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


           -------------------------------------------------------------------- 
          |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,       |                     |








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          |                |     |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; 










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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