A recent audit by the Massachusetts Office of the State Auditor has brought to light significant abuses related to the administration of psychotropic drugs to children in the care of the Department of Children and Families (DCF). The audit, which covers the period from July 2019 to December 2023, highlighted alarming deficiencies in how DCF handles the psychiatric care of children in protective custody. With an objective of ensuring the safety and well-being of at-risk youth, the DCF is responsible for various critical services, including adoption, foster care, and family support. The shocking revelations from the audit indicate systemic failures that compromise the health and safety of vulnerable children who are already facing immense challenges due to past abuse or neglect.
The audit found that out of 17,891 children in DCF’s protective custody, approximately 22% — or 3,899 children — were prescribed at least one psychotropic medication. This included staggering numbers of prescriptions across different categories: over 48,000 for stimulants alone, alongside significant quantities of antidepressants, anti-anxiety medications, and antipsychotics. Given this high prevalence of psychotropic medication usage, it becomes crucial for DCF social workers to meticulously track each child’s medication history and ensure proper oversight. Yet, the audit unveiled that many of the basic protocols meant to safeguard children regarding their medication management were routinely ignored.
One major concern raised by the audit was that DCF frequently failed to secure court approval for the use of antipsychotic medications, necessary for safeguarding the well-being of children unable to give informed consent themselves. Additionally, the audit found that DCF did not properly maintain or keep updated healthcare records in its information system, further jeopardizing the health of the children they are meant to protect. The lack of accurate documentation could lead to overprescribing and misuse of dangerous medications, putting children at grave risk. Alarmingly, the audit indicates that DCF’s neglect of record-keeping—including failing to document prescribed medications in Medical Passports—has profound implications for the health of these children.
In what could be described as the most troubling finding, the audit revealed that DCF showed serious lapses in obtaining documented consent for administering psychotropic medications. Incredibly, 94% of the children reviewed had no required documentation of consent or court approval for their prescribed medications. The failure to adhere to protocol raised alarming questions about how prescriptions were continued, altered, or increased without oversight. Compounding this issue is DCF’s rationale that psychotropic medication was considered “routine healthcare,” absolving them from following documentation protocols for all medications prescribed. Such a perspective suggests a alarming normalization of potentially harmful practices and underscores the need for urgent changes in procedure.
Moreover, the audit revealed that DCF did not ensure children received the recommended psychosocial services that are vital for their holistic treatment and well-being. Effectively, these children were not only being prescribed powerful mind-altering drugs without the necessary accompanying therapies but were doing so with dosages exceeding the safety limits outlined by the Food and Drug Administration (FDA). Alarmingly, around 20% of children in the audit were reported to receive dosages surpassing FDA recommendations. This lack of comprehensive treatment raises serious ethical questions about the priorities of the professionals responsible for these children’s welfare and the prescribing practices of attending doctors.
The summary of failures in the audit raises essential questions regarding accountability and oversight. How can a department tasked with the protection of at-risk children fail so profoundly to document, oversee, and evaluate critical aspects of their care? Will the individuals responsible for these oversights face consequences? Furthermore, what systems will be established to prevent these types of issues from occurring in the future? There is an urgent need for both independent reviews of personnel involved and a framework to enforce compliance with existing protocols, ensuring the safety and health of children in state custody. While the auditor has promised to follow up on DCF’s progress within six months, the pressing concern remains whether children categorized as at-risk will be safe during this timeframe.
In the larger context, the findings from this audit resonate beyond Massachusetts, as they reflect systemic challenges in child welfare agencies across the United States. The alarming lack of effective oversight in administering psychotropic medications to at-risk populations points to critical gaps that need to be addressed at both state and national levels. Organizations like AbleChild call for the public to recognize and support this cause, advocating for the rights and well-being of these vulnerable children. Donation campaigns emphasize that every contribution can help strengthen safeguards for children and foster a system where their mental health needs are comprehensively addressed. The plight of these at-risk children demands immediate attention and action to ensure their mental health is valued and protected.