DCF: 44-5-2.1

standards regarding the delivery of health care

Psychotropic Medications: Informed Consent    Policy 44-5-2.1

 
 
Introduction -
 

In the last twenty years, there has been a marked increased in the use of psychotropic medications for the treatment of mental disorders in children and adolescents. As a result, the standard of care in most states is for mental health professionals to provide assistance to the state's child welfare agency regarding the informed consent process for the use of psychotropic medications. The following policy reflects the practice in Connecticut for children in DCF's care.

DCF has established a centralized mechanism, via a computerized database, to track all requests for psychotropic medications and the decisions made regarding those requests.

This policy provides a streamlined process through which providers will interact directly with DCF medical and nursing staff who are trained and board certified in psychiatric and behavioral health care.


Policy -


The Department shall ensure that prescribing practitioners obtain appropriate informed consent regarding a child in the care of DCF who requires medically-necessary psychotropic medication. 

DCF shall make available to practitioners treating children in the care of DCF a copy of the DCF

"Guidelines for Psychotropic Medication Use for Children and Adolescents."

DEFINITIONS -

"Agency Medical Director" means the child and adolescent psychiatrist who is responsible for oversight of the Regional Medical Directors and the Centralized Medication Consent Unit.

"CMCU APRN" means an advanced practice registered nurse who serves as the Commissioner's designee in reviewing and approving the use of psychotropic medications.

"Centralized Medication Consent Unit" (CMCU) means a centralized unit that is responsible for the receipt, triage, communication, data collection and decision-making processes used to provide consent to treat children with psychotropic medications. The CMCU is staffed by APRNs and child psychiatrists, who have been designated by the Commissioner to provide consent for psychotropic medication requests.

 

"Designee," as used in this policy, means a representative of the Commissioner who has been given authority to review and provide consent for psychotropic medications. Designees are the Agency Medical Director, Regional Medical Directors, CMCU APRNs, and senior medical staff on-call after hours.

"Informed consent" means permission granted by a child’s guardian to prescribe psychotropic medication. As part of the consent process, the prescriber shall provide the patient and/or the patient's representative with the following:

  • the nature and seriousness of the diagnosis;
  • the nature of the medication;
  • the risks of the medication;
  • the expected benefits of the medication;
  • any reasonable alternative treatments other than medication; and
  • the possible common, long-term and/or infrequent side effects of the medication.

"Non-business hours" means Monday through Friday after 5:00 PM, weekends, state holidays, and other times when normal day-to-day business is not being conducted.

"Psychotropic medications" means medications that affect the central nervous system and influence thinking processes, emotions and behaviors.

"Reasonable efforts" (to gain consent) means the strategies employed by DCF staff to contact and inform a child's parent or guardian, and to inform a child over the age of 14, of the reason for the psychotropic medication and the risks and benefits of the administration of the psychotropic medication.  What is "reasonable" depends on the circumstances of the case, including time of day, the condition of the child, whether the child will suffer serious physical or mental harm if administration of medication is delayed and the availability of a parent or guardian.  "Reasonable efforts" include, but are not limited to, telephone calls or in-person visits to any person who is likely to know how to contact a parent or guardian.

 

"Regional Medical Director" means a child and adolescent psychiatrist assigned to designated regions, each consisting of a grouping of DCF Area Offices. The Regional Medical Director may act as the Commissioner's designee for purposes of the medication approval process.

"Request for Review" means a request made by a provider to the Agency Medical Director or a Regional Medical Director to review and, if appropriate, overturn the denial of a medication request by a medical designee.

"Timely manner" means the expected time frame to obtain consent for medication treatment. Whenever possible, requests shall be processed within 24 business hours. Requests that require consultation with the provider or contain insufficient information may not be completed within these timeframes.

DCF Forms -


DCF-465
- the “Psychotropic Medication Consent Request” form that must be submitted by the provider for each request to prescribe a psychotropic medication. The final outcome of the request is also recorded on the DCF-465 by the Regional Medical Director or CMCU APRN and a copy is returned to the prescribing provider.

DCF 465A – the “Notification – Discontinuation of a Psychotropic Medication” that must be completed by the prescribing provider whenever discontinuing a psychotropic medication for which consent has been previously received.

DCF 465B - the “Suspected Adverse Drug Reaction Reporting Form” that must be submitted to the CMCU by the prescriber or designee whenever a child has or is suspected of having a known adverse reaction to a psychotropic medication.

Protocols for Consent -

The DCF Commissioner or designee shall make a determination regarding the use of psychotropic medication in a timely manner, consistent with the best interests of the child. A Regional Medical Director or a CMCU APRN shall review each request for the use of psychotropic medication prior to making a determination regarding consent.

Requests for Review -

A Request for Review may be submitted to the Agency Medical Director:

  • when the prescribing provider or designee disagrees with a DCF designee's denial of consent to prescribe a psychotropic medication; or
  • when requested by the DCF Commissioner, a DCF Regional Director or a DCF Facility Superintendent.

Responsibilities of the Centralized Medication Consent Unit -

The Centralized Medication Consent Unit (CMCU) shall ensure that requests for consent to prescribe psychotropic medications are received and reviewed and final decisions are sent to the prescribing providers in a timely manner as follows:

  • the CMCU shall accept medication requests from the prescribing provider on the DCF-465;
  • the CMCU shall verify the child’s demographic information, assigned Area Office and legal status in LINK;
  • based on the child’s legal status, the CMCU shall determine the steps necessary to ensure informed consent; and
  • the CMCU shall triage and communicate appropriate decisions regarding each medication request.

Legal Status of Child and Consent -

The following chart indicates, according to the legal status of the child, who may provide informed consent:

Legal status of child

Consent needed and by whom

Voluntary Services commitment

Parent or legal guardian

Family with Service Needs commitment

Parent or legal guardian

Delinquency commitment (see below for special instructions)

Parent or legal guardian

96-hour hold

Parent or legal guardian

Order of temporary custody

Parent or legal guardian

Abuse, neglect or uncared for (CPS) commitment

DCF Commissioner or designee

Dual commitment (delinquent and CPS commitments running concurrently)

DCF Commissioner or designee

Statutory parent (termination of parental rights granted)

DCF Commissioner or designee


Child Whose Legal Status Requires Parental Consent -

 

For any child  whose legal status requires parent or guardian consent, the social worker shall make reasonable efforts to obtain the informed consent of the child's parent or guardian, and the child if over 14 years of age.

If the parent or guardian is not available to provide consent, the social worker shall:

  • ensure that the child is provided with all necessary medical care, which may include an examination by a physician or mental health professional;
  • consult with an Area Office attorney or Assistant Attorney General for further advice regarding reasonable efforts to obtain consent, potential court proceedings to obtain judicial consent and any other legal issues that may arise;
  • when appropriate, seek a court order authorizing the use of psychotropic medication;
  • document all efforts to gain informed consent from a parent or guardian, and a child over 14 years of age, as well as any refusals; and
  • continue to update the parent or guardian and the child's attorney regarding the child’s medical condition.

Note: A physician may authorize emergency medical care without the consent of a parent or guardian while the social worker continues to make reasonable efforts to inform the parent or guardian. The authorization for treatment during an emergency shall last only as long as the emergency exists.


Note:
For after-hours emergencies, consultation with a DCF legal manager is recommended, but not required. However, legal staff shall be consulted the next business day following the after-hours emergency.

Cross-Reference: DCF Policy 34-11, Medical Examination of a Child"; DCF Policy 34-10-4.1, "Immediate Removal/96 Hour Hold Procedures."

Child Whose Legal Status Permits DCF Consent -

In the case of a child whose legal status permits DCF to provide consent, the CMCU shall:

  • enter the medication consent request, and all information related to the medication request in the computerized database;
  • review the medication consent request;
  • if additional information is required, request information from the Area Office social worker, the RRG nurse or the provider;
  • make and enter the decision into the computerized database and document in LINK the reason for any denials;
  • fax or email the finalized DCF-465 to the prescribing provider; and
  • send notification of the final outcome to the CMCU, Behavioral Health Program Director, Area Office social worker and RRG nurse.
Children Committed Delinquent -
 

In the case of a child who has been committed to DCF as a delinquent, the Commissioner or designee may authorize medical treatment, including medication, of the child without the consent of the parent or guardian as long as DCF makes reasonable efforts to inform a parent or guardian of the need for treatment prior to the treatment being administered.

Following treatment, DCF shall notify a parent or legal guardian in writing of the treatment provided, the necessity for the treatment and the outcome of the treatment.

Legal Reference:  Conn. Gen. Stat. §17a-10(c)

 

Protocol for Non-Business Hours -

The Hotline social work supervisor shall ensure that:

  • reasonable efforts are made to gain consent for administration of medication from the parent or guardian of a child whose legal status so requires.

When DCF is the legal guardian, the Hotline social work supervisor shall ensure that:

  • the requesting prescriber has faxed or emailed a completed DCF-465 to the Hotline;
  • all pertinent and available information regarding the child is gathered prior to contacting the physician on call; and
  • the physician on call is consulted regarding all new consent requests for psychotropic medication made during non-business hours.

Note: When a psychotropic medication has already been approved, as indicated by LINK documentation, and the request is only to continue a current medication, the Hotline social work supervisor shall give consent without contacting the physician on call.

 

Notification of Discontinuation of Psychotropic Medication -

The prescribing provider is expected to notify DCF whenever discontinuing a psychotropic medication. Notification may be part of other changes already requested on a new DCF-465. However, if the discontinuation is the only change, notification to the Department must be made by faxing or emailing the DCF 465A to the CMCU APRN.


Note:
While the prescribing provider is not required to seek informed consent for discontinuation of a medication, the child's parent or guardian and the child, if appropriate, shall be informed of the decision and the reasons therefore, as soon as practicable, by the provider or the Department.

The CMCU shall:

  • receive the DCF-465A notification form;
  • enter the information in the computerized database and in LINK;
  • send notification of the medication discontinuation to the Area Office social worker; and
  • document the discontinuation in the database.

Provider Request for Review -

A prescribing provider may submit a Request for Review to overturn a denial made by a CMCU designee. 

A review of the decision of a CMCU designee shall be assessed by the Agency Medical Director and the decision of the Agency Medical Director shall be final.

The CMCU shall:

 

·         record the Request for Review and final outcome in the database and in LINK; and

·         send notification of the final decision to the provider and to the Area Office staff.

 

Adverse Drug  Reaction -

The prescribing provider must submit the DCF 465B whenever there is a known or suspected adverse drug reaction to a psychotropic medication. A complete description of signs and symptoms of the adverse reaction, along with treatment received, must be submitted on

DCF 465B for CMCU collection and review.


 

Connecticut Department of Children and Families                      Effective Date: Draft June 7, 2011 (New)

 

 





Content Last Modified on 7/13/2011 10:12:28 AM