BILL ANALYSIS Ó SB 319 Page 1 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 | | | | | | | |----------------+-----+-----------------------+---------------------| SB 319 Page 2 |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 SB 319 Page 3 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) SB 319 Page 4 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 SB 319 Page 5 ($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; SB 319 Page 6 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 SB 319 Page 7 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