The audit examined the cases of 168 children who were prescribed psychotropic medication while in protective custody and were enrolled in one of two MassHealth assistance programs. In total, there are approximately 4,000 children in DCF protective custody who had at least one prescription for a psychotropic medication during the surveillance period between June 1, 2019, and December 31, 2023, including nearly a quarter of those in DCF protective custody.

The report states that anxiety and depression medications, antipsychotics, stimulants and mood stabilizers help children cope with mood swings, anger and delusions. However, it can have serious side effects such as mania, seizures, and suicidal thoughts.

DiZoglio emphasized how vulnerable children in DCF’s protective custody can be.

“Many of these children are left without the help of family members and other supports, and that is why they are detained,” he said.

Daniel Mahoney, deputy general counsel of the state public defender’s office’s child and family law division, called DCF’s drug treatment of children a long-standing concern in the state.

“The audit demonstrates a lack of consistent court approval and documentation of potentially harmful medications prescribed to children in DCF custody,” he said in an emailed statement, “which undermines legal and medical safeguards designed to protect these children.”

In 2009, the Office of the Child Advocate expressed concerns about the agency’s use of psychotropic medications. 2015 annual report. According to the child advocate who served as a watchdog for DCF, the agency needed to do more than medicate children. Prescriptions should be part of a larger behavioral health plan that is routinely reviewed and evaluated, the report said.

A spokesman for the child advocate said both his office and DCF recognize the importance of keeping proper records.

However, during the inspection, it was determined that despite the previous warnings of the child lawyer, children receiving medication were still not receiving complementary treatment. Of the sampled cases, 25 received no treatment and 34 remained untreated for more than four months. The group studied included 28 children who expressed suicidal thoughts and used psychotropic medication.

DCF did not respond to an interview request Thursday but released a statement saying it largely agreed with the audit’s findings and was addressing them. them. The agency has a team of experts, including a child psychiatrist, consultant psychiatric nurse and psychiatric social worker, who provide guidance on prescribing psychotropic medications to children. The psychiatrist also oversees a monitoring program that examines requests to prescribe antipsychotics to children.

The agency is relying more on MassHealth’s records to better track prescriptions and now conducts a medical review every time a child is prescribed an antipsychotic, according to the statement.

Dr. is a psychiatrist and chief medical officer at Judge Baker Children’s Center, which provides services and education related to children’s behavioral health. Keeping accurate and up-to-date medical records is a challenge in the child welfare field, Christopher Bellonci said. Digital data systems can be cumbersome, foster parents and caseworkers may not be able to exchange complete information about medical care, and keeping accurate records can often be time-consuming.

“There are a lot of places where this can break down,” Bellonci said. “This is certainly not an excuse, but it is a fact.”

The audit found that there were 36 children in the sample who were taking antipsychotic medication, but four were taking the medication without court permission. This is a violation of state regulations that require the agency to obtain court permission, called the Rogers Order, before administering antipsychotic medications to children too young to give legal consent. Six children were given antipsychotics after the court order expired. In one case, the child was still taking medication eight months after the court order expired.

In the majority of cases, DCF did not keep accurate records of approval or court approval of psychotropic medications, according to the audit.

DCF has offered various explanations for its failure to obtain the required court approval. In one case, the agency told auditors that the child was not in protective custody and had been drugged before interacting with DCF. In another case, a prescription was filled but not taken. In another case, the COVID-19 pandemic caused delays in a court hearing.

The audit found DCF records contradicted or failed to verify the agency’s statements. It was also stated that even if the child does not use medication, prescriptions should not be filled without a judge’s order.

Additionally, the auditor found that DCF did not require monitoring of the Rogers process to ensure it was being followed properly.

The agency responded in its auditor’s report that it would do better to follow court proceedings.

The audit found gaps in the digital medical records of all but two of the 168 children prescribed psychotropic medication. DiZoglio said these records are critical to child care, and if a child needs emergency care, the doctor will rely on them to determine a safe course of treatment. Among cases studied from two MassHealth plans, nearly 88 percent had either no or incomplete information about prescriptions for children’s mental or behavioral health treatment.

Keeping records of doctor appointments and mental health services was equally disorganized.

“DCF may be creating a treatment plan for a child that is not safe or effective because it is missing important information that would impact that child’s health care,” the auditor’s report stated.

The Ministry also does not have procedures to provide additional attention to children using prescription drugs. Doses exceeding Food and Drug Administration recommendations.

Jason Laughlin can be reached at [email protected]. follow him @jasmlaughlin.