BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 319|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: SB 319
Author: Beall (D)
Amended: 6/2/15
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/21/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Child welfare services: public health nursing
SOURCE: National Center for Youth Law
DIGEST: This bill expands the duties of the foster care public
health nurse to include monitoring and oversight of the
administration of psychotropic medication to foster children, as
specified. This bill also requires counties to provide child
welfare public health nursing services by contracting with the
community child health and disability prevention program
established by the county.
ANALYSIS:
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Existing law:
1)Establishes a program of public health nursing in the child
welfare services program that provides health-related case
management services from a foster care public health nurse to
coordinate with child welfare service workers regarding the
provision of health care services to children in foster care.
(WIC 16501.3)
2)Specifies, but does not limit, the health-related case
management duties of the foster care public health nurse to
include documenting that each child receives initial and
follow-up screenings, collecting health information and other
relevant data, expediting referrals, facilitating the
acquisition of necessary court authorizations for procedures
or medications, and others. (WIC 16501.3)
3)Limits the scope of services provided by the foster care
public health nurse to services reimbursable under Title XIX
of the federal Social Services Act, which provides a 75
percent match for health-related case management, but which
excludes the direct provision of health care services. (WIC
16501.3 and 42 USC Sec. 1396)
4)Requires counties to establish a community child health and
disability prevention program for the purpose of providing
early and periodic assessments of the health status of
children in the county or counties and provides that counties
shall be reimbursed for the amount required in accordance with
the approved community child health and disability prevention
plan. (HSC 124040 and 124065)
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. (WIC 395.5)
This bill:
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1)Recasts the requirement for collaboration between the foster
care public health nurse and the child's social worker,
requiring both to consult, collaborate and share information
in a timely manner to ensure that the child's physical,
mental, dental and developmental needs are met.
2)Expands the duties of the foster care public health nurse to
include monitoring, in collaboration with the child's county
social worker and mental health worker, each child in foster
care who is administered one or more psychotropic medication
including:
a) Reviewing each court request to ensure that all required
information is provided in the application to the court, as
specified.
b) Reviewing, monitoring, engaging and documenting the
child's health and education passport to ensure that
laboratory tests, and other specified assessments required
to meet reasonable standards of medical practice have been
completed.
c) Reviewing, monitoring and confirming that the juvenile
court has authorized the psychotropic medication to be
administered to the child.
d) Reviewing, monitoring, and engaging with the caregiver
and confirming that periodic follow up visits with the
prescribing physician, lab work, and other measurements are
completed.
e) Documenting in the child's health and education passport
information about authorized psychotropic medication.
f) Reviewing and documenting the response of the child to
the administration of psychotropic medication, as
specified.
1)Provides that the foster care public health nurse shall be
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considered a third party, legally authorized to have access to
the child's medical, dental and mental health care
information.
2)Authorizes a provider of health care to disclose medical
information to the foster care public health nurse, as
specified.
3)Authorizes the disclosure of information and records obtained
in the course of providing services, as defined, to specified
state and county mental health services and providers of
services related to developmental disabilities to the foster
care public health nurse.
4)Applies privacy and non-disclosure provisions pertaining to
the above authorizations to the foster care public nurse.
Background:
The Health Care Program for Children in Foster Care (HCPCFC).
This program operates within the child welfare services system
to provide a public health nurse to assist the child welfare
system in meeting the medical, dental, mental and developmental
needs of children and youth in foster care. Currently,
administrative responsibilities for the program are managed by
the local Child Health and Disability Prevention (CHDP) program
and counties are required to provide foster care public health
nursing services. Under the program, foster care public health
nurses provide the following services in consultation and
collaboration with social workers and probation officers:
1)Medical and health care case planning;
2)Assistance foster caregivers in obtaining timely health
assessments and dental examinations for children;
3)Expediting referrals for medical, dental, mental health and
developmental services;
4)Coordinating health services for children in out-of-county and
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out-of-state placements;
5)Providing medical education through the interpretation of
medical reports and training;
6)Participating in the creation and updating of the Health and
Education Passport.
Services provided by foster care public health nurses are
eligible for enhanced federal matching funds of 75 percent and
are limited to health-related case management and may not
include direct health care services per federal law.
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. The category of psychotropic medication is broad,
intending to treat symptoms of conditions ranging from ADHD to
childhood schizophrenia. Some of the drugs used to treat these
conditions are FDA-approved, including stimulants like Ritalin
for ADHD, however only about 31 percent of psychotropic
medications have been approved by the U.S. Food and Drug
Administration (FDA) for use in children or adolescents. It is
estimated that more than 75 percent of the prescriptions written
for psychiatric illness in this population are "off label" in
usage, meaning they have not been approved by the FDA for the
prescribed use, though the practice is legal and common across
all manner of pharmaceuticals.
Anti-psychotic medications, used to treat more severe mental
health conditions, have very limited approval by the FDA for
pediatric use beyond rare and severe conduct problems that are
resistant to other forms of treatment, such as Tourette's
syndrome, behavioral symptoms associated with autistic disorder,
childhood schizophrenia, and bipolar disorder. However, the
off-label use of these anti-psychotics among children is high,
particularly among foster children.
According to a study published in 2011, children who took
antipsychotic medications were likely to suffer ill health
effects including "cardiometabolic and endocrine side-effects"
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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." Compounding the potential for unintended side
effects is the use of combinations of psychotropic medications,
which foster youth are particularly likely to be prescribed,
despite limited evidence of clinical efficacy. Protecting the
health and well-being of children who are taking one or more
psychotropic medications requires extensive and ongoing health
and metabolic screenings to identify potential adverse effects
quickly, however in practice many children many fail to receive
ongoing screenings and adverse effects may go undetected,
causing permanent injury or death.
Recent media 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. A series published in the San Jose
Mercury News detailed significant challenges in accessing
pharmacy benefits claims data held by the California Department
of Health Care Services (DHCS), and demonstrated that
prescribing rates, dosages and regimens were far higher and more
concerning than had been anticipated by child welfare system
experts.
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:
1)The reasons for the request;
2)A description of the child's diagnosis and behavior;
3)The expected results of the medication;
4)A description of any side effects of the medication.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee, it is
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estimated that this bill would incur annual costs of $4.5
million per year to provide additional services to foster youth
who are administered psychotropic drugs (25 percent General Fund
and 75 percent federal funds). Their analysis further assumed
that counties would need additional public health nurses to
provide those additional services, at an average caseload of
1:200.
SUPPORT: (Verified6/2/15)
National Center for Youth Law (source)
Advokids
Alameda County Board of Supervisors
Alameda County Foster Youth Alliance
California Alliance
California Court Appointed Special Advocates (CASA)
California Department of Justice
California Nurses Association
California Youth Connection
Children's Advocacy Institute
Children's Law Center of California
Children Now
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
John Burton Foundation for Children Without Homes
Legal Advocates for Children and Youth
LIUNA Locals 777 & 792
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Youth Law Center
9 individuals
OPPOSITION: (Verified6/2/15)
None received
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ARGUMENTS IN SUPPORT:The author states that nearly one in four
foster children and 56 percent of children in group homes are
receiving psychotropic drugs, often without adequate oversight.
The author further states that without adequate oversight, these
medications can cause irreversible damage, and many youth
experience long-term side effects, including diabetes, heart
disease, irreversible tremors, tics, weight gain and drowsiness.
According to the author, this bill utilizes public health nurses
to oversee the medical monitoring of psychotropic drugs to
increase oversight and reduce the number of children prescribed
these drugs.
Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
6/2/15 21:03:09
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