63N-1.0085. Psychiatric Services

(1) Each Detention Center and residential commitment program shall have available, either within the facility, or by written agreements or contracts with off-site providers, provision of Psychiatric Services for treatment of serious Mental Disorders.

(2) Psychiatric Services shall be provided by a Psychiatrist or by a licensed and certified psychiatric advanced registered nurse practitioner (ARNP) under Chapter 464, F.S., who works under the clinical supervision of a Psychiatrist as specified in the collaborative practice protocol with the supervising Psychiatrist filed with the Florida Department of Health.

(a) The Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) providing Psychiatric Services in a departmental facility or program must comply with Rules 63M-2.010-2.023 and 63M-2.025-2.027, F.A.C., provisions regarding medication management whenever a youth is considered for, prescribed or receiving Psychotropic Medication.

(b) The Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) shall only prescribe Psychotropic Medications, which address the youth’s specific diagnoses and target symptoms.

(c) If Psychotropic Medications are required, the lowest dose of medication necessary to achieve therapeutic effect shall be used bearing in mind potential benefits and risks.

(d) The use of more than one Psychotropic Medication as part of a mental health treatment regimen requires documented clinical justification for each Psychotropic Medication utilized by the Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP).

(e) Psychotropic Medication shall be only one component of the therapeutic program. Additional treatment modalities such as individual, group and family therapy, behavioral therapy substance abuse counseling and psychosocial skills training shall be utilized in conjunction with the use of Psychotropic Medication.

(f) Psychotropic Medication shall not be used as punishment, for staff convenience, discipline, coercion, or retaliation, as a substitute for meaningful psychosocial, rehabilitative services or in quantities that lead to a loss of functional status.

(g) There shall be no pro re nata (PRN) or standing orders for Psychotropic Medications.

(h) There shall be no emergency treatment orders for use of Psychotropic Medication as a chemical restraint. Chemical restraint means a medication used to control behavior or restrict the youth's freedom of movement and is not a standard treatment for the youth's psychiatric condition.

(3) Each Detention Center’s and residential commitment program’s intake screening process must determine whether a youth is taking Psychotropic Medications. If so, the youth is to be referred for an Initial Diagnostic Psychiatric Interview to be conducted within fourteen days of the youth’s admission. The Initial Diagnostic Psychiatric Interview must be identified as such and documented on the Clinical Psychotropic Progress Note (HS 006), or a form developed by the program which contains all the information required in form HS 006. The Clinical Psychotropic Progress Note (HS 006, October 2014) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05365 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(4) Each youth who is currently receiving Psychotropic Medications at the time of admission or is prescribed Psychotropic Medication subsequent to admission must receive a psychiatric evaluation or an updated psychiatric evaluation. Youths currently receiving Psychotropic Medications at the time of admission must receive psychiatric evaluation within 30 days of admission. Youths prescribed Psychotropic Medication subsequent to admission must receive psychiatric evaluation within 30 days of the initiation of Psychotropic Medication.

(a) The Psychiatric Evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(b) If the youth’s file contains a psychiatric evaluation which was completed within the past 6 months, the previous psychiatric evaluation may be utilized by the facility’s Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) to conduct an updated psychiatric evaluation. The updated psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(5) Each youth who is receiving Psychotropic Medication shall be seen for medication review by the Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP), at a minimum, every 30 days. Medication review shall include evaluating and monitoring medication effects and the need for continuing or changing the medication regimen.

(6) Psychotropic Medication that is prescribed or Significantly Changed shall be documented on page 3 of the Clinical Psychotropic Progress Note Form (HS 006). Psychotropic Medication that is continued without Significant Change shall be documented either on page 3 of form HS 006 or a form developed by the program that contains all the information required on page 3 of form HS 006.

(7) Whenever a new Psychotropic Medication is prescribed, Psychotropic Medication is discontinued, or the drug dosage is Significantly Changed, parent/guardian notification and consent must be obtained unless the youth is 18 years of age or older or is emancipated as provided in Section 743.01 or 743.015, F.S., and is responsible for authorizing his or her own health care, or a physician determines that immediate treatment is needed as set forth in Section 985.18(7), F.S.

(8) Parental/guardian consent for Psychotropic Medication shall be accomplished through the following action:

(a) The Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) must attempt to contact the parent or legal guardian by telephone to obtain his or her verbal consent for the Psychotropic Medication.

(b) The Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) must document the parent or guardian’s verbal consent, when obtained, on page 3 of the Clinical Psychotropic Progress Note Form (HS 006), or a form developed by the program that contains all the information required on page 3 of form HS 006.

(c) A copy of the 3rd page of the Clinical Psychotropic Progress Note (HS 006) or a form developed by the program that contains all the information required on page 3 of form HS 006, and the Acknowledgment of Receipt of CPPN Form or Practitioner Form (HS 001) shall be mailed to the parent/guardian. The Acknowledgment of Receipt of CPPN Form or Practitioner Form (HS 001, August 2007) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-03784 or may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

(d) The parent or legal guardian’s signature on the Acknowledgment of Receipt of CPPN Form or Practitioner Form (HS 001) provides written consent for the Psychotropic Medications as recorded on page 3 of the CPPN form HS 001 mailed to the parent or legal guardian.

(9) Consent requirements for provision of Psychotropic Medication for youths in foster care whose parent or legal guardian’s rights have been terminated, or the parent/legal guardian refuses to participate in the youth’s treatment or the parent/legal guardian’s location or identity is unknown is addressed in Chapter 65C-35, F.A.C.

(10) The Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) must brief the facility’s treatment team on the psychiatric status of each youth receiving Psychiatric Services who is scheduled for treatment team review. The briefing may be accomplished through face-to-face interaction or telephonic communication with a representative of the treatment team, or through a detailed progress note submitted by the Psychiatrist or psychiatric advanced registered nurse practitioner (ARNP) prior to the treatment team meeting.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4),, 985.64(2) FS. History–New 6-20-14, Amended 7-9-15.