BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 528
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          Date of Hearing:  June 25, 2013

                           ASSEMBLY COMMITTEE ON JUDICIARY
                                Bob Wieckowski, Chair
                       SB 528 (Yee) - As Amended: June 20, 2013

                              As Proposed to be Amended

           SENATE VOTE  :  34-2
           
          SUBJECT  :  DEPENDENT CHILDREN AND PARENTS: CARE AND TREATMENT

          KEY ISSUE  :  IN ORDER TO BETTER ASSIST OLDER FOSTER YOUTH,  
          PARTICULAR NONMINOR DEPENDENTS AGE 18-21, SHOULD THE LAWS ON  
          MEDICAL CONSENT FOR FOSTER YOUTH AND ON PROVISION OF  
          AGE-APPROPRIATE REPRODUCTIVE HEALTH INFORMATION BE CLARIFIED,  
          AND SHOULD CHILDREN OF FOSTER YOUTH RECEIVE PRIORITY ENROLLMENT  
          IN CHILD CARE?

           FISCAL EFFECT :  As currently in print this bill is keyed fiscal.

                                      SYNOPSIS
          
          AB 12 (Beall and Bass, 2012) authorized the juvenile court to  
          exercise jurisdiction over, and extend foster benefits to,  
          nonminor dependents between the ages of 18 to 21 if they meet  
          specified criteria.  Thus, eligible nonminor foster youth are  
          now able to continue receiving support from the dependency  
          system as they transition into adulthood.  However, as  
          California has expanded foster care to serve older youth,  
          concerns related to reproductive health have become even more  
          urgent.  This bill, sponsored by the Alliance for Children's  
          Rights, the Children's Law Center of California, the John Burton  
          Foundation and Public Counsel, and supported by over 75 other  
          organizations, seeks to better address the health and welfare of  
          minor and nonminor foster youth, including those who have become  
          parents.  First, this bill authorizes social workers to provide  
          foster youth with access to age-appropriate, medically accurate  
          information about sexual development, reproductive health, and  
          prevention of unplanned pregnancies and sexually transmitted  
          diseases.  This bill clarifies that a dependent youth's right to  
          consent to certain medical care, including treatment for sexual  
          assault, medical treatment for care or prevention of pregnancy,  
          mental health treatment, or treatment for drug or alcohol abuse,  
          is not limited because a court or social worker is authorized to  








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          consent to medical care for the youth.  This bill also  
          authorizes a social worker to inform dependents who are 12 or  
          older of this right.  Finally, this bill adds minor and nonminor  
          dependent parents to the list of families prioritized for  
          subsidized state and federal child development services.  This  
          bill is opposed by the California Right to Life Committee.  It  
          passed out of the Assembly Human Services Committee on a 6-1  
          vote.

           SUMMARY  :  Provides additional considerations for foster children  
          and nonminor dependents with respect to access to medical care  
          and child care.  Specifically,  this bill :   

          1)Clarifies that a social worker's or court's authority to  
            consent to medical care for a child in the foster care system  
            is not to be construed to limit the child's right to consent  
            to, among other things, the diagnosis and treatment of sexual  
            assault, medical care regarding the prevention or treatment of  
            pregnancy, including contraception, abortion, and prenatal  
            care, treatment of infectious, contagious, or communicable  
            diseases, mental health treatment, and treatment for alcohol  
            and drug abuse.  Authorizes a social worker to inform a  
            dependent over the age of 12 of his or her right to consent to  
            and receive those health care services, as specified. 

          2)Authorizes social workers to provide dependent children with  
            access to age-appropriate, medically accurate information  
            about sexual development, reproductive health, prevention of  
            unplanned pregnancies and sexually transmitted infections. 

          3)Adds to the Foster Youth Bill of Rights the right of a minor  
            or nonminor in foster care to have access to medically  
            accurate, age-appropriate information about reproductive  
            health, the prevention of unplanned pregnancy, and the  
            prevention and treatment of sexually transmitted infections at  
            12 years of age or older. 

          4)States the intent of the Legislature to ensure that complete  
            and accurate data on parenting minor and nonminor dependents  
            and their children are collected, and that the Department of  
            Social Services shall ensure that specified information is  
            publicly available on a quarterly basis by county about  
            parenting minor and nonminor dependents and their children. 

          5)Permits child welfare agencies to provide dependents and  








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            nonminor dependents with access to social workers or resource  
            specialists who are trained on the needs of parenting  
            teenagers and available resources. 

          6)Encourages child welfare agencies to update a dependent's or  
            nonminor dependent's case plan with specified pregnant and  
            parenting information in collaboration with specified  
            individuals within 60 days of being notified that a dependent  
            or nonminor dependent has become pregnant.  Permits child  
            welfare agencies, when updating the case plan, to hold a  
            specialized conference to assist pregnant or parenting foster  
            youth and nonminor dependents, and to inform the case plan.   
            Requires the specialized conference to include the pregnant or  
            parenting minor or nonminor dependent, family members and  
            other supportive adults, and the specially trained social  
            worker or resource specialist.  Permits the specialized  
            conference to include other individuals, as specified.   
            Clarifies that participation in the specialized conference is  
            voluntary on the part of the foster youth or nonminor  
            dependent and assistance in identifying and accessing  
            resources is not dependent on participation in the conference.  


          7)Permits child welfare agencies, local educational agencies,  
            and child care resource and referral agencies to make  
            reasonable and coordinated efforts to ensure that minor  
            parents and nonminor dependent parents who have not completed  
            high school have access to school programs that provide onsite  
            or coordinated child care, and that minor dependent parents  
            are given priority for subsidized child care.  Adds parenting  
            minor and nonminor dependents to the list of families eligible  
            for federal and state subsidized child care.  

           EXISTING LAW  : 

          1)Allows a juvenile court to adjudicate a minor a dependent of  
            the court if the child has been neglected or abused.  (Welfare  
            & Institutions Code Section 300.  Unless stated otherwise, all  
            further statutory references are to that code.) 

          2)Establishes the California Fostering Connections to Success  
            Act of 2010, which, among other provisions, provides for the  
            extension of transitional foster care to eligible youth up to  
            age 21, as specified.  (AB 12 (Beall), Chap. 559, Stats. 2010;  
            Section 303.)








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          3)Establishes the Foster Care Bill of Rights to clearly  
            enumerate the rights of children placed in foster care.   
            (Section 16001.9.)

          4)Authorizes minors, 12 years of age and older, to consent to  
            specified health care and determine whether to keep it  
            private, including sexual and reproductive health services,  
            drug treatment, and mental health treatment or counseling  
            services if, in the opinion of the attending professional  
            person, the minor is mature enough to participate  
            intelligently in the mental health treatment or counseling  
            services.  (Health & Safety Code Section 124260; Civil Code  
            Section 56.11(c)(1); Family Code Sections 6924-29.)

          5)Authorizes a social worker who is responsible for, or  
            supervising the care of, a child to authorize medical,  
            surgical, dental or other remedial care, upon recommendation  
            by an attending physician, surgeon, or dentist, as specified.   
            Authorizes the juvenile court to make an order authorizing the  
            performance of necessary medical, surgical, dental or other  
            remedial care for a child for whom a dependency petition has  
            been filed, as specified.  (Section 369.)

          6)States the intent of the Legislature to support the  
            preservation of families headed by minor parents and nonminor  
            dependent parents, and provides that such families will be  
            provided with access to existing services for which they may  
            be eligible, as specified.  (Section 16002.5.)

          7)Requires the Superintendent of Public Instruction to adopt  
            rules and regulations related to the eligibility, enrollment,  
            and priority of services needed in the implementation of state  
            subsidized child care and child development services.   
            (Education Code Section 8263.)

           COMMENTS  :  AB 12 (Beall and Bass), Chap. 559, Stats. 2010, known  
          as the California Fostering Connections to Success Act,  
          authorized the juvenile courts to exercise jurisdiction over and  
          extend foster benefits to nonminor dependents between the ages  
          of 18 to 21 if they meet specified criteria.  Thus, eligible  
          nonminor foster youth are now able to continue receiving support  
          from the dependency system as they transition into adulthood.   
          However, as California has expanded foster care to serve older  
          youth, issues related to reproductive health and parenting have  








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          become even more urgent. 

          A 2009 Time article described why concerns are rising: 

               A study at the University of Chicago found that nearly half  
               of girls who had spent time in the foster-care system had  
               been pregnant at least once by the time they were 19 years  
               old. Even more troubling, unplanned pregnancy had already  
               become a pattern for many of the young women - close to  
               one-quarter had experienced multiple pregnancies in their  
               teens. ?

               The stats shouldn't come as a surprise to anyone who knows  
               the risk factors for teen pregnancy.  A report . . . by the  
               National Campaign to Prevent Teen and Unplanned Pregnancy  
               found that almost half of the 500,000 or so kids in foster  
               care had sex for the first time before age 16, compared  
               with 30 percent of their peers not in foster care.  They're  
               also more likely to have experienced forced sex and less  
               likely to use contraception. . . . 

               Perhaps the most important asset teenagers need to avoid  
               early parenthood is a strong relationship with parents or  
               other adults in their lives.  But these are precisely the  
               kinds of bonds that many foster teens lack.  "You're so  
               busy being transferred from home to home," says Alixes  
               Rosado, who has been in foster care in Connecticut since he  
               was 6 years old.  "You don't have a lot of stable  
               connections."  The 20-year-old estimates that he has worked  
               with a different social worker every year for the past 10.   
               "And not a single one talked about sex."  (Amy Sullivan,  
               Teen Pregnancy: An Epidemic in Foster Care, Time (July 22,  
               2009.)

          This bill addresses many of the issues which have become more  
          pressing with California's expansion of foster care to eligible  
          nonminors.  Among other provisions, this bill authorizes social  
          workers to provide foster youth specified reproductive health  
          information.  This bill also clarifies that existing law  
          permitting the court and social workers to authorize specified  
          medical care for a dependent child is not to be construed to  
          limit the medical consent rights of the child.  This bill also  
          allows child welfare agencies to ensure pregnant and parenting  
          dependents have access to case workers with specialized  
          training, and that case plans are developed through a team  








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          decision-making process.  This bill adds parenting minor and  
          nonminor dependents to the list of individuals eligible for  
          federal and state subsidized child development services and  
          provides priority enrollment for those families.  Finally, this  
          bill states the intent of the Legislature to ensure that  
          accurate data related to parenting minor and nonminor dependents  
          are collected, and that the data are available to the public on  
          a quarterly basis.

          In support of the bill, the author writes:

            Currently, young parents in the foster care system face both  
            the challenges of being in foster care as well as the  
            challenges of being a young, usually single, parent.  Studies  
            of both groups have found that they will experience higher  
            than average rates of poverty, unemployment and low  
            educational attainment.  While this has long been the case,  
            the issue of parenting youth in foster care has become more  
            pressing with the implementation of extended foster care in  
            California. 

            Research from the University of Chicago suggests that  
            extending foster care to age 21 will roughly  double  the  
            incidence of parenting youth in foster care.  Given this, it  
            is important that California's foster care system adapt itself  
            to meet the real needs of parenting youth and their children.   
            Doing so provides an important opportunity both to better  
            serve parenting foster youth and meet the needs of their  
            children in their first, most critical years of life.

           Helps Provide Foster Youth Access to Critical Health  
          Information  :  This bill authorizes social workers to provide  
          foster youth with age-appropriate, medically accurate  
          information about sexual development, reproductive health, and  
          prevention of unplanned pregnancies and sexually transmitted  
          diseases.  On the importance of foster youth receiving accurate  
          information about medical and health care, the Public Health  
          Institute wrote in a 2009 report: 

            Children and youth in foster care are often characterized by  
            the absence of a dependable family or social network, an  
            intense need for affection, the desire to possess something of  
            their own that they do not have to share, exposure to sexual  
            abuse, exposure to other types of violence, and limited skills  
            in identifying and accessing resources to support themselves  








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            now and in the future?. 

            Youth in foster care tend to change schools frequently due to  
            changes in foster placements and thus may experience lapses in  
            school attendance, falling behind not only in academic  
            subjects, but also missing the sex education sometimes  
            delivered in traditional schools. Foster and former foster  
            youth are therefore less likely to have had access to sex  
            education classes, despite their increased risk for unintended  
            pregnancy, HIV, and other STDs.  (Wendy Constantine, et al.,  
            Sex Education and Reproductive Health Needs of Foster and  
            Transitioning Youth in Three California Counties 4 (Public  
            Health Institute, March 2009).)

           Clarifies Existing Law Regarding Minor's Ability to Consent to  
          Specified Health Care Treatment  :  Under current law, at least  
          two parties may make specified medical decisions for a dependent  
          child 12 years of age or older.  First, existing law permits a  
          social worker or the juvenile court responsible for a child  
          taken into temporary custody to authorize specified medical care  
          upon recommendation by an attending physician, and permits a  
          social worker supervising the care of a dependent child to  
          authorize medical care.  
           
          Current law also permits minors, 12 years of age and older, to  
          consent to specified health care and to determine whether to  
          keep it confidential, including sexual and reproductive health  
          services, drug treatment, and mental health treatment or  
          counseling services if, in the opinion of the attending  
          professional person, the minor is mature enough to participate  
          intelligently in the mental health treatment or counseling  
          services.  

          This bill clarifies that a dependent youth's right to consent to  
          specified medical or mental health care, specifically including  
          treatment for sexual assault, medical treatment for care or  
          prevention of pregnancy, mental health treatment or treatment  
          for drug or alcohol abuse, is not limited because a court or  
          social worker is authorized to consent to medical care.  This  
          bill also authorizes the social worker to inform the dependent  
          who is 12 or older of this right.  Thus, while this provision  
          does not change current law, it will help ensure that dependents  
          are informed of important existing rights to consent to medical  
          treatment. 









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           Requires Complete and Accurate Data Collection on Parenting  
          Dependents and Their Children  :  This bill states the intent of  
          the Legislature to ensure that complete and accurate data on  
          parenting minor and nonminor dependents and their children is  
          collected, and made available on a quarterly basis.  The bill  
          specifies that information be collected regarding the total  
          number of parenting minor and nonminor dependents, the number of  
          their children, their age, their ethnic group, their placement  
          type and their time in care.  
           
          This information is important for the Legislature and counties  
          to first understand the needs of parenting foster youth and then  
          to better address those needs.  In support of the bill, the John  
          Burton Foundation writes, "currently we cannot answer the most  
          basic questions [about parenting youth and their children] such  
          as how many parenting youth are in foster care or how many of  
          their children have been removed and placed into foster care.   
          This information is vital if we are to understand how to target  
          limited resources to prevent unintended pregnancies, support  
          young parents, and prevent maltreatment of the children of  
          parenting foster youth."

           Connecting Parenting Dependents to Existing Resources  :   
          According to the author, parenting foster youth face a large,  
          uphill battle.  Recognizing that, in 2008, Los Angeles County  
          embarked on a project to aid pregnant and parenting dependents.   
          The Pregnant and Parenting Teen conference (PPT) is a voluntary  
          program in which pregnant or parenting dependents are connected  
          with a variety of resources from the child welfare system as  
          well as other benefit systems.  The PPT is a "team based"  
          approach, where a number of supportive adults, including a  
          resource specialist or social worker, as well as the youth, work  
          to create a plan for the youth with a focus on healthy parenting  
          and identifying appropriate resources.  The program has been  
          successful in Los Angeles, with an estimated 95 percent of  
          eligible youth participating. 

          Building on the program, this bill helps connect pregnant and  
          parenting minor and nonminor dependents with resources,  
          hopefully providing them the opportunity to become economically  
          stable and improve the health and well-being of their young  
          children.  

          Specialized conferences for pregnant and parenting youth:  This  
          bill allows child welfare agencies to provide minor parents and  








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          nonminor dependent parents with access to social workers or  
          resource specialists who have received training on the needs of  
          teenaged parents, and are able to direct dependents to the  
          resources and programs available them.  This bill also  
          encourages the county agency to update the case plans for  
          pregnant and parenting dependents within 60 calendar days of  
          being informed of the pregnancy.  When updating these case  
          plans, this bill allows child welfare agencies to hold a  
          specialized conference to inform the case plan.  

          These provisions are largely based on the pregnant and parenting  
          teen conferences that have been utilized in Los Angeles County.   
          These specialized conferences must include a social worker or a  
          resource specialist trained in the needs of pregnant or  
          parenting dependents, but could also include family members,  
          other supportive adults, a public health nurse, or other  
          personnel from public or private sectors with a comprehensive  
          knowledge of available maternal and child resources, including  
          public benefit programs.  The conferences would be voluntary for  
          a pregnant or parenting dependent, but would give the youth an  
          opportunity to develop a birth plan for the child and related  
          issues, such as how the birth of the child will affect foster  
          care placement, education and childcare.  
                
           Subsidized child care:  This bill adds parenting minor and  
          nonminor dependents to the list of individuals eligible for  
          federal and state subsidized child development services and  
          provides priority enrollment for those families.  In support of  
          this bill, the Children's Advocacy Institute writes, "parenting  
          and pregnant youth in foster care are 200 percent more likely to  
          drop out of high school than to graduate, leaving them without  
          the means to achieve economic stability.  One key reason for  
          this is a lack of reliable, affordable child care.  SB 528 will  
          prioritize foster youth who are parents for subsidized child  
          care, thereby allowing foster youth to complete their education  
          and get one step closer to achieving economic stability for  
          themselves and their children." 

          Extending benefits to eligible dependents until the age of 21  
          has had unintended consequences for nonminor dependent parents.   
          For example, while parenting minor dependents may be eligible  
          for subsidized childcare under particular programs, such as  
          Cal-Learn, and adult parents are eligible under programs such as  
          CalWORKS, currently, there are no specific child care programs  
          or services directed toward parenting nonminor dependents which  








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          allow them to meet the above requirements while simultaneously  
          caring for their child.  Thus, parenting nonminor dependents may  
          be forced to exit extended foster care or lose their child.   
              This bill addresses this issue by adding pregnant and parenting  
          dependents, regardless of age, to the list individuals eligible  
          for federal and state subsidized child development services.  

           ARGUMENTS IN OPPOSITION  :  In opposition to this bill, California  
          ProLife Council argues that the bill "would force state agencies  
          and workers to create ways for minor parents and non-minor  
          dependents to receive abortions.  Many of these children have  
          been abused, neglected and now will have state agencies make  
          items like abortion their focus rather than the needs of those  
          they are charged with."  

          In response the author states that the bill does not expand  
          medical services that are already available to foster youth, but  
          it is aimed to "prevent unintended pregnancies and awareness  
          about the consequences of engaging in sexual behavior."

           Prior Legislation  :  AB 499 (Atkins), Chap. 652, Stats. 2011,  
          authorized a minor, who is 12 years of age or older, to consent  
          to medical care related to the prevention of a sexually  
          transmitted disease. 

          SB 543 (Leno), Chap. 503, Stats. 2010, authorized a minor who is  
          12 years of age or older to consent to mental health treatment  
          or counseling, except as specified, on an outpatient basis, or  
          to residential shelter services, if specified conditions are  
          satisfied.

          SB 244 (Wright, 2009) would have required a study on the  
          feasibility of providing priority enrollment in high-quality  
          child care and development programs for children from birth to  
          five years of age who are in the foster care system, in relative  
          care or reunification, or were formerly in the foster care  
          system, who are at risk of abuse, neglect, or exploitation, are  
          homeless, or had a custodial parent who meets specified  
          criteria.  Held in Assembly Rules.

          AB 769 (Torres, 2009) would have expanded priority enrollment in  
          state-funded preschool programs to children who have a  
          biological parent who is, or who has been within the previous  
          six months, under the jurisdiction of the delinquency or  
          dependency court.  AB 769 was vetoed by the Governor.  








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          AB 270 (De La Torre, 2009) would have required courts to  
          continue jurisdiction over nonminors when required documents,  
          screenings and information were not provided or completed.  This  
          bill died in the Assembly Appropriations Committee.

           REGISTERED SUPPORT / OPPOSITION  :

           Support  

          The Alliance for Children's Rights (co-sponsor)
          Children's Law Center of California (co-sponsor)
          John Burton Foundation (co-sponsor) 
          Public Counsel (co-sponsor)
          A Better Way 
          Abode Services 
          ACLU 
          Alameda County Office of Education 
          Alternative Family Services 
          Advancement Project 
          Aspiranet 
          Bay Area Youth Centers 
          Bill Wilson Center 
          Black Women for Wellness 
          California Adolescent Health Collaborative 
          California Alliance of Child and Family Services 
          California Alternative Payment Program Association 
          California Attorneys for Criminal Justice 
          California Coalition for Youth 
          California Federation of Teachers 
          California Latinas for Reproductive Justice 
          California Public Defenders Association 
          California State PTA 
          California Women's Law Center 
          Casa de Amparo 
          Children's Advocacy Institute 
          Citizens for Choice 
          Coalition For Youth
          Alameda County Court Appointed Special Advocates 
          Covenant House California 
          Crittenton Services for Children and Families 
          Dependency Legal Group of San Diego 
          East Bay Children's Law Offices 
          EMQ Families First 
          Every Child Foundation 








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          Family Care Network, INC. 
          Feminist Majority 
          First Place for Youth 
          Five Acres 
          Fred Finch Center 
          Gavilan College, EOPS 
          Goldman School of Public Policy, UC Berkeley 
          Hillsides 
          Home Start 
          Housing California 
          Justice Policy Institute 
          Imperial Valley Regional Occupational Program 
          InVision Shelter Network 
          Larkin Street Youth Services 
          League of Women Voters of California 
          Legal Services for Children 
          LIFETIME 
          Moorpark College 
          Mountain Circle Family Services 
          National Association for the Education of Homeless Children and  
          Youth 
          National Association of Social Workers - California Chapter  
          (NASW) 
          National Center for Youth Law 
          National Council of Jewish Women 
          National Foster Parent Association 
          New Alternatives
          NYC Children's Services, Theresa Moser, Attorney 
          Oakland Unified School District, Lydell K Willis 
          OPTIMIST Youth Homes & Family Services 
          Peacock Acres 
          Promesa Behavioral Health 
          Redwood Children's Services
          Seneca Family Agencies 
          Social Advocates for Youth 
          Stars Community Services 
          Stars Behavioral Health Group 
          St. Anne's 
          Transition Age Foster Youth, Santa Cruz County 
          Twigs to Trees Inc. 
          UCSF Research Director, Janet Malvin, Ph.D. 
          University of Southern California School of Social Work 
          West Coast Children's Clinic 
          Western Center on Law & Poverty 
          Youth and Family Programs 








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          Youth and Family Services YMCA, Santa Barbara 
          YWCA Santa Monica 
          Many individuals
           
            Opposition 
           
          California ProLife Council

           Analysis Prepared by  :  Leora Gershenzon / JUD. / (916) 319-2334