BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1220|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: SB 1220
Author: McGuire (D)
Amended: 4/6/16
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/12/16
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SUBJECT: Child welfare services: case plans: behavioral
health services
SOURCE: Author
DIGEST: 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.
ANALYSIS: Existing federal law 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))
Existing state law:
1)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)
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2)Establishes a state and local system of child welfare
services, including foster care, for children who have been
adjudged by the court to be at risk or have been abused or
neglected, as specified. (WIC 202, et seq.)
3)Makes a 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)
4)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 other considerations, as defined. (WIC 16501.1
(d))
5)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, and other
information. (WIC 16501.1 (f))
6)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:
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1)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.
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.
Background
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 2015, about 62,600 children were in
the custody of the child welfare system in California.
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. 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
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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 the Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) program 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. 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.
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
the Department of Health Care Services (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.
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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 the Department
of Social Services (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 DSS released
state guidelines for the use of psychotropic medication with
children and youth in foster care.
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 issued
jointly by DSS 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. The
report states, "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."
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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
Child and Family Team (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 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 the Health Insurance Portability
and Accountability Act.
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.
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Related/Prior 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 to review each county's plan and
report to the state.
SB 1466 (Mitchell, 2016) requires screening services under the
children's Medi-Cal 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 DSS to provide a monthly report to each
county 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) required the state
departments to develop data methodology to identify and
investigate group homes that are potentially overmedicating
children and youth in their care.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Committee on Appropriations, this bill
would incur a 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.
SUPPORT: (Verified 5/27/16)
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None received
OPPOSITION: (Verified5/27/16)
None received
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
5/28/16 17:15:07
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