Massachusetts State Auditor audited the Department of Children and Families; here is what it uncovered

BOSTON — State Auditor Diana DiZoglio’s Office has released an audit of the Department of Children and Families, which reviewed the period from July 1, 2019 to December 31, 2023.

DCF is tasked with providing services to children who are at risk or who have been victims of abuse or neglect, as well as their families. These services include adoption, guardianship, foster care, housing stabilization, and family support and stabilization.

Among the audit’s findings is that DCF did not always obtain or renew court approval before children in its protective custody were administered antipsychotic medications. If DCF does not obtain or renew court approvals for antipsychotic medications, which includes presenting treatment plans to the courts, it cannot ensure that these treatment plans are safe and appropriate. In addition, this is removing the courts’ oversight of children in DCF protective custody, who are too young to consent to their treatment plans and need a neutral, third party to ensure any prescribed medications are in the children’s best interest.

The audit found that DCF did not always document and/or update psychotropic medications listed in children’s medical passports. Without accurate and complete information, DCF and healthcare providers may make decisions that conflict with existing medical treatments or do not reflect a child’s best interests, such as overprescribing psychotropic medications, which can lead to adverse side effects.

Moreover, DCF did not document follow-up doctor appointments and recommended psychosocial services, such as counseling, in the iFamilyNet system for children in its protective custody receiving psychotropic medications. If DCF does not keep accurate and complete medical records in iFN, then children in DCF’s protective custody may not receive the services needed to treat their conditions. This may delay the growth, development, or recovery of the children who did not receive needed care. Failure to keep accurate and complete medical records may also prevent DCF from determining which medical treatments or providers are most effective or cost-efficient for serving the medical needs of children in its care.

The audit also found that DCF did not always document its consent in iFN for children in its protective custody to receive psychotropic medications. Without documentation of consent or court approval for prescriptions of psychotropic medications, DCF cannot ensure that its social workers and/or medical social workers are providing children in DCF protective custody with medical treatment that is legally required.

Furthermore, DCF did not ensure that children received recommended psychosocial services in conjunction with their prescriptions for psychotropic medications. If children do not receive the recommended therapy and psychosocial services with psychotropic medications, treatment effectiveness can be negatively affected. Moreover, DCF cannot monitor the effectiveness of these medications and cannot identify and mitigate any side effects that these children may experience.

In addition, the audit found that DCF does not have adequate oversight policies or procedures for children prescribed psychotropic medications that exceed the FDA’s recommended maximum dosage.

During the course of the audit, additional, high-risk areas of concern that were outside the original scope of objectives came to the office’s attention. Given the high-risk nature of these areas, the office examined them while still engaged with DCF. These areas include human trafficking prevention measures, as well as DCF’s implementation of recommendations by the Massachusetts Commission on LGBTQ Youth.

In July 2022, the U.S. Department of Health and Human Services Office of Inspector General issued a report that cited Massachusetts as one of five states where there was no evidence that children in foster care were screened for human trafficking after they had gone missing from, and later returned to, foster care. The audit recommends DCF coordinate with other state agencies, law enforcement, and other child-serving agencies to address how to detect and respond to human trafficking.

The audit also recommends DCF collaborate with the Massachusetts Commission on LGBTQ Youth to implement recommendations from its annual report.

Finally, the audit found that DCF did not ensure that all employees with access to COVID-19 funds received annual refresher cybersecurity awareness training. If DCF does not ensure that all its employees complete cybersecurity awareness training, then it is exposed to a higher-than-acceptable risk of cyberattacks and financial and/or reputational losses.

“As we strive to ensure the Commonwealth’s children are fully protected and supported, it is so important that we shine a light on areas for improvement, especially when it comes to a child’s mental health and overall safety,” said Auditor DiZoglio. “We acknowledge the Department of Children and Families’ full cooperation with our audit team to ensure that we are able to, together, help make government work better for our most vulnerable populations. We will be following up with a six-month post-audit review to track progress.”