BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 319


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          SENATE THIRD READING


          SB  
          319 (Beall)


          As Amended  September 3, 2015


          Majority vote


          SENATE VOTE:  40-0


           -------------------------------------------------------------------- 
          |Committee       |Votes|Ayes                   |Noes                 |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Human Services  |7-0  |Chu, Mayes, Calderon,  |                     |
          |                |     |Lopez, Maienschein,    |                     |
          |                |     |Mark Stone, Thurmond   |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Health          |19-0 |Bonta, Maienschein,    |                     |
          |                |     |Bonilla, Burke,        |                     |
          |                |     |Chávez, Chiu, Gomez,   |                     |
          |                |     |Gonzalez, Roger        |                     |
          |                |     |Hernández, Lackey,     |                     |
          |                |     |Nazarian, Patterson,   |                     |
          |                |     |Ridley-Thomas,         |                     |
          |                |     |Rodriguez, Santiago,   |                     |
          |                |     |Steinorth, Thurmond,   |                     |
          |                |     |Waldron, Wood          |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|








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          |Appropriations  |17-0 |Gomez, Bigelow, Bloom, |                     |
          |                |     |Bonta, Calderon,       |                     |
          |                |     |Chang, Nazarian,       |                     |
          |                |     |Eggman, Gallagher,     |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |                |     |Eduardo Garcia,        |                     |
          |                |     |Holden, Jones, Quirk,  |                     |
          |                |     |Rendon, Wagner, Weber, |                     |
          |                |     |Wood                   |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
           -------------------------------------------------------------------- 


          SUMMARY:  Includes the monitoring and oversight of psychotropic  
          medications among the duties of foster care public health  
          nurses, and ensures these nurses' access to relevant medical  
          information.  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  
            to screenings, assessments, and laboratory tests necessary to  
            monitor the administration of psychotropic medications.


          3)Requires that a foster care health nurse have access to a  
            child's medical, dental, and mental health care information in  








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            order to allow that nurse to fulfill his or her duties, as  
            specified, and in a manner that is consistent with all  
            relevant privacy requirements.


          4)Includes among the duties of public health nurses the  
            monitoring and oversight of psychotropic medications.


          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)Requires public health nurses to receive training related to  
            psychotropic medications, as specified. 


          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  
            identify, respond to, and enhance the physical, mental,  
            dental, and developmental well-being of children in the child  
            welfare system.  (Welfare and Institutions Code (WIC) Section  
            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 Section  
            16501.3)








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          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  
            Section 16501.3 and 42 United States Code Section 1396 et  
            seq.)


          4)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  
            Section 5328.04)


          5)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 Section 369.5 (d))


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, this bill may result in the following costs:


          1)Unknown, but likely significant, ongoing costs to DCHS for  
            foster care public health nurses to monitor and oversee  
            psychotropic medications.


          2)Ongoing non-reimbursable costs of approximately $6 million  








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            ($4.85 million General Fund (GF)) to DSS for social workers to  
            work with foster care public health nurses to coordinate  
            health care services. (Proposition 30 exempts the State from  
            mandate reimbursement for realigned programs, however,  
            legislation that has an overall effect of increasing the costs  
            already borne by a local agency for realigned programs,  
            including child welfare services, apply to local agencies only  
            to the extent that the State provides annual funding for the  
            cost increase.)


          3)One time costs of $45,000 ($22,000 GF) and ongoing costs of  
            $7,000 ($3,500 GF) to DHCS to develop curriculum and train  
            public health nurses.


          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  
          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;  








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          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.  


          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.  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 zero  
          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%.


          Need for this bill:  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  








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          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."




          Analysis Prepared by:                                             
                          Daphne Hunt / HUM. S. / (916) 319-2089  FN:  
          0002025