BILL ANALYSIS Ó
SB 484
Page 1
SENATE THIRD READING
SB
484 (Beall)
As Amended August 28, 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 | |
| | | | |
|----------------+-----+----------------------+--------------------|
|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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SB 484
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SUMMARY: Requires the collection of information on the
administration of psychotropic medications to foster youth
placed in group homes, and adopts measures aimed at reforming
the practices of those group homes with levels of psychotropic
medication utilization that warrant additional review.
Specifically, this bill:
1)Requires that psychotropic medications for youth in group
homes be used only in accordance with the written directions
of the prescribing physician and as authorized by the juvenile
court, as specified.
2)Requires group home facilities to maintain in a child's
records a copy of any court order authorizing psychotropic
medication, as well as a separate log for each prescribed
psychotropic medication that contains information about that
medication and its administration, as specified.
3)Clarifies that the Department of Social Services (DSS), and
not its director, is responsible for publishing and making
available a list or lists covering all community care
facilities and the services for which they are licensed, as
specified.
4)Requires DSS to compile, at least once per year and to the
extent feasible, Health Effectiveness Data and Information Set
(HEDIS) data, as specified and to include:
a) Follow-up care for children prescribed attention deficit
hyperactivity disorder medication;
b) Use of multiple concurrent antipsychotics in children
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and adolescents;
c) Use of first-line psychosocial care for children and
adolescents on antipsychotics; and
d) Metabolic monitoring for children and adolescents on
antipsychotics.
5)Requires DSS to post the list of data to be collected pursuant
to this bill on its Internet Web site.
6)Requires DSS to consult with the Department of Health Care
Services (DHCS) and stakeholders to establish a methodology,
by July 1, 2016, for identifying group homes that have levels
of psychotropic drug utilization warranting further review.
Further, requires periodic review of this methodology if
necessary.
7)Requires DSS to inspect annually any facility found to have
levels of psychotropic drug utilization warranting additional
review. Further, requires this annual inspection to include,
but not be limited to, the following:
a) A review of the facility's: plan of operation, policies,
procedures, and practices; child-to-staff ratios; staff
qualifications and training; implementation of children's
needs and services plans; availability of psychosocial and
other alternative treatments to the use of psychotropic
medications; other factors that the department determines
contribute to levels of psychotropic drug usage warranting
additional review; and
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b) Confidential interviews with children living in the
facility at the time of the inspection.
8)Permits the inspection to also include, but not be limited to,
confidential interviews of children who resided in the
facility within the last six months and confidential
discussions with prescribing physicians.
9)Requires DSS to share relevant information or observations
from inspections with specified parties.
10)Requires facilities to submit a plan of correction, as
specified, if DSS finds a risk to the health, safety or
personal rights of clients in care, and requires the
department to monitor the implementation of this plan, as
specified.
11)Requires DSS to adopt emergency regulations by January 1,
2017, to implement this bill, as specified, and to adopt final
regulations by January 1, 2018. Further, permits DSS to
implement this bill through all-county letters or similar
instructions until emergency regulations are filed with the
Secretary of State.
12)States that nothing in this bill is intended to replace or
alter other requirements regarding group home complaints,
inspections, or visits.
13)Requires DSS, by January 1, 2017, and in consultation with
specified entities, to develop additional performance
standards and outcome measures that require group homes to
implement alternative programs and services for children in
group homes, as specified.
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14)Exempts runaway and homeless shelters, as specified, from the
bill's data collection and reporting and inspection
requirements.
15)Requires DSS to, at least once per year, post a statewide
summary of the information gathered pursuant to this bill on
its Internet Web site, as specified.
EXISTING LAW:
1)Establishes the California Community Care Facilities Act to
provide for the licensure and regulation of community care
facilities. (Health and Safety Code (HSC) Section 1500 et
seq.)
2)Requires DSS to conduct unannounced visits of each licensed
community care facility, except for foster family homes, and
requires that no facility or center be visited less frequently
than once every five years. Further requires DSS to conduct
annual unannounced visits of licensed facilities under
specified circumstances, such as when a license is on
probation. Additionally requires annual visits of a random
sample of at least 20% of facilities and centers not subject
to annual inspections for specified circumstances and states
that, should the total citations for this 20% of facilities
and centers exceed the previous year's by 10%, the random
sample subject to annual inspection shall increase in the next
year by 10%. Because of this trigger, 30% of eligible
facilities and centers are now randomly sampled each year for
inspection. (HSC Section 1534)
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3)Requires DSS, in consultation with group home providers and
other stakeholders, to develop performance standards to
measure group home program performance. (Welfare and
Institutions Code (WIC) Section 11469)
4)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 limited to, anxiolytic agents, antidepressants, mood
stabilizers, antipsychotic medications, anti-Parkinson agents,
hypnotics, medications for dementia, and psychostimulants.
(WIC Section 369.5 (d))
5)States that only a juvenile court judicial officer has the
authority to make orders for the administration of
psychotropic medications for a minor who has been adjudged a
dependent of the court. (WIC Section 369.5)
FISCAL EFFECT: According to the Assembly Appropriations
Committee, this bill may result in the following costs:
1)Ongoing costs in the range of $300,000 to $600,000 (General
Fund (GF)) per year to DSS to conduct annual site visits at
group homes identified as having disproportionately high and
inappropriate levels of psychotropic medication use by foster
youth. There are about 1,000 group homes in the state. The
costs above assume that DSS identifies the top 10% to 20% of
group homes for additional scrutiny.
2)One time costs of approximately $250,000 (GF) to DSS to
compile information on group homes, consult with stakeholders,
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and develop a methodology to identify group homes for
additional scrutiny.
3)Ongoing costs of $130,000 ($65,000 GF) to DHCS to identify,
evaluate and collate claims data packages to be used for the
purposes of this bill.
COMMENTS:
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%.
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Need for this bill: According to the author:
More than half of the children in our state's
institutions for foster children ('group homes') are
medicated with powerful psychotropic drugs.
Resistance to taking the drugs can be, and is,
punished by expulsion from the facility. The most
problematic of the medications are the 'antipsychotic'
drugs designed to suppress the most uncontrollable
behavior of schizophrenics. As a witness at last
year's Congressional hearing said, 'these drugs are
too often misused as "chemical straitjackets." This
is a haphazard attempt to simply control and suppress
undesirable behavior, rather than treat, nurture and
develop these treasured young people.' Causes of
overmedication include: poorly trained staff; sedated
children allow for reduced staffing ratios; lack of
therapeutic intervention alternatives; energetic
promotion by manufacturers; and lack of state
oversight.
Analysis Prepared by:
Daphne Hunt / HUM. S. / (916) 319-2089 FN:
0001728
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