Report 2015-131 Recommendation 19 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 #19 To: Sonoma County

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should ensure that all foster children are scheduled to receive a follow-up appointment within 30 days of starting a new psychotropic medication.

Annual Follow-Up Agency Response From October 2018

In early summer of 2017, FYC and DHS filled 2.0 FTE Public Health Nurse (PHN) positions that now work in collaboration with FYC/Probation staff and the Psychiatrist who reviews prescriptions to ensure that clients are also receiving case management and monitoring of appointments and visits with providers—including their required 30 day follow up if they begin a new medication. The PHNs are following up with Social Workers/Probation Officers as needed for clients that are in need of a 30 day follow up. In some cases, PHNs are also following up directly with caregivers to inquire if 30 day follow up visits are needed and being completed. The reviewing Psychiatrist has also contacted and followed up directly with prescribing physicians to let them know that there must be a follow up within 30 days for prescribed medications.

In September of 2017, a new Psychiatric Nurse position was filled and started at FYC. Her primary responsibilities are to monitor psychotropic medications in collaboration with the Psychiatrist. The Psychiatric Nurse also ensures that 30 day follow up visits are being made and tracked. She is continuing to refine and improve this tracking process to ensure full implementation of this recommendation. In addition, caregivers are being educated around their responsibilities during the Resource Family Approval (RFA) process related to prescriptions and support for youth taking psychotropic medication.

Completion Date: September 2017

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Annual Follow-Up Agency Response From November 2017

Please refer to our one year response

Estimated Completion Date: April 2018

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

1-Year Agency Response

In early summer of 2017, FYC and DHS filled 2.0 FTE Public Health Nurse (PHN) positions that now work in collaboration with FYC/Probation staff and the Psychiatrist who reviews prescriptions to ensure that clients are also receiving case management and monitoring of appointments and visits with providers—including their required 30 day follow up if they begin a new medication. Currently the PHNs are following up with Social Workers/Probation Officers as needed for clients that are in need of a 30 day follow up. In some cases PHNs are also following up directly with caregivers to inquire if 30 day follow up visits are needed and being completed. The reviewing Psychiatrist has also contacted and followed up directly with prescribing physicians to let them know that there must be a follow up within 30 days for prescribed medications.

In September of 2017, a Psychiatric Nurse will start at FYC and some of their primary responsibilities will be to monitor psychotropic medications in collaboration with the Psychiatrist. The Psychiatric Nurse will also ensure that 30 day follow up visits are being made and tracked. In addition, caregivers are being educated around their responsibilities during the Resource Family Approval (RFA) process related to prescriptions and support for youth taking psychotropic medication.

Estimated Completion Date: November 2017
Response Date: August 2017

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

6-Month Agency Response

FY&C has recently received approval from the Board of Supervisors to add 2 Public Health Nurses and a psychiatric nurse effective in first quarter 2017. It is expected these nurses will likely be hired in Summer 2017. We anticipate that the psychiatric nurse will be assigned the task of monitoring psychotropic medication prescriptions including, but not limited to, follow-up with physicians to ensure each youth has a 30-day follow-up appointment with prescribing physicians when new medications are being taken by a foster youth.

FY&C will send letters to all known prescribing physicians advising them of the requirement to see youth within 30 days of a foster youth beginning to take a new psychotropic medication. Additionally, all foster caregivers, including residential treatment centers, will be sent letters advising them that they should ensure that 30-day follow-up appointments are scheduled at the time a new psychotropic medication is prescribed. It is expected these letters will be sent by July 1, 2017. Caregiver responsibilities regarding foster youth and psychotropic medication is being added to the Resource Family training curriculum. Caregivers will be provided responsibility and communication information during the Resource Family Approval (RFA) process and with each placement of a foster youth in their home/facility.

Estimated Completion Date: September 1, 2017
Response Date: February 2017

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

60-Day Agency Response

FY&C has recently received approval from the Board of Supervisors to add 3 Public Health Nurses and a psychiatric nurse effective in first quarter 2017. We anticipate that the psychiatric nurse will be assigned the task of monitoring psychotropic medication prescriptions including, but not limited to, follow-up with physicians to ensure each youth has a 30-day follow-up appointment with prescribing physicians when new medications are being taken by a foster youth.

Estimated Completion Date: May 30, 2017
Response Date: October 2016

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

All Recommendations in 2015-131

Agency responses received are posted verbatim.