Report 2015-131 Recommendation 3 Responses

Report 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 (Release Date: August 2016)

Recommendation #3 To: Los Angeles County

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should implement processes to ensure that foster children receive any needed mental health, psychosocial, behavioral health, or substance abuse services before and concurrently with receiving psychotropic medications.

1-Year Agency Response

The forms mandated by the Judicial Council require assurances that proper mental health services are being received along with the medication, and also that alternatives to medication are being considered.

(Please see supporting documentation. The revised approval and monitoring protocols were submitted as attachments to our February 23, 2017, response. Attached to this response are newly revised policies and procedures from the Department of Children and Family Services regarding psychotropic medication, and newly revised policies and procedures from the Department of Public Health on the role of public health nurses in the new approval and monitoring protocols.)

California State Auditor's Assessment of 1-Year Status: Fully Implemented

The documents that Los Angeles County mentions are available from our office.

6-Month Agency Response

While the new Judicial Council forms provide more information than previous forms——specifically with respect to enhancing input from multiple partners, ensuring that alternatives to medication are considered, and ensuring that other mental health services accompany the use of the medications——the Workgroup has focused on articulating that process.

Protocols now mandate agency input and specify how youth, caregivers, parents, tribes, attorneys, and others can provide input during the approval and administration phases. Notable changes include the inclusion of public health nurses (PHNs) in working with social workers and caregivers to assist with follow-up appointments, advising caregivers and social workers, monitoring medication effects, and recording activities.

(Please see supporting documentation.)

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Over the next year, the Workgroup detailed in our response to Recommendation 1 will develop strategies for processes to ensure that foster children receive any needed mental health, psychosocial, behavioral health, or substance abuse services before and concurrently with receiving psychotropic medications.

As mentioned previously, the Workgroup's initial focus has been the implementation of the new forms developed by the California Judicial Council to improve the process for the administration of psychotropic medications. The forms, which became effective on July 1, 2016, are designed (among other things) to enhance the quality and quantity of information presented to judges who are tasked by law with deciding whether or not to approve the administration of psychotropic medications; to enhance the engagement of youth, parents, caregivers, and agencies involved in the process; to ensure that alternatives to medication are appropriately considered; to ensure that other mental health services accompany the use of the medications; and to help monitor the effects of the medications.

In addition, on September 13, 2016, the Los Angeles County Board of Supervisors voted to instruct the Office of Child Protection to collaborate with the Department of Children and Family Services (DCFS) and the Department of Public Health (DPH) to consolidate the public health nurse (PHN) programs of DCFS and DPH within DPH. The Board of Supervisors also instructed the relevant entities to determine how to most effectively use the PHN program, a discussion that will necessarily include the issue of how best to use PHNs with respect to psychotropic medications.

(Please see supporting documentation.)

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2015-131

Agency responses received are posted verbatim.