California State Auditor Report Number : 2015-131

California's Foster Care System
The State and Counties Have Failed to Adequately Oversee the Prescription of Psychotropic Medications to Children in Foster Care

Appendix

SUMMARY TABLES SHOWING STATEWIDE AND COUNTY DATA REGARDING PSYCHOTROPIC MEDICATIONS PRESCRIBED TO FOSTER CHILDREN

As part of our review of psychotropic medications prescribed to children in foster care (foster children), we analyzed data obtained from the California Department of Social Services’ (Social Services) Child Welfare Services/Case Management System and Medi‑Cal pharmacy data from the Department of Health Care Services (Health Care Services). We present the results of our analysis that pertain to the four counties we visited in Chapter 1 and Chapter 2. The following tables summarize the results of our analysis for the State as a whole and for each of California’s 58 counties. To protect individual privacy, we omitted results of 10 foster children or fewer.

Table A‑1 shows the number of foster children in California and the number and proportion of those foster children with filled prescriptions for psychotropic medications for three fiscal years. As this Table shows, the number of foster children in California increased from fiscal year 2012–13 through 2014–15, while the number of foster children with filled prescriptions for psychotropic medications decreased over the same time period. Data for the counties included in the Table showed varying trends.

Table A‑1
Number and Proportion of Children in Foster Care With Filled Psychotropic Medication Prescriptions During Fiscal Years 2012–13 Through 2014–15, Statewide and by County

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi‑Cal pharmacy data.

Note: The term foster children refers to children aged zero to 17 in the foster care system.

* To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Table A‑2 lists the number and proportion of filled psychotropic medication prescriptions for foster children for three fiscal years. This Table shows that the number of psychotropic medication prescriptions statewide dropped from more than 110,000 in fiscal year 2012–13 to about 95,750 in fiscal year 2014–15, a decrease of 13 percent. Similarly, all but 12 counties had a decrease in their number of psychotropic medication prescriptions from fiscal year 2012–13 through 2014–15.

Table A‑2
Number and Proportion of Filled Psychotropic Medication Prescriptions for Children in Foster Care, Statewide and by County

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi‑Cal pharmacy data.

Note: The term foster children refers to children aged zero to 17 in the foster care system.

The average number of filled prescriptions per foster child may reflect that some foster children received more than one type of psychotropic medication. Alternatively, it may indicate that some foster children had paid prescriptions of a single medication filled a number of times during the year (perhaps on a monthly or bimonthly basis).

NA = Not applicable.

* To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

For Table A‑3, we separated the number and proportion of prescriptions for psychotropic medications into five different categories for fiscal year 2014–15. This Table shows that antidepressants and antipsychotics each made up 35 percent or more of all psychotropic medication prescriptions, and stimulants made up 26 percent. The last two classifications—antianxiety medications and mood stabilizers—were a very small proportion of the total psychotropic medication prescriptions, with each representing 2 percent or less. In many instances, county‑level data mirrored the State’s results.

Table A‑3
Number and Proportion of Filled Prescriptions for Psychotropic Medications for Children in Foster Care in Fiscal Year 2014–15 by Classification, Statewide and by County

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi‑Cal pharmacy data.

NA = Not applicable.

* To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Table A‑4 shows the number and proportion of foster children within certain age ranges who had psychotropic medication prescriptions filled during fiscal year 2014–15. As indicated in the Table, almost three‑quarters of foster children with filled prescriptions for psychotropic medications were aged 12 to 17. County‑level data mirrored the state results: most psychotropic medications in each county were also prescribed to foster children aged 12 to 17.

Table A‑4
Number and Proportion of Children in Foster Care With Prescriptions for Psychotropic Medications That Were Filled in Fiscal Year 2014–15 by Age Range

	FISCAL YEAR 2014–15 TOTAL		AGE RANGE
			0–1*		2–5*		6–11		12–17
	PERCENT	NUMBER	PERCENT	NUMBER	PERCENT	NUMBER	PERCENT	NUMBER	PERCENT	NUMBER
Statewide	9,317	100.0%	17	0.2%	217	2.3%	2,604	27.9%	6,895	74.0%
Counties
Alameda	298	3.2%					44	14.8%	254	85.2%
Butte	76	0.8					31	40.8	50	65.8
Calaveras	26	0.3					11	42.3	17	65.4
Contra Costa	215	2.3					45	20.9	175	81.4
El Dorado	69	0.7					16	23.2	54	78.3
Fresno	246	2.6					84	34.1	168	68.3
Humboldt	43	0.5					12	27.9	31	72.1
Imperial	75	0.8					30	40.0	43	57.3
Kern	249	2.7					61	24.5	193	77.5
Kings	51	0.5					22	43.1	31	60.8
Los Angeles	3,194	34.3					924	28.9	2,336	73.1
Merced	81	0.9					18	22.2	62	76.5
Monterey	94	1.0					19	20.2	72	76.6
Orange	257	2.8					66	25.7	201	78.2
Placer	56	0.6					16	28.6	41	73.2
Riverside	595	6.4					165	27.7	440	73.9
Sacramento	424	4.6					100	23.6	335	79.0
San Bernardino	660	7.1					213	32.3	460	69.7
San Diego	475	5.1					130	27.4	348	73.3
San Francisco	150	1.6					46	30.7	115	76.7
San Joaquin	248	2.7					88	35.5	168	67.7
San Luis Obispo	79	0.8					20	25.3	58	73.4
San Mateo	69	0.7					13	18.8	58	84.1
Santa Barbara	103	1.1					36	35.0	71	68.9
Santa Clara	213	2.3					40	18.8	178	83.6
Shasta	96	1.0					42	43.8	59	61.5
Solano	85	0.9					20	23.5	70	82.4
Sonoma	140	1.5					21	15.0	121	86.4
Stanislaus	117	1.3					27	23.1	90	76.9
Sutter	36	0.4					13	36.1	25	69.4
Tehama	33	0.4					11	33.3	22	66.7
Tulare	165	1.8					64	38.8	97	58.8
Ventura	153	1.6					38	24.8	120	78.4
Yuba	40	0.4					16	40.0	28	70.0
Other counties	406	4.4					102	25.1	304	74.9

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi‑Cal pharmacy data.

Notes: Totals may not add up to 100 percent because some children aged into a new age range during fiscal year 2014–15.

The term foster children refers to children aged zero to 17 in the foster care system.

* The 0–1 year and 2–5 years age ranges for each county contained 10 or fewer foster children in at least one of the two age ranges. To protect individual privacy, we omitted all county data for these two columns.

Table A‑5 shows the number of foster children in each age range who had paid antipsychotic medication prescriptions in fiscal year 2014–15. Similar to Table A‑4, the majority of foster children with paid prescriptions for antipsychotic medications were aged 12 to 17. Again, county‑level data mirrored the state results.

Table A‑5
Number and Proportion of Children in Foster Care With Prescriptions for Antipsychotic Psychotropic Medications That Were Filled in Fiscal Year 2014–15 by Age Range

	NUMBER OF FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR ANTIPSYCHOTIC PSYCHOTROPIC MEDICATIONS		FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR ANTIPSYCHOTICS			AGE RANGE
						0–1*		2–5*		6–11		12–17
			NUMBER	PERCENT		NUMBER		NUMBER		NUMBER		NUMBER
Statewide	9,317		4,339	46.6%						1,069		3,380
Counties
Alameda	298		147	49.3%						20		127
Butte	76		44	57.9						18		30
Contra Costa	215		108	50.2						17		95
Fresno	246		108	43.9						25		84
Kern	249		122	49.0						26		98
Los Angeles	3,194		1,409	44.1						389		1,051
Orange	257		127	49.4						33		98
Riverside	595		342	57.5						82		271
Sacramento	424		214	50.5						39		178
San Bernardino	660		359	54.4						87		279
San Diego	475		190	40.0						34		160
San Francisco	150		56	37.3						21		40
San Joaquin	248		111	44.8						37		82
San Luis Obispo	79		47	59.5						13		34
Santa Barbara	103		49	47.6						17		35
Santa Clara	213		108	50.7						19		91
Shasta	96		32	33.3						12		21
Tulare	165		71	43.0						23		51
Yuba	40		29	72.5						13		20
Other counties	1,534		666	43.4						144		535

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi-Cal pharmacy data.

Notes: Total percentages may not add up to 100 percent because some children aged into a new age range during fiscal year 2014–15.

The term foster children refers to children aged zero to 17 in the foster care system.

* The 0-to-1 year and 2-to-5 years age ranges for each county and the State contained fewer than 10 foster children in at least one of the two age ranges. To protect individual privacy, we omitted all data for these two columns.

Table A‑6 shows the number and proportion of foster children in fiscal year 2014–15 who had filled prescriptions for more than one psychotropic medication in the same class for antidepressants, antipsychotics, and stimulants, the three most widely prescribed classifications from Table A‑3. The data reflect that it is more common for foster children to be on multiple antidepressants than on multiple antipsychotics or multiple stimulants. The county‑level data show the same trend as the statewide data.

Table A‑6
Number and Proportion of Children in Foster Care With Multiple Filled Psychotropic Medication Prescriptions From the Same Class, Statewide and by County, Fiscal Year 2014–15

	NUMBER OF FOSTER CHILDREN WITH FILLED PSYCHOTROPIC MEDICATION PRESCRIPTIONS		FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR MORE THAN ONE ANTIDEPRESSANT*			FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR MORE THAN ONE ANTIPSYCHOTIC*			FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR MORE THAN ONE STIMULANT*
			NUMBER	PERCENT		NUMBER	PERCENT		NUMBER	PERCENT
Statewide	9,317		851	9.1%		330	3.5%		193	2.1%
Counties
Alameda	298		36	12.1%		13	4.4%		†	†
Contra Costa	215		21	9.8		†	†		†	†
Fresno	246		†	†		21	8.5		†	†
Kern	249		63	25.3		14	5.6		†	†
Los Angeles	3,194		267	8.4		69	2.2		42	1.3%
Monterey	94		14	14.9		†	†		†	†
Orange	257		12	4.7		18	7.0		†	†
Riverside	595		71	11.9		26	4.4		†	†
Sacramento	424		25	5.9		21	5.0		†	†
San Bernardino	660		86	13.0		13	2.0		†	†
San Diego	475		37	7.8		19	4.0		13	2.7
San Joaquin	248		17	6.9		11	4.4		†	†
Santa Clara	213		19	8.9		†	†		†	†
Sonoma	140		25	17.9		†	†		†	†
Tulare	165		†	†		†	†		11	6.7
Ventura	153		22	14.4		†	†		18	11.8
Other counties	1,691		116	6.9		72	4.3		45	2.7

Sources: California State Auditor’s analysis of data obtained from the Department of Health Care Services’ California Medicaid Management Information System, data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System, and matched Medi‑Cal pharmacy data.

Note: The term foster children refers to children aged zero to 17 in the foster care system.

* For our analysis, we only considered foster children to be on more than one psychotropic medication if they received more than one psychotropic medication within the same medication classification for more than 30 consecutive days.

^† To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Table A‑7 shows the number of foster children by age range in fiscal year 2014–15 whose number of filled prescriptions for psychotropic medications exceeded Social Services and Health Care Services’ guidelines for the safe administration of psychotropic medications to foster children.

Table A‑7
Number of Children in Foster Care Who Were Prescribed Psychotropic Medications That Exceeded the State Guidelines for Their Age Groups, Statewide and by County, Fiscal Year 2014–15

	TOTAL NUMBER OF FOSTER CHILDREN PRESCRIBED PSYCHOTROPIC MEDICATIONS		FOSTER CHILDREN AGE 0-5 PRESCRIBED MORE THAN ONE PSYCHOTROPIC MEDICATION*	FOSTER CHILDREN AGE 6-11 PRESCRIBED MORE THAN TWO PSYCHOTROPIC MEDICATIONS*	FOSTER CHILDREN AGE 12-17 PRESCRIBED MORE THAN THREE PSYCHOTROPIC MEDICATIONS*
Statewide	9,317		29	159	90
Counties
Kern	249		†	12	†
Los Angeles	3,194		†	34	14
Riverside	595		†	†	11
San Bernardino	660		†	17	†
Other Counties	4,619		17	†	55

Sources: California State Auditor’s analysis of data obtained from the Department of Health Care Services’ California Medicaid Management Information System, data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System, and matched Medi‑Cal pharmacy data.

Notes: State guidelines recommend that children aged zero to 5 take no more than one psychotropic medication, children aged 6 to 11 take no more than two psychotropic medications, and children aged 12 to 17 take no more than three psychotropic medications.

The term foster children refers to children aged zero to 17 in the foster care system.

* For our analysis, we considered foster children to be on multiple psychotropic medications when their prescriptions overlapped for more than 30 consecutive days.

^† To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Table A‑8 shows the number of foster children in fiscal year 2013–14 who did not have follow‑up medical appointments within 30 days after starting at least one new psychotropic medication. As the Table indicates, more than 29 percent of foster children who started new psychotropic medications did not have a corresponding Medi-Cal claim for a follow‑up medication service visit.

Table A‑8
Number and Proportion of Children in Foster Care With New Psychotropic Medication Prescriptions Filled in Fiscal Year 2013–14 Without a Corresponding Medi‑Cal Claim for a Follow‑Up Medication Service Within 30 Days, Statewide and by County

	NUMBER OF FOSTER CHILDREN WITH NEW PSYCHOTROPIC MEDICATION PRESCRIPTIONS*		NUMBER OF FOSTER CHILDREN WITH AT LEAST ONE FILLED PRESCRIPTION FOR A NEW PSYCHOTROPIC MEDICATION WITHOUT A CORRESPONDING MEDI‑CAL CLAIM FOR A FOLLOW-UP MEDICATION SERVICE
			NUMBER	PERCENT
Statewide	6,731		1,881	29.1%
Counties
Alameda	220		73	33.2%
Butte	54		20	37.0
Calaveras	17		†	†
Contra Costa	136		37	27.2
Del Norte	12		†	†
El Dorado	43		17	39.5
Fresno	156		63	40.4
Glenn	13		†	†
Humboldt	28		†	†
Imperial	60		39	65.0
Kern	158		58	36.7
Kings	31		17	54.8
Lake	20		†	†
Lassen	16		†	†
Los Angeles	2,252		334	14.8
Madera	17		†	†
Mendocino	32		15	46.9
Merced	50		27	54.0
Monterey	62		23	37.1
Napa	26		15	57.7
Orange	186		45	24.2
Placer	39		13	33.3
Riverside	406		167	41.1
Sacramento	283		83	29.3
San Bernardino	454		228	50.2
San Diego	372		86	23.1
San Francisco	116		28	24.1
San Joaquin	160		60	37.5
San Luis Obispo	58		21	36.2
San Mateo	45		22	48.9
Santa Barbara	63		25	39.7
Santa Clara	125		27	21.6
Santa Cruz	42		13	31.0
Shasta	75		20	26.7
Siskiyou	20		†	†
Solano	60		26	43.3
Sonoma	90		46	51.1
Stanislaus	80		39	48.8
Sutter	25		†	†
Tehama	35		13	37.1
Tulare	101		19	16.7
Ventura	114		19	16.7
Yolo	25		12	48.0
Yuba	24		†	†
Other counties	70		36	51.4

Sources: California State Auditor’s analysis of data obtained from the Department of Health Care Services’ Paid Claims and Encounters System, data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System, and matched Medi‑Cal pharmacy data.

Notes: The term foster children refers to children aged zero to 17 in the foster care system.

* We defined a new prescription as any prescription for a psychotropic medication that the child had not been prescribed in the prior 120 days and, as discussed in the Scope and Methodology section, we applied the National Committee for Quality Assurance's methodology for follow‑up care.

^† To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Table A‑9 shows the number of foster children in fiscal year 2013–14 who had at least one instance in which they did not receive psychosocial services within 30 days, either before or after receiving a prescription for psychotropic medications. In addition, Table A‑9 shows the number of foster children in the same fiscal year who had at least one instance in which they did not receive psychosocial services within 180 days, either before or after beginning a new prescription. As shown in the Table, between 3,965 and 7,489 (41 and 77 percent) of foster children statewide had at least one instance in which they did not receive corresponding psychosocial services within 30 days of receiving a prescription. We report a range of foster children who did not receive psychosocial services to accommodate for differences in the way the Department of Health Care Services and the National Committee for Quality Assurance use procedure codes to define psychosocial services.

Table A‑9
Number of Children in Foster Care With Paid Prescriptions for Psychotropic Medications Without a Corresponding Medi‑Cal Claim for Psychosocial Services, Statewide and by County, Fiscal Year 2013–14

	FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR PSYCHOTROPIC MEDICATIONS		NUMBER OF FOSTER CHILDREN WITH AT LEAST ONE INSTANCE OF NO SERVICE WITHIN...
			...30 DAYS BEFORE OR AFTER FILLING A PRESCRIPTION	...180 DAYS BEFORE OR AFTER FILLING A PRESCRIPTION
Statewide	9,707		3,965-7,489	1,564-4,512
Counties
Alameda	323		134-242	44-131
Butte	85		44-*	14-65
Contra Costa	221		88-165	32-118
Fresno	234		118-193	59-118
Humboldt	38		17-*	*-14
Imperial	68		47-*	21-56
Kern	253		124-210	48-134
Kings	46		33-*	15-33
Lake	34		*-*	*-15
Los Angeles	3,267		742-2,185	204-994
Mendocino	55		25-*	14-43
Merced	85		53-73	24-50
Monterey	116		51-82	*-36
Orange	301		107-275	46-210
Placer	57		32-45	16-30
Riverside	600		385-556	146-363
Sacramento	456		196-367	80-225
San Bernardino	680		442-545	196-343
San Diego	548		206-349	92-224
San Francisco	183		59-103	26-42
San Joaquin	269		116-252	65-184
San Luis Obispo	86		37-63	18-31
San Mateo	66		31-*	*-32
Santa Barbara	102		59-83	35-61
Santa Clara	205		73-180	27-118
Santa Cruz	56		16-43	*-23
Shasta	113		57-*	12-91
Siskiyou	27		*-*	12-*
Solano	86		40-*	*-53
Sonoma	142		98-*	56-98
Stanislaus	116		60-103	29-76
Sutter	40		16-*	*-20
Tehama	41		21-*	*-*
Tulare	166		72-142	34-80
Ventura	167		44-124	16-74
Yolo	41		*-*	21-*
Yuba	36		20-*	*-19
Other counties	198		131-175	61-137

Sources: California State Auditor’s analysis of data obtained from the Department of Health Care Services’ Paid Claims and Encounters System, data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System, and matched Medi‑Cal pharmacy data.

Note: The term foster children refers to children aged zero to 17 in the foster care system.

* To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

Further, when compiling statewide data, we found that Social Services' data is not formatted in a way that allows us to definitively identify if court authorizations or parental consents are associated with a specific psychotropic medication. As a result, we analyzed the statewide data to identify the frequency with which court authorizations or parental consents existed for any medication and if that approval was either 180 days before or 30 days after the date the psychotropic medication prescription was filled. As Table A‑10 shows, the number and proportion of foster children in fiscal year 2014–15 who had prescriptions filled for psychotropic medications and the type of authorization they received. As the data show, only 35 percent of the foster children statewide had court authorizations or parental consents for all their psychotropic medications. The other 65 percent were missing authorizations or consents for at least one psychotropic medication. Further, only 11 of the 35 counties shown had court authorizations or parental consents rates of 50 percent or more for all psychotropic medications prescribed for foster children.

Table A‑10
Number and Proportion of Children in Foster Care With Filled Prescriptions for Psychotropic Medications by Type of Consent Recorded in Social Services’ Data, Statewide and by County, Fiscal Year 2014–15

	TOTAL NUMBER OF FOSTER CHILDREN WITH FILLED PRESCRIPTIONS FOR PSYCHOTROPIC MEDICATIONS IN FISCAL YEAR 2014–15			TYPES OF CONSENT
				COURT AUTHORIZATION OR PARENTAL CONSENT FOR ALL PSYCHOTROPIC MEDICATIONS		NO COURT AUTHORIZATION OR PARENTAL CONSENT FOR ANY PSYCHOTROPIC MEDICATIONS		NO COURT AUTHORIZATION OR PARENTAL CONSENT FOR ONE OR MORE PSYCHOTROPIC MEDICATIONS
	NUMBER	PERCENT		NUMBER	PERCENT	NUMBER	PERCENT	NUMBER	PERCENT
Statewide	9,317	100.00%		17	0.20%	217	2.30%	2,604	27.90%
Counties
Alameda	298	3.2%		39	13.1%	174	58.4%	259	86.9%
Butte	76	0.8		21	27.6	12	15.8	55	72.4
Fresno	246	2.6		141	57.3	58	23.6	105	42.7
Humboldt	43	0.5		28	65.1	13	30.2	15	34.9
Imperial	75	0.8		14	18.7	29	38.7	61	81.3
Kern	249	2.7		143	57.4	54	21.7	106	42.6
Kings	51	0.5		17	33.3	18	35.3	34	66.7
Lake	33	0.4		13	39.4	11	33.3	20	60.6
Los Angeles	3,194	34.3		920	28.8	1,475	46.2	2,274	71.2
Mendocino	48	0.5		25	52.1	*	*	23	47.9
Merced	81	0.9		31	38.3	28	34.6	50	61.7
Monterey	94	1.0		57	60.6	*	*	37	39.4
Napa	30	0.3		13	43.3	*	*	17	56.7
Orange	257	2.8		106	41.2	51	19.8	151	58.8
Placer	56	0.6		16	28.6	24	42.9	40	71.4
Riverside	595	6.4		300	50.4	121	20.3	295	49.6
Sacramento	424	4.6		176	41.5	135	31.8	248	58.5
San Bernardino	660	7.1		227	34.4	201	30.5	433	65.6
San Diego	475	5.1		227	47.8	133	28.0	248	52.2
San Francisco	150	1.6		76	50.7	34	22.7	74	49.3
San Joaquin	248	2.7		108	43.5	54	21.8	140	56.5
San Luis Obispo	79	0.8		15	19.0	21	26.6	64	81.0
San Mateo	69	0.7		29	42.0	12	17.4	40	58.0
Santa Barbara	103	1.1		56	54.4	23	22.3	47	45.6
Santa Clara	213	2.3		50	23.5	69	32.4	163	76.5
Santa Cruz	43	0.5		18	41.9	15	34.9	25	58.1
Shasta	96	1.0		76	79.2	*	*	20	20.8
Solano	85	0.9		29	34.1	33	38.8	56	65.9
Sonoma	140	1.5		31	22.1	65	46.4	109	77.9
Stanislaus	117	1.3		12	10.3	65	55.6	105	89.7
Sutter	36	0.4		21	58.3	*	*	15	41.7
Tehama	33	0.4		13	39.4	*	*	20	60.6
Tulare	165	1.8		17	10.3	73	44.2	148	89.7
Ventura	153	1.6		65	42.5	25	16.3	88	57.5
Yuba	40	0.4		23	57.5	*	*	17	42.5
Other counties	562	6.0		79	14.1	369	65.7	483	85.9

Sources: California State Auditor’s analysis of data obtained from the California Department of Social Services’ Child Welfare Services/Case Management System and matched Medi‑Cal pharmacy data.

Note: The term foster children refers to children aged zero to 17 in the foster care system.

* To protect individual privacy, we omitted this number because it would identify 10 or fewer foster children. Such omission is in accordance with aggregate data reporting guidelines issued by the Department of Health Care Services.

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