A Foster Mother Struggles to Help Four

LUCETTE LAGNADO

Rebecca Green of Lancaster, Texas, is a foster parent to five children ranging in age from 5 to 7, including two brothers. Four have behavioral issues, she says, and are on, or have been on, antipsychotics, which she sees as critical to maintaining them safely in her home.

Fernando Siles, a pediatric psychiatrist for 30 years, is their doctor. He says he is aware of a growing interest in reducing the reliance on antipsychotic drugs for treating traumatized children.

He says the bulk of his Dallas-area practice involves foster children. Not many of his colleagues will even care for this population, he says, because of the economics. Medicaid, he says, pays him only $51.80 per visit—which means about 20 minutes of consultation, play therapy and a medication check. For a 45-minute therapy session, he says, Medicaid would pay him $90.

Children as young as 2, he says, can be candidates for antipsychotics "when they hurt another child, when they draw blood." He says he won't prescribe such drugs for anyone younger than that.

Ms. Green says she has worked in various aspects of social welfare for years. "The children that come, they are very angry at being taken from their parents, being taken from their homes," she says.

She has arranged for her foster children to get whatever therapies the system offers, including occupational and play therapy, but that isn't enough, she says. "They are not manageable. They are angry at everybody," she says. "The drugs seem to calm them down somewhat."

The two brothers under her care, age 5 and 6, came from a harrowing background, she says. The older one takes the antipsychotic Risperdal and an antidepressant. The younger one takes a low dose of Risperdal and a sedative, but "his behavior is still out of control," she says. "He screams for hours."

"I am the first one to say, I don't want a child zombied out," she says. "But you have kids who are 4 and they are throwing chairs and attacking the foster parents, and some at 3 are doing that. They kick you in the shins. They are very strong."

A version of this article appeared August 12, 2013, on page A2 in the U.S. edition of The Wall Street Journal, with the headline: A Foster Mother Struggles to Help Four.

http://online.wsj.com/article/SB1000142412788732452250457900304413778281...

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