Report 2015-131 Recommendation 4 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 #4 To: Los Angeles County

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should implement a systemic process for ensuring that court authorizations or parental consents are obtained and documented before foster children receive psychotropic medications and that court authorizations for psychotropic medications are renewed within 180 days as state law requires. The process should also ensure that the counties better document the court authorizations and parental consents in the foster children's case files.

1-Year Agency Response

We are also working with the Department of Children and Family Services, Probation, and other stakeholders (constituting the proverbial "village") to routinely inquire of children and caregivers on the use of medications and to fully document their answers. Our goal is to ensure that we are aware of every child involved in our systems who is being administered psychotropic medications, and to ensure that every one who is being medicated has in fact been the subject of the approval process designed to make sure that the use of these medications is appropriate.

(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

Our 60-day response filed in October 2016 referenced a standing order issued by the Presiding Judge of the Juvenile Court requiring the Department of Mental Health's credentialing of prescribers of psychotropic medications for children and youth in group homes. That process has been implemented, and the blanket order is attached to this submission.

The October response also referenced the development of an electronic system to track the use of psychotropic medications. Los Angeles County has been actively involved with the California Department of Social Services in its efforts to accomplish this through the state's development of its new CWS/NS, currently being built to replace the CWS/CMS case management option.

(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 to implement a systemic process for ensuring that court authorizations or parental consents are obtained and documented before foster children receive psychotropic medications, that court authorizations for psychotropic medications are renewed within 180 days (as state law requires), and that Los Angeles County better documents the court authorizations and parental consents in foster children's case files.

In addition to the Workgroup's efforts regarding forms and responsibilities, we most importantly want to ensure that we are aware of every child in our system who is being administered a psychotropic medication. We also want to know other things, including but not limited to what medications they are taking and why, where they live, who prescribed the medication, who authorized the medication, and much more. Los Angeles County is also engaged in developing a system to track the use of psychotropic medications electronically.

(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.