BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1220 (McGuire) - Child welfare services: case plans:
behavioral health services
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|Version: April 6, 2016 |Policy Vote: HUMAN S. 5 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 2, 2016 |Consultant: Jolie Onodera |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 1220 would require a county social worker to
complete the following activities with regard to a child's case
plan:
Include a summary or copy of the treatment plan
developed for a child who has been assessed as needing
behavioral health services.
Redact information that is otherwise confidential
regarding the child's condition or treatment in order to
include the treatment plan as part of the case plan.
Indicate in the case plan if a treatment plan has not
been finalized, and update the plan at the next regular
hearing after the treatment plan has been finalized.
Attach the treatment plan to a request to authorize the
administration of psychotropic medication submitted to the
court, as specified.
Fiscal
SB 1220 (McGuire) Page 1 of
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Impact:
Additional social worker activities : Potential increase in
social worker time for case management activities, potentially
in the range of $340,000 to $675,000 (General Fund*) annually
to read through the treatment plans and redact confidential
information. These activities could be required more than once
annually, as the guidelines require review and re-assessment
of the treatment plans to ensure they remain current and
appropriate based on the child's progress. No significant
workload impact is estimated to attach the treatment plan to
the psychotropic medication authorization to the court.
*Proposition 30 (2012) : Exempts the State from mandate
reimbursement for realigned responsibilities for "public
safety services" including the provision of child welfare
services, however, legislation enacted after September 30,
2012, that has an overall effect of increasing the costs
already borne by a local agency for public safety services
apply to local agencies only to the extent that the State
provides annual funding for the cost increase. The provisions
of Proposition 30 have not been interpreted through the formal
court process to date, however, to the extent the local agency
costs resulting from this measure are determined to be
applicable under the provisions of Proposition 30, could
result in additional costs to the State.
Background: Existing law requires a county social worker to create a case
plan for foster youth within a specified timeframe after the
child is introduced into the foster care system. Existing law
requires the case plan to be developed considering the
recommendations of the child and family team according to
specified requirements, including, among others, a requirement
that the child be involved in developing the case plan as age
and developmentally appropriate.
The California Guidelines for the Use of Psychotropic Medication
with Children and Youth in Foster Care (2015), jointly released
by the Department of Social Services and the Department of
Health Care Services provide a statement of best practices for
the treatment of children and youth in out of home care, some of
who may require the administration of psychotropic medications.
The Guidelines outline expectations regarding the development
and monitoring of treatment plans, the principles for emotional
and behavioral health care, psychosocial services, and
non-pharmacological treatments, and the principles governing
SB 1220 (McGuire) Page 2 of
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medication safety.
According to the Guidelines, "Children who have emotional,
cognitive, and/or behavioral dysregulation require a variety of
interventions to alleviate their symptoms and to promote optimal
psychosocial functioning and development. If the child or youth
meets Katie A. class or sub-class criteria, then the treatment
plan is a product of the Child and Family Team (CFT)?Treatment
plan elements include identified socio-emotional and behavioral
concerns, immediate and longer term treatment goals, and
interventions that are realistic for the child and family?the
treatment plan should be reviewed and re-assessed by the
treatment team, child, family, and supportive collaterals as
needed or as indicated by Katie A. status to ensure it remains
current and appropriate based on the child and family's progress
in services."
The Guidelines identify the components to be included in a best
practice treatment plan, as follows:
The child's diagnosis and a conceptualization of the
child's emotional, cognitive, and/or behavioral
dysregulation based on the child's history of abuse,
neglect, and/or removal from the home.
The child's baseline strengths and needs.
Target symptoms: stated in practical and everyday
language as agreed to by the child, family, and their
support network or CFT.
Client-driven short and long term treatment goals:
stated in ways that can be observed and measured on a
regular basis by specified means.
Treatment interventions: evidence-supported treatments,
additional psychosocial interventions such as substance
abuse prevention or treatment, case management, informal
mental health services, educational or behavioral services,
and/or extra-curricular and recreational activities. All
identified treatments and interventions should have start
dates. Psychotropic medications (if part of the Treatment
Plan) also should include a re-assessment date. If
medications are utilized, the dosage and medication
monitoring schedule must be specified.
Treatment and intervention periodic review and
reassessment: formal treatments, e.g. evidence-supported
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psychotherapeutic treatments as well as psychotropic
medications, are periodically reviewed by the child,
family, and CFT as indicated.
Updated medication treatment plans must be communicated
as an attachment to the JV220, as well as shared with the
child/youth, family caregiver, and child welfare social
worker and/or probation officer for distribution to all
necessary parties in accordance with HIPAA.
This bill seeks to ensure each child's case plan includes the
necessary, updated information from a child's treatment plan to
ensure compliance by all parties involved with the child's care
consistent with the best practices outlined in the Guidelines.
Proposed Law:
This bill would require a county social worker to complete the
following activities with regard to a foster youth's case plan:
Requires that a case plan for a child who has been
assessed as needing behavioral health services shall
include a summary or copy of the treatment plan developed
for the child.
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.
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.
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.
Prior
Legislation: SB 238 (Mitchell) Chapter 534/2015 requires
additional training on psychotropic medications for foster care
providers, and requires the DSS 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
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under Medi-Cal.
Staff
Comments: By increasing the tasks county social workers must
perform, this bill could potentially result in additional
ongoing state costs. It is estimated there will be an increase
in administrative time associated with the following duties of
social workers:
Coordinating with the child's treating provider in order to
obtain a treatment plan.
Updating the child's case plan to reflect whether or not the
treatment plan has been included or finalized.
Follow up with the child's treating provider to obtain a
treatment plan should it not be available at initial
completion of the child's case plan.
Reading through the treatment plan and redacting any
confidential information from the treatment plan that should
not be included as part of the case plan.
No significant workload increase is estimated for social workers
to attach the treatment plan to the JV220.
To the extent the required social worker activities would add an
additional 30 minutes of social worker time per update per child
for an estimated 9,300 case plans, additional costs could range
from $340,000 to $675,000 per year, based on the social worker
hourly cost of $72.60. To the extent the number of case plans to
review is larger or smaller in any one year, or to the extent
the time required to coordinate with the child's provider, read
through treatment plans, and redact confidential information is
greater or less than 30 minutes per update, costs would be
affected accordingly.
Proposition 30, passed by the voters in November 2012, among
other provisions, eliminated any potential mandate funding
liability for any new program or higher level of service
provided by counties related to realigned programs. Although the
provisions increasing social worker activities are a mandate on
local agencies, any increased costs would not be subject to
reimbursement by the state. Rather, Proposition 30 specifies
that for legislation enacted after September 30, 2012, that has
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an overall effect of increasing the costs already borne by a
local agency for realigned programs such as child welfare
services, the provisions shall apply to local agencies only to
the extent that the state provides annual funding for the cost
increase.
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