Calling for Changes in Systems of Care for Foster Youth

A former foster-child-turned-advocate told his story of survival, explained why policy changes in the foster care system are needed, and urged clinicians to be part of that change, according to a plenary session at the recent annual meeting of the American Academy of Child and Adolescent Psychiatry.

After he and his siblings were removed from their mother’s care by the state of Michigan due to severe neglect and abandonment, Karlos Dillard, advocate and author of “Ward of the State: A Memoir of Foster Care," said he endured more than 30 foster care placements. “Few good, many abusive,” he said. “If we are expecting mental health providers to help these children, we need you to understand the challenges we encounter.”

“I was so overmedicated that it was really hard to tell which emotions I was even feeling,” said Dillard, who told attendees he attempted suicide when he was just 8 years old. He was taking a cocktail of risperidone, dextroamphetamine, amphetamine, methylphenidate, and bupropion, and his mind was so foggy, he felt like a zombie.

According to a study issued in 2023, children in foster care are seven times more likely to be prescribed psychotropic medication than non-foster children on Medicaid, even after accounting for their age, gender, and number of mental and developmental diagnoses. Overall, 35% of foster youth were dispensed at least one prescription for psychotropic medication, compared to 8% of non-foster youth on Medicaid, according to the study by Rachel J. Keefe, M.D., M.P.H., at Baylor College of Medicine in Houston and colleagues, issued in the Journal of Child and Adolescent Psychopharmacology.

Another concern that warrants greater attention is how the $1.3 billion in federal government funding is doled out to foster parents, said Dillard, quoting figures from the Child Welfare League of America. The current system pays a premium to parents who take in youth with certain diagnoses or who are in need a higher level of care. “Often times foster parents will overexaggerate or lie about our behaviors to our doctors, with the promise that they will receive a higher monthly stipend from their agencies.” That can lead to overmedication, he said.

Dillard also called into question the system that allows foster parents to “stack” three or four high-needs children into one home to boost their monthly payments. This practice does not serve the youth living in such a home, he suggested. One set of foster parents beat him so badly that he was left covered in bruises all over his face and body, he recounted.

To hide their crime, the foster parents dialed 9-1-1 and lied to emergency services that Dillard was self-harming and suicidal. No one believed his side of the story, and after 72 hours, he was sent right back to that same family. Not only did the abuse continue, but the foster parents received higher payments from the state after Dillard’s hospitalization, he said.