BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 238 (Mitchell) - Foster care: psychotropic medication
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|Version: April 7, 2015 |Policy Vote: HUMAN S. 5 - 0, |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 11, 2015 |Consultant: Jolie Onodera |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 238 would require additional training, oversight,
and data collection and reporting by specified entities involved
in the process of the administration of psychotropic medication
in the foster care system. This bill would require the Judicial
Council, on or before July 1, 2016, in consultation with various
stakeholders, to develop updates to the forms required to
implement the bill's provisions, as specified.
Fiscal
Impact:
Training development : Potentially significant one-time costs
(General Fund) to DSS for the development of the training
component for licensed foster parents, group home
administrators, relative and nonrelative extended family
members, court-appointed counsel, child protective services
staff, and mandated reporters.
Periodic oversight : Annual costs to the courts of $1.6
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million (General Fund*) for workload associated with document
management of monthly reports. Associated costs for county
workers are noted under 'Child Welfare Services'. Staff notes
costs would be dependent on the meaning of "periodic," which
is undefined in the bill but assumed to be specified in the
rules of court to be adopted by the Judicial Council.
Judicial Council Forms/Updates : One-time costs of $77,000
(General Fund*).
Individualized monthly report : Potentially moderate one-time
costs in the low hundreds of thousands of dollars (General
Fund) for DSS to develop the monthly report and associated
form, to the extent DSS and DHCS are able to utilize
pre-existing data from their respective databases to develop
the report.
Automatic alert system : Unknown, but potentially major
one-time costs potentially in the millions of dollars (General
Fund) for DSS to develop or ensure access to a system that
automatically alerts social workers when psychotropic
medication has been prescribed to youth, subject to specified
conditions.
Child welfare services : Major costs potentially in the tens
of millions of dollars (General Fund**) annually for
increased costs incurred by county social workers, public
health nurses, and other county staff for time to attend
additional training, complete more comprehensive court forms,
facilitate periodic oversight hearings, respond to automatic
alerts, provide notifications, and provide additional
follow-up. While the magnitude of workload required to meet
the mandates in this bill are unknown at this time, for
context, even two additional hours per month of social worker
time for the 6,100 youth authorized to receive psychotropic
medications would result in costs of over $10.7 million.
Proposition 30** : Exempts the State from mandate
reimbursement for realigned programs, however, legislation
that has an overall effect of increasing the costs already
borne by a local agency for realigned programs, including
child welfare services, apply to local agencies only to the
extent that the State provides annual funding for the cost
increase.
*Trial Court Trust Fund
Background: Existing law provides that only a juvenile court judicial
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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. (Welfare and Institutions Code §
369.5.)
Pursuant to Rule of Court 5.640, the prescribing physician is
required 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.
As noted in the recent analysis of this measure by the Senate
Committee on Judiciary (April 28, 2015):
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. 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
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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. (p.2)
Proposed Law:
This bill would provide for various reforms to the process of
the administration of psychotropic medication in the foster care
system by requiring additional training, oversight, and data
collection, as specified. This bill would require the Judicial
Council, in consultation with various stakeholders, to implement
the provisions of this bill. Specifically, 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:
o Group home administrator certification;
o Initial pre-placement training of licensed foster
parents;
o Post-training of licensed foster parents;
o Training required to be made available to relative and
nonrelative extended family members through community
college districts;
o Judicial Council-developed training for dependency
judges;
o Training of court-appointed counsel of a child or
nonminor dependent;
o 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 mandated reporters
pursuant to the Child Abuse and Neglect Reporting Act.
Requires the Judicial Council, on or before July 1, 2016, in
consultation with DSS, the Department of Health Care Services
(DHCS), and specified stakeholders to implement and develop
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updates to the required forms pertaining to this bill.
Requires a process for periodic oversight by the court, that
is to be facilitated by the county social worker, public
health nurse, or other appropriate county staff, of orders
regarding the administration of psychotropic medications that
includes the following:
o 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;
o Information regarding the child's overall behavioral
health assessment and treatment plan is provided to the
court;
o 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;
o 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.
Requires DSS, in consultation with DHCS, the County Welfare
Directors Association (CWDA) 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:
o Psychotropic medications that have been authorized for
the child by the court;
o Data for medications that have been dispensed to the
child, including both psychotropic and non-psychotropic
medication;
o 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;
o Claims paid for behavioral health services provided to
the child, other than claims paid for psychotropic
medication; and
o The dosages of psychotropic medications that have been
authorized for the child and that have been dispensed.
Requires DSS, in consultation with DHCS, CDWA and other
stakeholders, to develop a form, to be used by a county child
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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.
Requires DSS in consultation with DHCS, CWDA, 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:
o Is prescribed in combination with another psychotropic
medication and the combination is unusual or has the
potential for a dangerous interaction;
o Is prescribed in a dosage that is unusual for a child of
that age; and
o Is not typically indicated for a child of that age.
Requires 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
Related Legislation: SB 253 (Monning) 2015 provides that an
order of the juvenile court authorizing psychotropic medication
shall require clear and convincing evidence of specified
conditions. 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. This
bill is pending hearing in this Committee.
SB 484 (Beall) 2015 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
DSS 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. This bill is pending hearing in this Committee.
SB 319 (Beall) 2015 expands the duties of the foster care public
health nurse (PHN) 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
PHN services by contracting with the community child health and
disability prevention program established by the county. This
bill is pending hearing in this Committee.
Staff
Comments: The Judicial Council has indicated three major costs
points associated with the provisions of this bill upon the
trial courts and the judicial branch: updating and creating
rules of court and forms to update provisions related to the
prescription of psychotropic medications ($77,000 one-time);
document management associated with the "sharing" of specified
information on a monthly basis regarding an individual child
receiving child welfare services ($1.6 million annually); and
training for judicial officers who are authorized to make orders
regarding the administration of psychotropic medications for a
dependent child or ward who has been removed from the physical
custody of his or her parent ($6,000 one-time for training
development).
Staff notes that the mandated periodic oversight process to be
facilitated by social workers, public health nurses, or other
county staff would also increase trial court workload, the
magnitude of which would be dependent on the frequency and
duration of the "periodic" oversight prescribed in the adopted
rules of court.
This bill imposes new duties on the DSS as detailed above in the
"Proposed Law" section of this analysis. The DSS would incur
one-time, potentially significant workload for the development
of the training component to be completed in consultation with
various stakeholders. It is estimated that DSS would incur
potentially moderate one-time costs in the low hundreds of
thousands of dollars to develop the individualized monthly
report and associated form. This estimated cost assumes DSS and
DHCS are able to utilize pre-existing data from their respective
databases to develop the report. It is estimated that the
one-time cost to DSS 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, could be substantial, potentially in excess of
several million dollars. There would likely be additional costs
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for ongoing maintenance and operation of the system.
This bill imposes activities on social workers, public health
nurses, and other county staff that could significantly increase
the time associated with the provision of child welfare services
for this population of youth. Potential workload increases could
be incurred by county social workers, public health nurses, and
other county staff for various activities, including time to
attend additional training, complete more comprehensive court
forms, facilitate periodic oversight hearings, respond to
automatic alerts, provide notifications, and provide additional
follow-up. While the magnitude of workload required to meet the
mandates in this bill are unknown at this time, for context,
even two additional hours per month of social worker time for
the 6,100 youth authorized to receive psychotropic medications
would result in costs of over $10.7 million.
Proposition 30, passed by the voters in November 2012, among
other provisions, eliminated any potential mandate funding
liability for any new program or higher level of service
provided by counties related to realigned programs. Although the
provisions of this bill are a mandate on local agencies, any
increased costs would not be subject to reimbursement by the
state. Rather, Proposition 30 specifies that for legislation
enacted after September 30, 2012, that has an overall effect of
increasing the costs already borne by a local agency for
realigned programs such as child welfare services, the
provisions shall apply to local agencies only to the extent that
the state provides annual funding for the cost increase.
While the potential costs of this measure are substantial, the
provision of increased system-wide training, monitoring, and
oversight over the process of the prescription of psychotropic
medications would promote further protection of the health and
well-being of youth in the child welfare system, and ultimately
result in more positive long-term outcomes for these youth.
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