BILL ANALYSIS Ó SB 528 Page 1 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 SB 528 Page 2 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 SB 528 Page 3 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.) SB 528 Page 4 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 SB 528 Page 5 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 SB 528 Page 6 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 SB 528 Page 7 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. SB 528 Page 8 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 SB 528 Page 9 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 SB 528 Page 10 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. SB 528 Page 11 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 SB 528 Page 12 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 SB 528 Page 13 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