BILL ANALYSIS Ó
SB 238
Page 1
Date of Hearing: August 19, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
SB 238
(Mitchell) - As Amended July 1, 2015
-----------------------------------------------------------------
|Policy |Judiciary |Vote:|10 - 0 |
|Committee: | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| |Human Services | |7 - 0 |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
-----------------------------------------------------------------
Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY: This bill requires the Department of Social Services
(DSS) to provide training for various individuals in the child
welfare system to cover aspects related to psychotropic
medications, and establishes measures to increase oversight of
the authorization and administration of psychotropic medications
for foster youth. Specifically, this bill:
SB 238
Page 2
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
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.
3)Requires DSS to develop specified reports, alerts, and
training, and requires county child welfare services agencies
and social workers to take specified actions in order to
ensure oversight of psychotropic medication prescribed to
foster children:
FISCAL EFFECT:
1)Potentially significant one-time costs (GF) 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.
SB 238
Page 3
2)Unknown, but potentially major one-time costs potentially in
the millions of dollars (GF) 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.
3)Major costs likely 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. DHCS
estimates that initial training for foster care public health
nurses will cost approximately $997,000 and approximately
$293,000 annually thereafter. (This legislation that has an
overall effect of increasing the costs already borne by
counties under realignment (Proposition 30), and thus will
apply to local agencies only to the extent that the State
provides annual funding for the cost increase.)
4)Ongoing costs of $130,00 ($65,000 GF) to DHCS to fund one
researcher position to identify, evaluate and collate claims
data packages to be used in the preparation of ongoing
individualizes monthly reports.
5)One-time costs of $150,000 ($100,000 GF) 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.
6)One-time costs of $77,000 (GF) to the Judicial Council to
develop and/or update forms.
SB 238
Page 4
COMMENTS:
1)Purpose. 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.
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."
2)Background. Existing law provides that only a juvenile court
judicial officer has the authority to make orders regarding
the administration of psychotropic medications for a minor who
is a dependent of the court and has been 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.
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
SB 238
Page 5
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.
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; for 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
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 Spring,
SB 238
Page 6
DHCS and DSS released state guidelines for the use of
psychotropic medication with children and youth in foster
care.
3)Proposition 30. 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, the provisions shall apply to local agencies only to the
extent that the state provides annual funding for the cost
increase.
4)Related Legislation. The following bills are part of a
four-bill package (including this bill) regarding the use of
psychotropic medication for children in foster care. All are
before this Committee today.
a) SB 253 (Monning) 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 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.
b) SB 319 (Beall) 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 238
Page 7
c) SB 484 (Beall) 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.
Analysis Prepared by:Jennifer Swenson / APPR. / (916) 319-2081