From the U.S. Government Accountability Office, www.gao.gov Transcript for: Oversight of Psychotropic Drug Prescriptions for Foster Children Audio interview by GAO staff with Greg Kutz, Director of Audit Services, Forensic Audits and Investigative Service Related GAO Work: GAO-12-270T: Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions Released on: December 1, 2011 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the Government Accountability Office. It's December 1, 2011. Oversight of psychotropic prescription drugs is especially important when children are the patients. Foster children who may be more likely to need these drugs due to past abuse or neglect are particularly vulnerable. A group led by Greg Kutz, Director of Audit Services in GAO's Forensic Audits and Investigative Service team, recently reviewed prescription rates and oversight of these drugs for foster children in several states. GAO's Jeremy Cluchey sat down with Greg to learn more. [ Jeremy Cluchey: ] How do prescription rates for psychotropic drugs for foster children compare to those rates for non-foster children? [ Greg Kutz: ] Well, because this is Medicaid, we had to look at certain states. There's 50 states; they have different programs, so we got data from six different states, and we're able to use data from five states. One of the states did not have reliable data. The states we use were Florida, Massachusetts, Michigan, Texas, and Oregon, and what we found for those states is that foster children were prescribed psychotropic drugs at rates that were 2.7 to 4.5 times higher than non-foster children that were in Medicaid in 2008. Now, this is something that is confirmed by other studies; these numbers may or may not be bigger than other studies, but it doesn't necessarily indicate inappropriate activity as foster children oftentimes have significant trauma from neglect and physical abuse that results in more serious mental health conditions that then would tend to require psychotropic medication to treat them. [ Jeremy Cluchey: ] Your team dug a little deeper into these rates, though, at looking into extent to which these drugs were prescribed together and to children of varying ages as well, including infants, can you elaborate on this? [ Greg Kutz: ] Sure. I mean, as I mentioned, the overall rates where the foster children are more likely to receive these drugs than non-foster were not necessarily surprising, can perhaps be explained. What isn't as easily explained are some of the higher-risk indicators we've found, you mentioned the concomitant use which is used at the same time of five or more of these drugs with different ingredients. Our experts have told us that that is a potentially risky practice here in something that there's no real clinical evidence to support. and the problem with that is potential adverse reactions and long- term side effects such as diabetes. The other one that you mentioned is infants or children under one year of age, and they were receiving certain drugs like anti-histamines, which may be prescribed for non-mental-health conditions, but regardless of what they're prescribed for, there is little evidence to show support for the use of these types of drugs in what are essentially babies. [ Jeremy Cluchey: ] You mentioned the experts in your team spoke with child psychiatrists to provide some contexts for these findings. What did you learn? [ Greg Kutz: ] Well, they have both, both the experts that we used, have done their own studies; they are familiar with the other studies out there showing this difference in the overall rates, so that was again something that our work confirmed, I think, what some people have reported and we dug pretty deep in these five states with the data. But they did express, and they are the ones that helped identify the concerns with the five or more drugs at the same time, the use of certain drugs with babies, and then there were some high dosage cases for example that we found where the dosages that were prescribed were higher than FDA levels, which could again have significant side effects and also does not increase the usefulness of the drug and in fact, can decrease the usefulness at some point. [ Jeremy Cluchey: ] Can you talk a little bit about the current state of oversight of these sorts of prescriptions for foster children? [ Greg Kutz: ] Right. We looked at actually six states for that. The five states I just mentioned plus Maryland. The reason we didn't use Maryland in our overall data analysis is because their data was not reliable. So, Maryland is not in the numbers analysis, but they’re in the controls analysis. And what we found that all these states have made some progress in the last several years, moving towards some of the best practices that are out there, but they all have areas for improvement. So, we took a look across the six states comparing them to best practices and found again that this is on the radar screen. They're all moving towards stronger controls, but that they each have a little ways to go. [ Jeremy Cluchey: ] Finally, what is GAO recommending in this report? [ Greg Kutz: ] What we've recommended is that the Department of Health and Human Services endorse nationwide guidelines so that there's more consistent and comprehensive controls for the use of psychotropic medications for foster children, which are a very vulnerable population. And we believe that the increased controls across states, more consistent controls, can better protect what is a very vulnerable population of children. [ Background Music ] [ Narrator: ] To learn more, visit GAO's website at gao.gov and be sure to tune in to the next edition of GAO's Watchdog Report for more from the congressional watchdog, the Government Accountability Office.