BILL ANALYSIS Ó
SB 319
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Date of Hearing: June 30, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
SB
319 (Beall) - As Amended June 2, 2015
SENATE VOTE: 40-0
SUBJECT: Child welfare services: public health nursing.
SUMMARY: Adds to the duties of foster care public health
nurses, including monitoring each child in foster care who is
administered one or more psychotropic medications.
Specifically, this bill:
1)Authorizes a provider of health care to disclose medical
information to a foster care public health nurse, as defined,
for the purpose of coordinating health care services and
medical treatment for a minor who has either been taken into
temporary custody, had a petition filed with the court, or
been adjudged a dependent child or ward of the juvenile court,
as specified.
2)Specifies that medical information regarding a minor, as
defined, disclosed by a provider of health care to authorized
entities includes, but is not limited to, information related
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to screenings, assessments, and laboratory tests necessary to
monitor the administration of psychotropic medications.
3)Recasts requirements for coordination between a foster care
public health nurse and a child's social worker to include
consultation, collaboration, and the sharing of information in
a timely manner to ensure that the child's physical, mental,
dental, and developmental needs are met.
4)Requires that a foster care health nurse have access to a
child's medical, dental, and mental health care information in
order to allow that nurse to fulfill his or her duties, as
specified.
5)Requires a foster care public health nurse to, among other
things at the request of and under the direction of a nonminor
dependent, assist the nonminor dependent in making informed
decisions about his or her health care by, at a minimum,
providing educational materials.
6)Adds to the duties of a foster care public health nurse the
monitoring of each child in foster care who is administered
one or more psychotropic medications and further requires that
this monitoring include, but not be limited to, all of the
following:
a) Reviewing each request for psychotropic medication, as
specified, to verify that all required information is
provided to the court;
b) Monitoring and recording the appropriate completion of
laboratory tests, other screenings and measurements,
evaluations and assessments in a child's health and
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education passport, as specified;
c) Reviewing, monitoring, and confirming that the juvenile
court has authorized the psychotropic medication to be
administered to a child;
d) Taking steps to confirm that appropriate periodic
follow-up health visits and procedures are scheduled and
completed, as specified;
e) Completing appropriate documentation concerning
psychotropic medications in a child's health and education
passport, as specified; and
f) Reviewing and documenting the response of a child to the
administration of psychotropic medication, as specified,
and providing information to the child's social worker to
be included in court reports if necessary.
EXISTING LAW:
1)Requires the Department of Social Services (DSS) to establish
and maintain a public health nursing program in the child
welfare services system, as specified, whereby counties are
required to use the services of foster care public health
nurse. Further states that the purpose of this program is to
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identify, respond to, and enhance the physical, mental,
dental, and developmental well-being of children in the child
welfare system. (WIC 16501.3)
2)Requires foster care public health nurses to work with the
appropriate child welfare services workers to coordinate
health care services, as specified. Further outlines the
duties of foster care public health nurses. (WIC 16501.3)
3)Limits the services a foster care public health nurse can
provide to those reimbursable under Title XIX of the federal
Social Security Act, which provides enhanced matching funds
(75%) for services pertaining to health-related case
management, but not for direct health care services. (WIC
16501.3 and 42 USC Sec. 1396 et seq.)
4)Allows for the summary of a foster child's health and
education information to be maintained in the form of a health
and education passport, and requires certain information to be
contained in that summary, as specified. (WIC 16010)
5)Establishes conditions under which confidential information
and records regarding a minor who has been taken into
temporary custody or adjudged a dependent child or ward of the
court may be shared with specified entities for purposes of
coordinating health care services and medical treatment. (WIC
5328.04)
6)States that only a juvenile court judicial officer has the
authority to make orders for the administration of
psychotropic medications for a minor who has been adjudged a
dependent or ward of the court. (WIC 369.5 and 739.5)
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7)Defines "psychotropic medication" or "psychotropic drugs" as
those medications administered for the purpose of affecting
the central nervous system to treat psychiatric disorders or
illnesses. Further states that these medications include, but
are not limtied to, anxiolytic agents, antidepressants, mood
stabilizers, antipsychotic medications, anti-Parkinson agents,
hypnotics, medications for dementia, and psychostimulants.
(WIC 369.5 (d))
FISCAL EFFECT: According to the May 28, 2015, Senate
Appropriations Committee analysis, this bill may result in
annual costs of $4.5 million per year to provide additional
services to foster youth who are administered psychotropic drugs
(25% General Fund and 75% federal funds), and the bill would
require additional public health nurse services for foster youth
who are administered psychotropic medications.
COMMENTS:
Foster care public health nurses: AB 1111 (Chesbro), Chapter
147, Statutes of 1999, required DSS to establish a program of
public health nursing within the child welfare services program.
This program - the Health Care Program for Children in Foster
Care- is located in county child welfare agencies and probation
departments and serves to assist in meeting the medical, dental,
mental health, and developmental needs of foster youth.
Foster care public health nurses work with child welfare
caseworkers and probation officers to promote access to
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comprehensive health services. Federal funding requirements
stipulate that the services provided by foster care public
health nurses must be limited to health-related case management
and not involve the provision of direct health care services.
Under the supervision of supervising public health nurses,
foster care public health nurses consult and collaborate with
social workers and probation officers to provide services such
as: medical and health care case planning; expediting referrals
for medical, dental, mental health and developmental services;
and helping to develop and maintain each child's Health and
Education Passport, which provides a summary of all obtainable
health and education information for foster youth that travels
with each youth throughout out-of-home placement.
According to the County Welfare Directors Association of
California, there are approximately 250 foster care public
health nurses working throughout the state.
Psychotropic medications and foster youth: Psychotropic
medications include drugs prescribed to manage psychiatric and
mental health disorders or issues including depression,
obsessive-compulsive disorder, attention deficit hyperactivity
disorder, bipolar disorder, schizophrenia, and others. These
medications include antipsychotics such as Seroquel,
antidepressants like Prozac, mood stabilizers including Lithium,
and stimulants like Ritalin.
There continues to be significant concern over the use of
psychotropic medications for children, due to a vast array of
side effects (which can include aggressive behavior, hostility,
seizures, significant weight gain, and more) and due to the fact
that the long-term effects for children using these drugs are
largely unknown. Additionally, many of the psychotropic
medications prescribed to children are "off label" - that is,
they are used to treat symptoms other than those for which the
FDA originally approved each drug. While off-label use is not
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illegal, there are concerns about how well-understood these
medications and their uses are by prescribers and patients.
Over 75% of psychotropic drug use in children and adolescents is
believed to be off-label. One class of psychotropic
medications, antipsychotics, raise particular concern; these are
potent drugs with a high potential for side-effects, and there
is little known about their impact on growth, development, and
children's neurological systems.
Research has repeatedly indicated that children and youth in
foster care face higher levels of inappropriate or excessive
medication use, and that those foster youth placed in group home
settings are particularly vulnerable to over-prescription and
misuse of psychotropic medications. Data shared by the author's
office indicate that, in fiscal year 2013-14, almost 15% of all
foster youth in California ages 0 to 20 years old were
prescribed at least one psychotropic medication; looking
specifically at all foster youth ages 12 through 20, this rate
was almost 25% and for youth placed in group homes, it was 50%.
In late 2011, the U.S. Department of Health and Human Services
issued a letter to states encouraging them to coordinate with
partners who worked with foster youth to address enhanced
efforts to appropriately prescribe and monitor psychotropic
medication among children placed in out-of-home care. As a
result, the Department of Health Care Services (DHCS) and DSS
developed the Quality Improvement Project to strengthen the
state's Medicaid and child welfare services system by, among
other things, improving safe and appropriate prescribing and
monitoring of psychotropic drugs; this project has enabled the
state to access the knowledge and perspectives of various
experts, and has continued to hold various workgroup meetings
and set and accomplish objectives related to its mission.
Additionally, this Spring, DHCS and DSS released state
guidelines for the use of psychotropic medication with children
and youth in foster care.
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Need for this bill: Foster care public health nurses can
provide an important touch-point within the child welfare
services system, offering another layer of review and monitoring
regarding the prescription and use of psychotropic medications
among foster youth.
According to the author, "Nearly one in four children in foster
care and 56% of children in group homes are receiving
psychotropic drugs, often without adequate oversight. It is
currently unclear if foster youth are being given these potent
drugs as part of a therapeutic regimen or whether these
medications are being used solely to control a youth's behavior.
Without adequate oversight, these powerful drugs can cause
irreversible damage, and many youth experience long-term side
effects, including diabetes, tics, weight gain, and drowsiness.
This bill is grounded in the expertise we've developed working
with medical experts in the State's Quality Improvement Project,
the federally mandated process for developing protocols and
procedures to govern the use of these medications on foster
children. The bill utilizes Public Health nurses; one of the
great resources of our child welfare system, to oversee the
medical monitoring of psychotropic drugs to increase oversight
and reduce the number of children prescribed these powerful
drugs."
RELATED LEGISLATION:
SB 238 (Mitchell), 2015, requires DSS to develop expanded
training for foster parents, social workers, group home
administrators, and others involved in the care and oversight of
dependent children on issues related to psychotropic
medications. Further requires Judicial Council to, in
consultation with other entities, update court forms related to
the authorization of psychotropic medications, and requires DSS
to establish an individualized monthly report and other tools
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for use by county welfare agencies to monitor the administration
of psychotropic medications to foster youth.
SB 253 (Monning), 2015, modifies juvenile court practices and
requirements regarding the authorization of psychotropic
medications for foster youth by, among other things, requiring
clear and convincing evidence that administration of the
medication is in the best interest of the child and, in
specified circumstances, prohibiting the authorization of
psychotropic medication administration for a child unless a
second opinion is obtained from a child psychiatrist or
behavioral pediatrician.
SB 484 (Beall), 2015, requires DSS to compile and post on its
Internet Web site specified information regarding the
administration of psychotropic medications to children placed in
group homes and to establish a methodology for identifying group
homes with high levels of psychotropic drug use. Further
establishes certain requirements for those group homes.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Health Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
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Abode Services
Advokids
Alameda County Board of Supervisors
California Alliance of Child and Family Services
California Department of Justice
Children's Law Center of California (CLC)
Children Now
Citizens Commission on Human Rights (CCHR)
Consumer Watchdog
County Welfare Directors Association of California (CWDA)
Disability Rights California
Family voices of California
Humboldt County Transition Age Youth Collaboration
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John Burton Foundation for Children Without Homes
National Center for Youth Law
North American Council on Adoptable Children (NACAC)
The Children's Partnership
The Mockingbird Society
Santa Clara county Board of Supervisors
5 individuals
Opposition
None on file.
Analysis Prepared by:Daphne Hunt / HUM. S. / (916)
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319-2089