BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 319|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
UNFINISHED BUSINESS
Bill No: SB 319
Author: Beall (D), et al.
Amended: 9/3/15
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
SENATE FLOOR: 40-0, 6/3/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 9/8/15 - See last page for vote
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.
SB 319
Page 2
Assembly Amendments replace requirements that the foster care
public health nurse review that specific procedures have been
adhered to for children who are prescribed any psychotropic
medications with a general requirement that the public health
nurse monitor and oversee psychotropic medication usage.
Additional amendments require the foster care public health
nurse coordinate with mental health and other professionals,
adhering to appropriate privacy requirements. Amendments also
add chaptering language with SB 238 (Mitchell).
ANALYSIS:
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 to provide
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. (WIC 16501.3)
3)Limits the scope of services provided by the foster care
public health nurse to those reimbursable under Title XIX of
the Social Services Act, which provides a 75 % match for
health-related case management, but excludes direct provision
of health care services. (WIC 16501.3, 42 USC 1396)
4)Requires counties to establish a community child health and
SB 319
Page 3
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:
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
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,
SB 319
Page 4
providing educational materials.
6)Requires public health nurses to receive training related to
psychotropic medications, as specified.
Background
The Health Care Program for Children in Foster Care (HCPCFC).
HCPCFC implements California statute establishing a program of
public health nursing within the child welfare services system.
The program provides public health nurse expertise to meet 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. Under the program, public
health nurses, in consultation and collaboration with social
workers and probation officers, provide medical and health care
case planning, help caregivers obtain timely health and dental
exams for children, and expedite referrals for services, among
other duties.
Foster care public health nurses. CDSS established a program of
public health nursing within the child welfare services program
in 1999. This program - the Health Care Program for Children in
Foster Care - is located in county child welfare agencies and
probation departments and to assist caseworkers and probation
officers in meeting the medical, dental, mental health, and
developmental needs of foster youth.
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
SB 319
Page 5
Welfare Directors Association of California, approximately 250
foster care public health nurses are working throughout the
state.
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 fairly 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, include powerful brand-name drugs such as
Haldol, Risperdal, Abilify, Seroquel and Zyprexa. They 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.
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 "cardio
metabolic and endocrine side-effects" 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
SB 319
Page 6
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
medication 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to an analysis by the Assembly Appropriations
Committee, this bill may result in unknown, but likely
significant, ongoing costs to DCHS for foster care public health
nurses to monitor and oversee psychotropic medications, as well
as ongoing non-reimbursable costs of approximately $6 million
($4.85 million General Fund (GF)) to CDSS 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.) This bill
also may incur 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.
SUPPORT: (Verified9/8/15)
National Center for Youth Law (source)
Advokids
Alameda County Board of Supervisors
Alameda County Foster Youth Alliance
All Saints Church Foster Care Project
California Academy of Child & Adolescent Psychiatry
California Alliance
California Court Appointed Special Advocates (CASA)
California Department of Justice
SB 319
Page 7
California Nurses Association
California Youth Connection
Children's Advocacy Institute
Children Now
Children's Defense Fund--California
Children's Partnership
Consumer Watchdog
County Welfare Directors Association of California
Dependency Legal Group of San Diego
Disability Rights California
First Focus Campaign for Children
Humboldt County Transition Age You Collaboration
Legal Advocates for Children and Youth
LIUNA Locals 777 & 792
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Santa Clara County Board of Supervisors
Youth Law Center
9 individuals
OPPOSITION: (Verified9/8/15)
None received
ARGUMENTS IN SUPPORT: According to the author, nearly one in
four foster children and 56 percent 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," the author writes. "This 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."
SB 319
Page 8
ASSEMBLY FLOOR: 79-0, 9/08/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
9/8/15 21:18:07
**** END ****