BILL ANALYSIS Ó
SB 238
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Date of Hearing: July 14, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
SB
238 (Mitchell) - As Amended July 1, 2015
SENATE VOTE: 40-0
SUBJECT: Foster care: psychotropic medication.
SUMMARY: Requires training for various individuals in the child
welfare system to cover aspects related to psychotropic
medications and adopts measures to increase oversight of the
authorization and administration of psychotropic medications for
foster youth.
Specifically, this bill:
1)Specifies that training for group home administrators, foster
parents, specified judges and appointed counsel, relative and
nonrelative extended family member caregivers, mandated child
abuse reporters and members of the child welfare delivery
system, and public health nurses shall include, but not be
limited to: the authorization, uses, risks, benefits,
administration, oversight, and monitoring of psychotropic
medications, and trauma, behavioral health, and other
available behavioral health treatments, for children receiving
child welfare services, including how to access those
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treatments.
2)Requires, by July 1, 2016, the Judicial Council, in
consultation with specified entities, to develop
implementation updates and related forms and adopt or amend
related rules of the court regarding that authorization and
administration of psychotropic medications to dependent
children who have been removed from the physical custody of
their parents, including minors who have been adjudged a ward
of the court. Further requires these implementation updates
to:
a) Ensure all of the following: the opportunity for the
child and his or her and court-appointed special advocate
to provide input on the medications being prescribed; that
specified information regarding a child's behavioral health
assessment and treatment plan and the rationale for the
proposed medication is provided to the court; and that
guidance is provided to the court on how to evaluate
requests for authorization; and
b) Include a process for periodic oversight by the court of
orders regarding the administration of psychotropic
medications that includes specified information, is
facilitated by appropriate county staff, and that is
conducted in conjunction with other regularly scheduled
court hearings and reports.
1)Requires the following in order to ensure oversight of
psychotropic medication prescribed to foster children:
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a) The Department of Social Services (DSS), in consultation
with other designated entities, to develop and provide an
individualized monthly report to each county child welfare
services agency that includes, for each foster child for
whom one or more psychotropic medications has been
authorized, specified information related to the
authorization and administration of psychotropic and
nonpsychotropic medication and provision of other
behavioral health services;
b) County child welfare services agencies to use a form
developed by DSS and other stakeholders to share the
aforementioned information, as specified;
c) DSS to develop or ensure access to a system that
automatically alerts a child's social worker when that
child has been prescribed a psychotropic medication that
either: is prescribed in unusual and/or potentially
dangerous combination with another psychotropic medication,
is prescribed in an unusual dosage for that child's age,
has the potential to interact dangerously with other
medications prescribed to the child, or is not typically
indicated for a child of that age;
d) The child's social worker to, upon receipt of an alert
from the system described above, notify specified entities
that the alert has been received and to include a
discussion of any alerts and their resolutions, if any, in
the next court report filed in the child's case; and
e) DSS to, in consultation with stakeholders, develop
training that may be provided to various entities who work
with children receiving child welfare services regarding
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the authorization, uses, risks, benefits, administration,
oversight, and monitoring of psychotropic medications, and
trauma, behavioral health, and other available behavioral
health treatments, for children receiving child welfare
services, including how to access those treatments.
EXISTING LAW:
1)Establishes a state and local system of child welfare
services, including foster care, for children who have been
adjudged by the court to be at risk or have been abused or
neglected, as specified. (WIC 202 et seq.)
2)Allows a juvenile court to adjudge a child a ward or a
dependent of the court for specified reasons, including but
not limited to if the child has been left without any
provision for support, as specified. (WIC 300)
3)Permits the juvenile court to retain jurisdiction over a ward
or dependent of the court until he or she reaches the age of
21. (WIC 303)
4)Establishes circumstances under which a minor may be adjudged
a ward of the juvenile court, including, but not limited to,
being beyond the control of his or her parents, guardian, or
custodian, or violating any city, county, state, or federal
laws, except for certain serious violations that warrant
prosecution under the general law in a court of criminal
jurisdiction, as specified. (WIC 601 and 602)
5)States that only a juvenile court judicial officer has the
authority to make orders for the administration of
psychotropic medications for a minor who has been adjudged a
dependent or ward of the court. (WIC 369.5 and 739.5)
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6)Defines "psychotropic medication" or "psychotropic drugs" as
those medications administered for the purpose of affecting
the central nervous system to treat psychiatric disorders or
illnesses. Further states that these medications include, but
are not limited to, anxiolytic agents, antidepressants, mood
stabilizers, antipsychotic medications, anti-Parkinson agents,
hypnotics, medications for dementia, and psychostimulants.
(WIC 369.5 (d))
7)Requires the director of DSS to develop a certification
program for the adminstrators of group home facilities, and
states that this program shall require a minimum of 40 hours
of training in specified areas of knowledge. (HSC 1522.41)
8)Requires every licensed foster parent to complete a minimum of
12 hours of training before any foster children are placed
with him or her, and also requires a minimum of 8 hours of
foster parent training annually. Further specifies the topics
to be covered in these trainings. (HSC 1529.2)
9)Requires the Judicial Council to develop and implement
standards for the education and training of all judges who
conduct dependency hearings, as specified, and further
requires certain topics to be covered. (WIC 304.7)
10)Requires the Judicial Council to promulgate rules
establishing training requirements for appointed counsel for
children in the dependency system, as specified. (WIC 317)
11)Requires each community college district with a foster care
education program to make available training covering
specified topics for relative and nonrelative extended family
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member caregivers. (WIC 16003)
12)Provides for statewide coordinated training for county child
protective services social workers and other members of the
child welfare delivery system, as specified. (WIC 16206)
13)Requires the Department of Social Services (DSS) to establish
and maintain a public health nursing program in the child
welfare services system, as specified, whereby counties are
required to use the services of foster care public health
nurse. Further states that the purpose of this program is to
identify, respond to, and enhance the physical, mental,
dental, and developmental well-being of children in the child
welfare system. (WIC 16501.3)
FISCAL EFFECT: According to the May 28, 2015, Senate
Appropriations Committee analysis, this bill may result in the
following costs:
1)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.
2)One-time costs of $77,000 (General Fund) related to developing
and/or updating Judicial Council forms.
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3)One-time costs of $150,000 ($100,000 General Fund) for DSS to
develop the individualized report and associated form, to the
extent DSS and the Department of Health Care Services (DHCS)
are able to utilize pre-existing data from their respective
databases to develop the report.
4)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.
5)Major costs potentially in the low 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, respond to automatic alerts,
provide notifications, and provide additional follow-up.
(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.)
COMMENTS:
Psychotropic medications and foster youth: Psychotropic
medications include drugs prescribed to manage psychiatric and
mental health disorders or issues including depression,
obsessive-compulsive disorder, attention deficit hyperactivity
disorder, bipolar disorder, schizophrenia, and others. These
medications include antipsychotics such as Seroquel,
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antidepressants like Prozac, mood stabilizers including Lithium,
and stimulants like Ritalin.
There continues to be significant concern over the use of
psychotropic medications for children, due to a vast array of
side effects (which can include aggressive behavior, hostility,
seizures, significant weight gain, and more) and due to the fact
that the long-term effects for children using these drugs are
largely unknown. Additionally, many psychotropic medications
are prescribed to children "off label" - that is, they are used
to treat symptoms other than those for which the FDA originally
approved each drug. While off-label use is not illegal, there
are concerns about how well-understood these medications and
their uses are by prescribers and patients. Over 75% of
psychotropic drug use among children and adolescents is believed
to be off-label. One class of psychotropic medications,
antipsychotics, raises particular concern; these are potent
drugs with a high potential for side-effects, and there is
little known about their impact on growth, development, and
children's neurological systems.
Research has repeatedly indicated that children and youth in
foster care face higher levels of inappropriate or excessive
medication use, and that those foster youth placed in group home
settings are particularly vulnerable to over-prescription and
misuse of psychotropic medications. Data provided by the
Department of Health Care Services (DHCS) indicate that, in
fiscal year 2013-14, almost 15% of all foster youth in
California ages 0 to 20 years old were prescribed at least one
psychotropic medication; looking specifically at all foster
youth ages 12 through 20, this rate was almost 25% and for youth
placed in group homes, it was 50%.
In late 2011, the U.S. Department of Health and Human Services
issued a letter to states encouraging them to coordinate with
partners who worked with foster youth to address enhanced
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efforts to appropriately prescribe and monitor psychotropic
medication among children placed in out-of-home care. As a
result, DHCS and DSS developed the Quality Improvement Project
to strengthen the state's Medicaid and child welfare services
system by, among other things, improving safe and appropriate
prescribing and monitoring of psychotropic drugs; this project
has enabled the state to access the knowledge and perspectives
of various experts, and has continued to hold various workgroup
meetings and set and accomplish objectives related to its
mission. Additionally, this Spring, DHCS and DSS released state
guidelines for the use of psychotropic medication with children
and youth in foster care.
Need for this bill: This is one of four bills proposing a set
of reforms aimed at curbing excessive and inappropriate
authorization and administration of psychotropic medications
among foster youth. This bill requires DSS, and other
stakeholders, to develop monthly data reports to facilitate the
matching of authorization and pharmacy dispensing data for a
child for whom one or more psychotropic medications have been
authorized; this data would be shared with county child welfare
agencies, and these agencies would in turn share the data with
relevant parties, including the court and a child's attorney.
This bill also creates an alert system that would notify a
county child welfare agency any time psychotropic medications
are prescribed in a potentially dangerous combination or dosage;
again, this data would be shared with relevant parties.
Additionally, this bill calls for updates to court processes and
forms, providing the important opportunity for children and
other key stakeholders to provide information and feedback
regarding the child's overall behavioral health treatment plan.
Lastly, this bill requires topics related to psychotropic
medications and other behavioral health supports to be included
in training for group home administrators, foster parents,
specified judges and appointed counsel, relative and nonrelative
extended family member caregivers, mandated child abuse
reporters, and public health nurses.
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A number of professionals and individuals come into contact with
a child in the state's child welfare services system. This bill
seeks to strengthen the potential of this support network to
protect a child from the administration of psychotropic drugs
that are unwarranted or potentially dangerous by increasing
workers' and caregivers' knowledge about psychotropic
medications and their alternatives, and by fostering crucial
communication across the system.
The sponsor of this bill, the County Welfare Directors
Association of California, states that "we are not seeking the
authority for county staff, attorneys or judges to take the
place of the trained medical professionals who serve our
children. Rather, we want to arm these other practitioners with
the necessary tools and training to ask the right questions and
probe further when psychotropic medications are prescribed and
when potentially harmful interactions could occur. This bill
represents a critical piece of the response to this important
issue."
According to the author, this bill, "will ensure that the
department and legislature are receiving the reports that we
need to monitor our foster youth, that triggers are in place to
make sure the children are not being over medicated, and that
those who are in trusted with the youth's well-being receive
adequate and appropriate training."
RELATED LEGISLATION:
SB 253 (Monning), 2015, modifies juvenile court practices and
requirements regarding the authorization of psychotropic
medications for foster youth by, among other things, requiring
clear and convincing evidence that administration of the
medication is in the best interest of the child and, in
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specified circumstances, prohibiting the authorization of
psychotropic medication administration for a child unless a
second opinion is obtained from a child psychiatrist or
behavioral pediatrician.
SB 319 (Beall), 2015, adds to the duties of foster care public
health nurses, including monitoring each child in foster care
who is administered one or more psychotropic medications.
SB 484 (Beall), 2015, requires DSS to compile and post on its
Internet Web site specified information regarding the
administration of psychotropic medications to children placed in
group homes and to establish a methodology for identifying group
homes with high levels of psychotropic drug use. Further
establishes certain requirements for those group homes.
SECOND COMMITTEE OF REFERENCE . This bill was previously heard
in the Assembly Judiciary Committee, on June 30, 2015 and was
approved on a 10-0 vote.
REGISTERED SUPPORT / OPPOSITION:
Support
Abode Services
Advokids
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Alameda County Foster Youth Alliance (FYA)
Alameda County Social Services Agency
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
Accessing Health Services For California's Children In Foster
Care Task Force
California Alliance of Child and Family Services
California CASA Association
California Department of Justice
California State Association of Counties (CSAC)
California State Conference of the NAACP
California Youth Connection (CYC)
Children Now
Children's Advocacy Institute
Children's Defense Fund
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Children's Law Center of California
Consumer Watchdog
Contra Costa County Board of Supervisors
County Welfare Directors Association of California (CWDA),
co-sponsor
Dependency Legal Group of San Diego
Family Voices of California
First Focus Campaign for Children (FFCC)
First Place for Youth
Humboldt County Transition age Youth Collaboration
John Burton Foundation for Children without Homes
National Center for Youth Law, co-sponsor
North American Council on Adoptable Children (NACAC)
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Peers Envisioning and Engaging in Recovery Services (PEERS)
Public Counsel's Children's Rights Project
San Joaquin County Human Services Agency (HSA)
Santa Clara County Board of Supervisors
Stanislaus County Community Services Agency
The Children's Partnership
The Jamestown Community Center
The Mockingbird Society
Urban Counties Caucus (UCC)
Ventura County Board of Supervisors
Youth Law Center (YLC)
Opposition
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None on file.
Analysis Prepared by:Daphne Hunt / HUM. S. / (916)
319-2089