentation raises concerns about potential overprescription or dangerous drug interactions.
- Consent and Approvals: In 94% of cases sampled, there was no documentation of DCF’s consent or court approval for children receiving psychotropic medications. This lack of record-keeping is a significant breach of protocol, leaving children vulnerable to inappropriate or excessive medication.
- Psychosocial Services: DCF also failed to ensure that children received recommended psychosocial services, such as therapy, which are crucial in conjunction with medication. This oversight suggests a reliance on drugs as a quick fix rather than addressing the root causes of behavioral or emotional issues.
Perhaps most troubling is the discovery that 20% of children in the audit were prescribed psychotropic drugs in dosages exceeding the recommendations set by the Food and Drug Administration (FDA). Overmedication poses serious risks, including adverse side effects and long-term health consequences. The audit did not specify whether these excessive dosages led to any documented adverse events, but the potential for harm is significant.
The audit paints a grim picture of systemic failures within DCF. Beyond the immediate risks to children’s health, it raises several critical questions:
- What consequences will DCF employees face for these failures?
Will there be disciplinary actions or independent reviews to hold caseworkers accountable for not adhering to mandated protocols? - What role do prescribing doctors play?
The audit did not examine whether prescribing physicians were aware of or complicit in the overmedication or lack of oversight. Should stricter guidelines be imposed on healthcare providers working with children in state custody? - Will new safeguards be implemented?
The audit calls for improved oversight, but what specific measures will be taken to prevent these issues in the future? Will DCF be required to implement stricter documentation and approval processes?
Massachusetts is one of only two states, along with Florida, that audit the use of psychotropic drugs on children in foster care. Unfortunately, both states have reported significant failures in their oversight systems. This raises concerns about the broader national landscape, where many states lack any auditing processes, potentially leaving thousands of children similarly vulnerable.
The Massachusetts State Auditor has pledged to follow up in six months to track DCF’s progress in addressing these deficiencies. While this commitment is a step in the right direction, it remains to be seen whether meaningful reforms will be implemented in time to protect the state’s at-risk youth.
In the meantime, advocacy groups like AbleChild, which focuses on protecting children from overmedication, are sounding the alarm. They argue that DCF’s failure to properly manage psychotropic drug use underscores a deeper issue within the system: a troubling prioritization of expedience over comprehensive care.
The audit’s findings reveal a disturbing pattern of neglect and mismanagement in Massachusetts’ child welfare system. With thousands of children in state care subjected to potentially harmful drug regimens without proper oversight, urgent reforms are necessary. Lawmakers, advocates, and the public must demand accountability to ensure the safety and well-being of the most vulnerable members of society. Whether DCF can regain the trust it has lost will depend on its willingness to confront these failures head-on and implement lasting changes.
