Psychotropic Medications

What is Psychotropic Medication? Any drug prescribed with the primary intent to stabilize or improve mood, mental status, behavioral symptoms, or mental illness is considered a Psychotropic or Psychotherapeutic Medication.  Florida Department of Children and Families recognizes seizure medication as psychotropic even though the intended use is not psychotropic. The medications include, but are not limited to Antipsychotics; Antidepressants; Anxiolytics; Mood stabilizers; Psychomotor stimulants or Atomoxetine; and other medications commonly used that may include but are not limited to alpha 2 blockers, beta blockers, anticonvulsants, cognition enhancers, and opiate blockers.  These “other medications” must be considered a psychotropic medication when used to stabilize or improve mood, mental status, behavior, or mental illness. 

There is a formal process that must occur when a child comes into care already on, needs to start or needs a change in type or dosage of Psychotropic Medications.  The information below outlines this process for children in out-of-home care.

Express Informed Consent for Psychotropic Medication:Before providing psychotropic medications to a child in out of home care, the Case Manager (CM) must attempt to obtain ‘express and informed consent’ from the child's parent or legal guardian and document those efforts.  The Psychotropic Medication Report must be used to document ‘express and informed consent’ from the child’s parent or legal guardian after being informed about medication and treatment intent directly by the prescribing physician.

Court Ordered Consent for Psychotropic Medication:When ‘express and informed consent’ cannot be obtained from the child’s parents (parental rights of the parent have been terminated, the parent's location or identity is unknown or cannot reasonably be ascertained, or the parent declines to give express and informed consent) the CM must submit to Child Legal Services (CLS) a request for court authorization to provide psychotropic medications within 12 working hours of receipt of the prescription.  CLS will file a motion.  This motion must be accompanied by a Medication Report completed by the prescribing physician and a report by the CM detailing efforts to obtain ‘express and informed consent’ and other treatment recommended/considered for the child.  SCC/CLS must notify all parties of the proposed action within 48 hours of filing.

Emergency administration:                                                                                                              If the child's prescribing physician certifies that a delay in providing a prescribed psychotropic medication would more likely than not cause significant harm to the child, the medication may be provided in advance of the issuance of a Court Order.  In such event, the Medical Report must provide the specific reasons why the child may experience significant harm and the nature and the extent of the potential harm.  A motion seeking continuation of the medication and the physician's medical report must be filed with the Court within 3 working days.  CM must seek the order at the next regularly scheduled Court hearing, or within 30 days after the date of the prescription, whichever occurs sooner.  In emergency psychiatric placements Psychotropic medications may be administered in advance of a Court Order (hospitals, crisis stabilization units, and in statewide inpatient psychiatric programs).  Within 3 working days after the medication is started, CM must seek Court authorization.

 

Consent or Court Ordered Psychotropic Medications for children age 11 and under:                   If the child is age 11 or under and in an out-of-home placement, a Licensed Child Psychiatrist must provide a ‘Pre-Consent Review’ prior to the child beginning the medications.  A Pre-Consent Review and additional information may be obtained by clicking on the following link: http://dcf.psychiatry.ufl.edu/submit-review-form/  Additionally, PRIOR TO seeking parental consent or the Court Order for the psychotropic medications, the CM must submit the documentation to a DCF contracted consultant Child Psychiatrist who will review the Treatment Plan and document recommendations within 1 business day of receipt of the plan.  NOTE:  When a physician has clearly documented the psychotherapeutic medication is being prescribed for purposes other than to improve mood, mental status, behavior or mental illness; a Pre-Consent Review is not required.

Discontinuation of Psychotropic Medications:                                                                             The CM must obtain documentation that the Prescribing Physician recommends discontinuation of the psychotropic medication; and must notify the Court when it has been discontinued.

Documentation Requirements:                                                                                     Psychotropic medication MUST be documented in Florida Safe Families Network (FSFN) within 24 hours of the medication administration.  A standard date of 01/01/1900 must be used in FSFN for date of current court order or parental consent when the child begins the medication under emergency provisions and prior to consent or court order (FSFN will not allow this page to be saved without a date).  The CM must ensure copies of the parental consent or the Court Orders are obtained and placed in the case file. The CM is responsible to ensure a parental consent or Court Order is obtained any time there is a change in the dosage or type of psychotropic medications prescribed to the child.  The CM must also ensure these changes are documented in a FSFN note and entered into the Medications Tab in FSFN.  The CM ensures all Judicial Review Social Study Reports (JRSSR) include details of the effectiveness of all psychotropic medications and any changes not otherwise found in the medical records being filed as attachments.

CM home visit responsibilities for children on psychotropic medication:                                 The Home Visit Checklist is to be completed at each monthly home visit for a child prescribed psychotropic medication.  The checklist needs to be completed at the home with the caregiver and child, if developmentally appropriate.  The caregiver, CM, and child (if appropriate) must sign and date this checklist and it is to be uploaded into FSFN as an attachment to the home visit note and filed in ASK. The checklist includes (1)the names of all psychotropic medications prescribed (2)Children Resource Record (CRR) review and signature, (3)Medication Log viewed, discussed and filed monthly, (4)ensuring all medication information, Medication Report and Court Order are in CRR, (5)discussion of medication with child as appropriate and his assent, (6)discussion of updates and details with caregiver regarding treatment including upcoming appointments and lab tests or assessments and who will be responsible for reporting any test/assessment results to all parties, and (7)side effects and who will be notified and by whom.

***All Psychotropic Medication resources can be found on the J-drive in the Forms folder.