DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

   
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Handbook 1: Handbook Title
13-6.1 Chapter Title
Handbook Title
13-7.1 Pscyhotropic Medication
Reference Points
Overview
Psychotropic Medications Defined
Authority  for Consent
Emergency Treatment
Children Who Are Detained in Out-fo-Home Care and Prescribed Psychotropic Medication (Pre-Dispo)
Authority to Give Consent for Psychotropic Medication for Dependents in Placement
Forms Used and How to Access 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 CASA and Caregivers
Submitting the Applciation Packet to Court
Processing Authorizations by the Court
When Does the Order for Psychotropic Medication Expire
Continuation of a Previously Prescribed Medication
Court Authorization for Parental Consent to Pscyhotropic Medicatons
Follow-up During Social Worker Monthly Contacts
Addressing Psychotropic Medication in Status Review Reports)
Psychotropic Medication PHN Follow-up
When a Child/Youth is No Longer Taking Pscyhotropic Medication
On-going Monitoring of Compliance with JV-220 Process
Children's Rights Related to Pscyhotropic Medication
Resources for Foster  Youth
Resources for Social Workers
Psychiatric Hospitalizations
Electro Convulsive Shock Therapy (ECT)
Psychosurgery
Contacts
Additional Resources


Reference Points
Effective Date: 04/01/2008
Last Updated: 12/09/2015
 Legal Basis:
Popup Window Welfare & Institutions Code (WIC) §369.5
Popup Window Welfare & Institutions Code (WIC) § 5326.8
Popup Window California Rules of Court 5.640
Popup Window Local Juvenile Rules of Court  - JUVENILE RULE 1(M)
 Non CWS/CMS Forms:
MS Word Forms Text
 CWS/CMS Forms:
PDF Information About Psychotropic Medication Forms (JV-219-INFO) Created in CWS/CMS
PDF Application Regarding Psychotropic Medication - Juvenile (JV-220) Created in CWS/CMS
PDF Prescribing Physician’s Statement – Attachment (JV-220a) Created in CWS/CMS
PDF Proof of Notice: Application Regarding Psychotropic Medication (JV-221) Created in CWS/CMS
PDF Opposition to Application Regarding Psychotropic Medication (JV-222) Created in CWS/CMS
PDF Order Regarding Application for Psychotropic Medication (JV-223) Created in CWS/CMS
PDF Case Plan
PDF Case Plan Update
PDF Health Notebook


Overview  

In Santa Clara County, the oversight, monitoring and tracking of the use of psychotropic medications by children in foster care within the child welfare system is a shared responsibility of the Department of Family and Children’s Services, the Juvenile Court, the Department of Mental Health and the Public Health Department.  Within the last few years, all the departments, mentioned above, have reviewed and modified existing policies, procedures and practices in an effort to fortify their areas of oversight, monitoring and tracking as well as comply with amended legislation and regulations.

 

Obtaining consent for a child who is a dependent of the court to be administered psychotropic medication 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. If appropriate, the social worker may recommend that the Court delegate the authority to the child’s parents to consent to the administration of the medication.

 

Court authorization is not required for Non-Minor Dependents (NMDs), who can consent to their medical treatment including psychotropic medication.

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Psychotropic Medications

Defined
 

Psychotropic Medications is defined by the California Rule of Court 5.640 as “those medications prescribed to affect the central nervous system to treat psychiatric disorders or illnesses. They may include, but are not limited to, anxiolytic agents, antidepressants, mood stabilizers, antipsychotic medications, anti-Parkinson agents, hypnotics, medications for dementia, and psychostimulants.” 

 

Some physicians also view any “off-label” use of medications or use of supplements to treat the side-effects of psychotropic medications as falling within the definition above. For example, Melatonin to assist with sleep when due to the effects of other prescribed medications.

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Authority for Consent  

The social worker never has the authority to sign a consent authorizing the administration of any psychotropic medication.

 

The table below is to assist social workers in determining the authority to consent to the administration of psychotropic medication for a child who is temporarily detained, pending court disposition and establishment of dependency as well as those for whom dependency has been established.

 

Court authorization is not required for the use of psychotropic medication by NMDs.

 

Physician Prescribes Psychotropic Medication for…. And .... Who may consent Who must be noticed SW required tasks
Child temporarily detained , pending court disposition and the establishment of dependency
  Parent/Guardian  agrees Parent or Legal Guardian Court, counsel and all parties via the social worker’s report.

Include this information in your Jurisdiction/Disposition Report

 

(Once dependency is established the social worker must follow the procedures outlined in the appropriate section below)
 

Parent/Guardian

disagrees
Court may make an order  or set matter for a hearing
  • Parents/Legal Guardians
  • Parent’s Attorneys
  • Child’s Attorney
  • CASA
  • Tribe, if applicable
  • Caretaker
  1. Receives JV-220(a) from physician and completes JV-220 application.
  2. Provide Required Notice and complete the declaration of notice (JV221).
  3. Submit JV-220 packet to County Counsel’s office who will forward to court for review
See below for more instruction
Child who is a dependent of the Court:
    Court shall make an order
  • Parents/Legal (Probate) Guardians
  • Parent’s Attorneys
  • Child’s Attorney
  • CASA
  • Tribe, if applicable
  • Caretaker
  1. Receives JV-220(a) from physician and completes JV-220 application.
  2. Provide Required Notice and complete the declaration of notice (JV221).
  3. Submit JV-220 packet to County Counsel’s office who will forward to court for review

See below for more instruction

  Unless any of the following apply:
 

Living with a parent or legal guardian receiving Family Maintenance Services

 

(Does not apply to cases in Permanent Placement with Guardian and continued dependency)
If in agreement, parent or legal guardian
  • Judicial Officer
  •  All attorneys of record
 
 

If not in agreement,

the Court may make the order or set matter for a hearing
  • Parents/Legal (Probate)Guardians
  • Parent’s Attorneys
  • Child’s Attorney
  • CASA
  • Tribe, if applicable
  1. Receives JV-220(a) from physician and completes JV-220 application.
  2. Provide Required Notice and complete the declaration of notice (JV221).
  3. Submit JV-220 packet to County Counsel’s office who will forward to court for review
See below for more instruction
  Is conserved & has an LPS conservator Conservator  
  1. Obtain information from conservator regarding the medication the child has been prescribed and provide to Psychotropic Oversight PHN for input
  2. Include information in next court report.
 

the Court has issued an order delegating the authority to  the parent to consent

(see section for more details)
If in agreement, parent who has been given authority by the Court.
  • Judicial Officer
  •  All attorneys of record
Include information in next court report.
 

If not in agreement,

the Court may make the order or set matter for a hearing
  • Parents/Legal Guardians
  • Parent’s Attorneys
  • Child’s Attorney
  • CASA
  • Tribe, if applicable
  • Caretaker
  1. Receives JV-220(a) from physician and completes JV-220 application.
  2. Provide Required Notice and complete the declaration of notice (JV221).
  3. Submit JV-220 packet to County Counsel’s office who will forward to court for review
See below for more instruction
 

Emergency treatment:

  • Physician determines child requires psychotropic medication to treat a psychiatric disorder or illness and
  • the purpose of the medication is:
    • To protect the life of the child or others, or
    • http://intranet.ssa.co.santa-clara.ca.us/opp2/13_xp/images/1pixel_003.gifTo prevent serious harm to the child or others, or
    • http://intranet.ssa.co.santa-clara.ca.us/opp2/13_xp/images/1pixel_004.gifTo treat current or imminent substantial suffering; and
    • http://intranet.ssa.co.santa-clara.ca.us/opp2/13_xp/images/1pixel_005.gifIt is impractical to obtain authorization from the court before administering the psychotropic medication to the child.
Medication may be given on an emergency basis, however, Court authorization must be sought ASAP and no more than 2 court days after the administration of the medication.
  • Parents/Legal Guardians
  • Parent’s Attorneys
  • Child’s Attorney
  • CASA
  • Tribe, if applicable
  • Caretaker
  1. Receives JV-220(a) from physician and completes JV-220 application.
  2. Provide Required Notice and complete the declaration of notice (JV221).
  3. Submit JV-220 packet to County Counsel’s office who will forward to court for review
See below for more instruction

 

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Emergency Treatment  

Psychotropic medications may be administered without a Court authorization in an emergency situation.

 

Laws and regulations further stipulate:

  • The emergency is determined by the treating physician.
  • The treating physician shall have the discretion to initiate the use of the psychotropic medication while attempting to obtain parental/guardian consent or Court authorization.
  • When psychotropic medication is administered in an emergency situation the physician must complete section #3 on the JV220(A) providing an explanation of the emergency.

 

An emergency situation occurs when:

  • A physician finds that a child requires psychotropic medication to treat a psychiatric disorder of illness and:
    •  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, however, in no case more than two days after the emergency administration of the psychotropic medication.

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Children/Youth Who Are Prescribed and Taking Psychotropic Medication Prior to Being Placed in Temporary Custody

(Pre-Disposition)
 

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.

 

In the Initial Hearing Report, the social worker should inform the Court that the child/youth had been prescribed and was taking psychotropic medication prior to being placed in temporary custody and provide the following information:

  • Name  and dose of medication prescribed
  • Diagnosis for which the medication was prescribed
  • Name of prescribing doctor
  • How long the child/youth has been taking medication
  • Who provided the social worker with the information (parent, child or doctor).

 

Child/youth can continue taking medication, however, if at Disposition, the proposed recommendation is for the child/youth to:

 

To.... Then.....
Remain in out of home care and be declared a dependent of the Court
  1. Obtain a JV-220(a) from the prescribing physician
  2. Complete the required forms for the JV-220 packet
  3. Provide required notice and complete the declaration of notice (JV221)
  4. Submit to County Counsel’s Office for review.
Return to the care of the parent with Family Maintenance Services and the parent(s) agree to the need for medication

Inform the Court, in the Jurisdiction/Disposition Report under the “Medical Section” for the child in the Disposition portion of the Report, that the parent(s) is/are agreeable to the prescribed medication and are willing to provide the necessary consent for medication.

Return to the care of the parent with Family Maintenance Services and the parent(s)  does not agree to the need for medication
  1. Obtain a JV-220(a) from the prescribing physician
  2. Complete the required forms for the JV-220 packet
  3. Provide required notice and complete the declaration of notice (JV221)
  4. Submit to County Counsel’s Office for review.

 

 

 

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Authority to Give Consent for Psychotropic Medications for Dependents in Placement

 

In the case of children who have been declared dependents of the Court and are in out-of-home placements, authorization to administer psychotropic medication can be given by the following:

  1. The Court.
  2. The child/youth’s parent(s) if given the authority by the Court (See section on page XX).
  3. If the child/youth has been conserved, the LPS Conservator (See section on page XX)).
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Forms Needed to Obtain Court Authorization for Psychotropic Medication and How to Access 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 of the JV forms are located in CWS/CMS. To access the forms see instructions click link to Quick Reference Guide (QRG):  CWS/CMS QRG JV220 Forms

 

Subsequent Applications

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 complete new Application Regarding Psychotropic Medication.  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.

 

 

Court orders for psychotropic medication are valid for six months before it expires and a new application must be re-submitted before the “in-effect” order expires.

 

 

 

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Additional Information Needed for CWS/CMS Entry  

Additional information that must be documented 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.
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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:

  • Emails, faxes or mails the JV-220(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, indicating the maximum daily dosage, for each prescribed medication to avoid the future necessity of applying to the Court to authorize any new prescribed dosage.
  • Reviews the JV-220(A) when the form is returned by the doctor, to make sure all required fields are complete, paying special attention to:
      • #1 – Current height and weight
      • #5 – Date of last face-to-face evaluation
      • #12 – Child’s response to information on recommended medications
      • #16 – Any medications that will be stopped if application is granted
      • #17 – Prior medications and reasons they were stopped
    • If there are any questions or any of the information listed above is missing, the social worker contacts the physician to clarify or complete the form.
    •  
  • Per WIC § 369.5(b)(1), within three business days of receiving the JV-220(A), the social worker completes the JV-220 application and begins required noticing.
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Completing Noticing (JV-221) Regarding Psychotropic Medication  
  • The following parties must be notified of the application:
    • Both parents and/or legal (probate) guardians
    • The child’s attorney of record
    • The parents’ and/or legal (probate) guardians' attorneys
    • The child’s caregiver
    • The child’s Court Appointed Special Advocate (CASA), if applicable.
    • The tribe, if applicable.

 

  • Noticing may be done by phone, email, fax 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. 
    • If a response to notice has not been received after four (4) Court days, then the social worker notes “no response.”
      • The practice in Santa Clara County is that the Court will not accept a JV-220 without a response from the child’s attorney. Therefore, if a response is not received from the child/youth’s attorney after 4 Court days, additional efforts should be made to get a response. (For example, social worker telephones attorney’s office to follow-up on emailed or faxed notice.)

The chart below identifies the sections of the JV-220 application packet that each party is entitled to and must receive:

 

 

Information

Regarding medication
JV219
JV220
JV220a
JV222
Parent(s)
x

x

(if mailed)

x

(if mailed)
Parents' Counsel
x
x

x

(w/side effects)
x
Minor's Counsel
x
x

x

(w/side effects)
x
Caregiver
CASA
Tribe
x
x

x

(w/side effects)
x

 

See sections below for more information regarding procedures for proper notice.

 

The Court requires DFCS to provide notice to the necessary parties 4 Court days prior to submitting the JV-220 application to County Counsel for review and submission to Court to allow ample time for consideration and a response.

 

 

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Notice to Child’s Attorney and Parents/Legal Guardians’ Attorney  

The social worker must give notice to all attorneys of record, including the child/youth’s attorney and attorneys for the parents/legal guardians, 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)
    • Must include information regarding potential side effects of medication.
  • 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 or parent/legal guardian may be represented by:

    • Legal Advocates for Youth (LACY)  (child/youth only)
    • Conflicts attorney
    • Dependency Advocacy Center, which includes Family Legal Advocates and Office of Dependency Counsel
    • Private attorney
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Notice to Parents/Legal Guardians  

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, 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 or guardians.

    • Contact the parents/legal guardians 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.

If unable to reach the parents or guardians or their attorneys of record by phone, the social worker emails, faxes or mails to them:

  • E-Mail, Fax or Mail Notice
      • Letter to parent/legal guardian which includes the following information:
        • 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) in Department (number) of the Santa Clara County Juvenile Court
      • 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) with information on side effects.
      • 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.

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.

 

  Reminder: The Court requires DFCS to provide notice to the necessary parties 4 Court days prior to submitting the JV-220 application to allow ample time for consideration and a response. However, if a response is not received from the child/youth’s attorney after 4 Court days, additional efforts should be made to get a response.  

 

Note: Social workers should also enter a brief contact into CWS/CMS regarding noticing and the parents/guardians response.

 

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Notice to the Child's Caregiver and CASA  

The child's caregiver and the child's CASA must be provided the following information only:

  • a physician is asking to treat the child with psychotropic medication,
  •  the name of the medication(s) and
  •  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 send an email or 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.

 

Note: Social workers should also enter a brief contact into CWS/CMS regarding provision of notice to child’s caregiver and CASA.
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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 along with information on potential side effects of medication
  • Proof of Notice: Application Regarding Psychotropic Medication (JV-221) completed by the social worker
  • Blank Copy of the 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 forwards the completed packet to the Lead Paralegal in the County Counsel- Child Dependency Unit (CDU) Office for review and submission to Court.

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Processing Authorizations by the Court  

If there is no objection to the Application and the Order Regarding Application for Psychotropic Medication (JV-223), the approved application is:

  • Forwarded to County Counsel CDU staff who will send copies to:
    • Social worker who will:
      • Email or fax an endorsed copy of the JV-223 to the physician.
      • 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.
    • DI Control Clerk to enter the results of the hearing into CWS/CMS.
    • Psychotropic Oversight PHN to enter the medication into the Health section for the child in CWS/CMS.

 

If a parent/guardian, their attorney or the child’s attorney objects to the application for psychotropic medication, the court schedules an expedited hearing on the matter. The Lead Paralegal in the County Counsel CDU will send a scanned filed copy of the JV-220 Application with the Court’s notification of a hearing set for the matter as well as the name and of the County Counsel attorney who will be representing the department along with the social worker at the hearing.
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When Does the Order for Psychotropic Medication Expire  

The order for psychotropic medication expires six (6) months from the date it was signed by the Court 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 prior to the expiration of the existing order, following the same procedures outlined above.

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Continuation of a Previously Prescribed Medication When Change in Placement  

Whenever a dependent child of the Court, 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 until the expiration date of the existing order and the child’s medication is not to be abruptly discontinued for lack of such an order.

 

  Court orders for psychotropic medication are valid for six months before it expires and a new application must be re-submitted before the “in-effect” order expires.  

 

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Court Authorization for Parental Consent for Psychotropic Medication  

To request that the court authorize the parent or guardian to consent to the administration of psychotropic medication, the social worker includes the request and recommendation in either the Dispositional or Status Review Report or if between hearings, files a 388 Petition (JV-180).

If approved by the Court, the social worker should enter a contact into CWS/CMS indicating the Court has authorized the parents to consent to psychotropic medication. 
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Follow-up During Social Worker Monthly Contacts  

During required monthly contacts, the social worker is to follow up with a child/youth caregiver and the child/youth in out of home care to assess the following:

  • If the child/youth is taking the medication as prescribed.
  • If there have been any changes in the type or dosage of medication, (also to determine if an updated JV-220 application needs to be submitted).
  • If the child/youth is or has had any side effects of the medication***.
  • How the medication is managing the symptoms/behaviors.
  • That the child/youth is having regular follow-up appointments with the prescribing physician to monitor the child/youth’s progress on the medication and the date of the last appointment.

 

  ***Note: If it is reported by the caregiver or youth that the a child or youth is experiencing minor side effects, the social worker should advise the caregiver to consult by telephone with the prescribing physician. However, if a child/youth is having major side effects, the caregiver should be advised to make an urgent appointment to see the prescribing physician or to take the child/youth to the emergency room.  

 

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Addressing Psychotropic Medication in Status Review Reports

 

In each Status Review hearing report, the social worker needs to address the child’s use of psychotropic medication. The following points should be addressed as applicable in the “Medical” section under the “Evaluation of Child” of the child’s Court Report:

  • Name and dosage of psychotropic medications prescribed and if the child is taking the medication as prescribed.
    • The date of the most recent Court approval for the medication or
      • If the Court authorized the parent(s) to consent to the administration of psychotropic medication, the date the order was made.
      • If Family Maintenance case, note the parent consented to medication and the date the child/youth began or will begin taking medication.
  • The name of the physician who is monitoring the child’s use of psychotropic medication and
    • the frequency in which the child sees the physician and
    • the date of the last appointment and
    • the physician’s assessment of the effectiveness of the medication.
      • Side effects child/youth is having, if any
      • How the medication is managing the symptoms/behaviors.
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Psychotropic Medications PHN Follow-up  

The Psychotropic Medications PHN will make telephone contact with the foster child/youth’s caregiver. The purpose of the contact is to provide the caregiver &/or the youth with educational information regarding possible side effects as well as to provide monitoring for possible side effects of the medication(s).

 

Anytime, an initial JV-220 is approved for a child to begin psychotropic medication or a new psychotropic medication or the Psychotropic Medication PHN receives notification of a change in the dosage for a currently prescribed medication, the Psychotropic Medications PHN will make telephone contact with the foster child/youth’s caregiver and the foster youth, if over 12 years of age.

 

Typically, the Psychotropic Medications PHN will make contact every two weeks during the first month (beginning from the date the JV-220 is approved). If the child/youth is not experiencing any side effects of the medication, the Psychotropic Medications PHN will continue to do monthly follow-up. However, if it is reported by the caregiver or youth that the a child or youth is experiencing minor side effects, the Psychotropic Medications PHN will advise the caregiver to consult by telephone with the prescribing physician. The Psychotropic Medications PHN will follow-up with the care provider and, if necessary the prescribing physician.

 

During the follow-up telephone calls with caregivers or youth, the Psychotropic Medication PHN determines/assesses that child/youth is

  • receiving medication management with a clinician,
  • taking medication in compliance with current medication regime
  • assess the child/youth is receiving/offered therapeutic services,

 

Additionally, the Psychotropic Medication PHN can assist with the provision of care coordination with the social worker, probation officer, physician, and foster care provider, if needed. This assistance may include finding a new physician, helping refer children placed out of county for therapy, sending JV-220 to a new provider, and determining that current medication regime is in compliance with current JV-220, etc.

 

  Note: If a child/youth is having major side effects, the caregiver should be advised to make an urgent appointment to see the prescribing physician or to take the child/youth to the emergency room.  

 

The Psychotropic Medications PHN will enter a contact into CWS/CMS when following-up or monitoring telephone calls are made to the foster child/youth’s caregiver or the prescribing physician.

 

 

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When a Child/Youth is No Longer Taking Medication

  If a physician notes on the JV-220(A) that a child has stopped taking or will be discontinuing the use of a medication, the Psychotropic Medication Public Health Nurse (PHN) will update CWS/CMS, when the approved application is entered into CWS/CMS. However, if after a psychotropic medication order is signed by the Court, the child/youth declines to take any or all psychotropic medication, the social worker must notify the Psychotropic Medication PHN via email with the date the child/youth stopped taking the medication.  (Note: If the child/youth intermittently refuses to take medication, the social worker may want to wait until the end of the six month period for which the medication was approved, before submitting the information to the Psychotropic Medication PHN to end the medication in CWS/CMS.
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On-going Monitoring of Compliance with JV-220 Process

 

Two times per month a report generated from data in CWS/CMS is sent to Social Work Supervisors and Social Services Program Managers to assist in tracking and monitoring compliance of psychotropic medication administered to children and youth in foster care.

Social Work Supervisors are expected to review and use these reports to:

  • Assist social workers with tracking when an updated JV-220 is required.
  • Monitor the accuracy of information in CWS/CMS for those children who have been prescribed psychotropic medication.
  • Ensure compliance with the law, regulations, policies and procedures in regards to administering psychotropic medication to foster youth.

Social Service Program Managers are expected to review and use these reports to:

  • Monitor and ensure compliance with the law, regulations, policies and procedures in regards to administering psychotropic medication to foster youth.
  • Assist social work staff in identifying and addressing any obstacles which impede or effect the compliance with established policies and procedures.
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Children's Rights Related to Psychotropic Medication  

The following have been extracted from the California Department of Social Services’ Foster Youth Mental Health Bill of Rights.  To view entire document, including legal or regulatory citations click here

        • Foster youth have the right to receive information about their mental health, including their diagnosis and available treatment options, in a way that is easy to understand and age appropriate
        • Foster youth have the right to participate in decisions made about what mental health treatments, services, and medications they receive.
        • Foster youth have the right to take only medication or other chemical substances that are authorized by a doctor. 7
        • Foster youth have the right to be informed about the risks and benefits of psychotropic medications in an age appropriate manner.
        • Foster youth have the right to tell their doctor that they disagree with any recommendation to prescribe psychotropic medication.
        • Foster youth have the right to go to the judge and say they disagree with any recommendation to prescribe psychotropic medications. (Foster youth should be encouraged to talk to their attorney first to make sure the youth does not say something against his or her interests.)
        • Foster youth have the right to ask for mental health services, including re- assessments regarding their diagnoses and their prescriptions for psychotropic medications.
Foster youth have the right to work with their prescribing doctor in order to safely stop taking psychotropic medications..
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Resources to Use with Foster Youth  

Foster Youth Mental Health Bill of Rights (English)    (Spanish Version)

Questions to Ask About Medication (English)  (Spanish Version)

Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care.
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Resources for Social Workers  

For information on prescribed psychotropic medications: LACDMH Parameters 3.8 for Use of Psychotropic Medication for Children and Adolescents

In December 2014, the Los Angeles County Department of Mental Health (LACDMH), granted approval to the Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) the adoption of LACDMH Parameters 3.8 for Use of Psychotropic Medication for Children and Adolescents as Appendix B of the California Guidelines on Psychotropic Medication Use in Children and Adolescents in Foster Care.

 

 

Parameters 3.8 for Use of Psychotropic Medication for Children and Adolescents represents a consensus of best practices from among various experts from Los Angeles training institutions and experienced community based clinicians who provide treatment to children and adolescents. It is updated periodically to reflect improvements in evidence based treatments.

 

By adopting the Los Angeles Department of Mental Health Parameters 3.8 For Use of Psychotropic Medication for Children and Adolescents, as part of California Guidelines, it is our goal to further disseminate these parameters for use throughout the state.

 

 

 

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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).

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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 array of procedures and requirements is followed. In no event should a social worker authorize ECT.
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Psychosurgery

  Psychosurgery of children is prohibited in California.
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Contacts  

JV-220 Process and Policies

County Counsel: Kim Maruffi, Lead Paralegal, Child Dependency Unit

Kimberly.Maruffi@cco.sccgov.org

(408)758-4228

 

DFCS:  Annette Stahlnecker, Social Work Supervisor, ASB

          Annette.Stahlnecker@ssa.sccgov.org

          (408)501-6516

 

Psychotropic Medication Public Health Nurse

Alison Sikola, PHN, Health Care Program for Children in Foster Care

Alison.Sikola@phd.sccgov.org

(408)501-6769

 

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Other References  
PDF OPP Chapter 8-15 Request a Change in Court Order (JV-180)
PDF Other Reference Text goes here...
PDF Foster Youth Mental Health Bill of Rights (English)
PDF Foster Youth Mental Health Bill of Rights (Spanish)
PDF Questions to Ask About Medication (English)
PDF Questions to Ask About Medication (Spanish)
PDF Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care
PDF

 LACDMH Parameters 3.8 for Use of Psychotropic Medication for Children and Adolescents

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