BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 238|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: SB 238
Author: Mitchell (D) and Beall (D), et al.
Amended: 6/2/15
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/21/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE JUDICIARY COMMITTEE: 6-0, 4/28/15
AYES: Jackson, Anderson, Hertzberg, Leno, Monning, Wieckowski
NO VOTE RECORDED: Moorlach
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Foster care: psychotropic medication
SOURCE: County Welfare Directors Association of California
National Center for Youth Law
DIGEST: This bill requires certification and training programs
for foster parents, child welfare social workers, group home
administrators, dependency court judges and court appointed
council to include training on psychotropic medication, trauma,
and behavioral health, as specified, for children receiving
child welfare services. This bill requires the Judicial Council
to update court forms pertaining to the authorization of
psychotropic medication for foster youth, on or before July 1,
2016. Additionally, this bill requires the California Department
of Social Services (CDSS) to develop an individualized monthly
report, a form to share information, and an alert system, to be
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used by county child welfare agencies, about the administration
of psychotropic medication for a foster youth.
ANALYSIS:
Existing law:
1)Provides for the development of a group home administrator
certification program by the CDSS in collaboration with
specified stakeholders. Requires the certification program to
include a minimum of 40 hours of classroom instruction and
provide coverage of a specified uniform core of knowledge.
(HSC 1522.41)
2)Requires licensed foster parents to complete a minimum of 12
hours of training covering specified topics prior to the
placement of a foster child in the home, and eight hours
annually subsequently. (HSC 1529.2)
3)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. (WIC 304.7)
4)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. (WIC 317)
5)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. Requires the Judicial Council to adopt
rules of court and develop appropriate forms. (WIC 369.5)
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6)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. (WIC 16206)
This bill:
1)Requires the following trainings 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 preplacement training and post training of
licensed foster parents;
Training required to be made available to relative and
nonrelative extended family members;
Judicial Council-developed training for judges who
conduct trainings pursuant to Welfare and Institutions Code
Section 300;
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.
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1)Requires the Judicial Council, on or before July 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.
2)Requires the above implementation and updates 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.
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.
1)Requires the implementation updates to include a process for
periodic oversight by the court, facilitated by the county
social worker, public health nurse, or other appropriate
county staff, of orders regarding the administration of
psychotropic medication that includes specified information.
Provides that oversight shall be conducted in conjunction with
other regularly scheduled court hearings and reports provided
to the court.
2)Requires 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 specified
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information for each child receiving child welfare services.
3)Requires CDSS in consultation with DHCS, CDWA and other
stakeholders to develop a form to be used by a county child
welfare services agency to share with the juvenile court, the
child's attorney, and the court-appointed special advocate, if
one has been appointed, this information.
4)Requires 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 in specified conditions.
5)Requires a child's social worker, upon receipt of an alert, to
indicate to the child's attorney, the child's caregiver, and
an appointed court appointed special advocate, that the alert
has been received and to include a discussion of the alert and
its resolution in the next court report filed.
Background
Foster care training requirements. In 2003, federal law mandated
states to develop and implement standardized statewide training
for child welfare workers including specified curriculum. As a
result of the federal legislation, the California Social Work
Education Center, the Regional Training Academies and CDSS
developed the Common Core Curricula with courses beginning in
2005.
Existing law additionally mandates foster parents to receive a
minimum of 12 hours of foster parent training prior to placement
of a foster child and a minimum of eight hours of post-placement
training annually. Some counties require significantly more
training as a condition of county licensure. These trainings are
generally provided by California community colleges and in some
counties by California State Universities under the Foster and
Kinship Care Education Program initially established in 1984.
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Group home facility administrators are required to be certified
through CDSS-developed and approved programs that include 40
hours of classroom instruction. Group home administrators are
also required to renew their certification every two years
through 40 hours of classroom or online instruction covering
specified curriculum.
Existing law requires the Judicial Council to develop training
standards for dependency court judges and dependency attorneys,
providing the Judicial Council with broad discretion to define
the scope of the training. California Rules of Court, Rule 5.660
requires attorneys to complete a minimum of eight hours of
initial training or education in the area of juvenile
dependency, or have sufficient recent experience in dependency
proceedings, and to also complete at least eight hours of
continuing education every three years. Rule 5.660 requires the
superior court of each county to amend its local rules, and many
local courts have established training requirements far
exceeding the minimum requirements.
Psychotropic Medication Use in Children. Concern over the use of
psychotropic medications among children has been well-documented
in research journals and the mainstream media for more than a
decade. According to a study published in 2011, children who
took antipsychotic medications were likely to suffer ill health
effects including "cardiometabolic and endocrine side-effects"
as well as significant weight gain. The authors recommended that
collaboration between child and adolescent psychiatrists,
general practitioners and pediatricians is essential to "reduce
the likelihood of premature cardiovascular morbidity and
mortality."
Court oversight mechanisms. 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, based on a request from
a physician that includes the following:
The reasons for the request;
A description of the child's diagnosis and behavior;
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The expected results of the medication; and
A description of any side effects of the medication.
In accordance with this statute, the Administrative Office of
the Courts established a series of court documents generally
referred to as "the" JV-220, which includes a statement
completed and signed by the prescribing physician that includes
the child's diagnosis, relevant medical history, other
therapeutic services, the medication to be administered, and the
basis for the recommendation.
Oversight concerns. A broad range of stakeholders have expressed
concerns with the efficacy of current oversight mechanisms
citing the limited scope of information that is available on the
JV-220 and a lack of access to medical experts able to assist in
evaluating medical information. Further, due to frequent
placement changes of dependent youth, important medical history
may not accompany the youth such that prior, or current
medication regimens, may not be disclosed to a judge,
prescribing physician, social worker or caregiver. Additionally
important information related to alternative non-pharmacological
treatments that have (or have not) been tried may not be
available and this important information is often left blank on
the JV-220. Additionally, the JV-220 form has been criticized
for offering little opportunity for input from the community of
representatives and caregivers involved with the youth except to
offer a short window of opportunity to formally object.
Furthermore, the form does not include information related to
medically important metabolic screenings.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee:
Potentially significant one-time costs (General Fund) for CDSS
to develop the training component for licensed foster parents,
group home administrators, relative and nonrelative extended
family members, court-appointed counsel, child protective
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services staff, and mandated reporters.
One-time costs of $77,000 (GF - Trial Court Trust Fund)
associated with Judicial Council's updating of forms and rules
of court.
One-time costs of $150,000 ($100,000 GF) for CDSS to develop
the individualized report and associated form.
Unknown, but potentially major one-time costs potentially in
the millions of dollars (GF) for CDSS 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.
Major costs potentially in the low millions of dollars (GF)
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, respond to automatic alerts, provide
notifications, and provide additional follow-up.
SUPPORT: (Verified5/29/15)
County Welfare Directors Association of California (co-source)
National Center for Youth Law (co-source)
Advokids
Alameda County Foster Youth Alliance
California Alliance of Child and Family Services
California Court Appointed Special Advocates
California State Association of Counties
Children's Advocacy Institute
Children's Partnership
Dependency Legal Group of San Diego
First Focus Campaign for Children
Humboldt County Transition Age You Collaboration
Legal Advocates for Children and Youth
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Santa Clara County Board of Supervisors
Urban Counties Caucus
Youth Law Center
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9 individuals
OPPOSITION: (Verified5/29/15)
None received
ARGUMENTS IN SUPPORT: 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."
Prepared by: Sara Rogers / HUMAN S. / (916) 651-1524
6/2/15 16:39:56
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