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Lori Fuller, Bureau Chief CFSD Fernando Sandoval, Manager II CCLD 2

Marisa Sanchez 3

Workgroup Goals – Marisa Sanchez Legislative Overview –Chaptered Bills SB 238, SB 319, & SB 484 -Lori Fuller Overview of the Methodology Development for Group Home Reviews- Jennifer White Group Discussion on Methodology ◦ Additional Criterion for Consideration ◦ Short-Term Residential Treatment Centers Break Introduce Existing Training for Social Workers-Jessie Rosales Closing Remarks and Next Steps – Lori Fuller & Marisa Sanchez 4

 Gather input from our stakeholders on the implementation of SB 238 and SB 484  Develop methodologies.  Develop training protocols for the implementation of these bills.  Expand current training for professionals as it pertains to these bills.  Inform the regulation development process.  Data and information sharing. 5

 Review methodology developed by CDSS for Group Home Reviews  Group discussion focused on developing Methodology for identifying psychotropic medication usage warranting additional review  Discussion focused on training requirements 6

Lori Fuller 7

 Outlines criteria for the use of psychotropic medication for children and youth in foster care, and requires data sharing agreements between DHCS, CDSS and county placing agencies.  Requires CDSS, in consultation with DHCS and stakeholders, to develop and distribute a monthly report with specified information regarding foster youth taking psychotropic medications.  Requires county placing agencies to use form to share information with designated parties. 8

 Requires CDSS in consultation with stakeholders to develop training for social workers, probation officers, court staff, children’s attorneys, children’s caregivers, CASAs.  Training will address authorization, uses, risks, benefits, assistance with self-administration, oversight, and monitoring of psychotropic medications, trauma and substance use disorder treatments, and how to access those treatments. 9

 Reports would at a minimum include authorized psychotropic medications with medication name, quantity and dosage prescribed and available data regarding psychosocial interventions and incidents of polypharmacy.  Requires CDSS, in consultation with DHCS and stakeholders to develop a form to be utilized in sharing information from data reports to court, child’s attorney, Behavioral Health, and CASAs 10

 Adds foster care public health nurses to the list of allowable parties with whom health care providers can disclose medical information to for the purposes of coordinating healthcare services and medical treatment.  Clarifies existing law that directs the PHN to monitor prescription medications including psychotropic medications as part of their duty to coordinate, develop and participate in the medical care planning for foster youth. 11

 Adds additional record keeping/document requirements related to psychotropic medications for group home facilities to maintain in the child’s file.  Requires CDSS to compile specified information regarding the administration of psychotropic medications to children in foster care in group homes based on data from DHCS and at least annually post on its website. 12

 Requires CDSS, in consultation with the DHCS and stakeholders, to establish a methodology to identify those group homes that have levels of psychotropic drug utilization warranting additional review, and to inspect identified facilities at least once a year.  Share relevant information from inspections with county placing agencies, social workers, probation officers, court, minor’s attorneys, or medical board if applicable and/or with facilities and develop appropriate plans of action. 13

 Every three years, CDSS will be required to consult with DHCS and stakeholders to revise the methodology, if necessary. 14

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 CDSS conducted group home site visits June- July 2015 statewide.  Participants ◦ Children & Family Services Division staff ◦ Community Care Licensing Program Analysts (LPAs) ◦ DHCS Pharmacy Benefits Division staff  Methodology ◦ Targeted group home facilities with high medication usage rates of 90%, moderate usage rates of 50% and low usage rates of 10% ◦ Case File Reviews ◦ Youth Interviews ◦ Group Home Staff Interviews 16

Jennifer White 17

 Medi-cal pharmacy claims data were matched to CWS/CMS data. Pharmacy data includes: ◦ Includes fee-for-service & managed care paid claims for psychotropic medication, ◦ Quarterly exchange ◦ Six-month lag 18

 Group homes that may have been outside the expected range for the percent of children in their care who may have received psychotropic medication based on the group home’s (RCL). 19

 Percent Medicated was calculated as : ◦ Denominator: The total number of youth placed in the group home at any time during the12-month period. ◦ Numerator: Group home facilities with at least one youth who received at least one paid claim for psychotropic medication during the same 12-month period.  Percentage of children on medication per group home 20

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Foster care episodes less than 30 days Group homes in the denominator with fewer than six placements during the 12-month period Youth who entered and exited a group home on the same day 22

 Regardless of their percentage, any group home with these criteria could be reviewed:  Group homes with children 5 and under  Children with 3 or more concurrent medications  RCLs will go away with Continuum of Care Reform 23

Jessie Rosales 24

 Inform relevant staff who work with children under the jurisdiction of the juvenile court that address the authorization, uses, risks, benefits, assistance with self-administration, oversight, and monitoring of psychotropic medications, trauma, and substance use disorder and mental health treatments, including how to access those treatments 25

 County child welfare social workers  Probation officers  Judges  Children’s attorneys  Children’s caregivers  Court-appointed special advocates  Public health nurses 26

 CalSWEC/RTAs ◦ Social workers ◦ Tribes  RCFFP ◦ Probation officers ◦ Parent partners ◦ Youths  Community Care Licensing ◦ STRTC ◦ FFA 27

 CIBHS ◦ Mental health  FKCE ◦ Resource family  County CASA Programs ◦ Court-appointed special advocates  Judicial Council  Board of Registered Nursing (?) ◦ Public health nurses 28

 The role of medication in comprehensive treatment  Principles of the use of psychotropic medication in children and adolescents  Mental health conditions and symptoms that psychotropic medications treat  How medication management decisions are made  Details about the commonly prescribed classes of medicine 29

 Foster children and youth: special considerations and the authorization process  Psychosocial and psychotropic medication treatment plan  Trauma – PTSD, trauma-informed crisis management planning  Substance use disorder  Mental health treatments and how to access those treatments 30

 What other training curriculum is out there that can be shared? 31