BILL ANALYSIS Ó SB 238 Page 1 SENATE THIRD READING SB 238 (Mitchell and Beall) As Amended September 4, 2015 Majority vote SENATE VOTE: 40-0 -------------------------------------------------------------------- |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 Page 2 | | |Chang, Nazarian, | | | | |Eggman, Gallagher, | | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Holden, Jones, Quirk, | | | | |Rendon, Wagner, Weber, | | | | |Wood | | | | | | | | | | | | -------------------------------------------------------------------- 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; SB 238 Page 3 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 SB 238 Page 4 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. SB 238 Page 5 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 SB 238 Page 6 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) SB 238 Page 7 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 SB 238 Page 8 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