Definitions, Behavioral Health Services, Parent or Legal Guardian Involvement, Caregiver Involvement, Child Involvement in Treatment Planning, Taking a Child Into Custody Who Is Taking Psychotropic Medication, Authority to Provide Psychotropic ...
DEPARTMENT OF CHILDREN AND FAMILIES
Family Safety and Preservation Program
RULE NO.: RULE TITLE:
65C-35.001 Definitions
65C-35.002 Behavioral Health Services
65C-35.003 Parent or Legal Guardian Involvement
65C-35.004 Caregiver Involvement
65C-35.005 Child Involvement in Treatment Planning
65C-35.006 Taking a Child Into Custody Who Is Taking Psychotropic Medication
65C-35.007 Authority to Provide Psychotropic Medications to Children in Out-of-Home Care
65C-35.011 Medication Monitoring and Administration
65C-35.012 Requests for Second Opinions and Pre-Consent Reviews
65C-35.013 Medical Report
65C-35.014 Training on Psychotropic Medication
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 44 No. 33, February 16, 2018 issue of the Florida Administrative Register.
65C-35.001 Definitions.
(1) through (11) No change.
(12) “Express and Informed Consent” means 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. 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 the following information, provided and explained in plain language by the prescribing physician or designee 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) through (23) No change.
Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Amended 4-20-17, 6-29-17. Amended ______
65C-35.002 Behavioral Health Services.
(1) Behavioral health services shall be provided to children in out-of-home care once the need for such services is identified. Prior to prescribing a psychotropic medication, the physician or physician’s designee must consider other treatment interventions that may include medical, mental health, behavioral, counseling, or other services. All decision-making shall 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) No change.
(3) Prior to prescribing a psychotropic medication, the physician or physician’s designee 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) No change.
65C-35.003 Parent or Legal Guardian Involvement.
(1) No change.
(2) If the parent or legal guardian is unable to attend medical appointments, the CPI or case manager shall:
(a) Attempt to contact the parent or legal guardian upon learning of the recommendation for psychotropic medication by the prescribing physician or physician’s designee and provide specific information on how and when to contact the physician’s designee; and,
(b) No change.
(3) When the court has authorized the provision of psychotropic medication, the CPI or case manager 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 physician or physician’s designee 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.
65C-35.004 Caregiver Involvement.
(1) through (2) No change.
(3) The caregiver shall monitor the child and report to the prescribing physician or physician’s designee and the CPI or 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.
65C-35.005 Child Involvement in Treatment Planning.
(1) The prescribing physician or physician’s designee must discuss the proposed course of treatment with the child, in developmentally appropriate language the child can understand. The physician or physician’s designee must explain the risks and benefits of the prescribed medication to the child.
The physician or physician’s designee will discuss with the child the following:
(a) through (j) No change.
(k) The physician or physician’s designee’s plan to reduce and/or eliminate ongoing administration of the medication.
(2) The prescribing 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 physician or physician’s designee’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 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) No change.
(3) No change.
65C-35.006 Taking a Child Into Custody Who Is Taking Psychotropic Medication.
(1) No change.
(2) The CPI 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-08063. This authorization is good for the first 60 calendar days the child is in shelter status.
(a) No change.
(b) If the medication is not in the original container, is not clearly marked, or is not the child’s current prescription, the child shall not be continued on the medication unless the prescribing physician or physician’s designee or the dispensing pharmacy confirms that the child is currently on the prescribed medication and provides a new prescription to be filled or refilled.
(3) through (7) No change.
65C-35.007 Authority to Provide Psychotropic Medications to Children in Out-of-Home Care.
(1) through (2) No change.
(3) If the parents’ or guardians’ legal rights have been terminated, their identity or location is unknown, 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 be pursued as follows:
(a) No change.
(b) If the prescribing physician 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 physician. 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 physician or physician’s designee in the Medical Report. If the prescribing physician determines that the parent or legal guardian cannot provide express and informed consent, the basis for that determination must be recorded by the prescribing physician or physician’s designee in the Medical Report.
(c) Within three (3) business days of receiving the Medical Report from the prescribing physician or physician’s designee, 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) No change.
(4) No change.
5C-35.011 Medication Monitoring and Administration.
(1) No change.
(2) The caregiver and CPI or case manager are responsible for implementing the medication plan developed by the prescribing physician. 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 physician or physician’s designee.
(3) 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 physician or physician’s designee or caregiver on the following:
(a) through (e) No change.
(4) No change.
(5) Any person with information that questions the child’s health and safety, including the signs or symptoms of side effects or adverse reactions to the medication, shall as soon as possible bring that information to the attention of the prescribing physician or physician’s designee, CPI or case manager, the CPI or case manager’s supervisor, and emergency services shall be arranged to protect the child’s safety and well-being. The child’s CPI or case manager shall provide this information 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) through (12) No change.
(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 contact the prescribing physician or physician’s designee, if available, and dispensing pharmacist to ensure the proper identification and labeling of the medication by examining the pills (if unlabeled) or to arrange for a medical evaluation in order that treatment not be interrupted.
(14) No change.
65C-35.012 Requests for Second Opinions and Pre-Consent Reviews.
No change.
65C-35.013 Medical Report.
(1) If the parent or caregiver is unable to attend the medical appointment, the prescribing physician must complete, if not previously completed by the physician’s designee, review, and sign the Medical Report form, incorporated by reference in Rule 65C-35.001, F.A.C. The physician or physician’s designee 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, F.A.C.
(2) When the parent and caregiver are able to attend the medical appointment and the parent provides express and informed consent for the child to be administered psychotropic medications, the prescribing physician or physician’s designee 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) through (b) No change.
(3) through (4) No change.
65C-35.014 Training on Psychotropic Medication.
(1) All child protective investigators and sheriff’s officers who conduct child investigations shall receive training from Department trainers or trainers with the Sherriff’s Office. Case managers and other caregivers (foster parents and relatives/non-relatives) shall receive 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) through (4) No change.
Rulemaking Authority 402.40(6), 409.175(5)(a) 39.407(3)(d) FS. Law Implemented 402.40(5)(a), 409.175(14)(a) 39.407(3)(d) FS. History–New 4-20-17. Amended_____
