CA Group Homes Must Change Prescribing Practices

41 California group homes have been issued advisory notices to create corrective action plans following an investigation of their prescribing practices to foster youth in their care. The investigations were mandated under Senate Bill 484 which passed in 2015 as part of a package of bills aimed at reducing the overmedication of children in foster care with psychotropic drugs.

Senate Bill 484 requires the annual identification and investigation of California group homes that are found to prescribe beyond safety thresholds for youth. The first round of investigations, now complete revealed that of the 205 homes identified for review 45 were not investigated due to closure or no longer having youth placed in the facility. 30% of the 161 group homes investigated received Advisory Notices as required by the bill to undergo corrective action plans.

The most common reasons for issuing an Advisory Note included:

• Staff received insufficient training regarding psychotropic medication. Many were unsure of facility protocol and/or Title 22 regulations.
• Many of the children’s Needs and Services plans were unsigned, despite 22 CCR § 84062(d)(1) requirement that the licensee shall not implement a needs and services plan unless prior written approval of the plan has been obtained from the child's authorized representative(s). Others had also not been completed within 30 days of the child’s placement.
• Many medication logs were missing initials and lacking proper documentation regarding medication refusals, side effects experienced, medication destruction, etc.

Another common finding from discussions with youth living in the facilities was that they experienced punishment or consequences for refusing to take medications. Under California law children and youth have the right to refuse psychotropic medication and can give their input to the court regarding their treatment.

Reviews occurred across the state:

• Northern California—11 Advisory Notes issued out of 58 facilities
• Central California—10 Advisory Notes issued out of 60 facilities
• Pacific Inland—9 Advisory Notes issued out of 51 facilities
• Los Angeles Tri-Coastal—2 Advisory Notes issued out of 13 facilities
• Los Angeles Metro and Valley—9 Advisory Notes issued out of 26 facilities
• Out of State—0 Advisory Notes issued out of 3 facilities