Report 2015-131 Recommendation 11 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 #11 To: Riverside, County of

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.

6-Month Agency Response

Fully Implemented - DPSS, RUHS-Behavioral Health and Public Health Nursing continue to meet to address oversight of the prescribing of psychotropic medications for dependent children and youth. Behavioral Health's Quality Improvement (QI) Department has dedicated staff psychiatrists to oversee psychotropic medication. Any request for court approval for psychotropic medication that does not align with standards is returned to the provider for additional information and review. Currently, this process has resulted in a decrease in requests being returned by the court. The interagency protocol has been updated and is implemented.

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

60-Day Agency Response

The DPSS, RUHS-Behavioral Health and Public Health Nursing meet regularly to address the process for oversight of the prescribing of psychotropic medications for dependent children and youth. Behavioral Health's Quality Improvement Department now has dedicated staff overseeing psychotropic medications, and has initiated a new process: if a request for psychotropic medication does not align with standards, the QI staff return it to the provider for additional information and review. Many of those concerns then get resolved and do not involve the court. Any concerns noted are also relayed to the provider. The interagency protocol has been updated and will be implemented.

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

All Recommendations in 2015-131

Agency responses received are posted verbatim.