BILL ANALYSIS Ó
SB 319
Page 1
SENATE THIRD READING
SB
319 (Beall)
As Amended September 3, 2015
Majority vote
SENATE VOTE: 40-0
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|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
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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 | |
| | | | |
| | | | |
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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