Senate Bill (SB) 238 would enable county social workers and other key parties to provide more comprehensive oversight for children receiving child welfare services (CWS) who are prescribed psychotropic medications.
This bill would require certification and training programs for group home administrators, foster parents, child welfare social workers, dependency court judges, and court appointed counsel to include training on psychotropic medication, trauma, and behavioral health, as specified, for children receiving child welfare services. This bill would require the Judicial Council to update court forms pertaining to the authorization of psychotropic medication for foster youth and ensure specified changes are made to those forms, on or before July 1, 2016.
This bill would also require the California Department of Social Services to develop an individualized monthly report, a form to share information and an alert system, to be used by county child welfare agencies, regarding the administration of psychotropic medication for a foster youth.
STATUS:
Introduced: 02/17/2015
Last Amend: 04/07/2015
Disposition: Pending
Location: Senate Appropriations Committee
BACKGROUND:
In 1999, the Legislature passed SB 543 (Bowen, Ch. 552, Stats. 1999), which provided that only a juvenile court judicial officer has the authority to make orders regarding the administration of psychotropic medications for foster youth. SB 543 also provided that the juvenile court may issue a specific order delegating this authority to a parent if the parent poses no danger to the child and has the capacity to authorize psychotropic medications. This legislation was passed in response to concerns that foster children were being subjected to excessive use of psychotropic medication, and that judicial oversight was needed to reduce the risk of unnecessary medication. The Judicial Council was required to adopt rules of court to implement the new requirement. Accordingly, Rule 5.640 specifies the process for juvenile courts to follow in authorizing the administration of psychotropic medications and permits courts to adopt local rules for the courts to use to further refine the approval process.
In 2004, the provisions of SB 543 were amended by AB 2502 (Keene, Ch. 329, Stats. of 2004), which required a judicial officer to approve or deny, in writing, a request for authorization to administer psychotropic medication, or set the matter for hearing, within seven days. This amendment was intended to ensure timely consideration of requests for authorization to administer psychotropic medication to dependent children.
Despite these measures, concerns remain that psychotropic medication is overused and underreported in the child welfare system. A recent Los Angeles Times article reported that “Los Angeles County’s 2013 accounting failed to report almost one in three cases of children on the drugs while in foster care or the custody of the delinquency system. The data show that along with the 2,300 previously acknowledged cases, an additional 540 foster children and 516 children in the delinquency system were given the drugs. There are 18,000 foster children and 1,000 youth in the juvenile delinquency system altogether. … State data analysts discovered the additional cases of medicated children by comparing case notes of social workers and probation officers with billing records for the state’s Medi-Cal system. The billing records for those additional children did not appear to have corresponding case notes, leaving child advocates concerned that the drugs may have been prescribed without appropriate approval.”
The high rate of psychotropic usage is not limited to Los Angeles County – it is a national issue. Governing magazine recently noted that children in the United States are on drugs for longer and more often than kids in any other country. (Chris Kardish, Bad Medicine: How states are overmedicating low-income kids, Governing, March 2015.) Much of the concern stems from the fact that the long-term effects of psychotropic drugs on children are unknown, and the short term effects, including obesity, diabetes, and tremors, can be debilitating. Yet, many medical and child welfare professionals agree that some foster youth may benefit from these medications at some point in their lives. These children, who have suffered abuse and neglect at the hands of family, often have clinically significant emotional or behavioral problems. However, when psychotropic medications are prescribed to a foster child whose parent has been found, at least temporarily, unfit to approve the administration of the drugs, the question arises as to whether the court is capable of making the important inquiries that a parent should make before administering any medication to his or her child.
This comprehensive bill seeks to address the issues related to the administration psychotropic drugs in the foster system by requiring additional training, oversight, and data collection by caregivers, courts, counties, and social workers. This bill would require the Judicial Council, in consultation with other specified groups, to implement the provisions of this bill, as specified.
CHANGES TO EXISTING LAW:
Existing law provides for the development of a group home administrator certification program by the California Department of Social Services (CDSS) in collaboration with specified stakeholders to ensure certified persons have appropriate training to provide care and services. Existing law also requires the certification program to include a minimum of 40 hours of classroom instruction and provide coverage of a specified uniform core of knowledge. (Health & Saf. Code Sec. 1522.41.)
Existing law requires every licensed foster parent to complete a minimum of 12 hours of foster parent training covering specified topics prior to the placement of a foster child in the home, and eight hours each year thereafter. (Health & Saf. Code Sec. 1529.2.)
Existing law requires the Judicial Council to develop and implement standards for the education and training of all judges who conduct hearings pursuant to Welfare and Institutions Code Section 300, pertaining to dependent children. (Welf. & Inst. Code Sec. 304.7.)
Existing law requires court appointed counsel of a child or nonminor dependent to have specified training, promulgated by the Judicial Council as rules of the court that ensures adequate representation of the child or nonminor dependent. (Welf. & Inst. Code Sec. 317.)
Existing law provides that only a juvenile court judicial officer shall have authority to make orders regarding the administration of psychotropic medications for a minor who has been adjudged a dependent of the court and removed from the physical custody of his or her parent. Existing law also requires the Judicial Council to adopt rules of court and develop appropriate forms. (Welf. & Inst. Code Sec. 369.5.)
Existing law provides for the development of a statewide coordinated training program designed specifically to meet the needs of county child protective services social workers, agencies under contract with county welfare departments to provide child welfare services, and persons defined as a mandated reporter pursuant to the Child Abuse and Neglect Reporting Act. (Welf. & Inst. Code Sec. 16206.)
This bill requires trainings for the following groups to additionally include the authorization, uses, risks, benefits, administration, oversight, and monitoring of psychotropic medication, and trauma, behavioral health, and other available behavioral health treatments, for children receiving child welfare services, including how to access those treatments:
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group home administrator certification;
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initial pre-placement training of licensed foster parents;
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post training of licensed foster parents;
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training required to be made available to relative and nonrelative extended family members;
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Judicial Council-developed training for dependency judges;
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training of court appointed counsel of a child or nonminor dependent; and
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training provided to specified county child protective services social workers, agencies under contract with county welfare departments to provide child welfare services, and persons defined as a mandated reporter pursuant to the Child Abuse and Neglect Reporting Act.
This bill would require the above implementation and updates to ensure the following:
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the child and his or her caregiver and court-appointed special advocate, if any, have a meaningful opportunity to provide input on the medications being prescribed;
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information regarding the child’s overall behavioral health assessment and treatment plan is provided to the court;
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information regarding the rationale for the proposed medication, including information on other pharmacological and non-pharmacological treatments that have been utilized and the child’s response, and an explanation how the psychotropic medication being prescribed is expected to improve the symptoms; and
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guidance is provided to the court on how to evaluate the request for authorization, including how to proceed if information, otherwise required to be included in a request for authorization, is not included in a request.
This bill would require CDSS, in consultation with DHCS, the County Welfare Directors Association (CDWA) and other stakeholders to develop and provide an individualized monthly report to each county child welfare services agency that includes the following for each child receiving child welfare services:
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psychotropic medications that have been authorized for the child by the court;
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data for medications that have been dispensed to the child, including both psychotropic and non-psychotropic medication;
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durational information relating to the child’s authorized psychotropic medication, including, but not limited to, the length of time a medication has been authorized and the length of time for which a medication has been dispensed by a pharmacy;
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claims paid for behavioral health services provided to the child, other than claims paid for psychotropic medication; and
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the dosages of psychotropic medications that have been authorized for the child and that have been dispensed.
This bill would require CDSS, in consultation with DHCS, CDWA and other stakeholders, to develop a form, to be used by a county child welfare services agency on a monthly basis, to share with the juvenile court, the child’s attorney, and the court-appointed special advocate, if one has been appointed, the above information regarding a child receiving child welfare services authorized to receive one or more psychotropic medication.
This bill would require CDSS in consultation with DHCS, CDWA and other stakeholders to develop, or ensure access to, a system that automatically alerts a social worker of a child receiving child welfare services when psychotropic medication has been prescribed that fits the following descriptions:
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is prescribed in combination with another psychotropic medication and the combination is unusual or has the potential for a dangerous interaction;
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is prescribed in a dosage that is unusual for a child of that age; and
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is not typically indicated for a child of that age.
This bill would require a child’s social worker, upon receipt of an alert, to indicate to the court that the alert has been received by the child’s attorney, the child’s caregiver, and the child’s court appointed special advocate, if one has been appointed, and to include a discussion of the resolution of the alert in the next court report filed.
COMMENT:
1. Stated need for the bill
According to the author:
Recent newspaper articles have highlighted the use and overuse of psychotropic medications in foster care facilities. Reports provided by the Department of Health Care Services and the Department of Social Services are limited in providing needed information to determine how psychotropic medicine is being provided and distributed. The goal of this legislation is to develop and review data, to develop a system of flags, to improve county reporting and to establish further consultation/second opinion options for cases in which psychotropic medications and/or antidepressants are being prescribed for a foster youth.
2. Better monitoring of psychotropic medication in foster care
Under existing law, only the court may authorize the use of psychotropic medication for any child in the dependency system. Rules of Court require the prescribing physician to complete and submit an application to the court, known as the “JV-220” form. The JV-220 requires the inclusion of specific information, including: (1) the child’s diagnosis; (2) the specific medication with the recommended maximum daily dosage and length of time this course of treatment will continue; (3) the anticipated benefits to the child from the use of the medication; (4) a list of any other medications, prescription or otherwise, that the child is currently taking, and a description of any effect these medications may produce in combination with the psychotropic medication; and (5) a statement that the child has been informed in an age-appropriate manner of the recommended course of treatment, the basis for it, and its possible results. The court is required, upon review of the JV-220, to deny, grant, or modify the application for
authorization of psychotropic medication within seven days, or to set the matter for hearing. The court may also set a date for review of the child’s progress and condition.
(See Cal. Rule Ct. Sec. 5.640 and Welf. & Inst. Code Sec. 369.5.)
Supporters of this bill argue that courts are often not being provided with the full story. Upon reviewing a JV-220, a judge may have no indication that the child is already on psychotropic medication, what a proper dosage for a child is, or what less invasive alternatives are available. Supporters further assert that the existing rule, which sets arguably loose parameters and includes no considerations that the court must take into
account when evaluating a JV-220, is too broad for judges and courts that may lack the tools to properly evaluate medical recommendations and are overburdened with unmanageable caseloads. In addition, the current process does not offer any meaningful way for other adults, caretakers, or those who interact with a foster child on a regular basis, to contribute information to a physician’s recommendation.
Accordingly, this bill would ensure that a child, his or her caregiver, and his or her court appointed special advocate have an opportunity to provide input to the court on the medications being prescribed. This bill would further require that the court is provided with the tools to properly analyze the authorization request, and that the court monitor the child’s progress by way of periodic oversight facilitated by the social worker, public health nurse, or other appropriate county staff. The County Welfare Directors Association, a sponsor of the bill, states that “recent reports indicating that
psychotropic medications are over-prescribed in the child welfare system have prompted a needed look at the procedures by which those medications are authorized and overseen. The children we serve have experienced severe trauma that often warrants behavioral health services such as trauma-informed therapy and other targeted treatments. We believe it is appropriate for some children to receive medication, when thoughtfully prescribed as part of an overall treatment plan that includes non-pharmacological interventions, as well. With those medications, however, must come oversight to ensure that the treatment plan is in place and that children are responding well to the authorized medications.”
3. Training and education on psychotropic medication for those adults who are entrusted with the safety and care of foster youth
This bill would require the adults who provide care, protection, and services to foster children to receive training on the “authorization, uses, risks, benefits, administration, oversight, and monitoring of psychotropic medication, and trauma, behavioral health, and other available behavioral health treatments, for children receiving child welfare services, including how to access those treatments.” The Youth Law Center agrees that this training is essential, and writes that they would support this bill if it were extended to include probation youth as well.
These adults, including, foster parents, relative and nonrelative extended family members, juvenile court judges, minor’s counsel, and specified social workers, are in a unique position to recognize and advocate for a child’s best interest. With the proper training, these adults may be able to recognize when a child is not responding properly to medication, and provide valuable information to assist the court in the oversight of a
child’s treatment plan. Thus, the court will not be forced to rely on the opinion of the prescribing physician alone. This required education and training on the risks and uses of psychotropic drugs would arguably help the adults in a foster child’s life better assist the youth in achieving behavioral and emotional health.
Support: Advokids; Alameda County Foster Youth Alliance; California Court
Appointed Special Advocates (CASA); California State Association of Counties;
Children’s Advocacy Institute; Children’s Law Center; Dependency Legal Group of San
Diego; First Focus Campaign for Children; Humboldt County Transition Age Youth
Collaboration; John Burton Foundation; Legal Advocates for Children and Youth;
National Center for Youth Law; Peers Envisioning and Engaging in Recovery Services;
Public Counsel’s Children’s Rights Project; Urban Counties Caucus; 6 individuals
Opposition: None Known
HISTORY:
Source: County Welfare Directors Association of California
Related Pending Legislation:
SB 253 (Monning) provides that an order of the juvenile court authorizing psychotropic medication shall require clear and convincing evidence of specified conditions. Furthermore this bill prohibits the authorization of psychotropic medications without a second independent medical opinion under specified circumstances. It also prohibits the authorization of psychotropic medications unless the court is provided documentation that appropriate lab screenings, measurements, or tests have been completed, as specified. Furthermore it requires the court, no later than 45 days following an authorization for psychotropic medication, to conduct a review to determine specified information regarding the efficacy of the child’s treatment plan.
SB 484 (Beall) requires the CDSS to publish and make available to interested persons specified information regarding the administration of psychotropic medication in residential facilities serving dependent children. Additionally, it requires CDSS to inspect facilities at least once per year, as specified, if the facility is determined to have a higher than average rate of psychotropic medication authorization for children residing in the facility and to monitor corrective action plans, as specified.
SB 319 (Beall) expands the duties of the foster care public health nurse to include monitoring and oversight of the administration of psychotropic medication to foster children, as specified. It also requires counties to provide child welfare public health nursing services by contracting with the community child health and disability prevention program established by the county.
Prior Legislation:
AB 3015 (Brownley, Chapter 557, Statutes of 2008) required training programs for group home administrators, licensed foster parents and relative caretakers to include basic instruction on the safety of foster youth at school and school environment antiharassment protections.
AB 2675 (Strickland, Chapter 421, Statutes of 2006) permitted no more than half of the required 40-hour continuing education requirement to be satisfied through online courses.
AB 458 (Chu, Chapter 331, Statutes of 2003) established and required provider training regarding the right of foster children to fair and equal access to all available services, placement, care, treatment, and benefits, and to not be subjected to discrimination or harassment on the basis of actual or perceived race, ethnic group identification, ancestry, national origin, color, mental or physical disability, or HIV status.
AB 1694 (Committee on Human Services, Chapter 918, Statutes of 2002) required California Community Colleges that provide foster parent training programs to make those programs available to non-relative extended family members.
AB 2307 (Davis, Chapter 745, Statutes of 2000) required California Community Colleges that provide foster parent training programs to make those programs available to relative and kinship care providers.
SB 543 (Bowen, Chapter 552, Statutes of 1999) mandated that once a child has been adjudged a dependent of the state only the court may authorize psychotropic medications for the child, based on a request from a physician including specified information.
AB 3062 (Friedman, Chapter 1016, Statutes of 1996) mandated all foster parents to obtain pre-placement and post-placement training.
Prior Vote: Senate Human Services Committee (Ayes 5, Noes 0)
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