BILL ANALYSIS
AB 1655
Page 1
Date of Hearing: March 23, 2010
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall, Jr., Chair
AB 1655 (Evans) - As Introduced: January 15, 2010
SUBJECT : Dependent children: psychotropic medications
SUMMARY : Establishes a pilot in three counties to add
requirements to the court approval process for the
administration of psychotropic medications to foster children
and increase oversight following approval. Specifically, this
bill :
1)Requires the Department of Social Services (DSS), in
consultation with the California Welfare Directors
Association, Judicial Council, and the California Mental
Health Directors Association, to select three counties to
participate in the pilot.
2)Adds the child's medical history, additional information
regarding side effects and risks associated with medications,
and a description of recommended therapy to the information
that must be submitted to the court as a basis for the
authorization of psychotropic medications.
3)Requires the physician submitting the request to conduct a
medical examination of the child in compliance with Section
2242 of the Business and Professions Code (BPC).
4)Requires the juvenile court officer to make the following
findings prior to authorizing the administration of
psychotropic medication:
a) The child's caregiver and the child have been informed
about the recommended medications and the anticipated
benefits and side effects, as well as the right to request
a hearing prior to the authorization; and,
b) A plan is in place for the physician to monitor the
effectiveness and side effects of the child's medication in
consultation with the child's caregiver, mental health
provider and others, as appropriate.
5)Requires the child to attend any court hearing ordered
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pursuant to this section, unless the child waives his or her
right to attend or the court finds there is good cause for the
child's absence.
6)Clarifies that psychotropic medications may be administered
without court authorization in emergency situations pursuant
to Section 369 of the Welfare and Institutions Code (WIC).
7)Requires DSS to report to the Legislature on the demographic
data of foster youth prescribed psychotropic medications as
part of the pilot and mental health outcomes for these youth,
with input from stakeholders before July 1, 2014.
8)Sunsets provisions of this bill on January 1, 2015.
EXISTING LAW
1)Defines psychotropic medications as those medications
affecting the central nervous system used to treat psychiatric
disorders or illnesses. WIC 369.5, 739.5.
2)Requires court approval before psychotropic medications may be
administered to a foster child and allows the court to grant
that approval to a parent provided the parent does not pose a
danger to the child. WIC 369.5.
3)Requires the court to make the decision regarding the
administration of psychotropic medication based on a
physician's request with the following information specified:
a) The reasons for the request;
b) A description of the child's diagnosis and behavior;
c) The anticipated results of the medication; and,
d) A description of the medication's side effects.
4)Requires the judicial officer to provide written approval or
denial within seven court days of receipt of a completed
request or to set the matter for hearing at the request of the
parent, legal guardian, or the child's attorney. WIC 369.5.
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5)Provides the juvenile court with the option to order the
social worker to acquire psychiatric and other mental health
services to determine appropriate treatments for the child.
WIC 370.
6)Defines prescribing, dispensing, or furnishing dangerous drugs
without an appropriate prior examination and a medical
indication as unprofessional medical conduct, except as
specified. BPC 2242.
FISCAL EFFECT : Unknown
COMMENTS : While California already requires judicial officer
approval to administer psychotropic medications to foster youth,
this bill would increase that oversight in a three county pilot
so that the effectiveness of this treatment can also be
monitored and assessed. In addition, this bill would require
the court in participating counties to inform foster youth and
their caregivers regarding the plan to administer psychotropic
medications, and the potential side effects, and provide foster
youth with the ability to request a hearing prior to
authorization.
Need for this bill : According to the author:
Additional safeguards in the court approval process for
psychotropic medications requests are needed to ensure that
such medications are prescribed by qualified professionals
who have access to complete an accurate information about
the child's medical history and current condition; that
youth themselves and their parents or caregivers are
informed and given an opportunity to participate in
decisions about medication and other mental health
treatment; that effectiveness and side effects of
medications are carefully monitored; and that medication is
accompanied by therapy or other behavioral interventions as
appropriate.
The author of this bill points out that psychotropic medications
are an effective treatment for some youth in the foster care and
youth probation systems for conditions that affect their safety,
emotional well-being, and their ability to succeed in school.
However, the author also notes that mental health professionals,
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children's advocates and former foster youth have expressed
concerns in recent years regarding possible overuse and under
use among children in the foster care and probation systems.
Additional background on the use of psychotropic medication
among foster youth: Foster youth testified before the
California Blue Ribbon Commission on Foster Care and the Select
Committee on Foster Care in 2006 that they had been administered
psychotropic medications as young as 4 or 5 years old, and that
they were often prescribed multiple medications at once.
According to their testimony, medications had been changed
frequently, as placements and mental health providers changed,
and serious side-effects from these medications included
drowsiness, weight gain, insomnia, drooling and facial tics.
Foster youth and foster youth advocates expressed concern
regarding the lack of monitoring and wrap-around therapeutic and
other behavioral interventions to attempt to address the
underlying need for medication.
Nationally, studies reveal that youth in foster care are three
to four times more likely than other low-income Medicaid-insured
children to receive psychotropic medications. Studies have also
indicated that among foster youth administered psychotropic
medications, over 40% were administered more than three
different classes of these drugs in 2004. A February 2009
Government Accountability Office (GAO) report to the
Congressional Committee on Ways & Means, "Foster Care: State
Practices for Assessing Health Needs, Facilitating Service
Delivery, and Monitoring Children's Care," found:
Concerns have been expressed that psychotropic medications
have frequently not been tested for their safety and
efficacy with children, and one study of children in foster
care found that the most frequently prescribed medication
was an antipsychotic drug that had not been tested for use
by children and adolescents.
Like most states, California does not yet have adequate data on
rates at which psychotropic medications are prescribed and
administered to foster children. However, in 2008, DSS issued
an All County Letter directing counties to track the percent of
children in foster care who have been authorized to receive
psychotropic medications by court order or parental consent
pursuant to AB 636 (Steinberg), Chapter 678, Statutes of 2001.
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Sponsor of the bill, the California Youth Law Center of Los
Angeles, states:
The results of the pilot projects will be very helpful in
guiding future legislation, policy and practice in this
important and complex issue?
As a result of the trauma they have experienced, many youth
in foster care suffer from mental health problems that can
affect their safety and well-being. For some of these
children, psychotropic medications are a key part of
effective mental health care. Existing law provides for a
court approval process for psychotropic medications for
foster children, but does not ensure that courts have all
the information they need to make fully informed decisions
about medication issues, does not ensure that foster youth
are fully informed and have an opportunity to participate
in medication decisions, and does not provide for ongoing
oversight and monitoring of children's medications?.
Los Angeles County, through the initiative of our Presiding
Judge Michael Nash, and our county's Department of Children
and Family Services, has already voluntarily adopted a
medication monitoring and oversight process very similar to
what AB 1655 would create. Our experience with this
process has demonstrated that these enhanced safeguards can
be successfully implemented in the state's largest
county-without unmanageable increases in cost or workload.
Related legislation:
This bill is substantially similar to AB 82 (Evans), introduced
last year. AB 82 was vetoed by Governor Schwarzenegger with the
following veto message:
I am returning Assembly Bill 82 without my signature.
While this bill advances an appropriate policy objective
that I would normally be inclined to support, I cannot in
this current fiscal environment. The implementation and
oversight of a new pilot program, requiring increased
monitoring and evaluation is labor-intensive, especially as
both state and county welfare programs are struggling with
their existing mandated activities.
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For this reason, I am unable to sign this bill.
SB 543 (Bowen), Chapter 552, Statutes of 1999 established the
judicial authorization requirement for the administration of
psychotropic medication for foster children. Concerns over the
potential overuse of psychotropic medication for children in
foster care and the inappropriateness of allowing parents whose
children were removed to consent to the use of such medications
(unless the juvenile court specifically determined that they
should have such authority) prompted the introduction of SB 543.
SB 543 specified that only a juvenile court judicial officer
has the authority to make orders regarding the administration of
psychotropic medication, except when the court issues an order
delegating this authority to a parent upon finding that the
parent poses no danger to the child and has the capacity to
provide authorization.
AB 2502 (Keene) Chapter 239, Statutes of 2004 created timelines
for submissions to the court of requests for authorization to
administer psychotropic medications, and for the court to grant,
deny or set the matter for hearing.
DSS sponsored AB 1514 (Maze), Chapter 120, Statutes of 2007,
which conformed the practice of court authorization for wards in
foster care to that of dependents in foster care.
AB 1330 (Evans 2007) and AB 2645 (Mountjoy 2004), would have
required DSS to collect and maintain data on youth in foster
care prescribed psychotropic medications. Both bills were held
in Assembly Appropriations.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Judiciary Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Children's Law Center of Los Angeles (Sponsor)
California Youth connection (CYC)
County Welfare Directors Association of California (CWDA)
Disability Rights California
Executive Committee of the Family Law Section (State Bar of CA)
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Juvenile Court Judges of CA (JCJC)
Western Center on Law and Poverty
Opposition
Governor's Office of Planning and Research
Analysis Prepared by : Michelle Doty Cabrera / HUM. S. / (916)
319-2089