Clik here to view.
(Illustration by Christine Ongjoco / The Imprint)
This story was co-published with The Imprint, a national nonprofit news outlet covering child welfare and youth justice, as part of its series Medicated in Foster Care: Who’s Looking Out? Sign up for The Imprint’s newsletters here.
Nearly one in four New York City foster youth ages 7 to 17 is placed on psychiatric medications — a powerful class of drugs including stimulants, mood stabilizers, antipsychotics and antidepressants.
In group facilities, it’s one in three, and there’s a growing number of school-age kids receiving multiple meds at once.
These statistics can be found in the latest Administration for Children’s Services prescribing reports, offering rare insight into a long-running national public health concern: the frequent and sometimes haphazard prescribing of psychotropic drugs to foster youth. Federal authorities have warned about the health dangers for more than a dozen years.
Among older teens raised in the city’s care, one in 10 is given an antipsychotic, the heavily sedating type of psychiatric medicine designed to treat adults for schizophrenia and bipolar disorder. It has been linked to obesity, diabetes and uncontrollable tremors.
Still, in New York City’s child welfare system, 868 out of 5,786 children in foster care had psychiatric drugs prescribed to them as of Sept. 30 of last year — a relatively low rate compared to the most recent available national averages.
And the city’s release of the data is a rarity among local child welfare agencies.
Clik here to view.
In an email, a spokesperson for the Administration for Children’s Services (ACS) emphasized the careful clinical considerations that shape each foster child’s medical care, and the agency’s goal “to only prescribe medication(s) to those who need it.”
“ACS and our medical staff work every day to protect and support the mental health of New York City’s children — this data shows just that,” says spokesperson Marisa Kaufman. “Accurate, insightful data informs our work, and these reports provide us with both an opportunity for transparency while alerting us to important trends to promote best practice.”
Still, the local numbers are cautionary for those close to the issue. One former foster youth who was heavily medicated in the system reviewed the prescribing rates, and implored doctors to try other, non-medication approaches more often — and to treat patients as they’d treat their own kids
“Put the drugs down and listen to the kid’s face,” says Summer, 30, who asked to be identified by her middle name only, to protect her privacy. “Just ask them how they’re doing, why are they upset? Ask them how they are a million times.”
New York state’s Office of Children and Family Services is not as transparent with its prescribing data — unlike other large states including Texas, Florida and California. Federal guidance from a decade ago has required “sharing accurate and up-to-date information related to psychotropic medications to clinicians, child welfare staff, and consumers.” Yet little is publicly known about the medications given to nearly 6,500 children in the state’s child welfare system who do not live in New York City.
After a month of delays, a spokesperson for the Office of Children and Family Services responded to repeated inquiries by stating that the state agency does not collect data on psychotropic prescribing practices. And while the Department of Health monitors children’s prescriptions, it does not produce regular reports on foster youth.
An Imprint investigation published Wednesday revealed that although the dangers of over-prescribing to foster youth have been known for decades — and the federal government requires state oversight — dangerous levels of medication continue to be administered. There are currently a dozen related class-action lawsuits moving through the courts, and recent federal audits and academic studies show widespread signs of risky overreliance on drug treatments for vulnerable, traumatized kids and teens.
Some psychiatric drugs help stabilize children’s emotions or tamp down acting-out behaviors during or after periods of extreme distress, like being pulled from home or after revealing abuse in court, interviews with dozens of foster youth, caregivers, pediatricians and psychiatrists confirmed.
Guidance from medical associations like the American Academy of Child and Adolescent Psychiatry notes possible benefits for kids on psychotropic medication, such as helping with school anxiety, and “reducing very aggressive behavior.” Ten to 20 milligrams daily of the antidepressant Prozac, for example, is approved by the Food and Drug Administration for children with major depressive disorders after age 7.
Since 2011, federal legislation has required state child welfare agencies to develop and report protocols for “the appropriate use and monitoring” of psychotropics. Since then, foster youths’ prescriptions for antipsychotics — the most powerful kind of psychotropics — have declined nationwide, according to a 2023 study from Rutgers University epidemiologists.
But there is little disagreement that psychotropic medications overall are still likely used too frequently and heavily. Psychotropics can have powerful and lifelong side effects that can range from mild, temporary loss of appetite from some ADHD medications, to increased risk of suicidal behavior on many antidepressants — all dependent on the drug, the dosage, the combination of meds and the duration of a child’s exposure. Bounced from home to home, often without medical records, oversight can be scant.
New York City has taken some protective measures.
In 2020, its Administration for Children’s Services issued a new “informed consent” policy to ensure that foster youth who suffer the aftereffects of trauma and upheaval were protected from being dosed up on too many sedating meds. The 23-page document defines red flag prescriptions that medical staff must review for safety after children are prescribed. The policy also requires that parents be informed of doctors’ prescriptions for their children in foster care and be asked for their consent. Unlike in most states, that consent must be renewed after the first six months, and then annually.
Roughly two years ago, the child welfare agency began publishing quarterly data on prescriptions of “psychiatric medicine,” including drugs for attention-deficit/hyperactivity disorder, antidepressants, antipsychotics and antianxiety medicine, using records from the state’s Office of Mental Health.
New York City’s overall prescribing rate — 15% of the roughly 6,000 foster youth in its care — falls well below the 26% national average found in one recent federal review of insurance claims. But former foster youth, children’s advocates and mental health experts interviewed by The Imprint cite ongoing concerns.
“There’s been many strides that ACS has made on this issue, and improved the system in a number of ways. We have this data now, which is great,” says Kate Wood, a juvenile rights attorney with New York City’s nonprofit Legal Aid Society. “But there are still these gaping holes and there’s not a sense of urgency to figure out solutions.”
Wood, who helped champion the 2022 city council bill that required the release of the city’s data on the use of psychotropic medication in foster care, says it’s been hard to confirm whether all prescriptions made at group facilities are included in the agency’s quarterly reports. Similarly, she says, the city’s oversight policy for riskier prescriptions — red flag reviews of two meds for kids under 6 or two antipsychotics at once — is essentially an honor system. Wood says there’s no way for ACS to confirm if agencies are failing to notify them.
Destiny Moura, 25, describes a culture of secretiveness and lax oversight over medications she received while living in a New York City group home. Moura, who grew up in the Bronx, says she was given a confusing psychological evaluation as soon as she entered foster care at 17, and “automatically” given medication after she reported having similar symptoms as her peers. Although she didn’t think pills were as necessary for her, they were widespread in the culture.
“It was a very daunting experience,” Moura says. “There’s really no room for no.”
Moura, who is now a youth advisor to the Court Appointed Special Advocates for Children program of New York City, says foster youth need alternative treatments to heal from trauma rather than facing off with at-times detached doctors who simply prescribe a mix of drugs.
Too often, she says, “We’re just feeding them all these pills, just because we think it’s going to work.”
Dr. Martin Irwin, a child and adolescent psychiatrist who developed the city’s 2020 consent policy as its former mental health director, also hails the city’s relatively low rate of prescribing to all foster youth.
But he notes some weaknesses in the data, such as the number of times parents’ objections to psychotropics are brushed aside. New York City parents who have temporarily lost custody due to abuse and neglect allegations have the right to be informed, and to consent to psychotropics their children are prescribed. Irwin says that, based on his reviews of parents’ objections in child welfare cases across the country, the vast majority were reasonable, and based on their concerns about side effects, and a preference for non-medication treatments.
According to New York City data, parents’ rare formal objections to medication, therapy or psychiatric hospitalizations are frequently met with an “override.” Last year, overrides were approved by employees at foster care nonprofits or the city’s medical and mental health staff in 26 of 37 cases, an increase from half of all cases in 2023.
Irwin, now a clinical professor at New York University’s Grossman School of Medicine, also points to a concerning increase in 7- to 12-year-olds who’ve been placed on three or more medications — an increase from 45 children in early 2022 to 60 in late 2024.
“I tend to doubt there needs to be that many,” he says.
Experts have long pointed to the hazards of “polypharmacy” practices with children, or multiple medications taken at once, and the Children’s Services medical unit automatically reviews such prescriptions. A 2021 review of ADHD treatments in the Journal of Child and Adolescent Psychopharmacology stated that the practice “frequently yielded more side effects,” with limited evidence of additional benefits for kids.
The city spokesperson characterizes the number of parental overrides and the number of young kids on multiple meds as “not very high.” She says the city’s data do not fully capture the “deliberate and thorough” process behind unique clinical decisions by licensed psychiatrists.
“We aim to consolidate and streamline medication regimens as much as possible,” she says, adding: “this is not always possible or clinically appropriate, especially in the short-term.”
Regarding how they track red-flag cases, the agency’s spokesperson notes they receive requests to review prescriptions from many sources, including hospital staff, attorneys and parents, and also “actively review” a state prescribing database.
Summer says she was glad to hear that the city appears to rely on psych meds less frequently than the rest of the country, and that the issue has gotten more attention since she spent roughly six years in foster care until 2013.
In an interview, she says at one point during her time in foster care, she was hospitalized for two years simply because caseworkers couldn’t find her a suitable home.
At the time, her mother had died and she had survived abuse by a relative. Summer, at 14, describes being plied with four medications that she knew nothing about, including two antipsychotics. In one year, 2009, her records show she was prescribed lithium, a medication to treat bipolar disorder, as well the antipsychotic Seroquel.
Child psychiatrists interviewed for this report as well as published research emphasize that children should not be taking two antipsychotics at once, due to the potential health hazards and the lack of proven efficacy and long-term safety.
These days, Summer says she’s clear-headed and has been medication-free for 15 years. When she needs to soothe herself she journals in a spiral notebook and paints acrylic portraits. She’s remained steadily employed managing a bakery.
In a recent Saturday conversation, Summers says tomatoes at her Brooklyn farmers’ market are on her mind.
“I just want to make soup right now,” she says, reflecting on her unburdened state these days. “Why did they have me on drugs for schizophrenia?”
As part of a network of former foster youth advocating for policy changes in the city, youth advisor Moura suggests having an unbiased, third-party guardian in the psychiatrist’s office, who could help young patients understand complex medical terminology and give them more of a voice in consenting to medication.
Moura says she’d like to be that person. But as a former foster youth lacking familial support, she’s relying on a GoFundMe account to help pay for her master’s program in social work at Hunter College, where she starts in the fall.
She may end up in the clinical field, in part to be that extra pair of eyes when doctors are prescribing to foster youth in clinic offices.
“Maybe I can be the one in the room,” Moura says.