BILL ANALYSIS Ó
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2015 - 2016 Regular Session
SB 238 (Mitchell)
Version: April 7, 2015
Hearing Date: April 28, 2015
Fiscal: Yes
Urgency: No
NR
SUBJECT
Foster care: psychotropic medication
DESCRIPTION
This bill would require certification and training programs for
group home administrators, foster parents, child welfare social
workers, dependency court judges, and court appointed counsel to
include training on psychotropic medication, trauma, and
behavioral health, as specified, for children receiving child
welfare services. This bill would require the Judicial Council
to update court forms pertaining to the authorization of
psychotropic medication for foster youth and ensure specified
changes are made to those forms, on or before July 1, 2016.
This bill would also require the California Department of Social
Services to develop an individualized monthly report, a form to
share information and an alert system, to be used by county
child welfare agencies, regarding the administration of
psychotropic medication for a foster youth.
BACKGROUND
In 1999, the Legislature passed SB 543 (Bowen, Ch. 552, Stats.
1999), which provided that only a juvenile court judicial
officer has the authority to make orders regarding the
administration of psychotropic medications for foster youth. SB
543 also provided that the juvenile court may issue a specific
order delegating this authority to a parent if the parent poses
no danger to the child and has the capacity to authorize
psychotropic medications. This legislation was passed in
response to concerns that foster children were being subjected
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to excessive use of psychotropic medication, and that judicial
oversight was needed to reduce the risk of unnecessary
medication. The Judicial Council was required to adopt rules of
court to implement the new requirement. Accordingly, Rule 5.640
specifies the process for juvenile courts to follow in
authorizing the administration of psychotropic medications and
permits courts to adopt local rules for the courts to use to
further refine the approval process.
In 2004, the provisions of SB 543 were amended by AB 2502
(Keene, Ch. 329, Stats. of 2004), which required a judicial
officer to approve or deny, in writing, a request for
authorization to administer psychotropic medication, or set the
matter for hearing, within seven days. This amendment was
intended to ensure timely consideration of requests for
authorization to administer psychotropic medication to dependent
children.
Despite these measures, concerns remain that psychotropic
medication is overused and underreported in the child welfare
system. A recent Los Angeles Times article reported that "Los
Angeles County's 2013 accounting failed to report almost one in
three cases of children on the drugs while in foster care or the
custody of the delinquency system. The data show that along
with the 2,300 previously acknowledged cases, an additional 540
foster children and 516 children in the delinquency system were
given the drugs. There are 18,000 foster children and 1,000
youth in the juvenile delinquency system altogether. ? State
data analysts discovered the additional cases of medicated
children by comparing case notes of social workers and probation
officers with billing records for the state's Medi-Cal system.
The billing records for those additional children did not appear
to have corresponding case notes, leaving child advocates
concerned that the drugs may have been prescribed without
appropriate approval."
The high rate of psychotropic usage is not limited to Los
Angeles County - it is a national issue. Governing magazine
recently noted that children in the United States are on drugs
for longer and more often than kids in any other country.
(Chris Kardish, Bad Medicine: How states are overmedicating
low-income kids, Governing, March 2015.) Much of the concern
stems from the fact that the long-term effects of psychotropic
drugs on children are unknown, and the short term effects,
including obesity, diabetes, and tremors, can be debilitating.
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Yet, many medical and child welfare professionals agree that
some foster youth may benefit from these medications at some
point in their lives. These children, who have suffered abuse
and neglect at the hands of family, often have clinically
significant emotional or behavioral problems. However, when
psychotropic medications are prescribed to a foster child whose
parent has been found, at least temporarily, unfit to approve
the administration of the drugs, the question arises as to
whether the court is capable of making the important inquiries
that a parent should make before administering any medication to
his or her child.
This comprehensive bill seeks to address the issues related to
the administration psychotropic drugs in the foster system by
requiring additional training, oversight, and data collection by
caregivers, courts, counties, and social workers. This bill
would require the Judicial Council, in consultation with other
specified groups, to implement the provisions of this bill, as
specified.
CHANGES TO EXISTING LAW
Existing law provides for the development of a group home
administrator certification program by the California Department
of Social Services (CDSS) in collaboration with specified
stakeholders to ensure certified persons have appropriate
training to provide care and services. Existing law also
requires the certification program to include a minimum of 40
hours of classroom instruction and provide coverage of a
specified uniform core of knowledge. (Health & Saf. Code Sec.
1522.41.)
Existing law requires every licensed foster parent to complete a
minimum of 12 hours of foster parent training covering specified
topics prior to the placement of a foster child in the home, and
eight hours each year thereafter. (Health & Saf. Code Sec.
1529.2.)
Existing law requires the Judicial Council to develop and
implement standards for the education and training of all judges
who conduct hearings pursuant to Welfare and Institutions Code
Section 300, pertaining to dependent children. (Welf. & Inst.
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Code Sec. 304.7.)
Existing law requires court appointed counsel of a child or
nonminor dependent to have specified training, promulgated by
the Judicial Council as rules of the court that ensures adequate
representation of the child or nonminor dependent. (Welf. &
Inst. Code Sec. 317.)
Existing law provides that only a juvenile court judicial
officer shall have authority to make orders regarding the
administration of psychotropic medications for a minor who has
been adjudged a dependent of the court and removed from the
physical custody of his or her parent. Existing law also
requires the Judicial Council to adopt rules of court and
develop appropriate forms. (Welf. & Inst. Code Sec. 369.5.)
Existing law provides for the development of a statewide
coordinated training program designed specifically to meet the
needs of county child protective services social workers,
agencies under contract with county welfare departments to
provide child welfare services, and persons defined as a
mandated reporter pursuant to the Child Abuse and Neglect
Reporting Act. (Welf. & Inst. Code Sec. 16206.)
This bill requires trainings for the following groups to
additionally include the authorization, uses, risks, benefits,
administration, oversight, and monitoring of psychotropic
medication, and trauma, behavioral health, and other available
behavioral health treatments, for children receiving child
welfare services, including how to access those treatments:
group home administrator certification;
initial pre-placement training of licensed foster parents;
post training of licensed foster parents;
training required to be made available to relative and
nonrelative extended family members;
Judicial Council-developed training for dependency judges;
training of court appointed counsel of a child or nonminor
dependent; and
training provided to specified county child protective
services social workers, agencies under contract with county
welfare departments to provide child welfare services, and
persons defined as a mandated reporter pursuant to the Child
Abuse and Neglect Reporting Act.
This bill would require the Judicial Council, on or before July
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1, 2016, in consultation with CDSS, the Department of Health
Care Services (DHCS), and specified stakeholders to implement
and develop updates to the required forms pertaining to this
bill.
This bill would require the above implementation and updates to
ensure the following:
the child and his or her caregiver and court-appointed special
advocate, if any, have a meaningful opportunity to provide
input on the medications being prescribed;
information regarding the child's overall behavioral health
assessment and treatment plan is provided to the court;
information regarding the rationale for the proposed
medication, including information on other pharmacological and
non-pharmacological treatments that have been utilized and the
child's response, and an explanation how the psychotropic
medication being prescribed is expected to improve the
symptoms; and
guidance is provided to the court on how to evaluate the
request for authorization, including how to proceed if
information, otherwise required to be included in a request
for authorization, is not included in a request.
This bill would require CDSS, in consultation with DHCS, the
County Welfare Directors Association (CDWA) and other
stakeholders to develop and provide an individualized monthly
report to each county child welfare services agency that
includes the following for each child receiving child welfare
services:
psychotropic medications that have been authorized for the
child by the court;
data for medications that have been dispensed to the child,
including both psychotropic and non-psychotropic medication;
durational information relating to the child's authorized
psychotropic medication, including, but not limited to, the
length of time a medication has been authorized and the length
of time for which a medication has been dispensed by a
pharmacy;
claims paid for behavioral health services provided to the
child, other than claims paid for psychotropic medication; and
the dosages of psychotropic medications that have been
authorized for the child and that have been dispensed.
This bill would require CDSS, in consultation with DHCS, CDWA
and other stakeholders, to develop a form, to be used by a
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county child welfare services agency on a monthly basis, to
share with the juvenile court, the child's attorney, and the
court-appointed special advocate, if one has been appointed, the
above information regarding a child receiving child welfare
services authorized to receive one or more psychotropic
medication.
This bill would require CDSS in consultation with DHCS, CDWA and
other stakeholders to develop, or ensure access to, a system
that automatically alerts a social worker of a child receiving
child welfare services when psychotropic medication has been
prescribed that fits the following descriptions:
is prescribed in combination with another psychotropic
medication and the combination is unusual or has the potential
for a dangerous interaction;
is prescribed in a dosage that is unusual for a child of that
age; and
is not typically indicated for a child of that age.
This bill would require a child's social worker, upon receipt of
an alert, to indicate to the court that the alert has been
received by the child's attorney, the child's caregiver, and the
child's court appointed special advocate, if one has been
appointed, and to include a discussion of the resolution of the
alert in the next court report filed.
COMMENT
1.Stated need for the bill
According to the author:
Recent newspaper articles have highlighted the use and overuse
of psychotropic medications in foster care facilities. Reports
provided by the Department of Health Care Services and the
Department of Social Services are limited in providing needed
information to determine how psychotropic medicine is being
provided and distributed. The goal of this legislation is to
develop and review data, to develop a system of flags, to
improve county reporting and to establish further
consultation/second opinion options for cases in which
psychotropic medications and/or antidepressants are being
prescribed for a foster youth.
2.Better monitoring of psychotropic medication in foster care
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Under existing law, only the court may authorize the use of
psychotropic medication for any child in the dependency system.
Rules of Court require the prescribing physician to complete and
submit an application to the court, known as the "JV-220" form.
The JV-220 requires the inclusion of specific information,
including: (1) the child's diagnosis; (2) the specific
medication with the recommended maximum daily dosage and length
of time this course of treatment will continue; (3) the
anticipated benefits to the child from the use of the
medication; (4) a list of any other medications, prescription or
otherwise, that the child is currently taking, and a description
of any effect these medications may produce in combination with
the psychotropic medication; and (5) a statement that the child
has been informed in an age-appropriate manner of the
recommended course of treatment, the basis for it, and its
possible results. The court is required, upon review of the
JV-220, to deny, grant, or modify the application for
authorization of psychotropic medication within seven days, or
to set the matter for hearing. The court may also set a date for
review of the child's progress and condition. (See Cal. Rule Ct.
Sec. 5.640 and Welf. & Inst. Code Sec. 369.5.)
Supporters of this bill argue that courts are often not being
provided with the full story. Upon reviewing a JV-220, a judge
may have no indication that the child is already on psychotropic
medication, what a proper dosage for a child is, or what less
invasive alternatives are available. Supporters further assert
that the existing rule, which sets arguably loose parameters and
includes no considerations that the court must take into account
when evaluating a JV-220, is too broad for judges and courts
that may lack the tools to properly evaluate medical
recommendations and are overburdened with unmanageable
caseloads. In addition, the current process does not offer any
meaningful way for other adults, caretakers, or those who
interact with a foster child on a regular basis, to contribute
information to a physician's recommendation.
Accordingly, this bill would ensure that a child, his or her
caregiver, and his or her court appointed special advocate have
an opportunity to provide input to the court on the medications
being prescribed. This bill would further require that the
court is provided with the tools to properly analyze the
authorization request, and that the court monitor the child's
progress by way of periodic oversight facilitated by the social
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worker, public health nurse, or other appropriate county staff.
The County Welfare Directors Association, a sponsor of the bill,
states that "recent reports indicating that psychotropic
medications are over-prescribed in the child welfare system have
prompted a needed look at the procedures by which those
medications are authorized and overseen. The children we serve
have experienced severe trauma that often warrants behavioral
health services such as trauma-informed therapy and other
targeted treatments. We believe it is appropriate for some
children to receive medication, when thoughtfully prescribed as
part of an overall treatment plan that includes
non-pharmacological interventions, as well. With those
medications, however, must come oversight to ensure that the
treatment plan is in place and that children are responding well
to the authorized medications."
3.Training and education on psychotropic medication for those
adults who are entrusted with the safety and care of foster
youth
This bill would require the adults who provide care, protection,
and services to foster children to receive training on the
"authorization, uses, risks, benefits, administration,
oversight, and monitoring of psychotropic medication, and
trauma, behavioral health, and other available behavioral health
treatments, for children receiving child welfare services,
including how to access those treatments." The Youth Law Center
agrees that this training is essential, and writes that they
would support this bill if it were extended to include probation
youth as well.
These adults, including, foster parents, relative and
nonrelative extended family members, juvenile court judges,
minor's counsel, and specified social workers, are in a unique
position to recognize and advocate for a child's best interest.
With the proper training, these adults may be able to recognize
when a child is not responding properly to medication, and
provide valuable information to assist the court in the
oversight of a child's treatment plan. Thus, the court will not
be forced to rely on the opinion of the prescribing physician
alone. This required education and training on the risks and
uses of psychotropic drugs would arguably help the adults in a
foster child's life better assist the youth in achieving
behavioral and emotional health.
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Support : Advokids; Alameda County Foster Youth Alliance;
California Court Appointed Special Advocates (CASA); California
State Association of Counties; Children's Advocacy Institute;
Children's Law Center; Dependency Legal Group of San Diego;
First Focus Campaign for Children; Humboldt County Transition
Age Youth Collaboration; John Burton Foundation; Legal Advocates
for Children and Youth; National Center for Youth Law; Peers
Envisioning and Engaging in Recovery Services; Public Counsel's
Children's Rights Project; Urban Counties Caucus; 6 individuals
Opposition : None Known
HISTORY
Source : County Welfare Directors Association of California
Related Pending Legislation :
SB 253 (Monning) provides that an order of the juvenile court
authorizing psychotropic medication shall require clear and
convincing evidence of specified conditions. Furthermore this
bill prohibits the authorization of psychotropic medications
without a second independent medical opinion under specified
circumstances. It also prohibits the authorization of
psychotropic medications unless the court is provided
documentation that appropriate lab screenings, measurements, or
tests have been completed, as specified. Furthermore it requires
the court, no later than 45 days following an authorization for
psychotropic medication, to conduct a review to determine
specified information regarding the efficacy of the child's
treatment plan.
SB 484 (Beall) requires the CDSS to publish and make available
to interested persons specified information regarding the
administration of psychotropic medication in residential
facilities serving dependent children. Additionally, it requires
CDSS to inspect facilities at least once per year, as specified,
if the facility is determined to have a higher than average rate
of psychotropic medication authorization for children residing
in the facility and to monitor corrective action plans, as
specified.
SB 319 (Beall) expands the duties of the foster care public
health nurse to include monitoring and oversight of the
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administration of psychotropic medication to foster children, as
specified. It also requires counties to provide child welfare
public health nursing services by contracting with the community
child health and disability prevention program established by
the county.
Prior Legislation :
AB 3015 (Brownley, Chapter 557, Statutes of 2008) required
training programs for group home administrators, licensed foster
parents and relative caretakers to include basic instruction on
the safety of foster youth at school and school environment
anti- harassment protections.
AB 2675 (Strickland, Chapter 421, Statutes of 2006) permitted no
more than half of the required 40-hour continuing education
requirement to be satisfied through online courses.
AB 458 (Chu, Chapter 331, Statutes of 2003) established and
required provider training regarding the right of foster
children to fair and equal access to all available services,
placement, care, treatment, and benefits, and to not be
subjected to discrimination or harassment on the basis of actual
or perceived race, ethnic group identification, ancestry,
national origin, color, mental or physical disability, or HIV
status.
AB 1694 (Committee on Human Services, Chapter 918, Statutes of
2002) required California Community Colleges that provide foster
parent training programs to make those programs available to
non-relative extended family members.
AB 2307 (Davis, Chapter 745, Statutes of 2000) required
California Community Colleges that provide foster parent
training programs to make those programs available to relative
and kinship care providers.
SB 543 (Bowen, Chapter 552, Statutes of 1999) mandated that once
a child has been adjudged a dependent of the state only the
court may authorize psychotropic medications for the child,
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based on a request from a physician including specified
information.
AB 3062 (Friedman, Chapter 1016, Statutes of 1996) mandated all
foster parents to obtain pre-placement and post-placement
training.
Prior Vote : Senate Human Services Committee (Ayes 5, Noes 0)
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