BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 484
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|Author: |Beall |
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|Version: |February 26, 2015 |Hearing |April 21, 2015 |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sara Rogers |
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Subject: Juveniles
SUMMARY
This bill requires the California Department of Social Services
(CDSS) to publish and make available to interested persons
specified information regarding individual group homes,
transitional housing placement providers, community treatment
facilities, and runaway and homeless youth shelters regarding
the administration of psychotropic medication to children
residing in each facility. Additionally, this bill requires CDSS
to inspect facilities at least once per year, as specified, if
the facility is determined to have a higher than average rate of
psychotropic medication authorization for children residing in
the facility and requires CDSS to monitor corrective action
plans, as specified.
ABSTRACT
Existing law:
1) Establishes the Community Care Facilities Act, which
provides for the licensure and regulation of community care
facilities, including group homes, by CDSS, and requires
that licensed facilities be subject to unannounced
inspections under specified circumstances. (HSC 1500 et
seq, and 1534)
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2) Requires CDSS to establish a rate classification level
(RCL) structure for group homes with a corresponding rate
structure according to the level of care and services that
will be provided, as specified. (WIC 11462)
3) Permits a group home to be classified as an RCL 13 or 14
if the program only accepts children with special treatment
needs and meets other requirements. Additionally, requires
the California Department of Health Care Services (DHCS) to
annually certify group homes seeking classification as RCL
13 or 14 and permits such facilities to accept minor
dependents who are seriously or emotionally disturbed if
certain conditions are met. (WIC 11469, WIC 4096.5 and HSC
1502.4)
4) Requires CDSS to publish and make available to
interested persons a list or lists covering all licensed
community care facilities, other than foster family homes
and certified family homes, to include specified
information regarding group homes, transitional housing
placement providers, community treatment facilities or
runaway and homeless youth shelters including complaints,
citations, fines and the number of law enforcement contacts
made by group homes. (HSC 1536)
This bill:
1) Requires CDSS to add to the information contained in the
above-mentioned lists the following information:
The number of children administered
psychotropic medication in the facility.
The number of children for whom the juvenile
court authorized the medication.
The number of children administered a
psychotropic medication on an emergency basis.
The number of those children who are between
the ages of 6 and 11 years.
The number of those children who are between
the ages of 12 and 17 years.
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The number of children administered an
antipsychotic, mood stabilizing or antianxiety
medication.
The number of children administered two,
three, four, or more psychotropic medications
concurrently.
The number of children administered one or
more medications for longer than 90 days.
The number of children terminated from the
program due to the child's refusal to take
psychotropic medication.
1) Requires CDSS to inspect facilities once a year if the
facility is determined to administer psychotropic
medication at a rate exceeding the average authorization
for all group homes in order to examine the factors that
the department determines contribute to the high
utilization of psychotropic medications, as specified.
2) Requires a facility that is inspected to submit a
corrective action plan within 60 days of the inspection,
and in the plan to address the steps the facility shall
take to reduce the utilization of psychotropic medication
among residents.
3) Requires CDSS to monitor the facility's implementation
of the corrective action plan to determine whether the
facility has reduced the rate that psychotropic medications
are administered, and whether and to what extent
alternative less invasive treatments are being provided to
residents.
4) Requires CDSS to submit a report to the Children and
Family Services Division of the department and to any
public agency that has certified any component of the
facility's program, including the state Department of
Health Care Services (DHCS).
5) Requires CDSS and DHCS in consultation with specified
stakeholders to develop additional performance standards
and outcome measures that require group homes to implement
programs and services to reduce the utilization of
psychotropic medications in group homes, including
behavioral management programs, emergency intervention
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plans, and conflict resolution processes.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, more than half of the children in
California group homes are medicated with powerful psychotropic
medications. The author states that these medications are
misused to control and suppress undesirable behavior, rather
than treat, nurture and develop the young people residing in the
facility.
The author states that this bill identifies those group homes
that appear to rely on psychotropic medication as the first-line
or only treatment and requires those with the highest rates of
medication to reduce those rates and to adopt alternative, less
invasive, treatment approaches.
Group Homes
Group homes are 24-hour residential facilities licensed by CDSS
to provide board and care to foster youth from both the
dependency and delinquency jurisdictions. Group home facilities
are organized under a system of rate classification levels
(RCLs) ranging from 1-14 that are based on levels of
professional training and adult-to-child ratios. In practice,
the majority of group homes are at RCL 10 and above with nearly
50 percent of group homes at RCL 12. There is wide variation in
group home size from as few as six children to group homes that
house more than 100 children.
Existing law requires that children removed from their homes and
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made dependents of the court be placed in the most family-like
and "least restrictive" setting. Existing law requires counties
to seek timely permanent placements, such as guardianship or
adoption, for dependent youth that are removed from their homes.
Group homes, which provide an institutional type of care as
opposed to a family like setting, are not intended to be long
term placements, however in practice many children placed in
group homes remain in that setting for the duration of their
time in foster care, and many age out of the system while
residing in group home placements. While in a group home
program, it is intended that children receive services and
treatment designed to eliminate or reduce the conditions,
behaviors and characteristics that led to their group home
placement, and to teach new, adaptive skills and behavior.<1>
Group Home Rate Classification
Existing law provides for the classification of group home
programs for the purpose of establishing AFDC-FC rates. Through
regulation, CDSS implemented the Rate Classification Level (RCL)
point system in which the hours of child care and supervision,
social work activities, and mental health treatment services
provided to children, are weighted to take into consideration
experience, education, training, and professional qualifications
of the staff. These are calculated and then divided by an
adjusted expected capacity of the group home program. Every
year, CDSS issues an updated rate structure based on required
increases associated with the California Necessities Index.
Group homes classified as RCL 13 and 14 are permitted to accept
a child assessed as seriously emotionally disturbed as long as
the child does not need inpatient care in a licensed health
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<1> California Alliance for Child and Family Services. Group
Homes for Foster Children Fact Sheet
http://c.ymcdn.com/sites/www.cacfs.org/resource/resmgr/advocacy/p
ublicpolicy10.pdf
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facility.<2> To receive this classification, a facility may only
accept children who have been assessed as seriously emotionally
disturbed through an interagency placement committee, or by a
licensed mental health professional. These group homes must be
both licensed by CDSS and certified by DHCS as a program that
provides mental health treatment services for seriously
emotionally disturbed children.
Group Home Program Statement
Group homes are required to establish a "group home program
statement" that includes a training plan that is appropriate for
the client population and the training needs and skill level of
child care staff. Through regulation, existing law provides that
newly hired staff complete at least 24 hours of training within
90 days of being hired, and 40 hours within 12 months, as
specified, with all existing staff receiving 20 hours annually.
Regulations provide for the minimum topics that must be included
(e.g. discipline policies and procedures, behavior
problems/psychological disorders, and mental health/behavioral
interventions). Social work staff is required to establish a
"needs and services plan" for each child that identifies the
specific needs of an individual child, and delineates those
services necessary in order to meet the child's identified
needs.
Group homes are required to submit to the department an
emergency intervention plan, identifying how the facility will
use emergency interventions to address aggressive or assaultive
behavior of residents. The plan is required to be designed by
the licensee and a qualified behavior management consultant and
must be appropriate for the client population served by the
group home, and for the staff qualifications and staff emergency
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<2> Health and Safety Code Section 1502.4
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intervention training.<3>
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.<4>
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.<5> However, the off-label use of these
anti-psychotics among children is high, particularly among
foster children. According to a study published in 2011,
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<3> Title 22 CCR 84322
<4>https://www.magellanprovider.com/mhs/mgl/providing_care/clinic
al_guidelines/clin_monographs/psychotropicdrugsinkids.pdf
<5> Harrison, et al, "Antipsychotic Medication Prescribing
Trends in Children and Adolescents," Journal of Pediatric Health
care, March 2012.
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children who took antipsychotic medications were likely to
suffer ill health effects including "cardiometabolic and
endocrine side-effects" as well as significant weight gain.<6>
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
are particularly likely to be prescribed, despite limited
evidence of clinical efficacy.<7> 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.
Drugging our Children Media Series
A recent series of stories published in the San Jose Mercury
News<8> and most recently in the Los Angeles Times, highlighted
growing concerns that psychotropic medications have been relied
on by California's child welfare and children's mental health
systems as a means of controlling, instead of treating, youth
who suffer from trauma-related behavioral health challenges. The
series detailed significant challenges in accessing pharmacy
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<6> DeHert, Dobbelaere, Sheridan, et al "Metabolic and endocrine
adverse effects of second-generation antipsychotics in children
and adolescents: A systematic review of randomized, placebo
controlled trials and guidelines for clinical practice,"
European Psychiatry, April 2011, pgs 144-58.
<7> http://www.ncbi.nlm.nih.gov/pubmed/25022817
<8> Drugging our Kids. Karen De Sa. San Jose Mercury News.
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benefits claims data held by the California Department of Health
Care Services (DHCS), eventually overcome through a Public
Records Act request and lengthy negotiations, and it
demonstrated that prescribing rates were far higher than had
been anticipated by child welfare system experts.
Related legislation:
SB 238 (Mitchell, 2015) requires specified certification and
training programs for group home administrators, foster parents,
child welfare social workers, dependency court judges and court
appointed council to include training on psychotropic
medication, trauma, and behavioral health, as specified, for
children receiving child welfare services. This bill
additionally requires the Judicial Council to update court forms
pertaining to the authorization of psychotropic medication, and
requires CDSS to develop an individualized monthly report, a
form to share information and an alert system, used by county
child welfare agencies, regarding the administration of
psychotropic medication for a foster youth.
SB 253 (Monning, 2015) provides that an order of the juvenile
court authorizing psychotropic medication shall require clear
and convincing evidence of specified conditions. This bill also
prohibits the authorization of psychotropic medications without
a second independent medical opinion under specified
circumstances. It also prohibits the authorization of
psychotropic medications unless the court is provided
documentation that appropriate lab screenings, measurements, or
tests have been completed, as specified. Finally, it requires
the court, no later than 45 days following an authorization for
psychotropic medication, to conduct a review to determine
specified information regarding the efficacy of the child's
treatment plan.
SB 319 (Beall, 2015) 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. It also requires counties to provide child welfare
public health nursing services by contracting with the community
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child health and disability prevention program established by
the county.
COMMENTS
Staff notes that this bill appears to make personally
identifiable information available on a public website regarding
the administration of psychotropic medication to foster youth
residing in group homes. In response to these concerns, the
author proposes the following amendments to instead require CDSS
to provide oversight of facilities deemed to have
disproportionately high rates of psychotropic medication use,
based on an evaluation methodology developed by existing quality
improvement stakeholder work groups held by CDSS and DHCS.
POSITIONS
Support:
Advokids
Alameda County Foster Youth Alliance
California Court Appointed Special Advocates (CASA)
California Youth Connection
Children's Advocacy Institute
Children's Partnership
Dependency Legal Group of San Diego
East Bay Children's Law Offices
East Bay Community Law Center
First Focus Campaign for Children
Humboldt County Transition Age You Collaboration
Legal Advocates for Children and Youth
Legal Services for Prisoners with Children
National Association of Social Workers
National Center for Youth Law
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Youth Law Center
10 individuals
Oppose:
None.
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Amendments Mock-up for 2015-2016 SB-484 (Beall (S))
*********Amendments are in BOLD*********
Mock-up based on Version Number 99 - Introduced 2/26/15
The people of the State of California do enact as follows:
SECTION 1. Section 1536 of the Health and Safety Code is amended
to read:
1536. (a) (1) At least annually, the director shall publish and
make available to interested persons a list or lists covering
all licensed community care facilities, other than foster family
homes and certified family homes of foster family agencies
providing 24-hour care for six or fewer foster children, and the
services for which each facility has been licensed or issued a
special permit.
(2) For a group home, transitional housing placement provider,
community treatment facility, or runaway and homeless youth
shelter, the list shall include both all of the following:
(A) The number of licensing complaints, types of complaint, and
outcomes of complaints, including citations, fines, exclusion
orders, license suspensions, revocations, and surrenders.
(B) The number, types, and outcomes of law enforcement contacts
made by the facility staff or children, as reported pursuant to
subdivision (a) of Section 1538.7.
(C) The number of children administered psychotropic medications
in the facility, and all off the following information
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pertaining to those children:
(1) The number of children for whom the juvenile court
preauthorized the administration of the psychotropic medication.
(2) The number of children administered psychotropic medication
on an emergency basis.
(3) The number of those children who are 6 to 11 years of age,
inclusive.
(4) The number of those children who are 12 to 17 years of age,
inclusive.
(5) The number of children administered an antipsychotic, mood
stabilizing, or antidepressant medication.
(6) The number of children administered two or more drugs from
the same class, including, but not limited to, antidepressants,
antipsychotics, antianxiety medications.
(7) The number of children administered two, three, four, or
more psychotropic medications concurrently.
(8) The number of children administered one or more medications
for longer than 90 days.
(9) The number of children terminated from the program due to
the child's refusal to take psychotropic medication.
(b) Subject to subdivision (c), to encourage the recruitment of
foster family homes and certified family homes of foster family
agencies, protect their personal privacy, and to preserve the
security and confidentiality of the placements in the homes, the
names, addresses, and other identifying information of
facilities licensed as foster family homes and certified family
homes of foster family agencies providing 24-hour care for six
or fewer children shall be considered personal information for
purposes of the Information Practices Act of 1977 (Chapter 1
(commencing with Section 1798) of Title 1.8 of Part 4 of
Division 3 of the Civil Code). This information shall not be
disclosed by any state or local agency pursuant to the
California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code),
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except as necessary for administering the licensing program,
facilitating the placement of children in these facilities, and
providing names and addresses only to bona fide professional
foster parent organizations upon request.
(c) Notwithstanding subdivision (b), the department, a county,
or a foster family agency may request information from, or
divulge information to, the department, a county, or a foster
family agency, regarding a prospective certified parent, foster
parent, or relative caregiver for the purpose of, and as
necessary to, conduct a reference check to determine whether it
is safe and appropriate to license, certify, or approve an
applicant to be a certified parent, foster parent, or relative
caregiver.
(d) The department may issue a citation and, after the issuance
of that citation, may assess a civil penalty of fifty dollars
($50) per day for each instance of a foster family agency's
failure to provide the department with the information required
by subdivision (h) of Section 88061 of Title 22 of the
California Code of Regulations.
(e) The Legislature encourages the department, when funds are
available for this purpose, to develop a database that would
include all of the following information:
(1) Monthly reports by a foster family agency regarding family
homes.
(2) A log of family homes certified and decertified, provided by
a foster family agency to the department.
(3) Notification by a foster family agency to the department
informing the department of a foster family agency's
determination to decertify a certified family home due to any of
the following actions by the certified family parent:
(A) Violating licensing rules and regulations.
(B) Aiding, abetting, or permitting the violation of licensing
rules and regulations.
(C) Conducting oneself in a way that is inimical to the health,
morals, welfare, or safety of a child placed in that certified
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family home.
(D) Being convicted of a crime while a certified family parent.
(E) Knowingly allowing any child to have illegal drugs or
alcohol.
(F) Committing an act of child abuse or neglect or an act of
violence against another person.
(f) At least annually, the Department shall post to its Internet
Web site a summary progress report with non-identifiable data,
of the information gathered pursuant to 1538.8.
SEC. 2. Section 1538.8 is added to the Health and Safety Code,
to read:
1538.8. (a) In order to identify group homes in which
psychotropic medications may be inappropriately administered to
children the director shall compile, at least annually, the
following information concerning each home:
(1) The number of children in the facility to whom psychotropic
medications were administered.
(2) The number of children in the facility who are 6 to 11 years
of age, inclusive, to whom psychotropic medications were
administered.
(3) The number of children who are 12 to 17 years of age,
inclusive, to whom psychotropic medications were administered.
(4) The number of children for whom the juvenile court
preauthorized the administration of the psychotropic medication.
(5) The number of children to whom psychotropic medications were
administered emergency basis.
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(6) The number of children to whom antipsychotic, mood
stabilizing, or antidepressant medications were administered.
(7) The number of children who received two or more drugs from
the same class, including, but not limited to, antidepressants,
antipsychotics, and antianxiety medications.
(8) The number of children who received two or more psychotropic
medications concurrently, and whether those children received
two, three, four, or more than four psychotropic medications
concurrently.
(9) The number of children who received one or more medications
for more than 90 days.
(10) The number of children who received psychosocial services
while in a group home placement while they received a
psychotropic medication.
(11) The number of children who received a dosage of a
psychotropic medication at a dosage above the maximum dosage
approved by the federal Food and Drug Administration.
(12) The number of children who received metabolic monitoring in
accordance with professional standards of care while they
received a psychotropic medication.
(13) The number of children who were prescribed antipsychotic
medications for a use not approved by the federal Food and Drug
Administration.
(b) The data in subdivision (a) concerning psychotropic
medication, mental health services, and placement shall be drawn
from existing data systems, including but not limited to, the
Medicaid Management Information System's medical and pharmacy
claims data, and the Child Welfare Services/Case Management
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System, through the data sharing agreement between the State
Department of Health Care Services and the State Department of
Social Services.
If the department, based upon the information gathered pursuant
to Section 1536, determines that the children and adolescents in
a facility are administered psychotropic medications at a rate
that exceeds the average authorization for all group homes, the
department shall inspect the facility at least once a year to
examine the policies, procedures, practices, child-to-staff
ratios, staff training, and other factors that the department
determines contribute to the high utilization of psychotropic
medications.
(b) A facility inspected pursuant to subdivision (a) shall
submit to the department a corrective action plan within 60 days
of that inspection. The plan shall address the steps that the
facility shall take to reduce the utilization of psychotropic
medications among residents.
(c) The department shall monitor a facility's implementation of
its corrective action plan to determine both of the following:
(1) Whether the facility has reduced the rate at which residents
are administered psychotropic medications, and, if so, the
percentage decrease in the administration of those medications.
(2) Whether and to what extent alternative, less invasive
treatments are being provided to residents.
(d) Following an inspection pursuant to subdivision (a), the
Community Care Licensing Division shall provide a report to the
department's Children and Family Services Division and to any
other public agency that has certified the facility's program or
any component of the facility's program, including, but not
limited to, the State Department of Health Care Services, which
certifies group homes pursuant to Section 4096.5 of the Welfare
and Institutions Code.
SEC. 3. Section 1538.9 is added to the Health and Safety Code to
read:
1538.9 (a) (1) The department, based upon the information
compiled pursuant to Section 1538.8, shall consult with the
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foster care ombudsman and existing stakeholder quality
improvement workgroups to establish a methodology to identify
those group homes that have disproportionately high levels of
psychotropic drug usage warranting additional review of the
facility.
(2) The department shall visit facilities identified in
paragraph (1) at least once a year to review the facilities plan
of operation, policies, procedures, practices, child-to-staff
ratios, staff qualifications and training, implementation of
children's needs and services plan, and other factors that the
department determines contribute to the high utilization of
dangerous psychotropic medication regimens and low utilization
of monitoring and psychosocial services.
(3) The department shall perform visits pursuant to paragraph
(2) with input from stakeholders, including but not limited to,
the foster care ombudsman and foster care mental health
ombudsman, foster youth, foster youth advocates, county welfare
departments, and county mental health departments.
(4) The department shall include in each visit confidential
discussions with current and former foster youth placed in the
facility's care and confidential discussions with physicians
identified as prescribing the medications. The State Department
of Health Care Services and the State Department of Social
Services shall use existing data systems, identify prescribers'
name, addresses, and contact information in order to facilitate
interviews with providers.
(b) If, during a visit pursuant to subdivision (a), the
department finds that the facility has a high utilization of
dangerous psychotropic medication regimens, based on measures
established pursuant to Section 1538.9, and inadequate
alternative, less invasive psychosocial, crisis management, and
other services, the facility shall submit to the department a
plan to address the steps that the facility shall take to reduce
inappropriate prescribing and treatment regimens within 60 days
of the visit. The plan shall do the following:
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(1) Include an improved crisis management plan, including
de-escalation techniques and procedures in which their staff
will be trained.
(2) Include an overall behavioral management plan which shall be
a trauma-informed plan.
(3) Identify a quantifiable goal to decrease the use of
antipsychotic medications for behavioral control, to decrease
polypharmacy, and to decrease the use of pro re nata
medications.
(4) Identify quantifiable goal of appropriate metabolic
monitoring as set forth in the state prescribing guidelines and
psychosocial, physical, mental, behavioral, and nutritional
services for children previously or currently prescribed
psychotropic medications while placed in that facility.
(c) The department shall monitor a facility's implementation of
the plan submitted pursuant to (b) to determine all of the
following:
(1) Whether the facility has reduced the rate at which residents
are administered pro re nata, multiple, and off-label
psychotropic medications, and, if so, the percentage decrease in
the administration of those medication regimens.
(2) Whether and to what extent alternative, less invasive
treatments are being provided to residents, and, if so, the
percentage increases in the provision of those services.
(3) Whether and to what extent appropriate metabolic monitoring
is being conducted and, if so, the percentage increases in the
provision of appropriate monitoring.
(d) Following an inspection pursuant to subdivision (a), the
Community Care Licensing Division shall provide a report to the
department's Children and Family Services Division and to any
other public agency that has certified the facility's program or
any component of the facility's program, including, but not
limited to, the State Department of Health Care Services, which
certifies group homes pursuant to Section 4096.5 of the Welfare
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and Institutions Code.
(e) (1) Notwithstanding the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code), until emergency regulations are filed with the
Secretary of State, the department may implement the amendments
made to this section by the act that added this subdivision
during the 2015-16 Regular Session of the Legislature through
all-county letters or similar instructions from the director.
(2) On or before January 1, 2017, the department shall adopt
regulations to implement the amendments to this section made by
the act that added this subdivision during the 2015-16 Regular
Session of the Legislature. The initial adoption, amendment, or
repeal of a regulation authorized by this subdivision is deemed
to address an emergency, for purposes of Sections 11346.1 and
11349.6 of the Government Code. After the initial adoption,
amendment, or repeal of an emergency regulation pursuant to this
section, the department may twice request approval from the
Office of Administration Law to readopt the regulation as an
emergency regulation pursuant to Section 11346.1 of the
Government Code. The department shall adopt final regulations on
or before January 1, 2018.
SEC. 4. Section 11469 of the Welfare and Institutions Code is
amended to read:
11469. (a) The department, in consultation with group home
providers, the County Welfare Directors Association of
California , the Chief Probation Officers of California, the
California Mental Health Directors Association, and the State
Department of Health Care Services, shall develop performance
standards and outcome measures for determining the effectiveness
of the care and supervision, as defined in subdivision (b) of
Section 11460, provided by group homes under the AFDC-FC program
pursuant to Sections 11460 and 11462. These standards shall be
designed to measure group home program performance for the
client group that the group home program is designed to serve.
(1) The performance standards and outcome measures shall be
designed to measure the performance of group home programs in
areas over which the programs have some degree of influence, and
in other areas of measurable program performance that the
department can demonstrate are areas over which group home
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programs have meaningful managerial or administrative influence.
(2) These standards and outcome measures shall include, but are
not limited to, the effectiveness of services provided by each
group home program, and the extent to which the services
provided by the group home assist in obtaining the child welfare
case plan objectives for the child.
(3) In addition, when the group home provider has identified as
part of its program for licensing, ratesetting, or county
placement purposes, or has included as a part of a child's case
plan by mutual agreement between the group home and the placing
agency, specific mental health, education, medical, and other
child-related services, the performance standards and outcome
measures may also measure the effectiveness of those services.
(b) Regulations regarding the implementation of the group home
performance standards system required by this section shall be
adopted no later than one year prior to implementation. The
regulations shall specify both the performance standards system
and the manner by which the AFDC-FC rate of a group home program
shall be adjusted if performance standards are not met.
(c) Except as provided in subdivision (d), effective July 1,
1995, group home performance standards shall be implemented. Any
group home program not meeting the performance standards shall
have its AFDC-FC rate, set pursuant to Section 11462, adjusted
according to the regulations required by this section.
(d) A group home program shall be classified at rate
classification level 13 or 14 only if all of the following are
met:
(1) The program generates the requisite number of points for
rate classification level 13 or 14.
(2) The program only accepts children with special treatment
needs as determined through the assessment process pursuant to
paragraph (2) of subdivision (a) of Section 11462.01.
(3) The program meets the performance standards designed
pursuant to this section.
(e) Notwithstanding subdivision (c), the group home program
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performance standards system shall not be implemented prior to
the implementation of the AFDC-FC performance standards system.
(f) On or before January 1, 2016, the department, in
consultation with the County Welfare Directors Association of
California , the Chief Probation Officers of California, the
California Mental Health Directors Association, research
entities, foster youth, advocates for foster youth, foster care
provider business entities organized and operated on a nonprofit
basis, Indian tribes, and other stakeholders, shall develop
additional performance standards and outcome measures that
require group homes to implement programs and services to
minimize law enforcement contacts and delinquency petition
filings arising from incidents of allegedly unlawful behavior by
minors occurring in group homes or under the supervision of
group home staff, including individualized behavior management
programs, emergency intervention plans, and conflict resolution
processes.
(g) On or before January 1, 2017, the department, in
consultation with the County Welfare Directors Association of
California , the Chief Probation Officers of California, the
California Mental Health Directors Association, research
entities, foster youth, advocates for foster youth, foster care
provider business entities organized and operated on a nonprofit
basis, Indian tribes, and other stakeholders, shall develop
additional performance standards and outcome measures that
require group homes to implement programs and services to reduce
the utilization of psychotropic medications for children in
group homes, including individualized behavior management
programs, emergency intervention plans, and conflict resolution
processes.
SEC. 5. No reimbursement is required by this act pursuant
to Section 6 of Article XIIIB of the California Constitution
because the only costs that may be incurred by a local agency or
school district will be incurred because this act creates a new
crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the
meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article
XIII B of the California Constitution.
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