Report 2015-131 Recommendation 20 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 #20 To: Sonoma County

To better ensure that foster children only receive psychotropic medications that are appropriate and medically necessary, counties should implement processes to ensure that foster children receive any needed mental health, psychosocial, behavioral health, or substance abuse services before and concurrently with receiving psychotropic medications.

Annual Follow-Up Agency Response From October 2018

Since the addition of PHNs in Summer of 2017, they have spent time providing case management and review of the foster youth taking medications. Part of this review is ensuring that psychosocial, behavioral health or substance use services are also being provided concurrently with medication. In addition, each foster youth's case carrying social worker is required to ask the youth and caregiver about the mental health, psychosocial, behavioral health and/or substance abuse services the youth is involved or engaged in before and concurrently with taking psychotropic medications at each monthly visit. A guide and template has been created within the monthly contact notes to assist social workers with including this information. FY&C social workers were trained on how to use the new contact note template in Fall 2017.

In addition to practice changes, FY&C began reviewing cases for adherence to Safety Organized Practice standards for all social workers in 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

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

1-Year Agency Response

Since the addition of PHNs in Summer of 2017, they have spent time providing case management and review of the foster youth taking medications. Part of this review includes finding out if the psychosocial, behavioral health or substance use services are also being provided concurrently with medication. In addition, each foster youth's case carrying social worker is required to ask the youth and caregiver about the mental health, psychosocial, behavioral health and/or substance abuse services the youth is involved or engaged in before and concurrently with taking psychotropic medications at each monthly visit. A guide and template has been created within the monthly contact notes to assist social workers with including this information. While the template has been created, FY&C must still train social workers on how to use the new contact notes. It is expected this training will be complete by December of 2017.

In addition to practice changes, FY&C is reviewing cases for adherence to Safety Organized Practice standards process for all social workers which will start Sept 1, 2017. Every social worker in a unit will have a case randomly selected to be reviewed by a Supervisor to ensure that standards were met or exceeded—this will include the review of how social workers update and provide accurate information in contact notes about psychotropic medications.

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

6-Month Agency Response

As the auditor's office is probably aware, the new JV-220(A) includes this question. If the prescribing physician does not provide an answer to the question or checks the "I don't know" box on the JV-220(A), the FY&C Social Worker and/or the Public Health Nurse will contact the caregiver and/or the prescribing physician to acquire the information and will assist the caregiver to define, locate, and engage services needed for each foster youth. Since the psychotropic medication monitoring Public Health Nurse has not been hired and all FY&C Social Workers have not yet been trained on this specific question, this recommendation is not yet fully implemented.

Each foster youth's case-carrying social worker will inquire, at each monthly visit with the youth and the caregiver, about the mental health, psychosocial, behavioral health, and/or substance abuse services the youth was/is involved or engaged in before and concurrently with taking psychotropic medication. The new guide for documenting monthly contacts, which will include the information addressed herein, will be effective March 2017. In addition, when JV-220(A) or (B) forms are received from doctors and the doctor has not completed the information, social workers will contact youth, caregivers, parents, etc. to obtain the information necessary to advise the reviewing psychiatrist and the court of other measures preceding or in tandem with medication.

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

60-Day Agency Response

As the auditor's office is probably aware, the new JV-220(A) includes this question. If the prescribing physician does not provide an answer to the question or checks the "I don't know" box on the JV-220(A), the FY&C Social Worker and/or the Public Health Nurse will contact the caregiver and/or the prescribing physician to acquire the information and will assist the caregiver to define, locate, and engage services needed for each foster youth. Since the psychotropic medication monitoring Public Health Nurse has not been hired and all FY&C Social Workers have not yet been trained on this specific question, this recommendation is not yet fully implemented.

Each foster youth's case-carrying social worker will inquire, at each monthly visit with the youth and the caregiver, about the mental health, psychosocial, behavioral health, and/or substance abuse services the youth was/is involved or engaged in before and concurrently with taking psychotropic medication.

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

All Recommendations in 2015-131

Agency responses received are posted verbatim.