BILL ANALYSIS Ó
SB 253
Page 1
Date of Hearing: June 30, 2015
ASSEMBLY COMMITTEE ON JUDICIARY
Mark Stone, Chair
SB
253 (Monning) - As Amended June 2, 2015
As Proposed to be Amended
SENATE VOTE: 40-0
SUBJECT: foster children: COURT OVERSIGHT OF psychotropic
medication
KEY ISSUE: IN ORDER TO BETTER PROTECT FOSTER CHILDREN FROM
INAPPROPRIATELY BEING PRESCRIBED POTENT PSYCHOTROPIC DRUGS WITH
POTENTIALLY SIGNIFICANT SHORT- AND lONG-TERM HEALTH
CONSEQUENCES, SHOULD THE LIMITED COURT OVERSIGHT DONE TODAY BE
SUBSTANTIALLY IMPROVED?
SYNOPSIS
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. This bill, sponsored by
the National Center for Youth Law, seeks to improve ongoing
court oversight to help ensure that these powerful drugs are
only used when medically necessary and appropriate for the
SB 253
Page 2
particular child and that such usage is carefully monitored to
ensure any benefits of the medication are not outweighed by its
short- and long-term risks.
In particular, the strengthened oversight in this bill requires
that a court determine, by clear and convincing evidence, that
administration of the medication is based on the best interest
of the child and must include specified documentation and
confirmations from the prescribing physician. This bill also
prohibits the authorization of psychotropic medications without
a second independent medical opinion under specified
circumstances.
This bill is supported by a long list of organizations,
including the Department of Justice, the Alameda County Board of
Supervisors, the county welfare directors and numerous
children's organizations. It has no reported opposition,
although several organizations have raised joint concerns about
the bill and have been working with the author to address them.
The amendments proposed to be taken in this Committee address
some, but not all, of their concerns. Assuming it passes this
Committee, this bill will be referred to the Human Services
Committee.
SUMMARY: Revises and strengthens, as of July 1, 2016, juvenile
court oversight requirements for administration of psychotropic
medications to dependents who have been removed from their
parents. Specifically, this bill:
1)Requires the court to ensure, when authorizing administration
of a psychotropic medication, that the medication is only one
part of a comprehensive treatment plan for the child, which
must specify the psychosocial services the child will receive
in addition to any authorized medication.
SB 253
Page 3
2)Allows the juvenile court to authorize psychotropic medication
to a dependent only if the court determines, by clear and
convincing evidence, that administration of the medication is
in the best interest of the child based on a determination
that the anticipated benefits of the psychotropic medication
outweigh the short- and long-term risks associated with it.
Provides that the medication cannot be ordered if it is being
used as a punishment, for staff convenience, as a substitute
for less invasive treatments, or in quantities that interfere
with the child's treatment program. Provides that the
authorization is effective for no more than 180 days.
3)Provides that an order authorizing psychotropic medication
shall only be granted if the court:
a) Is provided documentation confirming the child's
caregiver and the child have been informed, in an age and
developmentally appropriate manner, about the recommended
medications and asked about their concerns, and the child
has been informed of his or her right to object to the
authorization and request a hearing.
b) Is provided with the written assent or refusal to assent
from a child who is 12 years of age or older.
c) Determines that the medication is not being used as
punishment, for the convenience of staff, as a substitute
for less invasive treatments, or in quantities or dosages
that interfere with the child's treatment program.
d) Determines that the prescribing physician has conducted
a comprehensive examination of the child, as defined, and
confirm that there are no less invasive and effective
treatment options available to meet the child's needs; the
dosage is appropriate for the child; the short- and
long-term risks do not outweigh the benefits of the
SB 253
Page 4
medication; and all appropriate lab screenings for the
child have been completed.
e) Determines that a plan is in place for regular
monitoring of the child's medication and psychosocial
treatment plan, the effectiveness of the medication and
psychosocial treatment, and any potential side effects of
the medication.
4)Prohibits the authorization of psychotropic medications
without a second independent medical opinion by a child
psychiatrist or a behavioral pediatrician in any of the
following circumstances:
a) The child is five years old or less;
b) The request would result in the child receiving three or
more psychotropic medications concurrently;
c) The request is for concurrent medication of two or more
drugs; or
d) The request is for a dosage amount that exceeds the
amount recommended for children.
5)Requires the Department of Health Care Services, in
collaboration with the Judicial Council, to assist courts in
securing second opinions in order to avoid undue delays in
authorization of medication.
6)Prohibits the court from authorizing the administration of
psychotropic medications unless it is provided documentation
that all of the appropriate lab tests, done no more than 30
days prior to the submission of the request, have been
completed.
SB 253
Page 5
7)Requires the court, no later than 60 days following an
authorization for a new psychotropic medication, or at the
next review hearing scheduled no earlier than 45 days after
the authorization, to conduct a review hearing. Requires the
social worker to submit a report prior to the review hearing.
Requires the court to reconsider, modify or revoke its
authorization if it determines that the proffered benefits of
the medication have not been demonstrated or that the risks of
the medication outweigh the benefits.
8)Allows a psychotropic medication to be administrated without
court authorization in an emergency, provided that court
authorization is sought as soon as practical, but no more than
two court days after administering the medication and all of
the following are true:
a) The physician finds that the child requires the
medication to treat a psychiatric disorder or illness;
b) The medication is immediately necessary for the
preservation of life or prevention of serious bodily harm
for the child or others; and
c) It is impractical to obtain court approval prior to
administering the medication.
9)Provides that nothing in the bill grants anyone the authority
to administer psychotropic medication to a child who refuses
to take the medication. A child's refusal to take medication
is a treatment issue to be resolved by the prescribing
physician, and the child cannot be forced to take the
medication, unless otherwise permitted by statute. Provides
SB 253
Page 6
that no person may threaten, coerce, withhold privileges or
otherwise penalize a child for refusing to take psychotropic
medication.
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. (Welfare &
Institutions Code Section 300. Unless stated otherwise, all
further statutory references are to that code.)
2)Authorizes the court to make any and all reasonable orders for
the care, supervision, custody, conduct, maintenance and
support of a dependent child, including medical treatment.
(Section 362.)
3)Authorizes the court to allow a social worker to authorize the
medical, surgical, dental or other remedial care for a
dependent child who has been placed by the court under the
custody or supervision of a social worker, if it appears there
is no parent or guardian capable of authorizing or willing to
authorize medical, surgical, dental or other care. (Section
369(c).)
4)Authorizes a minor who is 12 years of age or older to consent
to mental health treatment or counseling services if, in the
opinion of the attending professional person, the minor is
mature enough to participate intelligently in the mental
health treatment or counseling services. (Health & Safety
Code Section 124260(b).)
5)Provides that only a juvenile court judicial officer shall
SB 253
Page 7
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. 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. (Section 369.5.)
6)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. (Id.; California Rules of Court,
Rule 5.640.)
FISCAL EFFECT: As currently in print this bill is keyed fiscal.
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
approved by the Food and Drug Administration (FDA) for the
SB 253
Page 8
prescribed use, though the practice is legal and common across
all manner of pharmaceuticals.
This bill seeks to improve ongoing court oversight to help
ensure that these powerful drugs are only used when medically
necessary and appropriate for the particular child and that such
usage is very carefully monitored to ensure any benefits of the
medication are not outweighed by its short- and long-term risks.
Background on Use and Misuse of Psychotropic Medication in
Foster Children. Concern over the use of psychotropic
medications among children has been growing for years.
According to a recent report by the Government Accounting Office
(GAO), 18 percent of foster children are taking psychotropic
medication, a "rate 2.7 to 4.5 times higher than were nonfoster
children in the Medicaid system." (GAO, Foster Children: HHS
Could Provide Additional Guidance to States Regarding
Psychotropic Medications 5, 7 (May 2014), citing data from the
Administration for Children and Families' National Survey of
Child and Adolescent Well-Being II (NSCAW II).) The rate for
foster children living in group homes is significantly higher
than for other foster children - 48 percent, as compared with 14
percent who live in non-relative foster homes and 12 percent who
live with a relative. (Id.)
Not only are more foster children taking psychotropic
medication, but many of them take multiple medications. The GAO
found that of those foster children taking psychotropic
medication, 13 percent took three or more such drugs
concurrently, even though research is lacking on the efficacy of
taking multiple psychotropics concurrently. (Id. at p. 6.) The
GAO found that increasing "the number of drugs used concurrently
increases the likelihood of adverse reactions and long-term side
effects, such as high cholesterol or diabetes, and limits the
ability to assess which of multiple drugs are related to a
particular treatment goal." (Id. at p. 7 (footnote omitted).)
SB 253
Page 9
Additionally, the GAO found that children in the Medicaid
system, including foster children, were prescribed doses higher
than the maximum recommended for children, noting that: "Our
experts said that this increases the risk of adverse side
effects and does not typically increase the efficacy of the
drugs to any significant extent." (Id. at p. 8.)
Another recent investigation, this one by the Inspector General
of the Department of Health and Human Services, uncovered
significant misuse of the most powerful psychotropic medication
- antipsychotics - in children receiving these drugs through the
Medicaid system, including children in the foster care system.
While the second generation antipsychotics (SGAs) reviewed in
the report are used to treat serious mental health conditions,
they can also "have serious side effects and little clinical
research has been conducted on the safety of treating children
with these drugs." (Inspector General, Department of Health and
Human Services, Second-Generation Antipsychotic Drug Use Among
Medicaid-Enrolled Children: Quality of Care Concerns 1 (March
2015).)
More disturbingly, the Inspector General examined records for
five states, including California, and found that there were
quality of care concerns in fully two-thirds of the cases
reviewed, including poor monitoring (53 percent of the time),
wrong treatment (41 percent), too many drugs (37 percent), taken
too long (34 percent), wrong dose (23 percent), taken too young
(17 percent), and side effects (7 percent). (Id. at p. 9.) As
a result, the Inspector General recommended that "children's
treatment with SGAs needs careful management and monitoring."
(Id. at p. 1.)
Recent in-Depth Media Coverage Confirms Significant Concerns
With Use of Psychotropic Medication in California's Foster
Children. A recent in-depth series of stories published in the
San Jose Mercury News (Karen de Sá, Drugging our kids, San Jose
SB 253
Page 10
Mercury News (Aug. - Dec. 2014)) and a more recent article in
the Los Angeles Times (Garrett Therolf, Rampant medication use
found among L.A. County foster, delinquent kids, Los Angeles
Times (Feb. 16, 2015)), highlighted growing concerns that
psychotropic medications have been relied on by California's
child welfare and children's mental health systems as a means of
controlling, instead of treating, youth who suffer from
trauma-related behavioral health challenges. The Mercury News
series detailed significant challenges in accessing pharmacy
benefits claims data held by the California Department of Health
Care Services, eventually overcome through a Public Records Act
request and lengthy negotiations, and found that prescribing
rates for foster children were far higher than children in the
overall population:
Abandoned and alone, [foster children] are among
California's most powerless children. But instead of
providing a stable home and caring family, the state's
foster care system gives them a pill.
With alarming frequency, foster and health care providers
are turning to a risky but convenient remedy to control the
behavior of thousands of troubled kids: numbing them with
psychiatric drugs that are untested on and often not
approved for children.
An investigation by this newspaper found that nearly 1 out
of every 4 adolescents in California's foster care system
is receiving these drugs - 3 1/2 times the rate for all
adolescents nationwide. Over the last decade, almost 15
percent of the state's foster children of all ages were
prescribed the medications, known as psychotropics, part of
a national treatment trend that is only beginning to
receive broad scrutiny. (Karen de Sá, Drugging our kids:
Children in California's foster care system are prescribed
SB 253
Page 11
unproven, risky medications at alarming rates, San Jose
Mercury News (Aug. 24, 2014).)
The Mercury News series went on to state that while psychotropic
medication is necessary for some children, side-effects, both
short- and long-term, are not fully understood and not always
fully considered:
No one doubts that foster children generally have greater
mental health needs because of the trauma they have
suffered, and the temptation for caregivers to fulfill
those needs with drugs can be strong. In the short term,
psychotropics can calm volatile moods and make aggressive
children more docile.
But there is substantial evidence of many of the drugs'
dramatic side effects: rapid-onset obesity, diabetes and a
lethargy so profound that foster kids describe dozing
through school and much of their young lives. Long-term
effects, particularly on children, have received little
study, but for some psychotropics there is evidence of
persistent tics, increased risk of suicide, even brain
shrinkage. (Id.)
Despite Requirement for Limited Court Oversight, Protections in
Current Law may be Inadequate. In 1999, the Legislature passed
SB 543 (Bowen), Chap. 552, Stats. 1999, which provided that only
a juvenile court judicial officer can make orders regarding the
administration of psychotropic medications for foster youth. SB
543 also provided that the juvenile court may issue a specific
order delegating this authority to a parent if the parent poses
no danger to the child and has the capacity to authorize
psychotropic medications. This legislation was passed in
response to concerns that foster children were being subjected
to excessive use of psychotropic medication, and that judicial
oversight was needed to reduce the risk of unnecessary
SB 253
Page 12
medication. The Judicial Council was required to adopt rules of
court to implement the new requirement. Accordingly, Rule of
Court 5.640 specifies the process for juvenile courts to follow
in authorizing the administration of psychotropic medications
and permits courts to adopt local rules to further refine the
approval process.
In 2004, AB 2502 (Keene), Chap. 329, sponsored by a coalition of
group homes, actually sped up the process for approving
psychotropic medication in foster children by requiring a
judicial officer to approve or deny, in writing, a request for
authorization to administer psychotropic medication, or set the
matter for hearing, within seven days.
Despite these measures, concerns remain that psychotropic
medication in the child welfare system is overused and
underreported, and statutory and regulatory oversight
requirements are not always complied with. The Los Angeles
Times discovered, through information obtained from a Public
Records Act request, that Los Angeles county failed to report on
almost one in three dependent or delinquent children in the
county receiving psychotropic medication. (Garrett Therolf,
Rampant medication use found among L.A. County foster,
delinquent kids, supra.) The Mercury News series noted that
while the court must approve any authorization to take
psychotropics, "forms the courts use often lack critical details
and a doctor's expertise is rarely questioned" by the court.
(Karen de Sá, Drugging our kids, supra.)
A Package of Bills Introduced to Address The Significant
Concerns That Foster Children May Be Overmedicated With Strong
Psychotropic Medication Without Sufficient Oversight. In
response to the significant and well-placed concerns about the
overuse of psychotropic drugs to treat foster children and the
need for increased oversight, four bills, including this one,
have been introduced in the Legislature this year. The other
SB 253
Page 13
three bills in the package are:
SB 238 (Mitchell and Beall) requires certification and training
programs for foster parents, child welfare social workers, group
home administrators, dependency court judges and court appointed
council to include training on psychotropic medication, trauma,
and behavioral health. This bill also requires the Judicial
Council to update forms and rules, and DSS to develop forms and
an alert system. SB 238 is also being heard in this Committee
today.
SB 319 (Beall) expands the duties of the foster care public
health nurse to include monitoring and oversight of the
administration of psychotropic medication to foster children.
This bill was referred to the Assembly Human Services and Health
Committees.
SB 484 (Beall) requires DSS to identify group homes in the
foster care system that may be inappropriately administering
psychotropic medications to foster youth and to require the
submissions of plans from those facilities to reduce
inappropriate use of psychotropic medications. This bill was
referred just to the Assembly Human Services Committee.
This Bill Provides the Critical Court Oversight Piece of the
Package. This comprehensive bill seeks to address the issues
related to psychotropic drugs in the foster system by providing
a detailed framework the court must use when determining whether
to approve the administration of such medication, and requires
judicial oversight of the child's ongoing treatment. Writes the
author:
SB 253
Page 14
Since 1999, juvenile courts have been the decision-makes,
the gatekeepers for authorizing psychotropic medications
for children in foster care. But we have not given the
courts standards by which to guide their decision-making
and the support necessary to make an informed decision.
California law upholds the rights of convicted felons
confined to our state prisons and county jails, sexually
violent predators, and those adjudicated not guilty by
reason of insanity to refuse the administration of
antipsychotic medications unless specific circumstances
exist and due process is afforded them. Among other
protections, they are entitled to counsel, to be present at
the hearing and to have decisions made on clear and
convincing evidence. Certainly we can and must afford our
foster children even greater protections against the
misuses of these medications.
SB 253 ensures out juvenile court judges are given the
information they need to make informed decisions before
authorizing these medications, provides criteria to guide
the decision-making, and safeguards our foster children's
health and safety by overseeing the affects of these
medications.
Bill Provides the Court With Better Tools for Evaluating the
Administration of Psychotropic Medication for Each Particular
Child. Under existing law, only the court may authorize the use
of psychotropic medication for any child in the dependency
system. Rules of court require the prescribing physician 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 dosage
SB 253
Page 15
and length of time this course of treatment will continue; (3)
the anticipated benefits to the child of 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. (See Rules of
Court, Rule 5.640.)
Supporters of this bill argue that courts are often not being
provided with the full story. Upon reviewing a JV-220, a judge
may have no indication that the child is already on psychotropic
medication, what a proper dosage for a child is, or what less
invasive alternatives are available. Supporters further assert
that the existing rule, which sets arguably loose parameters and
includes no considerations that the court must take into account
when evaluating a JV-220, is too broad for judges and courts
that may lack the tools to properly evaluate medical
recommendations and are overburdened with unmanageable
caseloads. In addition, the current process does not offer any
meaningful way for other adults, caretakers, or those who
interact with a foster child on a regular basis, to contribute
information to a physician's recommendation.
Accordingly, this bill ensures that a child and his or her
caregiver are informed of the risks and benefits of the
prescribed medication, and have had an opportunity to share any
concerns with the court. This bill further requires that the
court is provided with the tools to properly analyze the
authorization request, including receiving appropriate
laboratory reports and tests. Finally, by requiring the
SB 253
Page 16
prescribing physician to confirm that he or she has reviewed the
child's medical history in detail, and to provide that
information to the court, this bill will help ensure that foster
children are not unknowingly being prescribed multiple, and
incompatible, psychotropics.
In support, the Children's Partnership writes:
[A]lmost half of the children in foster care are prescribed
psychotropic medications, often without any supportive
services or appropriate follow-up care. The trauma that
led these children into foster care is often exacerbated by
poorly managed mental health care and the overuse of
mind-altering medications. So, while psychotropic
medication is sometimes the right way to help these
children and youth, the real world experience with such
medications calls for better oversight and management of
its use. . . . We believe that this bill takes an
important step forward in addressing the serious problems
that are currently being experienced by children and youth
in foster care through inappropriate, poorly managed, and
often over-use of psychotropic medications.
This Bill Provides for a Second Opinion in the Most
Disconcerting Cases, But Also Allows for Emergency
Authorization, When Necessary. This bill requires a second
opinion from a child psychologist or psychopharmacologist, prior
to the authorization to administer psychotropic medication, in
situations where prescribing psychotropics can be most
questionable: (1) the medication is for a child five years of
age or less; (2) the request would result in the child being
administered three or more psychotropic medications
concurrently; (3) the request is for a dosage that exceeds the
amount recommended for children; or (4) the request is for the
administration of a medication subject to a FDA black box
warning. To ensure that even with the second opinion
SB 253
Page 17
requirement, children who need psychotropic medication
immediately will not be harmed, the bill provides an emergency
procedure for the authorization of psychotropic medication if
the child is a danger to himself or others and there is not
adequate time to provide the court with all the required
information prior to the necessary administration of the
medication, with a required court petition filed afterwards.
Judicial Oversight Continues After Psychotropic Medication Has
Been Authorized. Under existing law, the court is given a few
parameters when approving the administration of psychotropic
drugs. However, with regards to oversight and monitoring of the
progress of the child once he or she begins taking psychotropic
medication, existing law is largely silent. This bill gives
more guidance to the court prior to the administration of the
medication, and also creates parameters for the court in
exercising oversight after the administration of the medication
has begun.
Accordingly, this bill requires that the court determine, prior
to authorizing a request to administer psychotropic medication
to a foster child, that a plan is in place for regular
monitoring of the child's medication and psychosocial treatment.
This plan must also monitor the effectiveness and the side
effects of the medication, and include input from the child's
caregiver, mental health care provider, and others who have
contact with the child. Further, this bill requires the court,
no later than 60 days following an authorization for a new
psychotropic medication, or at the next review hearing scheduled
no earlier than 45 days after the authorization, to review how
the child is responding to the medication. The court is
required to look at a number of factors, including whether the
child is taking the medication, the adverse effects of that
medication, any follow-up visits with the prescribing physician,
and whether the appropriate follow-up laboratory screenings have
been performed. If, based upon this review, the court
determines that the goals in administering the medication are
SB 253
Page 18
not being met, or the risks of the medication outweigh the
benefits, the court is required to reconsider, modify, or revoke
its authorization for the administration of the medication.
Concerns Raised That the Bill, With All its Requirements, Could
Keep Children Who Need Psychotropic Medication From Receiving it
in a Timely Manner, and the Author Proposes Amendments to
Address Many of These Concerns. Concern has been raised by a
group of medical associations and group homes, consisting of the
California Academy of Child and Adolescent Psychiatry, the
California Psychiatric Association, the California Behavioral
Health Directors Association, the California Alliance of Child
and Family Services and the California Medical Association, that
the bill, while attempting to fix a system that needs fixing,
could restrict timely access to necessary medications by some
foster children. In response to their concerns, the author
proposes to amend the bill in several key ways.
First, the bill will no longer give foster youth 14 years of age
and older the unilateral right to prevent the court from
authorizing a psychotropic medication. Instead, the judge will
be informed whether a youth 12 or older assents or refuses to
assent to taking the proposed medication and will be able to
consider the youth's assent when deciding whether to authorize
the medication. Second, as discussed above, the bill will allow
a psychotropic medication to be administrated without court
authorization in an emergency, provided that court authorization
is sought right afterwards. This procedure should help ensure
that children who need the medication can quickly get it, but is
not so broad that it creates a huge loophole in the law.
Finally, the amendments reduce the burden on physicians in terms
of what they must consider before prescribing psychotropic
medication.
The concerned groups are appreciative of the changes, but
believe that additional amendments are still required in order
SB 253
Page 19
to ensure that children who need psychotropic medication can
still receive it when appropriate. In particular, they remain
concerned with the requirement for a second opinion of a child
psychologist or behavioral pediatrician, because such a
psychologist or pediatrician may not be available in the area.
However, the emergency exception discussed above should help
reduce concerns with getting a second opinion in a timely
manner. The groups are also concerned that doctors may not be
provided with all the information they are supposed to review,
which these groups acknowledge is the standard of care, and
request that perhaps there should be a single point of contact
to help them access the required information. The author is
continuing to work with these groups to see if these additional
concerns can be addressed.
REGISTERED SUPPORT / OPPOSITION:
Support
National Center for Youth Law (sponsor)
Accessing Health Services for California's Children in Foster
Care Task Force
Advokids
Alameda County Board of Supervisors
Alameda County Foster Youth Alliance
SB 253
Page 20
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Alliance of Child and Family Services (if amended)
California CASA Association
California Department of Justice
California Youth Connection
Children's Advocacy Institute
Children's Law Center of California
Children's Partnership
Citizens Commission on Human Rights
Consumer Watchdog
County Welfare Directors of California
Dependency Legal Group of San Diego
Disability Rights California
SB 253
Page 21
Family Voices of California
First Place for Youth
Humboldt County Transition Age Youth Collaboration
John Burton Foundation
National Association of Social Workers - California Chapter
North American Council on Adoptable Children
Peers Envisioning and Engaging in Recovery Services
Youth Law Center
Some individuals
Opposition
None on file
SB 253
Page 22
Analysis Prepared by:Leora Gershenzon / JUD. / (916) 319-2334