Report 2015-131 Recommendation 21 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 #21 To: Sonoma 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.

Annual Follow-Up Agency Response From October 2018

FY&C has updated and implemented policies and procedures that require renewed authorizations to be documented in CWS/CMS within 180 days of the preceding authorization. Social Workers and Supervisors are able to access which clients have current authorizations and those who are missing or have an expired authorization in Safe Measures reports. The PHNs and the Psychiatric Nurse are also following up directly with Social Workers when they see that a client's authorization has or is expiring, and tracking those due dates. Probation developed similar lines of communication with the PHNs and the Delinquency Court has already developed protocols to memorialize parental consent/court authorizations via judicial minute orders. Probation developed protocols for documenting authorizations in CWS/CMS through an MOU with Health Services through PHN staff.

FY&C sends letters to caregivers informing them that a child in their care has a medication or medications expiring within 75 days. A list of expiring authorizations is generated monthly and reviewed with the PMOC—including the Psychiatric Nurse who started in fall 2017, they review this list and follow up with Social Workers and Caregivers directly to ensure they are aware that an authorization is coming due.

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

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

1-Year Agency Response

FY&C has updated and implemented policies and procedures that require renewed authorizations to be documented in CWS/CMS within 180 days of the preceding authorization. Social Workers and Supervisors are able to access which clients have current authorizations and those who are missing or have an expired authorization in Safe Measures reports. The PHNs are also following up directly with Social Workers when they see a client's authorization has or is expiring and tracking those due dates. Probation is developing similar lines of communication with the PHNs and the Delinquency Court has already developed protocols to memorialize parental consent/court authorizations via judicial minute orders. Probation is in the process of developing protocols for documenting authorizations in CWS/CMS.

FY&C is also working to draft letters to caregivers informing them that a child in their care has a medication or medications expiring within 75 days. A list of expiring authorizations will be generated monthly and reviewed with the PMOC—it is expected that when the Psychiatric Nurse starts in fall of 2017, they will review this list and follow up with Social Workers and Caregivers directly to ensure they are aware and authorization is coming due.

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

6-Month Agency Response

FY&C has convened a Psychotropic Medication Monitoring Workgroup that is developing, among other monitoring issues related to use of psychotropic medications by foster youth, policies and procedures to ensure that court authorization and parental consents are obtained before foster youth begin taking any prescribed psychotropic medications as well as to ensure that all psychotropic medication authorizations (whether by court order or parent consent) are renewed and documented in CWS/CMS within 180 days of the preceding authorization. It is anticipated this policy and procedure, as well as practice, will be updated and in effect by August 1, 2017. In the meantime, measures have been implemented to assist social workers to effectively track due dates: social workers and supervisors are routinely provided lists of authorization due to expire in 30 days, 60 days, 90 days and 120 days; and, caregivers will be sent a letter 75-60 days prior to the expiration of authorizations advising them of steps they need to take to schedule an appointment with the prescribing doctor, obtain a new JV-220(A) or (B), submit to the social worker, etc.

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

60-Day Agency Response

FY&C has convened a Psychotropic Medication Monitoring Workgroup that is developing, among other monitoring issues related to use of psychotropic medications by foster youth, policies and procedures to ensure that court authorization and parental consents are obtained before foster youth begin taking any prescribed psychotropic medications as well as to ensure that all psychotropic medication authorizations (whether by court order or parent consent) are renewed and documented in CWS/CMS within 180 days of the preceding authorization. It is anticipated this policy and procedure, as well as practice, will be updated and in effect by March 1, 2017.

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

All Recommendations in 2015-131

Agency responses received are posted verbatim.