[Sign Up Now] to Receive Our FREE Daily SCVTV-SCVNews Digest by E-Mail

SCVNews.com | Report: Calif. Foster Kids are Over-Medicated | 08-23-2016
Inside
Weather
Santa Clarita CA
Cloudy
Cloudy
63°F
 
Calendar
Today in
S.C.V. History
June 29
1978 - Original Colossus coaster opens at Magic Mountain [watch it being built]


A report released Tuesday from the California State Auditor shows that the state and counties have failed to provide adequate oversight for the prescription of psychotropic medications to children in foster care.

[DOWNLOAD FULL REPORT]

 

 

foster082316

[State Auditor] – Our audit concerning the oversight of psychotropic medications prescribed to California’s foster children revealed the following:

* Nearly 12 percent of California’s more than 79,000 foster children were prescribed psychotropic medications during fiscal year 2014-15.

* Some foster children were prescribed psychotropic medications in amounts and dosages that exceeded state guidelines, and counties did not follow up with prescribers to ensure the appropriateness of these prescriptions.

* Many foster children did not receive follow-up visits or recommended psychosocial services in conjunction with their prescriptions for psychotropic medications.

* Counties did not always obtain required court or parental approval for psychotropic medications prescribed to foster children as required by law.

* The State’s fragmented oversight structure of its child welfare system has contributed to weaknesses in the monitoring of foster children’s psychotropic medications.

* The California Department of Social Services and the Department of Health Care Services data systems together cannot completely identify which foster children are prescribed psychotropic medications.

* Foster children’s Health and Education Passports—documents summarizing critical health and education information—contained inaccurate and incomplete mental health data.

 

Results in Brief

Psychotropic medications such as antidepressants, mood stabilizers, and antipsychotics can provide significant benefits in the treatment of psychiatric illnesses, but they can also cause serious adverse side effects. Although the American Psychological Association has mentioned that studies since the 1970s have found that children in foster care (foster children) often have a greater need for mental health treatment, public and private entities have expressed concerns about the higher prescription rates of psychotropic medication among foster children than among nonfoster children. This issue is of particular importance to California, which has the largest population of foster children in the country. In fact, our analysis of the available state data found that nearly 12 percent of California’s more than 79,000 foster children were prescribed psychotropic medications during fiscal year 2014-15, whereas studies suggest that only about 4 to 10 percent of nonfoster children are prescribed these medications.

To examine the oversight of psychotropic medications prescribed to foster children, we reviewed case files for a total of 80 foster children in Los Angeles, Madera, Riverside, and Sonoma counties and analyzed available statewide data. We found that many foster children had been authorized to receive psychotropic medications in amounts and dosages that exceeded the State’s recommended guidelines (state guidelines), circumstances that should have prompted the counties responsible for their care to follow up with the children’s prescribers. For example, 11 of the 80 children whose files we reviewed had been authorized to take multiple psychotropic medications within the same drug class. Further, 18 of the 80 children had been authorized to take psychotropic medications in dosages that exceeded the State’s recommended maximum limits. Medications that exceed the State’s recommended guidelines may be appropriate under some circumstances, and we are not questioning prescribers medical expertise. However, in the instances above, the counties did not contact the prescribers to ensure the safety and necessity of the medications in question, as the state guidelines recommend.

Compounding these concerns is the fact that many of these children do not appear to have received follow-up visits or recommended psychosocial services in conjunction with their prescriptions for psychotropic medications. The American Academy of Child and Adolescent Psychiatry recommends that children should receive follow-up visits with their health care providers ideally within two weeks, but at least within a month, after they start psychotropic medications. Nonetheless, one-third of the 67 foster children who started at least one psychotropic medication during our audit period did not receive follow-up appointments with their prescriber or other health care provider within 30 days after they began taking new psychotropic medications, thus increasing the risk that any harmful side effects would go unaddressed. In addition, our review of the 80 case files indicates that foster children did not always receive corresponding psychosocial services before or while they were taking psychotropic medications, even though such services are critical components of most comprehensive treatment plans.

In response to a recent state law, the Judicial Council of California adopted new and revised forms—which became effective in July 2016—to be used in the court authorization process for foster children’s psychotropic medications. The proper completion of these newly revised forms should provide county staff with additional information necessary to identify instances when foster children are prescribed psychotropic medications in amounts or dosages that exceed the state guidelines. Among other things, these revised forms require prescribers to explain for each foster child why they prescribed more than one psychotropic medication in a class or dosages that are outside the state guidelines. If these forms are not properly completed, county staff will need to follow up with prescribers to obtain information necessary to ensure that the prescriptions beyond the state guidelines are appropriate.

We also found that, in violation of state law, counties did not always obtain required court or parental approval before foster children received prescriptions for psychotropic medications. Specifically, when we reviewed the case files for 67 foster children who should not have received psychotropic medications without authorization from a juvenile court, we found that 23 (34 percent) did not contain evidence of such authorization for at least one psychotropic medication. Similarly, when we reviewed the case files for 13 foster children who should not have received psychotropic medications without the consent of their parents, we found that five (38 percent) did not contain evidence of such consent for at least one psychotropic medication. In effect, these children were prescribed psychotropic medications without proper oversight from the counties responsible for their care.

Further, the fragmented structure of the State’s child welfare system contributed both to the specific problems we identified in our review of the 80 case files and to larger oversight deficiencies that we noted statewide. Specifically, oversight of the administration of psychotropic medications to foster children is spread among different levels and branches of government, leaving us unable to identify a comprehensive plan that coordinates the various mechanisms currently in place to ensure that the foster children’s health care providers prescribe these medications appropriately. Although the different public entities involved have made efforts to collaborate, the State’s overall approach has exerted little system-level oversight to help ensure that these entities collective efforts actually work as intended and produce desirable results.

The State’s fragmented oversight structure has also contributed to its failure to ensure it has the data necessary to monitor the prescription of psychotropic medications to foster children. The two state entities most directly involved in overseeing foster children’s mental health care are the California Department of Social Services (Social Services) and the Department of Health Care Services (Health Care Services). Even when combined, results from data systems these two departments operate still contain inaccurate and incomplete data related to foster children who are prescribed psychotropic medications. Consequently, neither agency can completely identify which foster children statewide are prescribed psychotropic medications or which medications those children are prescribed.

Further, the inaccurate and incomplete information in Social Services data system is used to produce Health and Education Passports, which are critical documents that are meant to follow foster children should their placement change. We found that all 80 of the Health and Education Passports we reviewed contained instances of incorrect start dates for psychotropic medications. Moreover, 13 of these 80 Health and Education Passports did not identify all the psychotropic medications that the courts authorized, and all 80 were missing information about the corresponding psychosocial services the foster children should have received for at least one psychotropic medication. These errors and omissions appear to have been caused in large part by a lack of county staff to enter foster children’s health information into Social Services data system and an unwillingness of some county departments to share foster children’s information with each other. However, caretakers, health care providers, social workers, and others rely on the Health and Education Passports to make decisions about foster children’s care; without accurate information, they may inadvertently make decisions that do not reflect the children’s best interests.

Also, the State has missed opportunities to ensure that the counties have reasonable processes for overseeing the prescription of psychotropic medications to foster children. For example, Social Services California Child and Family Services Reviews of the counties only recently began examining in more depth psychotropic medications prescribed to foster children. Because Social Services and Health Care Services have not historically examined the prescription of psychotropic medications to foster children in their periodic reviews, they have missed opportunities for in-depth, county-by-county reviews of this issue. However, as of March 2016, both departments had begun collecting from the counties certain information about these medications.

Finally, rather than publishing this audit report in June 2016 as originally intended, we had to delay publication by two months to allow us time to obtain and analyze additional data from Health Care Services and to revise the report’s text and graphics accordingly. In November 2015, our office began analyzing data originally provided by Health Care Services in response to our request for all Medi-Cal data related to the provision of psychotropic medications and related psychosocial services to foster children. These data provided the basis for the audit report we intended to publish in June 2016. However, about one week before we were to originally publish our audit report, Health Care Services confirmed that it had not provided all the medical services data that we originally requested. Although it had provided us data for medications, treatment authorizations, and services provided by specialty mental health plans, it had not given us services data for managed care plans or fee-for-service providers.1 Our review showed that the additional June 22, 2016, data consisted of approximately 617 million medical service records. The related text and graphics in our audit report reflect a consolidation of the original more than 46 million medical service records provided by Health Care Services in November 2015 and the additional 617 million medical service records it subsequently provided on June 22, 2016, for a total of more than 663 million claims for medical services. Because the results from the consolidated data did not substantively affect the conclusions we reached originally or the recommendations we made, we did not ask the auditees to resubmit their written responses to our June 2016 draft report.

 

Recommendations

 

Legislature

The Legislature should require Social Services to collaborate with its county partners and other relevant stakeholders to develop and implement a reasonable oversight structure that addresses, at a minimum, the insufficiencies in oversight and monitoring of psychotropic medications prescribed to foster children highlighted in this report.

 

California Department of Social Services

To improve the oversight of psychotropic medications prescribed to foster children, Social Services should collaborate with counties and other relevant stakeholders to develop and implement a reasonable oversight structure that addresses, at a minimum, the monitoring and oversight weaknesses highlighted in this report and that ensures the accuracy and completeness of Social Services data system and the resulting Health and Education Passports.

 

Counties

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should take the following actions:

* Implement procedures to more closely monitor requests for authorizations for psychotropic medications for foster children that exceed the state guidelines for multiple prescriptions or excessive dosages. When prescribers request authorizations for prescriptions that exceed the state guidelines, counties should ensure the new court authorization forms contain all required information and, when necessary, follow up with the prescribers about the medical necessity of the prescriptions. Counties should also document their follow-up in the foster children’s case files. In instances in which counties do not believe that prescribers have adequate justification for exceeding the state guidelines, counties should relay their concerns and related recommendations to the courts or the children’s parents.

* Ensure that all foster children are scheduled to receive a follow-up appointment within 30 days of starting a new psychotropic medication.

* Implement a process to ensure that foster children receive any needed mental health, psychosocial, behavioral health, or substance abuse services before and concurrently with receiving psychotropic medications.

* Implement a systemic process for ensuring that court authorizations or parental consents are obtained and documented before foster children receive psychotropic medications.

 

Agency Comments

The state entities and the counties agreed with our recommendations.

Further, Madera County told us that because it agreed with our report’s recommendations, it did not intend to submit a written response. We look forward to assessing Madera County’s implementation of our recommendations when it provides updates to us at 60 days, 6 months, and one year following the issuance of our report.

Comment On This Story
COMMENT POLICY: We welcome comments from individuals and businesses. All comments are moderated. Comments are subject to rejection if they are vulgar, combative, or in poor taste.
REAL NAMES ONLY: All posters must use their real individual or business name. This applies equally to Twitter account holders who use a nickname.

0 Comments

You can be the first one to leave a comment.

Leave a Comment


SCV NewsBreak
Loading...
Related Content
LOCAL NEWS HEADLINES
Wednesday, Jun 28, 2017
SCV Detectives Seek Help to ID Theft Suspect
Santa Clarita Valley Sheriff's Station detectives seek the public's help to identify a theft suspect who has committed multiple thefts in Saugus and Valencia.
Wednesday, Jun 28, 2017
Suspect in Newhall Bank Robbery Still at Large
Deputies from the Santa Clarita Valley Sheriff’s Station and FBI officials are investigating a robbery at the Chase Bank branch on Lyons Avenue in Newhall on Tuesday afternoon.
Wednesday, Jun 28, 2017
Wilk’s Request to Audit LA County Homeless Services Approved
Senator Scott Wilk, R-Antelope Valley, announces the Joint Legislative Audit Committee today agreed to his request for an audit of Los Angeles County Homeless Service spending.
Keep Up With Our Facebook

Latest Additions to SCVNews.com
1978 - Original Colossus coaster opens at Magic Mountain [watch it being built]
Tonight on SCV NewsBreak, local government, law enforcement and fire leaders held a press conference and fireworks demonstration. Plus, The House of Natural Resources Committee passed the St. Francis Dam Memorial Act. Watch these stories and more on tonight's edition of SCV NewsBreak.
SCV NewsBreak for Wednesday, June 28, 2017
Santa Clarita Valley Sheriff's Station detectives seek the public's help to identify a theft suspect who has committed multiple thefts in Saugus and Valencia.
SCV Detectives Seek Help to ID Theft Suspect
Four Summer Robotics Workshops for young people in grades 5 through 8 are set for NASA's AERO Institute in Palmdale in July.
NASA AERO Institute Sets Summer LEGO Robotics Workshops
Avery Romero homered in his first at-bat and reached base in all four of his plate appearances to help the Lancaster JetHawks defeat the Inland Empire 66ers, 7-1, on Wednesday afternoon at San Manuel Stadium.
Romero’s Big Wednesday Helps JetHawks’ Tinoco to Sixth Win
Deputies from the Santa Clarita Valley Sheriff’s Station and FBI officials are investigating a robbery at the Chase Bank branch on Lyons Avenue in Newhall on Tuesday afternoon.
Suspect in Newhall Bank Robbery Still at Large
Senator Scott Wilk, R-Antelope Valley, announces the Joint Legislative Audit Committee today agreed to his request for an audit of Los Angeles County Homeless Service spending.
Wilk’s Request to Audit LA County Homeless Services Approved
College of the Canyons has continued to meet accreditation standards since the college’s fall 2014 accreditation, the Accrediting Commission for Community and Junior Colleges' Western Association of Schools and Colleges has confirmed.
COC Continues to Meet Accreditation Standards
Santa Clarita Valley residents are looking forward to the city of Santa Clarita's annual Fourth of July Parade in Old Town Newhall Tuesday, July 4 from 9 a.m. to 12:30 p.m.
July 4: Santa Clarita Fourth of July Parade
Independence Day Classic runners looking to re-fuel and pancake lovers alike can enjoy the Santa Clarita Valley Rotary Club's annual pancake breakfast on Tuesday, July 4 from 6:30 a.m. to 9:30 a.m.
July 4: Rotary Pancake Breakfast
Artist Randall Williams has completed painting a new 20-foot mural for the Domestic Violence Center’s Santa Clarita shelter, commissioned by Logix Federal Credit Union.
Artist Completes New Mural at Domestic Violence Center
Firefighters battle a fast-moving blaze that consumed 850 acres Sunday afternoon and destroyed structures on the Disney movie ranch in Placerita Canyon. Sparked by a car crash, the fire threatened homes on both sides of the 14 Freeway.
Updated: Placerita Fire at 760 Acres, 95 Percent Contained [Video]
The California state tax rate on tobacco products other than cigarettes will increase from the current rate of 27.3 to 65.08 percent of the wholesale cost on July 1.
July 1: Tax on Tobacco Products Spikes Per Prop 56
The Santa Clarita Valley Senior Center Silvertone Singers under the direction of John Swinford will present their "Fifty Years on the Great Broad Way!" concert at the Senior Center on Thursday, June 29 from 2:45 p.m. to 4:30 p.m.
June 29: ‘Fifty Years on the Great Broad Way’ Concert at Senior Center
Santa Clarita-based Pet Me Happy Treats, maker of Artisan Dog Treats with Oregon Blueberries, celebrates its official Grand Opening with a Chamber of Commerce ribbon-cutting hosted by Shelter Hope Pet Shop on Tuesday, July 11 at 5:30 p.m.
July 11: Pet Me Happy Treats Grand Opening
Get your Fourth of July off to a running start by taking part in the 35th Annual Independence Day Classic 5K and 10K Run/Walk at Newhall Memorial Park starting at 7 a.m.
July 4: Independence Day Classic 5K, 10K Run-Walk
Everyone from first-time racers and kids to professionals and enthusiasts are invited to take part in the Santa Clarita PedalFest Racing Series at Central Park, with the first race on Thursday, June 29 starting at 5:30 p.m.
June 29: First 2017 ‘PedalFest’ Race
"Aloha Broha," an exhibit of original art by Cyrus Howlett, will be on display at The MAIN in Newhall from Wednesday, July 5 through Friday, July 28.
July 5-28: ‘Aloha Broha’ Exhibits Art by Cyrus Howlett
The Lancaster JetHawks scored four runs in the top of the first but couldn’t hold off the Inland Empire 66ers in a 14-7 loss on Tuesday night at San Manuel Stadium.
JetHawks Squander Early Lead En Route to Rout Tuesday
1926 - Film director Mel Brooks born in Brooklyn; shot "Blazing Saddles" at Vasquez Rocks and "Robin Hood: Men In Tights" in Sand Canyon [story]
Tonight on SCV NewsBreak, Chiquita Canyon's expansion is approved by the county. Plus, deputies arrest a man after a standoff in Stevenson Ranch. Watch these stories and more on tonight's edition of SCV NewsBreak.
SCV NewsBreak for Tuesday, June 27, 2017
The Los Angeles County Board of Supervisors unanimously voted to approve the Chiquita Canyon Landfill expansion Tuesday afternoon with some amendments.
Supes OK Chiquita Expansion; Higher Fees for Non-SCV Trash
LA Summerfest presents the Leslie Berra Singers in a special performance at the Rivendale Park & Open Space on Saturday, July 15 from 8 p.m. to 11 p.m.
July 15: Leslie Berra Singers at LA SummerFEST
The Small Business Development Center at College of the Canyons will host a Veteran Entrepreneurship Series Parts 1 and 2 workshop at the University Center at COC on Friday, June 30 from 9:30 a.m. to 1 p.m.
June 30: SBDC Veteran Entrepreneurship Workshop
Princess Cruises®announced today that Golden Princess®, Crown Princess® and Ruby Princess® will be the next three ships to feature the Ocean Medallion™ wearable device.
Princess Cruises Adds 3 Ships to Interactive ‘Ocean Medallion’ Class
Visitors to the Los Angeles County Board of Supervisors' website were not met with the usual homepage on Tuesday afternoon. Instead, they saw a black screen with text in the middle, displaying what appeared to be pro-ISIS propaganda.
County Supervisors’ Website is Latest Casualty of Hack
Santa Clarita Mayor Pro Tem Laurene Weste cut the ribbon to mark the official opening of the Newhall Pass Open Space, located by the I-5 and 14 interchange.
City Briefs: More Open Space Dedicated
In honor of the Fourth of July, Six Flags Magic Mountain will be transformed into a four-day “All-American” weekend of patriotic festivities from July 1-4,
Six Flags Magic Mountain Hosts Coca-Cola July 4th Fest
Representatives Steve Knight (CA-25) and Julia Brownley's (CA-26) bill, H.R. 2156, the St. Francis Dam Memorial Act passed the House Natural Resources Committee with unanimous support Tuesday.
St. Francis Dam Memorial Act Unanimously Clears Committee
Julia Fulmer, a 16-year-old cancer survivor, is making her directorial debut by calling the shots on "Rachel's Pitch," a new original short film that began shooting in Santa Clarita on Monday.
Teen Cancer Survivor Makes Film Directorial Debut in SCV
Santa Clarita and Los Angeles County fire and law enforcement officials will hold a press conference in Valencia Wednesday to demonstrate the dangers of illegal fireworks.
Pyrotechnics Demonstration to Show Danger of Illegal Fireworks
The California Coastal Commission has reached a tentative settlement with sand mining company Cemex that would lead to the shuttering of a controversial sand-removal operation that residents say is eroding the coast of Monterey Bay.
Cemex to Quit Mining Near Monterey Coast
June 25–July 1 is National Mosquito Control Awareness Week, designed to educate the public about the significance of mosquitoes in their daily lives and the important service provided by mosquito control workers around the world.
June 25-July 1: Mosquito Control Awareness Week
The city of Santa Clarita’s Thursdays@Newhall series in Old Town Newhall, presented by Galpin Subaru, continues in July with a unique blend of music, performances, a beach-themed SENSES block party and much more.
Thursdays at Newhall Brings the Heat in July
Wes Rogers drove in four runs in the first two innings, and the Lancaster JetHawks held off a late Inland Empire 66ers rally in a 9-6 win on Monday night at San Manuel Stadium.
JetHawks Stave Off Sixers to End Skid Monday
A standoff between a man and deputies from the Santa Clarita Valley Sheriff’s Station at Valencia Marketplace this morning has ended peacefully, according to officials.
Updated: Valencia Marketplace Standoff Ends Peacefully