Principles underlying Legislative Findings and Intent
1. California must take very seriously the protection of children from the improper
use of psychotropic medications, and at the same time incorporate scientific
evidence that supports the safe and effective use of antipsychotics in youth in a
number of circumstances.
2. It is not surprising that the rate of Medi-Cal youth, in particular foster youth, on
psychotropic medication is greater than the non Medi-Cal population. There is
evidence that the proportion of foster youth, for instance with trauma, emotional
and mental health needs is as high as 70 to 80 percent.
3. Medication use for behavioral issues as well and those for therapeutic needs are
both legitimate and evidenced based practices.
4. Gaps in treatment can be very damaging and potentially dangerous for any
individual with a serious mental disorder, particularly children and youth.
5. The effects of deferrals, adjudication and denials of prescriptions can lead to
avoidable hospitalizations, increased use of seclusion and restraints, higher rates
of emergency room use – in particular an increase in pediatric admissions for
aggression and agitation – and more restrictive placements, among many
adverse effects.
6. Tracking, monitoring, data analysis and reporting of the use of psychotropic
medications in the Medi-Cal program needs to be prioritized and made more
robust so that clear evidence of the effects of policies can produce informed,
consistent oversight and administration of the use of psychotropic medications.
7. The training involved for Board Certified child psychiatrists, who receive 4 years
of general psychiatry training and then in addition receive two years of
specialized training for the treatment of children and youth related supports
consideration of exclusion from TAR requirements for antipsychotics.
8. In a system with too few child psychiatrists, administrative burdens on those
psychiatrists must be minimized.
9. Because of the absence of pediatric research by pharmaceutical companies, most
medication use for children and adolescents for all medical conditions is ‘off
label’ i.e. used for indications that are not approved by the Federal Drug
Administration. Even so, a body of scientific literature on the use of antipsychotic
medications provides guidance to their safe and effective use with children and
youth.
Framework for TAR Legislation
1. The Secretary of the Health and Human Services Agency will direct the Director of
the Department of Health Care Services to:
a. rescind the current policy regarding mandatory antipsychotic treatment
authorization requests for all Medi-Cal beneficiaries under the age of 18.
b. convene an advisory group, composed of representatives of at least the
organizations below, for the express purpose of assisting the Department
to identify the specific problem or problems needing to be addressed,
and how the problems and issues differ between the population involved
in child welfare services, probation services and foster care and those in
unified family situations.
c. explore with the advisory group the various options for addressing the
identified problem or problems.
d. In the analysis of each identified problem, identify extant policy,
procedures and legal requirements, as well as any data or best practices
that support that option.
e. in consultation with stakeholders will seek a solution which has the most
protection for foster youth and the least chance of adverse health and
mental health consequences to the target population."
f. will develop a new draft policy and submit it to the advisory group for
review.
g. provide opportunity for the advisory group members to provide written
responses to the draft policy identifying any concerns and/or
recommendations.
h. ensure that in adopting final policy there is a written response to each
concern and or recommendation.
2. The Department shall issue a report on the policy it has developed to the
legislature on or before _______________, and will include in that report all of the
information generated the process above, in particular identifying
recommendations, concerns or objections of the advisory group or of any of its
constituent members and its response to them.
3. The advisory group shall consist of at least representatives from:
California Academy of Child and Adolescent Psychiatry
California Academy of Emergency Physicians
California Alliance of Child and Family Service Agencies
California Behavioral Health Directors Association
California Council of Community Mental Health Agencies
California Hospital Association
California Medical Association
California Pharmacists Association
California Psychiatric Association