The Department intends to amend Rules 65C-35.001-.013, F.A.C., to accomplish the following: (1) Incorporate documents; (2) Add definitions; (3) Specify the efforts that must be made in obtaining consent and caregiver involvement; (4) Delete ...

 

DEPARTMENT OF CHILDREN AND FAMILIES

Family Safety and Preservation Program

RULE NOS.:RULE TITLES:

65C-35.001Definitions

65C-35.002Behavioral Health Services

65C-35.003Parent or Legal Guardian Involvement

65C-35.004Caregiver Involvement

65C-35.005Child Involvement in Treatment Planning

65C-35.006Taking a Child Into Custody Who Is Taking Psychotropic Medication

65C-35.007Authority to Provide Psychotropic Medications to Children in Out-of-Home Care Placements

65C-35.008Parent or Legal Guardian Declines to Consent to or Withdraws Consent for the Provision of Psychotropic Medication

65C-35.009Parent or Legal Guardian Rights Terminated; Parent or Legal Guardian Refuses to Participate; or Parent or Legal Guardian Location or Identify Unknown

65C-35.010Emergency Administration of Psychotropic Medication

65C-35.011Medication Administration and Monitoring

65C-35.012Requests for Second Opinions

65C-35.013Medical Report

PURPOSE AND EFFECT: The Department intends to amend Rules 65C-35.001-.013, F.A.C., to accomplish the following: (1) Incorporate documents; (2) Add definitions; (3) Specify the efforts that must be made in obtaining consent and caregiver involvement; (4) Delete unnecessary rule provisions; (5) Clarify when a Medical Report must be completed; (6) Repeal rules and incorporate relevant provisions in other rules; (7) Add requirements regarding medication monitoring and administration; (8) Specify when pre-consent reviews must be sought; and (9) Add a training rule.

SUMMARY: The amendments accomplish or require the following: (1)The Medicaid Community Mental Health Services Coverage and Limitations Handbook, the Medical Report form, and the Emergency Intake form are incorporated by reference; (2) The child protective investigator (CPI) or case manager must attempt to invite the parent or legal guardian to the doctor’s appointment and facilitate transportation to the appointment, if necessary; or facilitate telephone or tele-medicine participation between the prescribing practitioner and the parent or legal guardian when unable to attend in person; (3) The CPI or case manager must attempt to contact the parent or legal guardian upon learning of the recommendation for psychotropic medication by the prescribing practitioner and provide specific information on how and when to contact the practitioner; and provide a copy of the Medical Report to the child’s parent or legal guardian; (4) The case manager must obtain a completed Medical Report from the prescribing practitioner if the prescribing practitioner determines that the medication is medically necessary for the child despite the lack of authorization by the parent or legal guardian; (5) The monitoring of the use of psychotropic medication provided to children will be the joint responsibility of the prescribing practitioner, the caregiver, the CPI or case manager, and the CPI or case manager’s supervisor; (6) The caregiver and CPI or case manager are responsible for implementing the medication plan developed by the prescribing practitioner; (7) The Department shall fully inform the court of the child’s medical and behavioral status at each subsequent Judicial Review hearing and shall furnish copies of all pertinent medical records contained in the child’s Resource Record that have been generated since the previous court hearing; (8) The CPI or case manager shall provide the caregiver specified information regarding the prescribed medication; (9) The CPI or case manager shall seek a pre-consent review when: (a) A practitioner proposes prescribing psychotropic medication or changing the dosage of prescribed psychotropic medication outside the dosage parameters documented in the Medical Report; and (b) The child is age birth through 10 years; and (c) The child is prescribed two (2) or more psychotropic medications; and (10) All child protective investigators and case managers shall receive Department-approved training from the community-based care lead agency or its contracted provider on medication management and administration.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department used a checklist to conduct an economic analysis and determine if there is an adverse impact or regulatory costs associated with this rule that exceeds the criteria in section 120.541(2)(a), F.S. Based upon this analysis, the Department has determined that the proposed rule is not expected to require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 39.0121, 39.407(3)(g), FS.

LAW IMPLEMENTED: 39.407(1), (2), (3), FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jodi Abramowitz. Jodi can be reached at 850-717-4189 or [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

65C-35.001 Definitions.

(1) “Assent” when used in this chapter means a process by which a provider of medical services helps the patient achieve a developmentally appropriate awareness of the nature of his or her condition; informs the patient of what can be expected with tests and treatment; makes a clinical assessment of the patient’s understanding of the situation and the factors influencing how he or she is responding; and solicits an expression of the patient’s willingness to accept the proposed care. 

(2) “Behavioral Health Assessment” means includes both Comprehensive Behavioral Health Assessments as defined by the Medicaid Community Mental Health Services Coverage and Limitations Handbook and all other assessments performed by mental health professionals. The Medicaid Community Mental Health Services Coverage and Limitations Handbook, March 2014, is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XX.

(3) “Caregiver” means, for purpose of this chapter, a person who is approved in writing by the Department as responsible for providing for the child’s daily needs, or any other person legally responsible for the child’s welfare in a residential setting.

(4) “Case Manager” means a child welfare professional who is responsible for ongoing safety management and service provision of children who, through assessment by a child protective investigator, have been determined to be unsafe.

(5) “Case Plan” means the dependency case plan as defined in Section 39.01(11), F.S., which refers to the services plan jointly developed between the family and dependency case manager, delineating specific interventions aimed at addressing the contributing factors and underlying conditions that led to child maltreatment.

(6)(4) “Chemical Restraint” means the use of a medication as a restraint to control behavior or restrict freedom of movement that is not an accepted treatment for the person's medical or psychiatric condition.

(7)(5) “Children’s Legal Services” is a statewide law firm focusing on children’s issues within the Department of Children and Families.

(8)(6) “Child Protective Investigator (CPI)” means a child welfare professional who is responsible for investigating alleged child maltreatment and conducting assessments regarding the safety of children. an authorized agent in a professional position within the Department or designated sheriff’s office with the authority and responsibility of investigating reports of child abuse, neglect, or abandonment received by the Florida Abuse Hotline, as defined in Section 39.01(62), F.S.

(9) “Community-based Care Lead Agency” means the not-for-profit or governmental community-based care provider responsible for the provision of support and services for eligible children who have been abused, abandoned, or neglected and their families.

(10) “Current Prescription” means a medication that is prescribed to the child and that the child is being administered or is directed to be administered at the time the child is taken into custody. 

(11)(7) “Department” means the Department of Children and Families Family Services.

(8) “Dependency Case Manager” means an individual who is accountable for service delivery regarding safety, permanency, and well-being for a caseload of children in out-of-home care.

(9) “Dependency case plan” means the dependency case plan as defined in Section 39.01(11), F.S., which refers to the services plan jointly developed between the family and dependency case manager delineating specific interventions aimed at addressing the contributing factors and underlying conditions that lead to child maltreatment.

(12)(10) “Expressed Express and Informed Consent” means, for the purposes of this chapter; voluntary written consent from a competent person who has received full, accurate, and sufficient information and explanation about a child’s medical condition, medication, and treatment to enable the person to make a knowledgeable decision without being subjected to any deceit or coercion. Expressed Express and informed consent for the administration of psychotropic medication may only be given by a parent whose rights have not been terminated, or a legal guardian of the child. Sufficient explanation includes but is not limited to the following information, provided and explained in plain language by the prescribing practitioner physician to the consent giver: the medication, reason for prescribing it, and its purpose or intended results; side effects, risks, and contraindications, including effects of stopping the medication; method for administering the medication, and dosage range when applicable; potential drug interactions; alternative treatments; and the behavioral health or other services used to complement the use of medication, when applicable.

(13)(11) “Florida Safe Families Network (FSFN)” means is the Department’s comprehensive, statewide automated case tool that supports child welfare practice. FSFN holds the state’s official case file for all children and families served.  FSFN is the Statewide Automated Child Welfare Information System (SACWIS) for the state of Florida. FSFN is the electronic system of record for each case.  It contains information regarding a particular child and his or her family.

(14)(12) “Guardian ad Litem” is defined in Section 39.820(1), F.S.

(15)(13) “Lead Agency” means the not-for-profit or governmental community-based care provider responsible for the provision of support and services for eligible children and their families who have been abused, abandoned, or neglected and their families.

(16)(14) “Legal Guardian” means a permanent guardian as described in Section 39.6221, F.S., or a “guardian” as defined in Section 744.102, F.S., or a relative with a court order of temporary custody under Chapter 751, F.S. Dependency Ccase managers and Guardians ad Litem do not meet the definition of legal guardian.

(17)(15) “Medical Report” means a report prepared by the prescribing physician that includes information required by Section 39.407(3)(c), F.S. The “Medical Report” form, CF-FSP 5339, December 2015, is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXX. The form for the medical report is “Medical Report” (form CF-FSP 5339 dated January 2010), which is hereby incorporated by reference and is available by contacting the Family Safety Program Office at 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700, or at http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx.

(18)(16) “Out-of-Home Care” means the placement of a child in licensed and non-licensed settings, arranged and supervised by the Department or contracted service provider, outside of the home of the parent. , arranged and supervised by the Department of Children and Families or its agent, outside the home of the child’s custodial parent or legal guardian. This includes placement in licensed shelter, foster home, group home, Residential Treatment Center (including Statewide Inpatient Psychiatric Programs), and non-licensed relative/non-relative settings.

(19) “Pre-Consent Review” means a review by a child psychiatrist of a proposed medication regimen to determine whether or not the proposed prescribed medication and dosage are consistent with accepted medical practice given the diagnosis and physical condition of the child. A pre-consent review is not a second opinion.

(20)(17) “Prescribing Practitioner Physician” means is a practitioner physician licensed under Chapter 458 or 459, F.S.

(21)(18) “Psychotropic Medication” means, for the purpose of this rule, any medication chemical substance prescribed with the primary intent to stabilize or improve mood, mental status, behavioral symptomatology, or mental illness. treat psychiatric disorders; and those substances, which though prescribed with the intent to treat other medical conditions, have the effect of altering brain chemistry or involve any of the medications in the categories listed below. The medications include, without limitation, the following major categories:

(a) Antipsychotics;

(b) Antidepressants;

(c) Sedative Hypnotics;

(d) Lithium;

(e) Stimulants;

(f) Non-stimulant Attention Deficit Hyperactivity Disorder medications;

(g) Anti-dementia medications and cognition enhancers;

(h) Anticonvulsants and alpha-2 agonists; and

(i) Any other medication used to stabilize or improve mood, mental status, behavior, or mental illness.

(22)(19) “Residential treatment center” means “Residential treatment center for children and adolescents” as defined in Section 394.67, F.S. a 24-hour residential program which provides mental health services to emotionally disturbed children or adolescents as defined in Section 394.492 (5) or (6), F.S. that is licensed by the Agency for Health Care Administration.  For purposes of this rule, therapeutic group homes are not considered a residential treatment center.

(23)(20) “Resource Record” means the child’s standardized record that contains copies of all available and accessible medical and psychological information (including behavioral health information) pertaining to the child as described in subsections 65C-30.001(21)(24) and 65C-30.011(4)-(6), F.A.C.

(21) “Statewide Inpatient Psychiatric Program” or “SIPP” means those residential mental health treatment programs selected and contracted by the Agency for Healthcare Administration to participate in the Institution for Mental Disease waiver.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Amended___.

 

65C-35.002 Behavioral Health Services. 

(1) Behavioral health services shall be provided to children in out-of-home care without delay once the need for such services is identified. Prior to prescribing a psychotropic medication, the practitioner physician must consider other treatment interventions that may include, but are not limited to, medical, mental health, behavioral, counseling, or other services. All decision-making shall should be guided by the principle that it is important to comprehensively address all of the concerns in a child’s life – family, legal, health, education, and social/emotional issues – as well as to provide behavioral supports and parent training, so that a child’s behavioral and mental health issues can be addressed in the least restrictive setting and in a comprehensive treatment plan.

(2) The child’s dependency case manager shall will ensure that all behavioral health services that are identified in behavioral health assessments or prescribed by a medical or mental health professional have been integrated into the child’s dependency case plan and are provided to the child in a timely manner.

(3) The department and contracted service providers who provide behavioral health services shall comply with the requirements of Section 39.407(3), F.S., and the Florida Rules of Juvenile Procedure 8.355 whenever a child is considered for administration of psychotropic medications.

(4) The Medical Report must include recommendations for medical, behavioral health, or other services that will be used in conjunction with psychotropic medication, as required by Section 39.407(3)(c)5., F.S.

(3)(5) Prior to prescribing a psychotropic medication, the practitioner physician must consider the child’s history for conditions that may indicate the presence of brain injury (for example, blows to head, fetal alcohol syndrome, loss of consciousness, head scars, fever above 104°) and document any follow-up assessments or referrals on the Medical Report.

(4)(6) The administration of medication for the sole purpose of chemical restraint is strictly prohibited.

Rulemaking Authority 39.407(3)(g), 39.0121 FS. Law Implemented 39.407(1), (3) FS. History–New 3-17-10 , Amended___.

 

65C-35.003 Parent or Legal Guardian Involvement.

(1) The child protective investigator (CPI) or dependency case manager or child protective investigator shall facilitate the attendance of the child’s parent (where parental rights are intact) or legal guardian at all attending of medical appointments. The CPI or case manager shall make the following minimum efforts to assist the prescribing practitioner in obtaining expressed and informed consent from the child’s parent or legal guardian:

(a) Attempt to invite the parent or legal guardian to the doctor’s appointment and facilitate transportation to the appointment, if necessary;

(b) Facilitate telephone or tele-medicine participation between the prescribing practitioner and the parent or legal guardian when unable to attend in person.

, and the parent or legal guardian obtaining of information about medications, possible side effects, and other details about treatment listed in subsection (2) of this section.

(2) If the parent or legal guardian is unable to attend medical appointments, the CPI or dependency case manager or child protective investigator shall:

(a) Attempt to contact the parent or legal guardian upon learning of the recommendation for psychotropic medication by the prescribing practitioner and provide specific information on how and when to contact the practitioner; and 

(b) Provide a copy of the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., to the child’s parent or legal guardian, which includes the prescribing practitioner’s contact information.

convey the information to the parent or legal guardian. The information conveyed shall include:

(a) A copy of the Medical Report;

(b)The method of administering the medication;

(c) An explanation of the nature and purpose of the treatment;

(d) The recognized side effects, risks and contraindications of the medication;

(e) Drug-interaction precautions;

(f) Possible side effects of stopping the medication;

(g) Alternative treatment options,

(h) How treatment will be monitored; and

(i) The physician’s plan to reduce and/or eliminate ongoing administration of the medication.

(3) When the court has authorized the provision of psychotropic medication, the CPI or dependency case manager or child protective investigator must continue to try to involve the parent or legal guardian in the child’s ongoing medical treatment planning, and shall continue to facilitate the parent or legal guardian’s communication with the prescribing practitioner physician so that the parent or legal guardian has the opportunity to consider whether to authorize the provision of any new medications or dosages, unless the parent or legal guardian’s rights have been terminated.

(4) The dependency case manager or child protective investigator shall make the following minimum efforts to enable the prescribing physician to obtain express and informed consent from the child’s parent or legal guardian:

(a) Attempt to invite the parent or legal guardian to the doctor’s appointment and to offer them transportation to the appointment, if necessary;

(b) Attempt to contact the parent or legal guardian as soon as possible upon learning of the recommendation for psychotropic medication by the prescribing physician and provide specific information to them on how and when to contact the physician; and 

(c) Facilitate transportation arrangements to the appointment and/or telephone calls between the parent or legal guardian and the prescribing physician.

(5) If there are any changes in medication, including dosage or dosage range, that go beyond the existing authorization, the dependency case manager or child protective investigator will be responsible for facilitating discussions between the prescribing physician and the parent or legal guardian or pursuing a new court authorization. The dependency case manager or child protective investigator shall inform Children’s Legal Services and all parties of any changes in medication and shall provide Children’s Legal Services with a copy of the amended Medical Report.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Amended___.

 

65C-35.004 Caregiver Involvement.

(1) The caregiver’s schedule must be taken into consideration when scheduling appointments. The child’s caregiver must make every effort to attend medical appointments and obtain the information about medications, possible side effects, and provide information about the child to the prescriber as requested other information as listed in subsection (2) of this section. Caregivers do not have the authority to provide expressed express and informed consent for psychotropic medication. However, nothing in this rule prohibits caregivers from expressing their concerns regarding prescribing psychotropic medication to children.

(2) If the caregiver is unable to attend the appointment and it cannot be rescheduled, then the child protective investigator (CPI) or case manager or his or her designee who has received training on psychotropic medications in accordance with Rule 65C-35.014, F.A.C., shall attend the appointment. The designee must also be familiar with the child.

(a) The CPI or case manager shall provide to the designee, in writing, the child’s medical and mental health history, behaviors, concerns, and effects of the current psychotropic medications on the child. 

(b) The CPI or case manager shall provide a copy of the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., to the caregiver and review the report with the caregiver to ensure the caregiver’s understanding of the report.

, the child’s appointment should be rescheduled to allow attendance. If the appointment cannot be rescheduled, the dependency case manager or child protective investigator shall attend the appointment and convey the information to the caregiver. The information to be conveyed shall include:

(a) A copy of the Medical Report;

(b) The method of administering the medication;

(c) An explanation of the nature and purpose of the treatment;

(d) The recognized side effects, risks and contraindications of the medication;

(e) Drug-interaction precautions;

(f) Possible side effects of stopping the medication;

(g) Alternative treatment options;

(h) How treatment will be monitored; and

(i) The physician’s plan to reduce and/or eliminate ongoing administration of the medication.

(3) The caregiver shall monitor the child, and report to the prescribing practitioner physician and the CPI or dependency case manager any behavior or other incident that could indicate an adverse reaction or side effect. The caregiver must seek emergency medical care for the child if the presence of an adverse reaction or side effect to the medication is affecting the child’s health or safety.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Amended___.

 

65C-35.005 Child Involvement in Treatment Planning.

(1) The prescribing practitioner physician must discuss the proposed course of treatment with the child, in developmentally appropriate language the child can understand. The practitioner physician must explain the risks and benefits of the prescribed medication to the child.

(2) The practitioner physician will discuss with the child the following:

(a) Tthe medication proposed;,

(b) Tthe reason for the medication;,

(c) and Tthe signs or symptoms to report to caregivers;. Information discussed with the child shall include:

(d)(a) Alternative treatment options;

(e)(b) The method of administering the medication;

(f)(c) An explanation of the nature and purpose of the treatment;

(g)(d) The recognized side effects, risks and contraindications of the medication;

(h)(e) Drug-interaction precautions;

(i)(f) Possible side effects of stopping the medication;

(j)(g) How treatment will be monitored; and

(k)(h) The practitioner’s physician’s plan to reduce and/or eliminate ongoing administration of the medication.

(2)(3) The prescribing practitioner physician must ascertain the child’s position with regard to the medication and consider whether to revise the recommendation based on the child’s input. The child’s position must be noted in the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C. The child protective investigator (CPI) or case manager shall provide the child with a copy of the Medical Report if the child is of sufficient maturity and intellectual capacity to understand the report.

(a) It is the practitioner’s physician’s responsibility to inform the child as clearly as possible and as fully as is appropriate. However, the child’s failure to understand or assent to treatment is not, by itself, sufficient to prevent the administration of a prescribed medication. Likewise, the child’s assent to the treatment is not a substitute for expressed express and informed consent by a parent or legal guardian or a court order. Children are more likely to be successful in treatment if they fully understand and participate in treatment decisions.

(b) Pursuant to Section 39.01305, F.S., If a child of sufficient age, understanding, and maturity declines to assent to the psychotropic medication, the CPI or dependency case manager shall or child protective investigator will request that Children’s Legal Services file a motion for the appointment of request an attorney be appointed for the child when the child declines to assent or the prescribing practitioner determines that the child is not developmentally able to provide assent.

(3)(4) Whenever the child requests the discontinuation of the psychotropic medication, and the prescribing practitioner physician refuses to order the discontinuation, the CPI or dependency case manager or child protective investigator shall will request that Children’s Legal Services request an attorney be appointed for the child. Children’s Legal Services will notice all parties and file a motion with the court, presenting the child’s concerns, the practitioner’s physician’s recommendation, and any other relevant information, pursuant to Section 39.407(3)(d)1., F.S.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Amended___.

 

65C-35.006 Taking a Child Into Custody Who Is Taking Psychotropic Medication.

(1) When a child protective investigator (CPI) takes a child into custody he or she they must ascertain determine whether the child is taking psychotropic medications. If so, the CPI child protective investigator must determine ascertain the purpose of the medication, the name and phone number of the prescribing practitioner physician, the dosage, instructions regarding administration (e.g., timing, whether to administer with food), and any other relevant information.

(2)(a) The CPI child protective investigator must seek written authorization from the parent or legal guardian to continue administration of currently prescribed psychotropic medications. The authorization shall be documented on the “Emergency Intake” form, CF-FSP 5314, May 2010, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref- XXX. This authorization is good for the first 60 28 calendar days the child is in shelter status.

(b) The child protective investigator must take the following actions:

1. If the medication is in its original container, and clearly marked as a current prescription for the child, the medication must continue to be provided to the child. The protective investigator must notify or cause to be notified the parent or legal guardian that the medication is being provided to the child.

(a)2. In order for medication to be administered to a child, the medication must be a current prescription, in the original container, and clearly marked. If the medication is not in the original container, is not clearly marked, or is not the child’s and current prescription, the child shall not be continued on the medication unless the prescribing practitioner or the dispensing pharmacy confirms that the child is currently on the prescribed medication and provides a new prescription to be filled or refilled. a physician or pharmacist must confirm that the medication is the child’s prescription and that the prescription is current. Current means the child is or should be taking the medication at the time the child is taken into custody, according to the prescription information.

(b) If the CPI is informed that the child is currently taking prescribed psychotropic medication, however, the original container is unavailable or the label on the container provided is indiscernible, the child must be evaluated by a practitioner at the initial health screening to determine if the medication is needed and provided instruction on proper dosing.

(3) If parental authorization is not obtained and the CPI receives a medical opinion that the child needs to continue taking the medication, the medical opinion must be in writing and provided to Children’s Legal Services.

3. If there is a pre-existing prescription and the other conditions regarding the medication’s container, labeling, and current date above are met, the psychotropic medication must be provided to the child as prescribed, but only until the emergency shelter hearing is held as required by Section 39.407(3)(b)1., F.S. 

4. The child protective investigator may determine that the medication does not meet the conditions of being “in the original container, clearly marked, and current.” In this case, the medication provided by the parent or legal guardian will not be administered to the child until the identity of the medication is confirmed by a physician or pharmacist.

5. If a physician or pharmacist is unable to confirm the identity of any provided medications, the child will be evaluated by a physician at the child health check-up (within 72 hours). The physician will determine the on-going need for a currently prescribed psychotropic medication. 

(2) To continue administering the medication beyond the date of the shelter hearing, the child protective investigator must have a determination from a physician licensed under Chapter 458 or 459, F.S., that the child should continue the psychotropic medication. This determination must be transmitted in writing to Children’s Legal Services.

(3) If the dependency case manager or the child protective investigator is unable to contact the prescribing physician prior to the shelter hearing, the information on the medication bottle may be used by the court as evidence of the intent of the prescribing physician to continue the medication until medical advice can be obtained by the dependency case manager or child protective investigator.

(4) In the absence of parent or legal guardian authorization, when a physician determines the child should continue psychotropic medication, Children’s Legal Services must file a motion requesting that continuation of the medication be determined at the shelter hearing. The motion must indicate the prescribing practitioner’s physician’s reasons for wanting to continue the medication and provide the court with any other available information relevant to the request.

(5) Authorization in a shelter order to continue the medication shall be valid only until the arraignment hearing on the petition for dependency, or for 28 calendar days following the date of removal, whichever occurs first.

(6) Within 28 calendar days of removal, or no later than the arraignment hearing on the petition for dependency, whichever occurs first, the child must be evaluated by a practitioner physician to determine whether it is appropriate to continue the medication.

(7) The CPI shall document in All actions taken by the child protective investigator will be entered into FSFN all actions in regards to the provision of the medication within three (3) business days of receipt of the parent or legal guardian authorization or court order approving the medication.

(8) The parent or legal guardian authorization to continue a psychotropic medication that was obtained at the point of a child’s removal is separate from the general “Consent for Treatment and Release of Information”. The general consent allows ordinary and necessary medical and dental care, to include immunizations, tuberculin testing, and well child care. The administration of psychotropic medication is considered an extraordinary procedure for which parental informed consent or a court order is required by law.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Amended___.

 

65C-35.007 Authority to Provide Psychotropic Medications to Children in Out-of-Home Care Placements.

(1) Parents or legal guardians retain the right to consent to or decline the administration of psychotropic medications for children taken into state care until such time as their parental rights, or court-ordered guardianship or custodial rights, have been terminated.

(2) In no case may the child protective investigator (CPI), case manager, child’s caregiver, or staff from Residential Treatment Centers provide expressed and informed consent for a child in out-of-home care to be prescribed a psychotropic medication.

(3)(2) If the parents’ or guardians’ legal rights have been terminated,; their identity or location is unknown,; or they decline to approve administration of psychotropic medication, or withdraw consent to the administration of psychotropic medication and any party to the dependency action believes that administration of the medication is in the best interest of the child and medically necessary, then authorization to treat with psychotropic medication shall must be pursued as follows:

(a) The case manager shall consult with the prescribing practitioner within one (1) business day of being notified that the parent:

1. Is unavailable,

2.Withdraws consent,

3. Declines to consent; or

4. Is found by the prescribing practitioner to lack the ability to provide expressed and informed consent.

(b) If the prescribing practitioner determines that the medication is medically necessary for the child despite the lack of authorization, the case manager must obtain a completed Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., from the prescribing practitioner. If the parent or legal guardian withdraws consent that was previously provided or declines to consent to the administration of psychotropic medication, the parent or legal guardian’s decision, and any reason provided therefore, must be recorded by the prescribing practitioner in the Medical Report.  If the prescribing practitioner determines that the parent or legal guardian cannot provide expressed and informed consent, the basis for that determination must be recorded by the prescribing practitioner in the Medical Report.

(c) Within three (3) business days of receiving the Medical Report from the prescribing practitioner, the case manager must submit the Medical Report and any supporting documentation to Children’s Legal Services, with a request for legal action to obtain a court order authorizing the administration of the prescribed medication.

(d) Children’s Legal Services must file a motion seeking court authorization for the provision of the psychotropic medication. Except as provided in Section 39.407(e), F.S., court authorization must occur before the psychotropic medication is administered to the child.

(4) Psychotropic medications may be administered in advance of a court order or parental authorization in accordance with Section 39.407(3)(b)1. and Section 39.407(3)(e), F.S.

through a court order. Children’s Legal Services must file a motion in court that will allow the court to “hear” the request and upon consideration of the facts, circumstances, and law, authorize the provision of the medication. Court authorization must occur before the psychotropic medication is administered to the child except in the circumstances described in Rule 65C-35.010, F.A.C. 

(3) In no case may the dependency case manager, child protective investigator, the child’s caregiver, representatives from the Department of Juvenile Justice, or staff from Residential Treatment Centers provide express and informed consent for a child in out-of-home care to be prescribed a psychotropic medication.

(4) The dependency case manager or child protective investigator must assist the prescribing physician in obtaining express and informed consent and must take steps as required in subsection 65C-35.003(4), F.A.C., to include the parent or legal guardian in the child’s consultation with the prescribing physician.

(5) All details about prescribed psychotropic medications, updates (including changes in dosage or physician prescribed cessation of the medication), and all actions taken by the dependency case manager or child protective investigator, will be entered into FSFN by the dependency case manager or child protective investigator within three (3) business days of the action.

(6) If a child on psychotropic medication is moved from an out-of-home placement and placed into another out-of-home placement, the dependency case manager or child protective investigator must obtain the child’s Resource Record and any psychotropic prescription medication currently taken by the child. The dependency case manager or child protective investigator must provide the caregiver receiving the child sufficient information about the medication, as provided below, to ensure that the medication is continued as directed by the prescribing physician. The dependency case manager or child protective investigator shall obtain the medication in labeled medication bottles, inventory the medications provided, and transport the medications to the child’s new caregiver. At no time shall the medication be handed to the child. The information provided to the caregiver shall include, at a minimum:

(a) The full name of the child for whom the medication is prescribed;

(b) The condition and purpose for which the medication is prescribed for the child;

(c) The prescribing physician’s name and contact information;

(d) The pharmacy from which the prescription was obtained and the contact information;

(e) The prescription number;

(f) The drug name and dosage;

(g) The times, frequency and method of administration, and if the dosages vary at different times;

(h) Any identified side effects, risks and contraindications (including possible side effects of stopping the medication);

(i) Any other specific instructions regarding the medication;

(j) The physician’s plan to reduce and/or eliminate ongoing administration of the medication; and

(k) A space for the caregiver to sign and date the medication inventory to indicate receipt of the child’s medication.

(7) If the child is moved from an out-of-home placement and placed into another out-of-home placement and the medication is in an unlabeled container or prescription information is insufficient, the dependency case manager or child protective investigator shall contact the prescribing physician to ensure the proper identification and labeling of the medication or to arrange for a medical evaluation in order that treatment not be interrupted.

(8) Whenever a child in out-of-home care is receiving psychotropic medications pursuant to express and informed consent by the parent or legal guardian or as authorized by an order of the court, the Department shall fully inform the court of the child’s medical and behavioral status at each subsequent Judicial Review hearing, and shall furnish copies of all pertinent medical records contained in the child’s Resource Record that have been generated since the previous court hearing, including the Medical Report.

(9) When court authorization is needed to provide psychotropic medication, the dependency case manager or child protective investigator shall provide Children’s Legal Services a written report that documents efforts made to enable the prescribing physician to obtain express and informed consent from the child’s parent or legal guardian. This report must include:

(a) Dates and time the dependency case manager or child protective investigator attempted to contact the parent or legal guardian by phone or other means upon learning of the recommendation for psychotropic medication by the prescribing physician.

(b) Dates, times, and methods used to attempt to contact the parent or legal guardian and provide them with specific information for how and when to contact the physician.

(c) Efforts to facilitate transportation arrangements to the appointment and/or telephone calls between the parent or legal guardian and the prescribing physician.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(2), (3) FS. History–New 3-17-10, Amended____.

 

65C-35.008 Parent or Legal Guardian Declines to Consent to or Withdraws Consent for the Provision of Psychotropic Medication.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Repealed____.

 

65C-35.009 Parent or Legal Guardian Rights Terminated; Parent or Legal Guardian Refuses to Participate; or Parent or Legal Guardian Location or Identity Unknown.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Repealed______.

 

65C-35.010 Emergency Administration of Psychotropic Medication.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Repealed_____.

 

65C-35.011 Medication Administration and Monitoring and Administration.

(1) The monitoring of the use of psychotropic medication provided to children will be the joint responsibility of the prescribing practitioner, the caregiver, the child protective investigator (CPI) or case manager, and the CPI or case manager’s supervisor. Child protective investigator supervisors and case manager supervisors shall provide on-going review and oversight of children prescribed psychotropic medications. 

(2) The caregiver and CPI or case manager are responsible for implementing the medication plan developed by the prescribing practitioner. The case manager or child protective investigator shall ensure any additional medical evaluations and laboratory tests required are completed. The CPI or case manager shall add all information to the child’s Resource Record and report the results of evaluations and tests to Children’s Legal Services, all parties, and the prescribing practitioner.

(3)(1) Psychotropic medications will be administrated only by the child’s caregivers. Children who are age and developmentally appropriate must be given the choice to self-administer medication under the supervision of the caregiver or school personnel. Children assessed as appropriate to self-administer medication must be educated by the practitioner or caregiver on the following:

(a) The method of administering the medication;

(b) The recognized side effects, risks and contraindications of the medication;

(c) Drug-interaction precautions;

(d) Possible side effects of stopping the medication; and

(e) How medication administration will be supervised by the caregiver.

(4) The Department, community-based care agency or its contracted service provider will develop locally approved medication logs for documenting the administration of psychotropic medications and any side effects or adverse reactions.

(a) The caregiver is responsible for filling out the medication administration logs.

(b) The case manager shall obtain the medication logs at each home visit and include the medication logs in the child’s FSFN record.

(2) The dependency case manager or other designee will attend medication reviews as requested by the prescribing physician and/or agency.

(3) The monitoring of the use of psychotropic medication provided to children will be a joint responsibility among the prescribing physician, caregiver, dependency case manager or child protective investigator, and the supervisor.

(4) The dependency case manager or child protective investigator is responsible for implementing the medication plan developed by the prescribing physician. The dependency case manager or child protective investigator will arrange for any additional medical evaluations and laboratory tests required. All information will be added to the child’s Resource Record. Results of evaluations and tests will be reported to Children’s Legal Services, all parties, and the prescribing physician.

(5) Any person with information that questions calls into question the child’s health and safety, including but not limited to the signs or symptoms of side effects or adverse reactions to the medication, shall as soon as possible immediately bring that information to the attention of the prescribing practitioner physician, the CPI or and child protective investigator’s or dependency case manager, the CPI or case manager manager’s supervisor, and emergency services shall be arranged as appropriate to protect the child’s safety and well-being. The child’s CPI or case manager shall provide tThis information shall be provided to Children’s Legal Services. Children’s Legal Services shall notify, the court, and all parties within three (3) business days of the reported concerns.

(6) The case manager or designee, as defined in Rule 65C-35.004(2), F.A.C., shall attend medication reviews.

(7) All details about prescribed psychotropic medications, updates (including changes in dosage or practitioner prescribed cessation of the medication) and all actions taken by the CPI or case manager will be entered into the Florida Safe Families Network (FSFN) by the CPI or case manager within three (3) business days of the action.

(8) Whenever a child in out-of-home care is receiving psychotropic medications pursuant to expressed and informed consent by the parent or legal guardian or as authorized by an order of the court, the Department shall fully inform the court of the child’s medical and behavioral status at each subsequent Judicial Review hearing and shall furnish copies of all pertinent medical records contained in the child’s Resource Record that have been generated since the previous court hearing, including the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C.

(9) If a child on psychotropic medication is moved from an out-of-home placement and placed into another out-of-home placement, the CPI or case manager must obtain the child’s Resource Record and any prescription psychotropic medication currently taken by the child.

(10) The CPI or case manager shall encourage communication between the current and previous caregivers.

(11)  The CPI or case manager shall obtain the medication in original labeled medication bottles, inventory the medications provided, and transport the medications to the child’s new caregiver.

(12) To ensure that the medication is continued as directed by the prescribing practitioner, the CPI or case manager shall provide the caregiver with the following information:

(a) The full name of the child for whom the medication is prescribed;

(b) The condition and purpose for which the medication is prescribed for the child;

(c) The prescribing practitioner’s name and contact information;

(d) The pharmacy from which the prescription was obtained and the contact information;

(e) The prescription number;

(f) The drug name and dosage;

(g) The times, frequency and method of administration, and if the dosages vary at different times;

(h) Any identified side effects, risks and contraindications (including possible side effects of stopping the medication);

(i) Any other specific instructions regarding the medication;

(j) The practitioner’s plan to reduce and/or eliminate ongoing administration of the medication; and

(k) The dates and time of any follow-up appointments, including appointments for laboratory testing.

(13) If the child is moved from an out-of-home placement and placed in another out-of-home placement and the medication is in an unlabeled container or prescription information is insufficient, the CPI or case manager shall take steps to verify that the medication is the child’s current prescription in accordance with Rule 65C-35.007(3), F.A.C.

(6) The dependency case manager or child protective investigator, the supervisor, and the caregiver have joint responsibility to assure the physician’s directions and intent as documented in the completed Medical Report and Medication Treatment Plan are implemented.

(7) The Department or its contracted service providers will develop locally approved medication logs for documenting the administration of psychotropic medications and any side effects or adverse reactions.

(8) Dependency case manager supervisors and child protective investigator supervisors shall provide on-going review and oversight of children prescribed psychotropic medications.

(9) The Department may address the efficacy of psychotropic medication through requirements in lead agency contracts, including but not limited to the utilization of pre-consent reviews or second opinions by child psychiatrists.

(14)(10) Community-based care lLead agencies shall develop and implement protocols which ensure collaboration among those responsible for a child’s care, specifically addressing the use of psychotropic medication and the need to share all relevant information with all parties involved in the child’s care.

Rulemaking Authority 39.407(3)(g), 39.0121 FS. Law Implemented 39.407(2), (3) FS. History–New 3-17-10, Amended___.

 

65C-35.012 Requests for Second Opinions and Pre-Consent Reviews.

(1) Second Opinions.

(a)(1) The child protective investigator (CPI) or dependency case manager may seek a second medical opinion at any time after consultation with a supervisor as to the need for a second opinion.

(b)(2) When any party files a motion requesting that the court order a second medical opinion, the court may order the Department or its contracted service provider to obtain a second opinion within a reasonable timeframe as established by the court. Within one (1) business day of the court’s order, the CPI child protective investigator or the dependency case manager will make a referral for an appointment for the second opinion.

(c)(3) The CPI child protective investigator or dependency case manager must obtain the second opinion within twenty-one (21) calendar days of receipt of the court ordering the second opinion order.

(2) Pre-Consent Reviews. The CPI or case manager shall seek a pre-consent review when:

(a) A practitioner proposes prescribing psychotropic medication or changing the dosage of prescribed psychotropic medication outside the dosage parameters documented in the Medical Report; and

(b) The child is age birth through 10 years; and

(c) The child is prescribed two (2) or more psychotropic medications.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3)(d) FS. History–New 3-17-10, Amended____.

 

65C-35.013 Medical Report.

(1) If the parent or caregiver is unable to attend the medical appointment a court order is required to obtain authorization to administer psychotropic medication, the prescribing practitioner physician must complete and sign the Medical Report form, incorporated by reference in Rule 65C-35.001, F.A.C. that is incorporated by reference into Chapter 65C-35, F.A.C. The practitioner physician may submit a medical report on a form of their choice as long as the form includes all information required on the Medical Report that is incorporated by reference into Rule 65C-35.001 Chapter 65C-35, F.A.C.

(2) When the parent and caregiver are able to attend the medical appointment and the parent provides expressed and informed consent for the child to be administered psychotropic medications, the prescribing practitioner must complete Section 5: Parental Consent of the Medical Report Form. The parent must sign this section of the form attesting to his or her consent.

(a) The child protective investigator (CPI) or case manager shall provide to Children’s Legal Services the parent’s consent, as well as documentation noting the medications prescribed to the child, within three (3) business days of receipt of the parental consent and documentation.

(b) Children’s Legal Services shall notice all parties to the case of the parent’s consent to the administration of psychotropic medications and file the consent and documentation of prescribed medications with the court.

(2) When court authorization is needed to provide psychotropic medication, the CPI or case manager must document efforts made to enable the prescribing practitioner to obtain expressed and informed consent from the child’s parent or legal guardian on the Medical Report form. Efforts to enable the prescribing practitioner must include:

(a) Dates and times the CPI or case manager attempted to contact the parent or legal guardian by phone or other means upon learning of the recommendation for psychotropic medication by the prescribing practitioner;

(b) Dates, times, and methods used to attempt to contact the parent or legal guardian and provide them with specific information for how and when to contact the practitioner; and

(c) Efforts to facilitate transportation arrangements to the appointment and/or telephone calls between the parent or legal guardian and the prescribing practitioner.

(3) The Medical Report form must be uploaded in FSFN within (3) business days of receipt of the completed document.

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3)(c) FS. History–New 3-17-10, Amended___.

 

65C-35.014  Training on Psychotropic Medication

(1)  All child protective investigators and case managers shall receive Department-approved training from the community-based care lead agency (CBC) or its contracted provider on medication management and administration. Training must be completed prior to assuming responsibility for a child who is prescribed psychotropic medication.

(2) Approved trainings are available on the Center for Child Welfare’s website at http://www.centerforchildwelfare.org, or training may be developed by the CBC or its contracted provider. The training must include the following components:

(a)  An overview of the use and effects of psychotropic medications;

(b)  An overview of evidenced-based interventions and treatment options;

(c)  Names and uses of commonly prescribed psychotropic medications;

(d)  Medication management, roles and responsibilities; and

(e)  Monitoring for side effects of psychotropic medications.

(3)  The Department shall review all training curriculum on the use and administration of psychotropic medications to ensure that it includes the required components specified in (2) of this rule.  If the required components are included, the Department shall approve the curriculum.

(4)  All caregivers responsible for administering psychotropic medication must be trained by the CBC on the components specified in (2) of this rule within 30 calendar days of the child’s placement into the caregiver’s home.

Rulemaking Authority 39.407(3)(g) FS.    Law Implemented 39.407(3)(d) FS. History–New____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Courtney Smith

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Mike Carroll

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 12/27/16

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 12/21/16