BILL ANALYSIS Ó
SB 1220
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Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Susan Bonilla, Chair
SB
1220 (McGuire) - As Amended April 6, 2016
SENATE VOTE: 39-0
SUBJECT: Child welfare services: case plans: behavioral
health services
SUMMARY: Requires that a summary or copy of a treatment plan be
included in the case plan of a child who is within the
jurisdiction of the child welfare system and who has been
assessed as needing behavioral health services, as specified.
Specifically, this bill:
1)Requires the following for a case plan developed considering
the recommendations of the child and family team for a child
in the child welfare system who has been assessed as needing
behavioral health services:
a) Include a summary or copy of the treatment plan
developed for the child;
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b) If a treatment plan for a child who has been assessed as
needing behavioral health services has not yet been
finalized, reflect that fact in the child's case plan, and
update the case plan at the next regular hearing after the
treatment plan has been finalized; and
c) Redact any confidential information in the treatment
plan regarding the child's condition or treatment.
2)Requires a child's physician or county clinician to provide a
summary or copy of the treatment plan to the child's social
worker.
3)Requires the child's social worker to attach the treatment
plan to a request to authorize administration of psychotropic
medication submitted to the court, as specified.
EXISTING LAW:
1)Permits the juvenile court to adjudge a child a dependent of
the court for specified reasons, including, but not limited
to, if a child has suffered or is at substantial risk of
suffering serious physical harm, emotional damage, or sexual
abuse, as specified. (WIC 300)
2)States that the purpose of foster care law is to provide
maximum safety and protection for children who are currently
being physically, sexually, or emotionally abused, neglected,
or exploited, and to ensure the safety, protection, and
physical and emotional well-being of children who are at risk
of harm. (WIC 300.2)
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3)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 369.5 (d))
4)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 369.5)
5)Defines "child and family team" as a group of individuals who
are convened by the placing agency and who are engaged through
a variety of team-based processes to identify the strengths
and needs of the child or youth and his or her family, and to
help achieve positive outcomes for safety, permanency, and
well-being. (WIC 16501 et seq.)
6)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, safe and proper care, and case management, and
that services are provided to the child and parents or other
caretakers 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)
FISCAL EFFECT: According to the Senate Appropriations Committee
on May 2, 2016, this bill may result in the following costs:
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1) 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.
2) 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.
COMMENTS:
Child Welfare Services: The purpose of California's Child
Welfare Services (CWS) system is to protect children from abuse
and neglect and provide for their health and safety. When
children are identified as being at risk of abuse, neglect or
abandonment, county juvenile courts hold legal dependency
jurisdiction; these children are served by the CWS system
through the appointment of a social worker. Through this
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juvenile dependency system, there are multiple opportunities for
the custody of the child, or his or her placement outside of the
home, to be evaluated, reviewed and determined by the judicial
system, in consultation with the child's social worker, to help
provide the best possible services to the child.
The CWS system seeks to help children who have been removed from
their homes reunify with their parents or guardians, whenever
appropriate. However, the court may determine that an alternate
permanent placement is more fitting; the court must give
preference to potential placements in this order: relatives,
nonrelative extended family members, or family foster homes.
First-priority settings for a child who has been removed from
his or her home have been and continue to be home-based family
settings; however, placement in group homes or other intensive
treatment placement settings are considered only in more
challenging situations where a child may require a specific
level of treatment. There are currently close to 63,000
children and youth in California's CWS system.
Case plans: A case plan is considered the foundation and
unifying tool that provides an overview of a child's needs and
services. Current law requires that the written case plan be
completed within a maximum of 60 days of the initial removal of
the child, or by the date of the dispositional hearing,
whichever is first. The case plan provides a centralized file
that includes: a description of the type of home or institution
in which the child is placed, the reasons for that placement
decision, including specific goals and appropriateness of the
planned services in meeting those goals, and the original
allegations of abuse or neglect or the conditions cited as the
basis for declaring the child a dependent of the court. Case
plans also detail the services provided to the child and their
parents, as well as any recommendations made by the child and
the family team, in order to ensure the protection and safe and
proper care of the child.
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Child and family teams are a recent development that emerged
from Continuum of Care Reform undertaken by DSS through AB 403
(Stone), Chapter 773, Statutes of 2015. Rather than relying on
a single social worker to make placement decisions, a child and
family team consists of a network of individuals tasked with
assessing the placement needs of a child or youth and exploring
alternative placement options to residential treatment-based
placements.
Challenges faced by foster youth: It is recognized that foster
youth may experience a number of challenges not experienced as
frequently by their peers who are not involved in the child
welfare system. Foster youth may be removed from the custody of
their parents due to abuse and neglect and can face myriad
challenges as a direct result of these experiences. Because the
childhood of a foster youth can be marked by instability and a
lack of sufficient care by adult role models, foster youth may
be more likely to experience mental and emotional health issues
that follow them into adulthood.
In California, 77% of foster youth experience three or more
placements; research has shown that placement instability can
result in youth becoming disengaged from their caregivers and
other adults. Many foster youth may not be afforded the
opportunity to form healthy attachments with the adults in their
lives. This lack of trusting, consistent relationships with
adults can result in attachment disorders in foster youth.
Psychotropic medications and foster youth: Psychotropic drugs
are prescribed to manage psychiatric and mental health disorders
or issues such as depression, obsessive compulsive disorder
(OCD), attention deficit hyperactivity disorder (ADHD), bipolar
disorder (BPD), schizophrenia, and others. These medications
include antipsychotics such as Chlorpromazine, antidepressants
like Prozac, mood stabilizers including Lithium, and stimulants
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like Ritalin. 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.
Psychotropic medications may also be prescribed to children for
"off-label" use, meaning they are used to treat symptoms other
than those for which the drug was originally approved by the
Federal Food and Drug Administration (FDA). While conclusive
research on the effects of psychotropic medication on children's
brains may be lacking, a study published by the University of
Iowa in 2013 illustrated negative effects of antipsychotics, not
the underlying illness, on the adult brain. Side effects of
these drugs (including rapid weight gain and diabetes), however,
are well-documented. In a 2009 study published by the Journal
of American Medical Association (JAMA) Psychiatry, children on
antipsychotics added up to 15% of their body weight in less than
two weeks. Of the study's 257 participants, each of them gained
weight.
While the number of foster youth in California has declined from
over 100,000 in 2004 to around 60,000 today, the number of youth
on psychotropic medication has remained relatively stable. Of
these children, white males over the age of 12 are most likely
to be prescribed psychotropic drugs, and 62% of all children on
psychotropic drugs, including those under the age of 12, are
prescribed antipsychotics, which are the strongest class of
drugs. Data provided by the Department of Health Care Services
(DHCS) indicate that, in fiscal year 2013-14, almost 15% of all
foster youth in California ages 0 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%.
In late 2011, the U.S. Department of Health and Human Services
issued a letter to states encouraging them to coordinate with
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partners who worked with foster youth to address enhanced
efforts to appropriately prescribe and monitor psychotropic
medication among children placed in out-of-home care.
Quality Improvement Project: In 2015, DHCS presented The
California Guidelines for the Use of Psychotropic Medication
with Children and Youth in Foster Care. Created in consultation
with the Department of Social Services (DSS) and relevant
stakeholders, the guidelines serve as a statement of best
practice for the treatment of children and youth in out-of-home
care. The guidelines include basic principles and values, the
principles for emotional and behavioral health care,
psychosocial services and non-pharmacological treatments,
principles for informed consent to medications, principles
governing medication safety, and expectations regarding the
development and monitoring of treatment plans. Treatment plans
often provide an overview to mental health professionals of what
a patient's current mental health challenges are and outline the
goals and strategies being utilized to assist the patient in
overcoming those challenges.
Need for this bill: According to the author's office,
"California's foster youth have experienced traumatic events
that lead to symptoms such as depression, behavioral problems,
and emotional difficulties. According to a 2013 report by the
Children's Aid Society, twenty-five percent of youth who age-out
of care experience Post-Traumatic Stress Disorder-double the
rate of U.S. war veterans.
The use of psychotropic medication among children in foster care
is of growing concern. Research has repeatedly indicated that
these children face heightened levels of medication use, and are
vulnerable to over-prescription. In fact, UC Berkeley reported
that over the past fifteen years, the rate of foster youth
prescribed psychotropic medication has increased 1,400 percent.
In 2011, the U.S. Department of Health and Human Services asked
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states to appropriately prescribe and monitor psychotropic
medication among children. As a result, the Department of
Health Care Services and the Department of Social Services
developed guidelines through the Quality Improvement Project to
improve the child welfare services system.
These guidelines provide an important tool in the state's
efforts to reduce the unnecessary use of psychotropic
medications in foster youth, outlining that psychotropic
medication should only be prescribed as part of a comprehensive
treatment plan that includes evidence-based or best practices
for non-pharmacological interventions- this means therapy and
other mental health services are required.
[This bill] will codify the use of the treatment plan as part of
the case plan which is the document which stays with the youth
the entire time they are in the State Foster Care System. It
requires that if a treatment plan is completed for a child who
is being approved for psychotropic medication, the treatment
plan needs to be attached to the judicial request form."
RELATED LEGISLATION:
SB 253 (Monning), 2015, would revise and strengthen juvenile
court practices and requirements for the administration of
psychotropic medications to wards and dependents of the juvenile
court. This bill is currently on the inactive file on the
Assembly Floor.
SB 238 (Mitchell), Chapter 534, Statutes of 2015, required DSS
to develop expanded training for foster parents, social workers,
group home administrators, and others involved in the care and
oversight of dependent children on issues related to
psychotropic medications. It further required Judicial Council
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to, in consultation with other entities, update court forms
related to the authorization of psychotropic medications, and
required DSS to establish an individualized monthly report and
other tools for use by county welfare agencies to monitor the
administration of psychotropic medications to foster youth.
SB 319 (Beall), Chapter 535, Statutes of 2015, added to the
duties of foster care public health nurses, including monitoring
each child in foster care who is administered one or more
psychotropic medications.
SB 484 (Beall), Chapter 540, Statutes of 2015, required DSS to
compile and post on its Internet Web site specified information
regarding the administration of psychotropic medications to
children placed in group homes and to establish a methodology
for identifying group homes with high levels of psychotropic
drug use. It further established certain requirements for those
group homes.
REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file.
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Analysis Prepared by:Kelsy Castillo / HUM. S. / (916)
319-2089