DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

   <<< Return to OPP Table of Contents
Handbook 13: Cross Program Protocols
13-7.1 Psychotropic Medication

 

Cross Program Protocols
13-7.1 Psychotropic Medication
Reference Points
Overview
Authority  for Consent
Children Who Are Detained in Out-of-Home Care and Prescribed Psychotropic Medication
Forms Needed to Obtain Court Authorization for Psychotropic Medication and How to Access Them in CWS/CMS
Additional Information Needed for CWS/CMS Entry

Physician's Statement

JV-220(A)

Completing Noticing (JV-221)Regarding Psychotropic Medication
Notice to the Child's Attorney
Notice to Parents/Legal Guardians and Their Attorneys
Notice to the Child's Caregiver and CASA
Submitting the Application Packet to Court
Processing Authorizations by the Court
When Does the Order for Psychotropic Medication Expire
Continuation of a Previously Prescribed Medication
Authorization for a Parent to Consent to the Administration of Psychotropic Medication
Psychiatric Hospitalizations
Electro convulsive shock Therapy (ECT)
Psychosurgery
Children's Rights to Consent
Other References


Reference Points
Effective Date: 4/1/08
Last Updated: 8/20/12
 Legal Basis:
Popup Window Welfare & Institutions Code (WIC) §369.5
Popup Window WIC § 5326.8
pdf California Rules of Court 5.640
Popup Window Local Juvenile Rules of Court  - JUVENILE RULE 1(L)
 CWS/CMS Forms:
bullet

Information About Psychotropic Medication Forms (JV-219-INFO)

bullet Application Regarding Psychotropic Medication - Juvenile (JV-220)
bullet Prescribing Physician’s Statement – Attachment (JV-220a)
bullet Proof of Notice: Application Regarding Psychotropic Medication (JV-221)
bullet Opposition to Application Regarding Psychotropic Medication (JV-222)
bullet Order Regarding Application for Psychotropic Medication (JV-223)
bullet Case Plan
bullet Case Plan Update
bullet Health Notebook


Overview  

Obtaining consent for a child who is a dependent of the court to be administered psychotropic medication is considered a medical emergency that requires immediate processing by the social worker.  Once a child is declared a dependent child of the court and is removed from the custody of the parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medication to the child. The social worker may recommend that the orders authorize the parents to consent to the administration of the medication or the worker may recommend that the court directly orders the administration of the medication.

Psychotropic medications or psychotropic drugs are those medications administered for the purpose of affecting the central nervous system to treat psychiatric disorders or illnesses. These medications include, but are not limited to, anxiolytic agents, antidepressants, mood stabilizers, anti psychotic medications, anti-Parkinson agents, hypnotics, medications for dementia, and psycho stimulants.

In Santa Clara County, an administering psychiatrist has the discretion to initiate the use of psychotropic drugs for a 14-day period while attempting to obtain parental/guardian consent or court authorization, if, after weighing the risks and benefits of such medication, the psychiatrist concludes there is no significant risk of irreversible side effects.  Court authorization must be sought as soon as practical but never more than two court days after the emergency administration of the medication.

If the parent, guardian or attorney for the child objects to the utilization of the drugs, the matter is set for hearing before a Judge or Commissioner of the Juvenile Court on an expedited basis.

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Authority for Consent  
  • The social worker never has authority to sign consent for the administration of psychotropic medication.
  • The parent or legal guardian may consent to the administration of psychotropic medication for a child who is temporarily detained, pending court disposition and the establishment of dependency by the Court.
    • The Judge or Commissioner and the child's attorney must be notified immediately in writing by memorandum if a physician prescribes psychotropic medication for a child for whom the parent or guardian has authorization consent.
    • If the parent or guardian has authority and disagrees with the physician's assessment regarding the child's need for medication, the social worker submits and Application to the Court prior to Dependency, and the Court may make an order.

  • Consent for the administration of psychotropic medication for a dependent child of the court always requires court approval, unless one of following applies:  
    • The child is conserved and has an LPS conservator, in which case the conservator has the sole authority to give consent for the administration of psychotropic medication to the child.
     
    • The dependent child is living with a parent or legal guardian receiving Family Maintenance Services, in which case the parent or legal guardian may consent to the administration of psychotropic medication for the child.
      • The Judge or Commissioner and the child's attorney must be notified immediately in writing by memorandum if a physician prescribes psychotropic medication for a child for whom a parent or guardian has authorization to consent.
      • If the parent or guardian has authority and disagrees with the physician's assessment regarding the child's need for medication, the social worker submits an Application to the Court, and the Court may make an order.
       
    • The Court has issued a court order authorizing the parent or legal guardian to consent to the administration of psychotropic medication for the child.
      • If the Court authorizes the parent or legal guardian to consent to administer psychotropic medication for the child, the social worker may contact the parent/guardian regarding all future medication needs of the child, without having to apply to the Court.  For this reason, if there is a stable, cooperative parent available, it is advised that the social worker recommends that the Court authorize the parent to give consent.
      • If the parent or guardian has authority and disagrees with the physician's assessment regarding the child's need for medication, the social worker submits an Application to the Court, and the Court may make an order.

    • Emergency treatment is required
      • Psychotropic medications may be administered without court authorization in an emergency situation. An emergency situation occurs when:
        1. A physician finds that the child requires psychotropic medication to treat a psychiatric disorder or illness; and
        2. The purpose of the medication is:
          • To protect the life of the child or others, or
          • To prevent serious harm to the child or others, or
          • To treat current or imminent substantial suffering; and
          • It is impractical to obtain authorization from the court before administering the psychotropic medication to the child.
      • Court authorization must be sought as soon as practical but in no case more than two court days after the emergency administration of the psychotropic medication.

  • If the court authorizes medication, it is the social worker's responsibility to provide the caregiver with a copy of the authorization.
  • If the court fails to authorize the medication, it is the social worker's responsibility to contact the physician and ensure that he/she does not prescribe or administer the medication.
 
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Children Who Are Detained in Out-of-Home Care and Prescribed Psychotropic Medication  

In the case of:

  • A child who is detained in out-of-home care and who has been prescribed psychotropic medication prior to having been taken into temporary custody or
  • A child who is prescribed psychotropic medication after being detained and prior to the dispositional hearing,

the Dependent Intake (DI) Social Worker begins the Application for Psychotropic Medication if the recommendation will be for placement of the child in out-of-home care.  

    • If the recommendation will be for Family Maintenance Services, the Application does not have to be completed as the parents or guardians will have authorization to consent.
      • If the parent or guardian has authority and disagrees with the physician's assessment regarding the child's need for medication, the social worker submits an Application to the Court and the Court may make an order.

 

If..

Then..

  • The psychiatrist returns the JV220a;
  • Proper notices are given; and
  • Responses from all parties are obtained prior to the Dispositional Hearing
 

The DI social worker submits the Application packet at or directly after the Dispositional Hearing so that the authorization may be obtained in conjunction with the child’s being adjudged a dependent of the court.

There is a delay in the completion of the application so that court authorization is not obtained in conjunction with the dependency order

  • The  DI social worker informs the Continuing Social Worker  of the status of the application and that court authorization has not been obtained.
  • The Continuing Social Worker completes the application and submits it to court as soon as possible.

 

 

    < Return to OPP Table of Contents | ^ Back to Top of Page
   

Forms

Needed to Obtain Court Authorization for Psychotropic Medication and How to Access Them in CWS/CMS

 

In order to obtain Court authorization for the administration of psychotropic medication(s) to a dependent child in out of home placement, the following documents are needed:

  1. Information About Psychotropic Medication Forms (JV-219-INFO)
  2. Application Regarding Psychotropic Medication - Juvenile (JV-220)
  3. Prescribing Physician’s Statement – Attachment (JV-220a) - completed by the physician
  4. Proof of Notice: Application Regarding Psychotropic Medication (JV-221)
  5. Opposition to Application Regarding Psychotropic Medication (JV-222)
  6. Order Regarding Application for Psychotropic Medication (JV-223)

 

All six forms are located in CWS/CMS.

  • Go into the Court Management Section (pink button).
  • Click (+) Create New Hearing.
  • Enter date that forms are being created under the Hearing Date field.
  • Enter Department 70 under the Court field.
  • Click (+) button ICWA/JV Document
  • Choose Santa Clara County in the drop down menu in the Generate New Documents Box.
  • Choose the JV form(s) to be generated.
  • Click O.K.
  • Complete the form online in CWS/CMS.
    • If someone other than the social worker is to complete the form, such as the JV-222, leave the form blank.
    • Social workers must choose the appropriate Court Department number from the drop down menu on the form.
    • The forms will auto populate with the Court address, Department number, child's name, and court case number. 
  • Print a copy of the form.
  • Save to the Database.
 

Click here for screen shot of CWS/CMS page for accessing forms.

When preparing to submit a subsequent application for the administration of psychotropic medication, for example, when the previous court order expires, social workers must create a new Application Regarding Psychotropic Medication - Juvenile (JV-220) and Proof of Notice: Application Regarding Psychotropic Medication (JV-221) in CWS/CMS so that a record of all of the applications (JV-220) and notices (JV-221) are documented there.  Do not write over existing JV-220 or JV-221 forms in CWS/CMS.  Blank forms, such as the JV-222, that are sent out for completion by others do not have to be recreated.  

 

Click here for a matrix showing which of the JV forms each of the parties receives.

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Additional Information Needed for CWS/CMS Entry  

Additional information that must be gathered on the JV forms for entry into CWS/CMS includes:

  • Date of onset of the condition or date of the first doctor’s appointment related to the condition.
    • An exact date is required or the entry cannot be saved in CWS/CMS.
  • The name of the doctor who made the diagnosis.
  • Identification of the condition.
    • The condition may be either behavioral or emotional.  For example, a behavioral condition might be “physically assaults peers and adults,”  while an emotional condition might be “ADHD.”


Additionally, CWS/CMS requires:

  • The name of the doctor who prescribed the medication.
  • Date the child actually started to take the medication.
    • An exact date is required or the entry cannot be saved in CWS/CMS.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   

Physician's Statement

JV-220(A)

 

To request court authorization for the administration or continued administration of psychotropic medication, the physician must complete the Prescribing Physician's Statement (JV-220(A)). 

The social worker:

  • Faxes or mails the JV-200(A) to the physician for completion.
    • Physicians may have their own supply of JV-220(A)forms.
  •  
  • May request that the doctor enter a range of dosage for each prescribed medication to avoid the future necessity of applying to the Court to authorize any new prescribed dosage.
  • Reviews the entries, when the form is returned by the doctor, to make sure they are all completed.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Completing Noticing (JV-221) Regarding Psychotropic Medication  
  • The following parties must be notified of the application:

    • Both parents or guardians
    • The child’s attorney of record
    • The parents’ or guardians' attorneys
    • The child’s caregiver
    • The child’s Court Appointed Special Advocate (CASA), if applicable
  •  
  • Noticing may be done by phone, fax, email, or in person.
  • There is no line on the Proof of Notice: Application Regarding Psychotropic Medication (JV-221) to enter the responses of the parties to the application.  The social worker writes in the responses of each of the parties by hand after printing out the completed form.
  • Social workers must handwrite on the JV-221 each party's response to the application.  Noticing must be given before filing the JV-221 with the court.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Notice to the Child's Attorney  

The social worker must give notice to the child's attorney of record by serving copies of the following documents via email, fax or personal service:

  • Information About Psychotropic Medication Forms (JV-219-INFO)
  • Application Regarding Psychotropic Medication - Juvenile (JV-220)
  • A copy of the completed Prescribing Physician’s Statement – Attachment (JV-220a)
  • Opposition to Application Regarding Psychotropic Medication (JV-222)
    • Do not fill in the JV-222 except for the Court address, Department number, child's name and court case number.

 

Reminder: A child may be represented by:

    • The District Attorney (fax: 299-2223)
    • Legal Advocates for Youth (LACY) (fax: 293-0106)
    • Conflicts attorney
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Notice to Parents/Legal Guardians and Their Attorneys  

The social worker must exercise due diligence to inform parents or legal guardians and their attorneys of the request for the administration of psychotropic medication to the child.  In order to satisfy the responsibility for notice to parents/guardians and their attorneys, the social worker uses one of the following options:

  • Verbal Notice

    Click here for a script for social workers to follow when leaving a voice mail message for parents, guardians and their attorneys.

    • Contact the parents/legal guardians and their attorneys of record by phone and inform them that:
      • A physician is asking to treat (name of child) by beginning or continuing (whichever applies) the administration of a psychotropic medication called (name of medication(s).)
      • The medication is necessary to treat the child's emotional or behavioral problems.
      • An Application Regarding Psychotropic Medication (JV-220) has been or will be filed with (name of judge or commissioner) in Department (number) of the Santa Clara County Juvenile Court
      • They may request from you or their attorney (for parents or guardians) a copy of the form:
        • Information about Psychotropic Medication Forms (JV-219-INFO) and/or
        • Opposition to Application Regarding Psychotropic Medication (JV-222)
      • They may also pick up a copy of either of the two forms at the Juvenile Court Clerk's Office.
       

 

The social worker handwrites the response of the parents or guardians and their attorneys on the JV-221.

If the parent/legal guardian has questions or concerns about the proposed medication, suggest that he/she contact the prescribing physician/psychiatrist.

 

 

  • Fax or Mail Notice
  •  

    • If unable to reach the parents or guardians or their attorneys of record by phone, the social worker faxes or mails to them:
      • Information About Psychotropic Medication Forms (JV-219-INFO)
      • Application Regarding Psychotropic Medication - Juvenile (JV-220)
      • A copy of the completed Prescribing Physician’s Statement – Attachment (JV-220a)
      • Opposition to Application Regarding Psychotropic Medication (JV-222)
        • Do not fill in the JV-222 except for the Court address, Department number, child's name and court case number.

      If the notice is done through fax or mail, the social worker may submit the application packet to the Court before a response is received by the parents or guardians or their attorneys.

       
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Notice to the Child's Caregiver and CASA  

The child's caregiver and the child's CASA, if the child has a CASA, must be notified only that a physician is asking to treat the child with psychotropic medication and that an application for request for authorization has been sent to the Court.   No JV forms need to be sent to them.  If the social worker cannot reach the caregiver or CASA by phone or voicemail, the social worker sends a letter to the caregiver or CASA to inform him/her of the required information.

Click here for a script for social workers to follow when leaving a voice mail message for caregivers and CASAs.

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Submitting the Application Packet to Court  

The social worker must submit the following documents to the court when requesting authorization for the administration of psychotropic registration:

  • Application Regarding Psychotropic Medication - Juvenile (JV-220) completed by the social worker
  • Prescribing Physician’s Statement – Attachment (JV-220a) completed by the physician
  • Proof of Notice: Application Regarding Psychotropic Medication (JV-221) completed by the social worker
  • Opposition to Application Regarding Psychotropic Medication (JV-222).
  • Order Regarding Application for Psychotropic Medication (JV-223) to be completed by the judge or commissioner



To submit the Application to the Court, the social worker may either:

  • Call the paralegal who appears in the Court Department and request that the paralegal submit the packet for court authorization, or
  • Hand carry the packet to the courthouse and place the packet in the basket labeled "Emergency Ex-Parte Documents" located in the Social Workers' Room.

     
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Processing Authorizations by the Court  

After the court signs the Order Regarding Application for Psychotropic Medication (JV-223), the social worker:

  • Picks up the packet from the out basket located in the Social Workers' Room.
  • Checks that the JV 223 has been file stamped by the County Clerk.
    • If the documents have not been file stamped, proceed to the County Clerk's office to have the documents stamped.
     
  • Faxes a file endorsed copy of the JV-223 to the physician.
  • Routes a file endorsed copy to County Counsel.
  • Files the file endorsed copy of the JV-223 in the case file.
  • Updates the child's Case Plan to incorporate the child's treatment plan, including the use of psychotropic medication.

Information regarding psychotropic medication is entered in the child's Health Notebook in CWS/CMS by designated clerical staff.   The designated clerical staff receive copies of the file endorsed psychotropic medication packets (JV forms) from a court assistant after a judge has signed the authorization. 

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
When Does the Order for Psychotropic Medication Expire  

The order for psychotropic medication expires after six (6) months or until terminated or modified by court order, whichever is earlier (CAL. Rule of Court 550.4[f]).

The social worker must submit a new JV-220 and accompanying forms to the court every six months, following the same procedures outlined above.

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Continuation of a Previously Prescribed Medication  

If a child has already been prescribed psychotropic drugs, the attending physician may continue the use of those previously prescribed drugs at the physician’s discretion. However, there shall be no increases in dosage without authorization pursuant to W & I Code §369.5. The parents/guardians do not have the authority to withhold consent for increases/decreases in dosage if the child has been removed from their
custody and control.

Whenever a dependent child of the Court, or minor in placement at the Children’s Shelter, is moved to a new placement or to a facility pursuant to W & I Code §5000, et seq., and the child is receiving prescribed
medication, the medical or other supervisor at the new placement may continue to administer that medication under supervision of the medical staff or the child’s physician. No further order of the Court is required and the child’s medication is not to be abruptly discontinued for lack of such an order.

    < Return to OPP Table of Contents | ^ Back to Top of Page
   

Authorization for a Parent to Consent to the Administration of Psychotropic Medication

 

To request that the court authorize the parent or guardian to consent to the administration of psychotropic medication, the social worker submits an Application for Order to the Court, using forms Notice of Ex-Parte Application (SCZ170) and Attachment to Notice (SCZ170a).

See OPP Chapter 8-6: Ex Parte Application for Order (App and Order).

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Psychiatric Hospitalizations  

Social workers cannot consent to involuntary psychiatric hospitalizations or any hospitalization of a dependent child of the court. Except as specifically provided in the Welfare and INstitutions Code (WIC), a dependent child of the Juvenile Court may not be placed in a secured or locked facility by order of the Juvenile Court (WIC § 206).  Most psychiatric hospitals are locked or secured. The Juvenile Court has no authority to hospitalize a child in a locked facility.

Presumably, consent for such placement cannot be obtained from the parent, either, if the child has been adjudicated to be a dependent child of the court under WIC § 300, as custody has been taken away from the parent and is within the control of the court.

Section 206 does not preclude placement of a dependent child of the court in a psychiatric facility pursuant to the provisions of LPS (72-hour hold, 14-day certification, 180-day post-certification or LPS conservator ship). Section 206 also does not preclude the Juvenile Court from authorizing such hospitalization when the child, upon advice of counsel, makes voluntary application for such treatment. (WIC § 6552)

    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Electro convulsive Shock Therapy (ECT)   ECT is considered a radical psychiatric therapy requiring special protections. It cannot be performed on a child under 12 years of age under any circumstances, and children 16 and older have all the due process rights of adults. ECT can only be performed on children age 12 to 15 in emergency situations in which such treatment is a lifesaving measure, and only if the full panoply of procedures and requirements is followed. In no event should a social worker authorize ECT.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Psychosurgery   Psychosurgery of children is prohibited in California.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Children's Rights to Consent  
  • An un emancipated minor child alone does not have the authority to consent to the use of psychotropic medications. (Civil Code § 5.9)
  • Recent trends in law question whether a court deems parental consent sufficient to administer psychotropic medication to an objecting child, age 14 or older, should the issue be litigated. Until the issue is resolved, consent from the parent or legal guardian is sufficient to authorize treatment except if the child has been adjudged a dependent child of the Juvenile Court.
  • An objecting child may have some due process rights to refuse treatment involving hospitalization. A pre-commitment hearing before a neutral fact-finder is required before a child 14 or older can be committed to a state hospital with parental consent. The fact-finder must determine whether the child is mentally ill or disoriented, and if the child is not gravely disabled or dangerous to himself or other, whether the admission is likely to benefit him or her. Commitment of dependent children of the Juvenile Court to a state hospital can only be accomplished through the provisions of LPS (Lanterman-Petris-Short Act).
  • A child 12 years or older has the right to consent to outpatient mental health treatment, provided he or she is mature enough to participate intelligently in the treatment and either has been the alleged victim of incest or child abuse, or would present a danger of physical or mental harm to himself or others without treatment (Civil Code § 25.9)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Other References  
bullet2 OPP Chapter 8-6: Ex Parte Application for Order (App and Order)
    < Return to OPP Table of Contents | ^ Back to Top of Page