Student Fights Overmedicating of Foster Youth
Cal State East Bay’s Tisha Ortiz shares difficult past
to help change the future for others
A swimming pool. Flashes of a video game. A TV with burn marks down one side. They’re fragments of Cal State East Bay senior Tisha Ortiz’ earliest memories — and the only ones she has of a place called home.
Tisha was just 4 years old when Child Protective Services knocked on her door for the first time, where her parents’ drug and alcohol abuse had taken precedent over feeding their toddler.
“I’m guessing it was a neighbor or a family member that called,” Ortiz says. “My first foster mom told me that it was impossible to get me to eat when I first came to them. I was skin and bones and I wouldn’t eat anything until I was physically in pain. I literally didn’t know what hunger was or how to eat.”
The journey that followed is far from uncommon, Ortiz says. Years of severe abuse, a string of different living situations, harrowing episodes of self-harm, and finally, treatment — in the form of powerful, lethargy-inducing medications intended to drown out depression and anger.
In fact, legislators and advocacy groups are finding this life is the norm for thousands of kids living within “the system” nationwide, who, according to the Centers for Disease Control and Prevention, are prescribed medication 3.5 times more frequently than all other children ages 12-18, and 50 percent of those meds are psychotropics — drugs that alter brain function and thus, create changes in mood, behavior and perception.
While Ortiz is no exception, there’s one thing about her that is different from many of her peers: She’s speaking out and fighting back.
This is her story.
Ortiz’ entry into the child welfare system started well. Her first foster placement lasted for four years, from ages 4-8, and she remembers the family who cared for her (and who she remains in contact with on Facebook) as stable and loving. However, she was returned to the care of her parents from ages 8-12, when the chaos surrounding their combined substance abuse — worsened in the midst of a divorce — wreaked lasting havoc on her life.
“Different things happened at each house,” she says. “My mother [had been] a big drug user, methamphetamines, and she developed mental health issues as a result. If I forgot to take the trash out, she would beat me up — she would leave cuts and bruises, or pick me up by my hair.
“My father was in a men’s home and was getting out soon,” Ortiz continues, “so he paid a woman to take care of me, and her son locked me up in closets and sexually abused me at night. I would go in the shower and he would figure out how to unlock the door and abuse me in there. He would bring his friends over to laugh at me. It took me a year to tell someone what was happening.”
But by then, Ortiz’ father had fallen back into drugs, was soon arrested and Tisha re-entered foster care.
For the next six years, until she moved to the Bay Area to attend Cal State East Bay, Ortiz bounced between neighbors, group and foster homes in California’s southwestern Imperial and Riverside counties, and did a stint with extended family in Arizona. At each juncture, she would return to the mainstay of foster youth in the area — the Betty Jo McNeece Receiving Home in El Centro, California, a temporary shelter.
“I spent my 10th, 13th and 18th birthdays there,” Ortiz says. “And eventually they start asking you, ‘OK, what did you do this time?’ A lot of times in the system you’re put down and told that you’re not good enough, you’re going to end up like everyone else — pregnant, in jail, dead. The message is that you’re a bad kid, that you did something wrong, that it’s your fault you’re in foster care.”
Prescription for Trauma
In the wake of the physical, emotional and sexual abuse Ortiz suffered in her adolescence, she began acting out and experiencing what she believes was post-traumatic stress disorder — a condition she still struggles with. At 14, she was put on her first psychotropic medication, and by 18, she was on a cocktail of antidepressants and mood stabilizers that amounted to 12 pills per day.
“When I started feeling really weird off of it [as a teenager], that’s when I started saying stuff. And people would say, ‘You’re just a kid, you don’t know what you’re talking about’ or tell me I was being a hypochondriac. So when the staff at the group home found out I was cheeking the pills [hiding them in her mouth] or spitting them out, they started forcing them down my throat.”
However, Ortiz says her feelings about what was going on were readily discounted in favor of diagnoses that led to further medication.
“All these other different labels they’ve tried to put on me — bipolar, borderline personality disorder — I just never felt like any of those were me,” Ortiz says. “Most of the time when I’m having trouble it’s because I’m remembering something that was pretty horrible and it’s affecting my day. People come back from war and they have PTSD, and that’s how I feel about my childhood. I was at war every day — extreme violence, drugs.”
Beginning in her early teens, Ortiz started on a downward spiral of acting out that included kicking staff in the group home who tried to touch her; breaking objects and using them to cut herself; refusing medication and being locked in a room and kept from going outside or to school as punishment; and multiple stays in mental facilities, many of which resulted in new or increased doses of pills.
“Things got worse,” she says of being medicated. “I started to feel angry all the time and wanting to punch things. And then I’d break something of mine and use it to hurt myself. I needed someone to help me find a way to cope, I needed therapy, something to help me besides self-harm.”
How it Happens
According to Cal State East Bay Associate Professor and Interim Chair of the Department of Social Work Holly Vugia, L.C.S.W., experiences like Ortiz’ result from a range of systemic failures in child welfare and behavioral health services, including a lack of appropriate training to handle complex behavioral issues; overwhelming caseloads for social workers and group and foster home staff; and breakdowns in communication between various state agencies when a child moves to a new placement and must see a new doctor, attend a new school, acclimate to a new living situation and so forth.
And frequently, Vugia explains, meds get prescribed based on how difficult those changes are for a child to navigate — especially if they’ve already experienced significant abuse or neglect at home.
“What happens when kids face trauma is that the neurochemistry of their brain gets wired such that it’s on hyperarousal,” says Vugia, who has experience at both UCLA’s Resnick Neuropsychiatric Hospital for adolescents and the university’s outpatient sexual assault program for kids. “A child who is operating from a state of hyperarousal is really different from a kid who hasn’t had that experience ... if you add more changes on top of what has already been experienced, you’re just triggering behavioral issues.
“We’ve also learned a lot over the years about attachment — how important it is,” Vugia adds. “And how any interruption in attachment with a primary care figure can potentially make us more vulnerable. It doesn’t mean that a child will be psychotic — it means they’re likely to have behavioral issues that can be hard to manage. Often foster parents don’t receive training on how to do that, or there isn’t a comprehensive plan in place, and even if there is, it’s very difficult to implement. Parenting or taking care of a child who has behavioral health issues can be exhausting. In a foster care situation, it can drive people to the point that they don’t know what to do — where, in not the best practice, meds get prescribed as the behavior management solution.”
Vugia, however, does believe medications have a place in child and adolescent therapy, but that they’re“absolutely” being overprescribed. “I don’t think we want to villainize the psychiatrists or the social workers, or Child Protective Services,” she says. “Most behavioral issues that require medication are helped by talk therapy, which is expensive. There is also an alarming shortage of child psychiatrists — around 8,300 trained child psychiatrists in our country (and upward of 400,000 kids in foster care, per childrensrights.org), and you can’t find a child psychiatrist. Often, it’s an adult psychiatrist or a pediatrician or a regular doc [who’s prescribing] meds that haven’t been researched for use in kids … and a lot of the problem is that people aren’t monitoring the medications correctly.”
How it Stops
The life experience of former foster youth such as Ortiz is key.
In 2010, the day after Ortiz turned 18, she arrived on a flight to the Bay Area, where she was met by a representative from Cal State East Bay’s Renaissance Scholars program, which supports foster youth through college.
Despite help moving into the dorms and getting started with school, Ortiz had difficulty transitioning into university life and dealing with her PTSD and medications on her own. By November, just two months into the fall quarter, her living situation was crumbling. In an attempt to help, Renaissance Scholars connected to her WestCoast Children’s Clinic, a nonprofit that provides case management and therapy services for 17-21 year olds transitioning between foster or group homes and being on their own in the community.
“It was the first time I had actual therapy that dealt with the things that happened when I was younger,” Ortiz says. “All the therapy I did before was based on ‘What’s going on in your foster home?’ and the immediate circumstances, not what was really going on with me and the trauma I experienced.”
Though she did in fact end up leaving Cal State East Bay for a time, during which she was homeless in Oakland before finding roommates in Union City and getting back into school at nearby Ohlone Community College, Ortiz’ therapist passed along a flier to her from the National Center for Youth Law calling for testimony from young adults who felt they had been overmedicated in the system. Ortiz answered that call, and was soon tapped to speak at the state capitol as a primary witness. In addition to the emotional impact of the medications, she described for legislators the physiological effects of the pills, corroborated by other young adults, such as weight gain, intense lethargy, suicidal thoughts and in her case, tunnel vision and body tremors.
William Grimm, senior attorney at NCYL, is a constant at Tisha’s side. Grimm has been litigating child welfare cases since the 1980s, and is currently overseeing advocacy efforts and gathering data on a suite of new bills called the Psych Drugs Action Campaign that NCYL — with Ortiz’ help — fought to push through in 2016.
“Many of these psychotropic medications have both short-term and long-term adverse effects on the youth who are taking them,” Grimm says. “And most of these medications, with the exception of the ADHD drugs and psychostimulants, really have not been tested on children and youth and adolescents, so nobody really knows what the long-term impact is for youth whose brains are still developing. We’re experimenting on [these children] because we really don’t know what the effects are.”
After starting as a volunteer with NCYL in February 2014, Ortiz has since been hired as a professional advocate, and began lobbying and testifying for six bills, ranging from increased oversight of medical records, group homes and prescribing physicians to laws aimed at improving records-keeping and sharing among health professionals.
A corresponding budget and five of the six bills have been passed in the last two years, including two just this past October. California Sen. Jim Beall, who sponsored three of the bills, worked closely with Ortiz to make his appeals in front of the Senate.
“Tisha’s appearance before legislators put a real face and an authentic voice to the issue of how foster care children are harmed by the overmedication of psychotropic drugs,” Beall says. “I admire her courage to testify in detail, on the record, about the impacts these powerful drugs had on her. Her testimony helped pass laws that will prevent what happened to her from happening to more children in foster care. She took a painful episode in her life and turned it on its head to create good.”
Hear THeir Voices
While Ortiz agrees that testifying is worth it for future generations of kids like her, preparing for each speech carries an emotional price tag.
“A lot of times before a big speech, I’m heavily in my head thinking about stuff that has happened and trying to put it down onto paper so that people can hear, ‘This is actually what I needed, and what other foster kids need. We want love.’ If I haven’t thought about something for a long time and it comes up, it makes me ask, ‘Why did this happen? What did the adults around me do that failed? What would need to be different to keep this from happening to someone else?’”
Her efforts have proven valuable, but the real fight — to see these laws become a reality — is just beginning.
“Where we are now is, when you take something away from the toolkit … you need to replace it with something,” Grimm says. “We know there are certain types of mental health services that are more effective and certainly much safer than psychotropic meds. So now we’re saying, ‘Once we reduce the reliance on these unsafe medications, we need to put in place the type of mental health services that are effective and safer for kids, and expand their access to those services.’”
This year, alongside Grimm and NCYL Senior Policy Associate Anna Johnson, Ortiz will focus on implementing the five new bills so they have an immediate effect on kids in the system. Johnson, Ortiz’ direct supervisor and a personal mentor for her, reports that Tisha has had a hand in developing the questions that will be used to survey children living in group homes about how they feel about the medications they’re on; providing feedback on new protocols for the monitoring and administration of medications; helping to create a workbook and foster care mental health bill of rights for children; and more.
“I see her as a very passionate and compassionate person, and she’s very intelligent, a critical thinker,” Johnson says. “She’ll never experience the change she’s advocating for — her time in the system is done. It’s out of her sense of justice, and not wanting this to happen to anyone else that she does this.”
As for Ortiz, who came back to Cal State East Bay in 2014 and is now a criminal justice major and honor roll student, today’s legislation is important, but she places an even higher value on tomorrow’s, hoping that someday she’ll be the one with the juris doctor, defending foster youth and implementing new laws to protect them.
“Since I was in kindergarten, I remember walking to school and telling myself, ‘I don’t want to be like my parents.’ And as I got older, it just expanded to ‘I want to go to college’ and ‘What do I want to be?’ It comes down to mindset. Even though I doubt myself sometimes, I just keep going. I’m not necessarily a positive person, but I’m determined. My biggest fear is getting so close and not making it.”
The Movement to Stop Medicating
In 2015, the San Jose Mercury News completed a yearlong investigation that resulted in a seven-part story featuring the stories of foster children who were overmedicated. The story also highlighted that efforts to address the issue reach back to 1999, with no definitive progress made until just recently.
Alongside Tisha Ortiz, Cal State East Bay alumna Joymara Coleman (BA ’15, Sociology) participated with the San Jose Mercury News. Coleman, a member of the National Center for Youth Law’s child welfare committee and psychotropic medications committee, and a child welfare intern for the Alameda County Department of Children and Family Services, will soon graduate from UC Berkeley with a master’s in social work — and plans to dedicate her career to changing the system she grew up in.
“None of the medication I took actually addressed the issues I was dealing with surrounding depression and anxiety, and none of it made me feel better,” Coleman says. “I want to work … specifically in this county because this is where I was born. I have a desire to improve [the system] because I want to prevent young people from falling through the cracks that I fell through.”
Since the San Jose Mercury News publication of “Drugging Our Kids,” including the award-winning documentary associated with the series, California legislators have launched a multifaceted effort to stop the overuse of medications within the child welfare system.