BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 1220
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|Author: |McGuire |
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|Version: |April 6, 2016 |Hearing |April 12, 2016 |
| | |Date: | |
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|Urgency: |No |Fiscal: |No |
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|Consultant|Mareva Brown |
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Subject: Child welfare services: case plans: behavioral health
services
SUMMARY
This bill requires that a case plan for a child who has been
assessed as needing behavioral health services must include a
summary or copy of the treatment plan developed for the child.
If the treatment plan has not yet been finalized, the case plan
must indicate that fact and be updated at the next regular court
hearing after the treatment plan has been finalized.
ABSTRACT
Existing law:
1) Under federal statute, vests responsibility for caring
for a child who has been removed from home and placed in
foster care with the state and any public agency which is
administering the foster care plan with the state. (42
U.S.C. 672 (a)(2)(B))
2) Under state statute, places the care of a child who has
been removed from his or her parents or guardian under the
jurisdiction of the juvenile court and defines abuse and
neglect criteria for such removal. (WIC 300 et seq)
3) Establishes a state and local system of child welfare
services, including foster care, for children who have been
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adjudged by the court to be at risk or have been abused or
neglected, as specified. (WIC 202 et seq.)
4) Makes Legislative declaration that the foundation and
central unifying tool in child welfare services is the case
plan, and that a case plan ensures that the child receives
protection and safe and proper care and case management,
and that services are provided to the child and parents or
other caretakers, as appropriate, in order to improve
conditions in the parent's home, to facilitate the safe
return of the child to a safe home or the permanent
placement of the child, and to address the needs of the
child while in foster care. (WIC 16501.1)
5) Requires that a case plan include such information as a
description of the type of home or institution in which the
child is to be placed, the reasons for that placement
decision, and considerations that must be made, as defined.
(WIC 16501.1 (d))
6) Requires the child welfare services case plan be
comprehensive enough to meet the juvenile court dependency
proceedings requirements, as defined, and specifies a
number of items to be included in the case plan, such as a
written description of the programs and services that will
help the child, documenting a child's readiness to
transition from the child welfare system, foster youth's
rights and other information. (WIC 16501.1 (f))
7) Restricts the authority to make orders regarding the
administration of psychotropic medications for a foster
child to a juvenile court officer, as specified, and
mandates that court authorization for the administration of
psychotropic medication shall be based on a request from a
physician, indicating the reasons for the request, a
description of the child's diagnosis and behavior, the
expected results of the medication, and a description of
any side effects of the medication. (WIC 369.5)
This bill:
1) Requires that a case plan for a child who has been
assessed as needing behavioral health services shall
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include a summary or copy of the treatment plan developed
for the child.
2) Requires that if the treatment plan has not been
finalized, the case plan must indicate that fact and shall
be updated at the next regular court hearing after the
treatment plan has been finalized.
3) Requires that information that is otherwise confidential
regarding the child's condition or treatment be redacted in
order to include the treatment plan as a part of the case
plan.
4) Requires the summary or copy of the treatment plan to be
provided to the social worker by the child's physician or
county clinician, and that the social worker shall attach
the treatment plan to a request to authorize the
administration of psychotropic medication submitted to the
court, as specified.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
This bill requires that if a treatment plan is completed for a
child who is being approved for psychotropic medication, that
the treatment plan be attached to the judicial request form. The
author states that the language of this bill comes from the
state's "Guidelines of the Use of Psychotropic Mediation with
Children and Youth in Foster Care," jointly released by the
state departments of Social Services and Health Care Services
and is an important tool in the state's efforts to reduce the
unnecessary use of psychotropic medications in foster youth. The
author states that psychotropic medication should only be
prescribed to the children and youth in California's care as
part of a comprehensive treatment plan that includes
evidence-based or best practices for non-pharmacological
interventions.
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Child Welfare System
California's county-based child welfare system protects children
at risk of child abuse and neglect or exploitation by providing
intensive services to families to allow children to remain in
their homes, or by arranging temporary or permanent placement of
the child in the safest and least restrictive environment
possible. It is the legal "parent" for children in the foster
care system. As of October 1, 2015, Approximately 62,600
children were in the custody of the child welfare system in
California.<1>
A series of national studies have documented the poor outcomes
of children and youth who are removed from their homes into the
child welfare system. Children have increased rates of chronic
health problems, developmental delays and disabilities, mental
health needs, and substance abuse problems.<2> Many youth have
experienced traumatic events that lead to symptoms such as
depression, behavior problems, and emotional difficulties.
Twenty-five percent of youth who age-out of care experience
Post-Traumatic Stress Disorder-double the rate of U.S. war
veterans, according to the report. Nationally, the birth rate
for teen girls in foster care is more than double that for those
outside the foster care system.
Mental health treatment
California's county-operated mental health system provides a
range of "specialty" mental health services and supports to
Medi-Cal beneficiaries and other vulnerable individuals whose
mental health needs are serious, including foster youth. Youth
with mild to moderate mental health needs, which are not covered
by the county mental health plans, are intended to be provided
by Medi-Cal managed care plans. Foster children and other
children enrolled in Medi-Cal are eligible for EPSDT, which
provides for periodic screenings to determine a child's needs
and, based upon the identified health care need, treatment
services that are to be provided.
Psychotropic medications and foster youth
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<1>http://cssr.berkeley.edu/ucb_childwelfare
<2>
http://www.childrensaidsociety.org/files/upload-docs/report_final
_April_2.pdf
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Psychotropic medications include drugs prescribed to manage
psychiatric and mental health disorders such as bipolar
disorder, schizophrenia, depression, obsessive-compulsive
disorder, attention deficit hyperactivity disorder (ADHD) and
others. These medications include antipsychotics such as
Seroquel, antidepressants like Prozac, mood stabilizers
including Lithium, and stimulants like Ritalin. Researchers and
administrators at the federal Health and Human Services Agency
have expressed significant concern over the use of psychotropic
medications for children, because effects can include aggressive
behavior, hostility, seizures, significant weight gain, and
because the long-term effects for children using these drugs are
largely unknown. One class of psychotropic medications,
antipsychotics, raises particular concern: These are potent
drugs with a high potential for side-effects, and there is
little known about their impact on children's neurological
systems.
The use of psychotropic medication among children in foster care
is of particular concern. Research has repeatedly indicated that
these children face heightened levels of medication use, and
that those foster youth placed in group home settings are
particularly vulnerable to over-prescription. Data provided by
DHCS indicates that, in fiscal year 2013-14, almost 15 percent
of all foster youth in California aged 0 to 20 were prescribed
at least one psychotropic medication. Nearly one in four foster
youth between age 12 and 20 was prescribed at least one
psychotropic medication and, among youth in group homes, the
rate rose to half of all youth.
In late 2011, the U.S. Department of Health and Human Services
issued a letter to states encouraging them to appropriately
prescribe and monitor psychotropic medication among children
placed in out-of-home care. As a result, DHCS and DSS developed
the Quality Improvement Project to strengthen the state's
Medicaid and child welfare services system by, among other
things, improving safe and appropriate prescribing and
monitoring of psychotropic drugs; this project has enabled the
state to access the knowledge and perspectives of various
experts. In 2015, DHCS and CDSS released state guidelines for
the use of psychotropic medication with children and youth in
foster care.
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In two hearings last year, the Senate Human Services and Health
committees heard testimony that breakdowns in the provision of
effective trauma-informed psychosocial services has led to
system-wide failures in treating children. In many of these
cases, psychotropic medication was seen as the only available
treatment option. Widespread reports from foster youth,
caregivers, children's attorney's and others report a lack of or
delayed delivery of mental health services that leave many
children without appropriate treatment.
State Guidelines for the Use of Psychotropic Medication with
Children and Youth in Foster Care
The Guidelines were jointly issued by the CDSS and DHCS in 2015
in response to concern about a growing percentage of foster
youth who were receiving psychotropic medications. The
guidelines provide best practice for the treatment of children
and youth in out of home care, and to be used in conjunction
with several other significant reform efforts that are underway
to improve the lives of foster youth, and of foster youth with
mental illness.
"These children and youth may require psychotropic
medications. Depending on the nature, severity and
persistence of their symptoms, medication may be indicated
as part of an initial treatment plan (as with ADHD, major
depression, psychosis and disabling anxiety); may be
considered only after appropriate psychosocial
interventions are employed (as with moderate
anxiety/depression); or may not be indicated at all (as
with learned defiance and "predatory" aggression). When
psychotropic medication is indicated, it should be used in
conjunction with psychosocial interventions. The exception
is when psychosocial interventions have been effective and
are therefore terminated but continued use of medication is
necessary to prevent the recurrence of symptoms."
Related legislation:
SB 1291 (Beall, 2016) requires each county to develop a foster
care mental health plan and define its scope of services for
annual submission to DHCS. It additionally requires an External
Quality Review Organization (EQRO) to review each county's plan
and report to the state.
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SB 1466 (Mitchell, 2016) requires screening services under the
children's Medi-Cal Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) Program to include screening for trauma.
SB 238 (Mitchell, Chapter 534, Statutes of 2015) required
additional training on psychotropic medications for foster care
providers, and required the California Department of Social
Services (CDSS) to provide a monthly report to each county
placing agency with information about each child for whom one or
more psychotropic medications have been paid for under Medi-Cal.
SB 484 (Beall, Chapter 540, Statutes of 2015) requires the state
departments to develop data methodology to identify and
investigate group homes that are potentially overmedicating
children and youth in their care.
POSITIONS
Support:
None received.
Oppose:
None received.
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