BILL ANALYSIS Ó
SB 238
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SENATE THIRD READING
SB
238 (Mitchell and Beall)
As Amended September 4, 2015
Majority vote
SENATE VOTE: 40-0
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Judiciary |10-0 |Mark Stone, Wagner, | |
| | |Alejo, Chau, Chiu, | |
| | |Gallagher, | |
| | | | |
| | | | |
| | |Cristina Garcia, | |
| | |Holden, Maienschein, | |
| | |O'Donnell | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Human Services |7-0 |Chu, Mayes, Calderon, | |
| | |Lopez, Maienschein, | |
| | |Mark Stone, Thurmond | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, Bloom, | |
| | |Bonta, Calderon, | |
SB 238
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| | |Chang, Nazarian, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Holden, Jones, Quirk, | |
| | |Rendon, Wagner, Weber, | |
| | |Wood | |
| | | | |
| | | | |
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SUMMARY: Increases training and information, and requires
development of updated rules and forms, regarding use of
psychotropic medication for children in the juvenile court
system. Specifically, this bill:
1)Requires trainings of the following individuals to include
information about the authorization, uses, risks, benefits,
assistance with self-administration, oversight and monitoring
of psychotropic medication, and substance use disorder and
mental health treatments, including how to access those
treatments:
a) Group home administrators;
b) Licensed foster parents, both for initial certification
and for post-placement annual training;
c) Relative and nonrelative extended family members;
d) Juvenile court judges, commissioners and referees who
hear dependency cases;
e) Court-appointed counsel of a minor or nonminor
dependent;
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f) County child welfare workers; and
g) Public health nurses.
2)Requires the Department of Social Services (DSS), in
consultation with specified stakeholders, to develop the
training specified in 1) above.
3)Requires the Judicial Council, on or before July 1, 2016, in
consultation with specified stakeholders, to amend and adopt
rules of court and develop appropriate forms regarding new
requirements for authorization of psychotropic medication to
wards or dependent children. Requires the rules and forms to
ensure:
a) The child and his or her caregiver and court-appointed
special advocate, if any, have an opportunity to provide
input on the medications being prescribed.
b) Information regarding the child's overall mental health
assessment and treatment plan is provided to the court.
c) Information regarding the rationale for the proposed
medication, including information about other
pharmacological and nonpharmacological treatments and the
child's response to those treatments, and an explanation
how the psychotropic medication being prescribed is
expected to improve the symptoms.
d) Guidance on how to evaluate the request for
authorization, including how to proceed if required
information is not included in a request.
4)Requires that, upon approval or denial by a court of a request
to administer psychotropic medication to a dependent child or
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ward, the child's caregiver be provided with a copy of the
court order.
5)Requires the rules and forms in 3) above, 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 be conducted in conjunction with other
regularly scheduled court hearings and reports provided to the
court.
6)Requires DSS, in consultation with specified stakeholders, to
provide monthly, county-specific reports that include
specified information for each child receiving psychotropic
medication paid for under Medi-Cal, as provided. Requires
that the monthly report on children receiving psychotropic
medication include indicators to identify children for whom
additional follow up may be appropriate, which may include,
but not be limited to, an indicator that identifies children
under five receiving any psychotropic medication and an
indicator that identifies children of any age prescribed three
or more psychotropic medications.
7)Requires that this information be shared with specified
individuals, on a form that DSS, in consultation with
stakeholders, must develop.
8)Requires the Department of Health Care Services (DHCS) to
provide DSS, pursuant to a data sharing agreement, information
for administration, oversight and implementation of health and
social services programs for children in foster care, and
allows county placing agencies to opt in to the data sharing
agreement and receive the data reports.
9)Adds chaptering out language.
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EXISTING LAW:
1)Provides that a minor may be removed from the physical custody
of his or her parents and become a dependent of the juvenile
court as the result of abuse or neglect.
2)Provides that a juvenile court has jurisdiction over a child
when that child has committed acts that trigger delinquency
jurisdiction rendering the child a ward.
3)Requires that DSS develop a group home administrator
certification program to ensure certified persons have
appropriate training to provide care and services.
4)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.
5)Requires the Judicial Council to develop and implement
standards for the education and training of all judges,
commissioners and referees who conduct dependency hearings.
6)Requires counsel appointed to represent a minor or nonminor
dependent to have specified training to ensure adequate
representation.
7)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 mandated reporters. Requires each
community college district with a foster care education
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program to provide orientation and training to relative and
nonrelative extended family member caregivers.
8)Provides that only a juvenile court judicial officer has
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. Defines "psychotropic medicine" as
those medicines administered to treat psychiatric disorders or
illnesses and includes anxiolytic agents, antidepressants,
mood stabilizers, antipsychotic medications, anti-Parkinson
agents, hypnotics, medications for dementia and
psychostimulants.
9)Requires court authorization for the administration of
psychotropic medication to be based on a request from a
physician, indicating the reasons for the request, a
description of the minor's diagnosis and behavior, the
expected results of the medication, and a description of any
side effects of the medication. Requires, within seven court
days, the juvenile court to either approve or deny in writing
a request for authorization for the administration of
psychotropic medication, or to set the matter for hearing.
Requires the Judicial Council to adopt rules of court and
develop appropriate forms for the requirement above.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Potentially significant one-time costs (General Fund (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.
2)Major costs likely in the low millions of dollars (GF)
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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, 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.)
3)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.
4)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 DHCS are able to utilize pre-existing data from
their respective databases to develop the report.
5)One-time costs of $77,000 (GF) to the Judicial Council to
develop and/or update forms.
COMMENTS: This bill is part of a package of bills introduced in
response to very troubling, recent reports on the overmedicating
of children in the foster care system with psychotropic drugs.
Psychotropic medication alters chemical levels in the brain
which impact mood and behavior and includes antipsychotics,
antidepressants and psychostimulants. The category of
psychotropic medication is fairly broad, intending to treat
symptoms of conditions ranging from ADHD to childhood
schizophrenia. Much of the use of psychotropic drugs in
children is considered "off label," meaning the use has not been
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approved by the Food and Drug Administration for the prescribed
use, although the practice is legal and common to all manner of
pharmaceuticals.
This bill seeks to address the concerns related to the
administration of psychotropic drugs in the delinquency and
foster care systems in several important ways. First, it
requires the Judicial Council to update forms and rules to
ensure improved and regularly updated information is solicited
from, and received by, appropriate individuals and entities
regarding use of psychotropic medication. Second, this bill
requires DSS to develop monthly reports on foster children
receiving these medications and requires certain data sharing
between DHCS and DSS, and the counties. Finally, this bill
requires training on the use of psychotropic medication by
foster children for group home administrators, foster parents,
relative and nonrelative caregivers, judges, children's counsel,
child welfare workers, and public health nurses.
Analysis Prepared by:
Leora Gershenzon / JUD. / (916) 319-2334 FN:
0002125