BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 238|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
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UNFINISHED BUSINESS
Bill No: SB 238
Author: Mitchell (D) and Beall (D), et al.
Amended: 9/4/15
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/21/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE JUDICIARY COMMITTEE: 6-0, 4/28/15
AYES: Jackson, Anderson, Hertzberg, Leno, Monning, Wieckowski
NO VOTE RECORDED: Moorlach
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/3/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 9/8/15 - See last page for vote
SUBJECT: Foster care: psychotropic medication
SOURCE: County Welfare Directors Association of California
National Center for Youth Law
DIGEST: This bill requires certification and training programs
for foster parents, child welfare social workers, group home
administrators, public health nurses, dependency court judges
and court appointed council to include training on psychotropic
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medication, trauma, and behavioral health, as specified, for
children receiving child welfare services. This bill requires
the Judicial Council to amend and adopt rules of court and
develop appropriate forms pertaining to the authorization of
psychotropic medication for foster youth, on or before July 1,
2016.
Assembly Amendments (1) strike provisions requiring the creation
of a system that automatically alerts a social worker when
psychotropic medication has been prescribed in specified, high
risk, circumstances; (2) require the Department of Health Care
Services (DHCS) to provide the Department of Social Services
(CDSS), specified information for children in foster care
pursuant to a data sharing agreement between the two
departments, to which county placing agencies may opt to
participate; (3) clarify the scope of the monthly-report to be
created by CDSS and provide that the report is required to be
provided only to counties that are signatories to the data
sharing agreement; and (4) make other technical amendments and
add chaptering language pertaining to AB 403 (Stone)
ANALYSIS:
Existing law:
1) Provides for the development of a group home administrator
certification program by CDSS in collaboration with specified
stakeholders. Requires the certification program to include a
minimum of 40 hours of classroom instruction and provide
coverage of a specified uniform core of knowledge. (HSC
1522.41)
2) Requires licensed foster parents to complete a minimum of 12
hours of training covering specified topics prior to the
placement of a foster child in the home, and eight hours
annually subsequently. (HSC 1529.2)
3) Requires the Judicial Council to develop and implement
standards for the education and training of all judges who
conduct hearings pursuant to Welfare and Institutions Code
Section 300, pertaining to dependent children. (WIC 304.7)
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4) Requires court-appointed counsel of a child or nonminor
dependent to have specified training, promulgated by the
Judicial Council as rules of the court, that ensures adequate
representation of the child or nonminor dependent. (WIC 317)
5) Provides that only a juvenile court judicial officer shall
have 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. Requires the Judicial Council to adopt
rules of court and develop appropriate forms. (WIC 369.5)
6) 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 persons defined as a mandated
reporter pursuant to the Child Abuse and Neglect Reporting
Act. (WIC 16206)
This bill:
1) Requires CDSS to develop training, in consultation with
DHCS, the Judicial Council, the County Welfare Directors
Association of California (CWDA), the County Behavioral
Health Directors Association of California, the Chief
Probation Officers of California, and stakeholders, that may
be provided to county child welfare social workers, probation
officers, courts hearing dependency or delinquency cases,
children's attorneys, children's caregivers, court-appointed
special advocates, and other relevant staff who work with
children under the jurisdiction of the juvenile court.
2) Requires the above training to address the authorization,
uses, risks, benefits, assistance with self-administration,
oversight, and monitoring of psychotropic medications,
trauma, and substance use disorder and mental health
treatments, including how to access those treatments.
3) Requires the following statutorily required trainings to
include the content described in #2 above:
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Group home administrator certification;
Initial preplacement training and post training of
licensed foster parents;
Training required to be made available to relative and
nonrelative extended family members;
Judicial Council-developed training for judges who
conduct trainings pursuant to Welfare and Institutions
Code Section 300;
Training of court-appointed counsel of a child or
nonminor dependent; and
Training provided to specified county child protective
services social workers, agencies under contract with
county welfare departments to provide child welfare
services, and persons defined as a mandated reporter
pursuant to the Child Abuse and Neglect Reporting Act.
1) Requires the Judicial Council, on or before July 1, 2016, in
consultation with CDSS, DHCS, and specified stakeholders to
amend and adopt rules of court and develop appropriate forms
pertaining to this bill.
2) Requires the above implementation and updates ensure the
following:
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.
Information regarding the child's overall behavioral
health assessment and treatment plan is provided to the
court.
Information regarding the rationale for the proposed
medication, as specified, including information on other
pharmacological and non-pharmacological treatments that
have been utilized and the child's response, a discussion
of symptoms not alleviated or ameliorated by other efforts
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and an explanation how the psychotropic medication being
prescribed is expected to improve the symptoms.
Guidance is provided to the court on how to evaluate
the request for authorization, including how to proceed if
information, otherwise required to be included in a
request for authorization, is not included in a request.
1) Requires the developed rules of court and forms to include a
process for the court to periodically oversee orders
regarding the administration of psychotropic medication that
includes specified information. Provides that oversight shall
be conducted in conjunction with other regularly scheduled
court hearings and reports provided to the court.
2) Requires CDSS, in consultation with DHCS, and other
specified stakeholders to develop county-specific monthly
reports that describe each child for whom one or more
psychotropic medications have been paid for under Medi-Cal,
including authorized medications, pharmacy data including the
quantity and dose of medications, other available information
regarding psychosocial interventions and incidents of
polypharmacy.
3) Requires, additionally, the monthly report to include an
indicator that identifies each child under five years of age
for whom one or more psychotropic medications is prescribed
and each child of any age for whom three or more psychotropic
medications are prescribed.
4) Requires CDSS distribute the monthly report to a county
placing agency, if the placing agency is a signatory to the
data sharing agreement, as described.
5) Requires CDSS in consultation with DHCS, CWDA and other
stakeholders to develop a form to be used by a county child
welfare services agency to share with the juvenile court, the
child's attorney, and the court-appointed special advocate,
if one has been appointed, information pertaining to the
child served.
Background
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Foster care training requirements. In 2003, federal law mandated
states to develop and implement standardized statewide training
for child welfare workers including specified curriculum. As a
result of the federal legislation, the California Social Work
Education Center, the Regional Training Academies and CDSS
developed the Common Core Curricula with courses beginning in
2005.
Existing law additionally mandates foster parents to receive a
minimum of 12 hours of foster parent training prior to placement
of a foster child and a minimum of eight hours of post-placement
training annually. Some counties require significantly more
training as a condition of county licensure. These trainings are
generally provided by California community colleges and in some
counties by California State Universities under the Foster and
Kinship Care Education Program initially established in 1984.
Group home facility administrators are required to be certified
through CDSS-developed and approved programs that include 40
hours of classroom instruction. Group home administrators are
also required to renew their certification every two years
through 40 hours of classroom or online instruction covering
specified curriculum.
Existing law requires the Judicial Council to develop training
standards for dependency court judges and dependency attorneys,
providing the Judicial Council with broad discretion to define
the scope of the training. California Rules of Court, Rule 5.660
requires attorneys to complete a minimum of eight hours of
initial training or education in the area of juvenile
dependency, or have sufficient recent experience in dependency
proceedings, and to also complete at least eight hours of
continuing education every three years. Rule 5.660 requires the
superior court of each county to amend its local rules, and many
local courts have established training requirements far
exceeding the minimum requirements.
Psychotropic medication use in children. Concern over the use of
psychotropic medications among children has been well-documented
in research journals and the mainstream media for more than a
decade. According to a study published in 2011, children who
took antipsychotic medications were likely to suffer ill health
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effects including "cardiometabolic and endocrine side-effects"
as well as significant weight gain. The authors recommended that
collaboration between child and adolescent psychiatrists,
general practitioners and pediatricians is essential to "reduce
the likelihood of premature cardiovascular morbidity and
mortality."
Court oversight mechanisms. SB 543 (Bowen, Chapter 552, Statutes
of 1999) mandated that, once a child has been adjudged a
dependent of the state, only the court may authorize
psychotropic medications for the child, based on a request from
a physician that includes the following:
The reasons for the request;
A description of the child's diagnosis and behavior;
The expected results of the medication; and
A description of any side effects of the medication.
In accordance with this statute, the Administrative Office of
the Courts established a series of court documents generally
referred to as "the" JV-220, which includes a statement
completed and signed by the prescribing physician that includes
the child's diagnosis, relevant medical history, other
therapeutic services, the medication to be administered, and the
basis for the recommendation.
Oversight concerns. A broad range of stakeholders have expressed
concerns with the efficacy of current oversight mechanisms
citing the limited scope of information that is available on the
JV-220 and a lack of access to medical experts able to assist in
evaluating medical information. Further, due to frequent
placement changes of dependent youth, important medical history
may not accompany the youth such that prior, or current
medication regimens, may not be disclosed to a judge,
prescribing physician, social worker or caregiver. Additionally
important information related to alternative non-pharmacological
treatments that have (or have not) been tried may not be
available and this important information is often left blank on
the JV-220. Additionally, the JV-220 form has been criticized
for offering little opportunity for input from the community of
representatives and caregivers involved with the youth except to
offer a short window of opportunity to formally object.
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Furthermore, the form does not include information related to
medically important metabolic screenings.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Appropriations Committee, this bill
may lead to potentially significant one-time costs (GF) to CDSS
for the development of the training components, and 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. Additionally, the analysis cites ongoing costs of
$130,00 ($65,000 GF) to DHCS to fund one researcher position for
the preparation of ongoing individualizes monthly report,
one-time costs of $150,000 ($100,000 GF) for CDSS to develop the
individualized report and associated form and one-time costs of
$77,000 (GF) to the Judicial Council to develop and/or update
forms.
SUPPORT: (Verified9/8/15)
County Welfare Directors Association of California (co-source)
National Center for Youth Law (co-source)
Advokids
Alameda County Foster Youth Alliance
California Alliance
California Court Appointed Special Advocates
Children's Advocacy Institute
Children's Partnership
County Welfare Directors Association of California
Dependency Legal Group of San Diego
First Focus Campaign for Children
Humboldt County Transition Age You Collaboration
Legal Advocates for Children and Youth
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Urban Counties Caucus
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Youth Law Center
Seven individuals
OPPOSITION: (Verified 9/8/15)
None received
ASSEMBLY FLOOR: 79-0, 9/8/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by: Sara Rogers / HUMAN S. / (916) 651-1524
9/8/15 21:47:09
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