Report 2015-131 Recommendation 1 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 #1 To: Los Angeles County

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should implement procedures to more closely monitor requests for authorizations for foster children's psychotropic medications that exceed the state guidelines for multiple prescriptions, specific age groups, or dosage amounts. 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 prescribers about the medical necessity of the prescriptions. Counties should also document their follow-up monitoring 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, the counties should relay their concerns and related recommendations to the courts or parents.

1-Year Agency Response

As noted in our report of February 23, 2017, Los Angeles County's efforts with respect to psychotropic medications are being coordinated by the Psychotropic Medication Workgroup (Workgroup) convened by the Los Angeles County Office of Child Protection in July 2016. The Workgroup has met monthly since that time, and has recently been joined by representatives from the California Youth Connection (CYC).

On April 15, 2017, Los Angeles County implemented revised protocols for the approval process and the monitoring process of the use of psychotropic medications for children and youth involved in both the child welfare and juvenile justice systems. These revised protocols incorporate the new forms mandated by the Judicial Council last year. We believe that the new forms and protocols, along with practice changes, are implementing the recommendations made by the State Auditor in its August 2016 report.

At the Workgroup's monthly meetings, the various member entities—including the departments of Children and Family Services, Probation, Mental Health, and Public Health, along with the Juvenile Court—report on how the protocols and practices are being followed and properly documented. While implementation is still a work in progress, we are satisfied that compliance is steadily improving.

(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

6-Month Agency Response

As mentioned in our 60-day response, most if not all of Los Angeles County's efforts in relation to the prescription and administration of psychotropic medications for child-welfare and juvenile-justice youth——including those in response to the State Auditor report——originate from a Psychotropic Medication Workgroup (Workgroup) convened by the Los Angeles County Office of Child Protection (OCP) in July 2016.

In addition to OCP staff, the Workgroup consists of representatives from the departments of Children and Family Services, Probation, Mental Health, and Public Health, the Board of Supervisors, the Juvenile Court, Children's Law Center, Los Angeles Dependency Lawyers Inc., the Public Defender, the Alternate Public Defender, Court Appointed Special Advocates, the Commission for Children & Families, the Alliance for Children's Rights, Public Counsel, the Association of Community Human Services Agencies, and L.A. Care.

In its monthly meetings, the Workgroup's primary focus has been the implementation of the new forms mandated by the California Judicial Council to be used during the process of prescribing and administering psychotropic medication for the above-mentioned children and youth. The Workgroup has redrafted protocols for the approval and monitoring of the use of psychotropic medications, and has attached these protocols to this submission.

(Please see supporting documentation.)

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

60-Day Agency Response

Most, if not all, of Los Angeles County's efforts in relation to the prescription and administration of psychotropic medications for child-welfare and juvenile-justice youth—including those in response to the State Auditor report—will originate from a Psychotropic Medication Workgroup (Workgroup) convened by the Los Angeles County Office of Child Protection (OCP) in July 2016. In addition to OCP staff, the Workgroup consists of representatives from the departments of Children and Family Services, Probation, Mental Health, and Public Health, the Board of Supervisors, the Juvenile Court, Children's Law Center, Los Angeles Dependency Lawyers Inc., the Public Defender, the Alternate Public Defender, Court Appointed Special Advocates, the Commission for Children & Families, the Alliance for Children's Rights, Public Counsel, the Association of Community Human Services Agencies, and L.A. Care.

Over the next year, this Workgroup will develop strategies to more closely monitor and follow up on authorizations for prescriptions that exceed the state guidelines. Its initial focus has been the implementation of new forms developed by the California Judicial Council that are designed to: enhance the quality/quantity of information presented to judges tasked by law with decisions on approving the administration of psychotropic medications; enhance the engagement of youth, parents, caregivers, and agencies involved in the process; ensure that alternatives to medication are appropriately considered; ensure that other mental health services accompany the use of the medications; and help monitor the effects of the medications.

Discussions have focused on clarifying which persons or agencies will be responsible for completing each form and the timelines for doing so. Similar decisions are being made with respect to the optional forms for youth and those that can be completed by parents, caregivers, attorneys for the parties, and others.

(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.