Audit of the Department of Children and Families (November 7, 2024)
November 7, 2024 · Department of Children and Families · Read the full official report on mass.gov ↗
Published November 7, 2024 Audit covers July 1, 2019 – December 31, 2023 Under Diana DiZoglio · 2023–present
source
“The Department of Children and Families did not always obtain or renew court approval before children in its protective custody were administered antipsychotic medications.”
Read the plain-English breakdown
This is a state performance audit of the Massachusetts Department of Children and Families covering July 1, 2019 through December 31, 2023.
“In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of the Department of Children and Families (DCF) for the period July 1, 2019 through December 31, 2023.”
Auditors looked at how DCF handled psychotropic medications for children in protective custody, including approvals, follow-up care, records, and oversight.
“In this performance audit, we examined DCF’s process related to psychotropic medications1 prescribed to children in its protective custody.”
These safeguards matter because children in DCF custody may be too young to make these decisions, and the court is supposed to help ensure medication plans are appropriate and in the child’s best interest.
“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 that any prescribed medications are in the children’s best interest.”
For Massachusetts residents, the audit shows whether a major child-protection agency is properly overseeing medical care, records, cybersecurity training, and federal support for young people leaving foster care.
“DCF services include adoption, guardianship, foster care, housing stabilization, and family support and stabilization.”
The auditor found multiple problems: missing or late court approvals, incomplete health records, missing consent documentation, gaps in recommended services, and incomplete cybersecurity training records.
“Below is a summary of our findings, the effects of those findings, and our recommendations, with links to each page listed.”
The report recommends that DCF strengthen monitoring, keep records current, document consent consistently, ensure psychosocial services are provided, and improve cybersecurity training controls.
“DCF should establish sufficient monitoring controls to ensure that children in its protective custody have up-to-date and accurate health records in iFN and that its social workers prevent these children from receiving medical care without approval, including the following:”
The report is significant because 3,899 children in DCF protective custody received at least one psychotropic medication during the audit period, making oversight of these medications a large child-welfare issue.
“During the audit period, 3,899 (22%) of the 17,891 children in DCF’s protective custody were prescribed at least one psychotropic medication.”
Psychotropic medications are drugs used for mental health conditions such as depression, anxiety, bipolar disorder, schizophrenia, and ADHD.
“Psychotropic medications are used to treat mental health disorders such as schizophrenia, depression, bipolar disorder, anxiety disorders, and attention deficit / hyperactivity disorder.”
What the Auditor checked
- Did not comply Did DCF obtain required court approval for antipsychotic medications and document its consent for psychotropic medications prescribed to children in its protective custody as required by Sections 11.14(3)(a), (4)(a), and (6)(a) of Title 110 of the Code of Massachusetts Regulations and DCF Policy 2010-001: Medical Examinations for Children Entering DCF Placement or Custody?
- Did not comply Did children in DCF’s protective custody receive follow-up visits and recommended psychosocial services in conjunction with prescriptions for psychotropic medications in accordance with the American Academy of Child and Adolescent Psychiatry’s 2005 “Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody: A Best Principles Guideline” and the American Academy of Child and Adolescent Psychiatry’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems?
- Did not comply Did DCF maintain medical passports for children in its protective custody who received psychotropic medications according to DCF Policy 85-003: Health Care Services to Children in Placement, DCF Policy 86-011: Ongoing Casework and Documentation, DCF Policy 2010-001, and Section 475 of the Social Security Act?
- Did not comply Did DCF provide oversight to children in its protective custody who received psychotropic medications that exceeded the US Food and Drug Administration’s (FDA’s) recommended maximum dosages?
- Partially Did DCF update its internal control plan to address the COVID-19 pandemic as required by the Office of the Comptroller of the Commonwealth’s “COVID-19 Pandemic Response Internal Controls Guidance,” and did DCF ensure that employees who had access to COVID-19 funds completed cybersecurity awareness training in accordance with the Executive Office of Technology Services and Security’s (EOTSS’s) Information Security Risk Standard IS.010?
- Complied Did DCF make outreach efforts to ensure that it reached eligible youths who aged out of DCF care to allocate funds from the John H. Chafee Foster Care Independence Program grant as required by the grant agreement ACYF-CB-PI-21-04?
What the Auditor found
Why it matters: DCF could not ensure treatment plans were safe and appropriate, and court oversight for children too young to consent was removed.
Standard: Section 11.14 of Title 110 of the Code of Massachusetts Regulations ( Section 11.14 of Title 110 of the Code of Massachusetts Regulations )
1 recommendation
- DCF should add monitoring controls to its policies and procedures to ensure that any Rogers guardianship orders are approved and renewed by the court.agency: agreed
Agency response & Auditor reply
Agency: "DCF agrees with this recommendation and will make improvements to its electronic case records system to better manage and track dates of court approvals for antipsychotic medications."
Auditor: "We commend DCF for working on steps to better manage the tracking of court approvals for children receiving antipsychotic medications."
Why it matters: Incomplete medication records could cause DCF and health providers to make treatment decisions that conflict with existing treatments or children’s best interests.
Standard: DCF Policy 86-011, DCF Policy 85-003, DCF Policy 2010-001, and Section 475 of the Social Security Act ( DCF Policy 86-011: Ongoing Casework and Documentation; DCF Policy 85-003: Health Care Services to Children in Placement; Section 475 of the Social Security Act )
1 recommendation
- DCF should review medical passports for children in its protective custody and update them at least every six months or when there are changes to a child’s prescription, whichever comes first (e.g., new prescriptions, dosage changes, or discontinued prescriptions).agency: agreed
Agency response & Auditor reply
Auditor: "We commend DCF for taking steps to improve its recordkeeping practices."
Why it matters: Children in protective custody may not receive needed services, and DCF may be unable to evaluate effective or cost-efficient treatment.
Standard: American Academy of Child and Adolescent Psychiatry’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems ( American Academy of Child and Adolescent Psychiatry’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems )
1 recommendation
- DCF should update iFN with all follow-up doctor appointments and psychosocial services for children in its protective custody, including the type and frequency of these appointments and services.agency: agreed
Agency response & Auditor reply
Auditor: "We commend DCF for taking steps to improve its recordkeeping practices."
Why it matters: DCF could not ensure that social workers or medical social workers were providing legally required medical treatment authorization.
Standard: Section 11.14(4)(a) of Title 110 of the Code of Massachusetts Regulations, DCF Policy 2010-001, DCF Policy 86-011, and AACAP’s 2005 Position Statement ( Section 11.14(4)(a) of Title 110 of the Code of Massachusetts Regulations; DCF Policy 86-011: Ongoing Casework and Documentation )
1 recommendation
- DCF should document its consent for psychotropic medication for children in its protective custody in iFN and store that consent in the same location in iFN for quick and accurate reviews.agency: agreed
Agency response & Auditor reply
Agency: "DCF agrees with the recommendation for additional monitoring controls to ensure that the Department is documenting a child’s health care in a timely and accurate way in iFN."
Auditor: "We appreciate that DCF shared its use of multiple oversight pathways to ensure safety for the use of psychotropic medications."
Why it matters: Treatment effectiveness could be negatively affected, and DCF could not monitor medication effectiveness or identify and mitigate side effects.
Standard: American Academy of Child and Adolescent Psychiatry’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems ( AACAP’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems )
1 recommendation
- DCF should ensure that all children in its protective custody who are prescribed psychotropic medications receive psychosocial services and DCF should implement sufficient monitoring controls to ensure that these services are provided and that the efficacy of these services is evaluated.agency: agreed
Agency response & Auditor reply
Agency: "DCF agrees with this recommendation, in that we will continue to improve monitoring controls to document psychosocial services are provided."
Auditor: "Based on its response, DCF is addressing our concerns in this area."
Why it matters: DCF was exposed to a higher-than-acceptable risk of cyberattacks and financial and/or reputational losses.
Standard: Section 6.2.4 of the Executive Office of Technology Services and Security’s Information Security Risk Management Standard IS.010 ( Section 6.2.4 of the Executive Office of Technology Services and Security’s Information Security Risk Management Standard IS.010 )
1 recommendation
- DCF should develop and implement policies, procedures, and controls to ensure that all its employees complete cybersecurity awareness training.agency: already implemented
Agency response & Auditor reply
Agency: "Since the audit review period, the Department and the Executive Office of Technology Services and Security (EOTSS) has developed and implemented additional procedures and controls to ensure compliance with annual refresher cybersecurity awareness training requirements."
Auditor: "We commend DCF for implementing stronger monitoring controls to ensure that all employees complete cybersecurity awareness training and believe DCF is taking steps to address this issue."
More audits of this entity
Other Office of the State Auditor reports on Department of Children and Families .
- Department of Children and FamiliesState Agency / Office · May 8, 2012
- Department of Children and FamiliesState Agency / Office · May 12, 2011
- Department of Children and FamiliesState Agency / Office · March 26, 2014
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