BILL ANALYSIS
AB 1655
Page 1
Date of Hearing: April 6, 2010
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
AB 1655 (Evans) - As Introduced: January 15, 2010
SUBJECT : Dependent children: psychotropic medications
KEY ISSUE : SHOULD A PILOT PROJECT BE ESTABLISHED TO TEST
INCREASED OVERSIGHT OF THE ADMINISTRATION OF PSYCHOTROPIC
MEDICATIONS TO FOSTER YOUTH AND WARDS?
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
SYNOPSIS
This bill seeks to provide better oversight of the use of
psychotropic medications for youth in foster care through the
establishment of a three-county pilot project that increases
requirements for court oversight of the administration of these
drugs to foster children. It is a repeat of last year's AB 82
(Evans), which passed out of this Committee and the Legislature
without a "no" vote, but was vetoed by the Governor. This bill
passed out of Assembly Human Services on April 23, 2010, on a
6-0 vote.
According to the author, many children and youth in foster care
and youth probation systems have unmet needs for mental health
care. For some of these youth, psychotropic medications are a
key component of effective treatment for conditions that affect
their safety, emotional well-being, and ability to succeed in
school and other settings. In recent years, however, mental
health professionals, children's advocates, and former foster
youth in California and nationally have expressed concerns about
the potential over- or under- use of psychotropic medications
for children in the foster care and probation systems. In
testimony provided before the Blue Ribbon Commission on Foster
Care and the Select Committee on Foster Care, some foster youth
told of being put on medications when they were very young - as
young as 4 or 5 years old - and remaining on different
medications their entire childhoods. Others described being
prescribed multiple medications, or having their medications
changed frequently and abruptly each time they were moved to a
new placement or new mental health care provider.
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This bill contains various helpful provisions to improve
oversight of the use of psychotropic medications for youth in
foster care and probation systems. This bill is sponsored by
the Children's Law Center of Los Angeles and supported by groups
including California Youth Connection, the County Welfare
Directors Association, the Family Law Section of the State Bar
and the Juvenile Court Judges. It is opposed by the Governor's
Office of Planning and Research.
SUMMARY : Establishes a pilot in three counties to add
requirements to the court approval process for the
administration of psychotropic medications to dependent children
and wards 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 juvenile 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, as provided.
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
pursuant to this section, unless the child waives his or her
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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, as
provided.
7)Requires DSS to report to the Legislature on the demographic
data of foster youth and probation 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. (Welfare & Institutions Code Sections
369.5, 739.5. Unless noted otherwise, all further references
are to that code.)
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. (Section 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. (Id.)
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. (Id.)
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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.
(Section 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. (Business & Professions Code Section 2242.)
COMMENTS : While California already requires judicial officer
approval to administer psychotropic medications to foster youth
and wards of the juvenile court, this bill increases that
oversight in a three-county pilot so that the effectiveness of
this treatment can also be monitored and assessed. In addition,
this bill requires the court in participating counties to inform
foster youth and wards and their caregivers regarding the plan
to administer psychotropic medications, and the potential side
effects, and provide foster youth and wards with the ability to
request a hearing prior to authorization.
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,
children's advocates and former foster youth have expressed
concerns in recent years regarding possible overuse and under
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use among children in the foster care and probation systems.
This bill is substantially similar to AB 82 (Evans), which
passed the Legislature last year without a "no" vote, but was
vetoed by Governor Schwarzenegger with the following message:
"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."
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 percent 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 that "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."
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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.
ARGUMENTS IN SUPPORT : Sponsor of the bill, the California Youth
Law Center of Los Angeles, writes:
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.
Adds the Juvenile Court Judges of California:
AB 1655 would help improve outcomes for foster youth by
further safeguarding the court approval process for
prescribing foster youth psychotropic medications.
Psychotropic medicine can be a key component of
effective treatment for conditions affecting foster
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youth, but to ensure that such treatment is
appropriate, it is critical that the court be able to
protect foster youth from the damaging side effects,
ineffective treatments, and incorrect dosing and
medicating that psychotropic medication may pose.
ARGUMENTS IN OPPOSITION : The Governor's Office of Planning and
Research writes in opposition:
Although we applaud the intent of the bill to better
monitor the use of this medication, AB 1655 is
identical to AB 82 which the Governor vetoed last year.
. . . Currently, California's budget deficit is
approaching $20 billion and the economic recession
continues to linger. As both the Legislature and the
Governor look at additional cost-saving measures this
year, the same fiscal concerns that prompted last
year's veto remain.
REGISTERED SUPPORT / OPPOSITION :
Support
Children's Law Center of Los Angeles (sponsor)
California Youth Connection
California Mental Health Directors Association
County Welfare Directors Association of California
Disability Rights California
Family Law Section of the State Bar
Juvenile Court Judges of California
Youth Law Center
Opposition
Governor's Office of Planning and Research
Analysis Prepared by : Leora Gershenzon / JUD. / (916) 319-2334