0600-514.10 | Revision Date: 7/05/22
Overview
This policy reviews the administration of psychotropic medications when prescribed by the child’s physician or psychiatrist.
TABLE OF CONTENTS
Psychotropic Medication Review and Monitoring Process
Psychotropic Medication Authorization Process
Court Authorization Not Required
Medication Monitoring by the Medical Board of California (MBC)
Physician/Psychiatrist Treatment Plan Includes Psychotropic Medication
Psychotropic Medication Authorization (PMA) Unit Responsibilities
Residential Care Liaison (RCL) CSW Responsibilities
Version Summary
This policy guide was updated from its 11/27/19 version to add the new JV-228, JV-228 INFO and JV-229 forms and incorporate new procedures required by Senate Bill (SB) 377 (Chapter 547, Statutes of 2019) as outlined in ACL 21-59. The new forms allow a child in foster care or their attorney to authorize the release of the child’s medical records to the Medical Board of California for the purpose of investigating prescribing practices of psychotropic medication that are inconsistent with the standard of care.
California law and the Los Angeles Superior Court have provided specific guidelines and limitations regarding a physician’s provision of psychotropic medication to a child who is a dependent of the Los Angeles Juvenile Court and under the supervision of DCFS. These guidelines were updated and the Rules of Court amended as a result of SB 238 (2015), SB 319 (2015) and SB 377 (2019).
| Form Number | Form Name | Completed By | Description | ||
|---|---|---|---|---|---|
|
Guide to Psychotropic Medication Forms |
N/A |
An informational guide that explains all the new, existing and revised PMA forms (formerly the JV-219-INFO) | |||
|
|
Child's Opinion About the Medicine |
Child (with assistance as needed) |
Children may use this optional¹ form to tell the judge about their opinion(s) about the medicine; also available in Spanish (JV-218 S) | ||
|
|
Statement About Medicine Prescribed |
Parents/Legal Guardians, caregiver, CASA, tribal representative |
These individuals may use this optional¹ form to tell the court how they feel about the JV-220, and the effectiveness and side effects of the medicine; also available in Spanish (JV-219 S) | ||
|
|
Application for Psychotropic Medication |
|
This form gives the court basic information about the child and their living situation, provides CSW/DPO contact information, and serves as the formal PMA request to court | ||
|
|
Physician's Statement - Attachment |
Prescribing physician² |
This form is used to ask for a new PMA order (i.e., JV-223); it provides a record of the child’s medical history, diagnosis, previous treatments, the child’s previous experience with psychotropic medications, and the doctor's reasons for recommending the psychotropic medication. It is also available in Spanish |
||
|
|
Physician's Request to Continue Medication - Attachment |
Prescribing physician² |
A shorter version of the JV-220 (A), this form may only be used by the same doctor who filled out the most recent JV-220 (A) form if they are prescribing the same medication with the same maximum dosage | ||
|
|
Proof of Notice of Application |
PMA Unit and Court PMA desk clerk |
This form shows the court that all parties with a right to receive notice were served a copy of the JV-220 and attachments; also available in Spanish (JV-221 S) |
||
|
|
Input on Application for Psychotropic Medication |
Parent, Legal Guardian, attorney of record for parent/guardian, the child, the child’s attorney, the child’s CAPTA guardian ad litem, tribal representative |
This optional form may be used when one or more parties do not agree that the child should take the recommended psychotropic medication, or one or more of the parties wishes to provide the court with additional information; also available in Spanish(JV-222 S) | ||
|
|
Order on Application for Psychotropic Medication |
Hearing Officer |
This serves as the official court PMA order; it lists the court’s findings and orders about the child’s psychotropic medication; a copy must be provided to the caregiver; also available in Spanish (JV-223 S) | ||
|
|
County Report on Psychotropic Medication |
Case-Carrying CSW or RCL³ CSW |
This form serves as the report DCFS submits to court that describes how the child is doing on the medication. | ||
|
|
Position on Release of Information to Medical Board of California (MBC) |
Child or their attorney |
Authorizes or declines consent to release the child’s contact information and/or limited psychotropic medication medical records to the MBC, should the MBC determine further review is warranted regarding any potential violation of the law or excessive prescribing of psychotropic medications inconsistent with the standard of care. | ||
|
|
Background on Authorization for Release of Information to Medical Board of California |
N/A |
Provides the child and their attorney with background information regarding the MBC investigation and authorization process, including confidentiality parameters; describes the process to withdraw their authorization for the release of their information to the MBC. | ||
|
|
Withdrawal of Information Release to Medical Board of California |
Child or their attorney |
Withdraws the child’s authorization to release their information to the MBC. | ||
|
N/A |
|
Public Health Nurse (PHN) |
This is a 1-page checklist designed to ensure that youth ages 14 to 18 are engaged in their treatment plan, are prepared to make decisions about their ongoing medical care, and are capable of monitoring their medication regimen should they choose to continue it. It should be attached to the back of the JV-224 form. |
¹ Although the JV-218 and JV-219 forms are optional, voluntary forms, some hearing officers may order one or both forms be submitted to the court along with the JV-224 form. In such instances, CSWs should follow up with the caregiver and/or child to inquire about the status of those forms and consult with County Counsel.
² In accordance with the Superior Court of California, County of Los Angeles, Central District, Juvenile Division’s Blanket Order dated July 27, 2016, any prescribing physician that submits an application for psychotropic medication authorization [JV-220(A), JV-220(B)] for a foster child/youth in residential placement, seeking an order pursuant to WIC 369.5, shall be credentialed by the Los Angeles County Department of Mental Health.
³ Formerly known as "D-Rate Evaluator" (DRE) CSW
Each JV-223 form, Order On Application for Psychotropic Medication for new or renewed medication(s), is routed to the Juvenile Court Services Psychotropic Desk Clerk, who then forwards it to the PMA Unit. The PMA unit uploads the JV-223 form into CWS/CMS and notifies the CSW and SCSW that the JV-223 has been uploaded. The PHN inputs the medication information into CWS/CMS in accordance with the Department of Public Health's Children's Medical Services (CMS) Child Welfare Public Health Nursing Program (CWPHNP) Policy and Procedure: Psychotropic Medication -- Role of the Public Health Nurse (PHN) #CW-3007.
The RCL CSW (formerly known as the D-Rate Evaluator Children's Social Worker) is responsible for completing and submitting the JV-224, County Report on Psychotropic Medication for those children placed in group homes/Short-Term Residential Therapeutic Programs (STRTPs). RCL CSWs must also complete JV-224s for children residing in group homes/STRTPs who move placements into a non-group home/STRTP setting with less than forty-five (45) days before the next court hearing that will address their psychotropic medication.
The assigned Case-Carrying CSW is responsible for completing and submitting the JV-224 form for those children residing in any type of placement other than group homes/STRTPs. The Case-Carrying CSW must also complete the JV-224 form for children residing in a non-group home/STRTP placement who move placements into a group home/STRTP with less than forty-five (45) days before the next court hearing that will address the child's psychotropic medication.
within two (2) judicial days. (question #5 can be answered by reviewing the Health and Education Passport)
| Document Distribution |
JV-218 |
JV-219 |
JV-220 |
JV-220 (A or B) |
JV-222 | Parent's Cover Letter | JV-228, JV-228 INFO, JV-229 |
|---|---|---|---|---|---|---|---|
|
Child's Attorney |
X | X | X | X | X | X | |
|
CASA (if on weekly case list) |
|
X |
X |
||||
|
Parents’ Attorneys |
|
X |
X |
X | |||
|
Juvenile Court Mental Health Services |
|
X* |
X |
|
*Label with name of child’s attorney and firm
Upon receipt of the JV-220 form, JV-220 (A) or JV-220 (B) form and recommendations/comments from JCMHS:
, County Report on Psychotropic Medication, attaches the Youth Engagement Worksheet to the back of the JV-224 form, if applicable, and submits both forms to court at least ten (10) days prior to: form, County Report on Psychotropic Medication Court authorization is required to prescribe non-emergency psychotropic medication in the following circumstance:
The court authorization is good for six (6) months unless otherwise ordered by the Juvenile Court. A separate authorization is required if the physician believes a longer course of medication is necessary or decides to change the type of medication or increase the dosage. A physician can continue to prescribe and administer medication while a renewal request is pending before the court.
If the court does not authorize the medication, it is the CSW’s responsibility to contact the child’s caregiver and the child’s physician and advise the physician that they may not prescribe or administer the medication but has the option to respond to the JCMHS comments with a new JV-220(A) or JV-220 (B) form.
If a CSW discovers a youth has been prescribed psychotropic medication that was not authorized by the court through the required PMA process, the CSW should notify their SCSW and inform the hearing officer via the next court report.
Court authorization is generally not required to prescribe psychotropic medication in the following circumstances:
On occasion, children may be prescribed psychotropic medication on an emergency basis by a psychiatrist who is not their usual doctor. This might happen during a psychiatric hospitalization or after-hours evaluation by an Exodus psychiatrist, and the newly-prescribed medications may not align with those medication(s) contained in an existing approved PMA. Please note that only one (1) PMA is valid at any given time. Therefore, in these cases, the treating psychiatrist will complete an “emergency PMA,” authorizing use of the newly-prescribed medication during the course of the hospitalization and up to thirty (30) days thereafter (if approved by the court). The psychiatrist must also address any previously-prescribed medications that will be continued or discontinued on page 6 of the JV-220 (A) form. Court authorization must be sought as soon as practical but in no case more than two (2) court days after the emergency administration of the psychotropic medication.
With a copy of the emergency PMA, the CSW or caregiver is authorized to fill the prescription and administer the medication. As soon as possible after discharge, CSWs or caregiver should ensure the child is seen by their treating psychiatrist, who will evaluate the child’s psychotropic medication regimen and submit a regular PMA, as required by the protocol.
The Juvenile Court authorizes psychotropic medication for children in the following circumstances:
The Mental Health Court shall have exclusive power to determine issues of consent to medication in all cases in which a permanent LPS conservatorship has been established.
In situations where a child who enters the Juvenile Court system is being treated with psychotropic medication, the physician may continue the medication pending an order from the court. Court authorization must be sought by the physician as soon as practical but in no case more than two (2) court days after the emergency administration of the psychotropic medication.
For dependents of the Juvenile Court who are being administered prescribed psychotropic medication pursuant to a court order or parental consent, the court authorization or the parent/legal guardian consent for the administration of the medication must be documented in the child’s CWS/CMS case record including the date of the court order or date of the consent by the parent/legal guardian.
Parent/legal guardian consent is required in all pre-adjudication cases and post-disposition cases where the child is placed in the home of a parent/legal guardian or in out-of-home care and the court has delegated psychotropic medication decision making authority to the parent/legal guardian. The JV-220(A) form, Physician’s Statement -- Attachment, or JV-220 (B) form, Physician's Request to Continue Medication -- Attachment, is not required in these cases.
Parent/legal guardian consent is not required in cases where parent/legal guardian consent cannot be obtained prior to disposition, or when the case is post-disposition and the child is placed in out-of-home care and the court has not delegated psychotropic medication decision making authority to the parent/legal guardian. In these cases, the physician must fax the completed JV-220(A) form, Physician’s Statement -- Attachment, or JV-220 (B) form, Physician's Request to Continue Medication -- Attachment, to the DCFS PMA Unit. The DCFS PMA Unit phone numbers are (562) 903-5335, -5333, -5334, -5336 or -5326. The fax number is (562) 941-7205.
Youth who are eighteen (18) years of age or older and are dependents of the court are defined as nonminor dependents (NMDs) and can consent to their own medical care without court authorization, unless there is a court order stating the contrary (e.g., conservatorship). If an NMD refuses medical treatment that places them in serious harm and/or at risk of death, contact the County Counsel on the case to discuss how to proceed. It may be necessary to inform the court, as the failure to consent to the medication could place the NMD at substantial risk. If the NMD refuses to consent and DCFS requests a court order, counsel for the NMD should be notified. It is likely that under this scenario a court order will be required.
When an NMD has legal-decision making authority, a JV-220(A) form, Physician’s Statement -- Attachment, or JV-220 (B) form, Physician's Request to Continue Medication -- Attachment, is not required. Decision-making authority includes privacy regarding psychiatric condition(s) and consenting to receive treatment or take psychotropic medication(s).
Information about known medical problems, medication, and other relevant health information for NMDs must be documented in the Health and Education Passport (HEP). Information in the HEP is confidential, but must be provided to the caregiver of any NMD placed in a licensed and approved setting (except for SILPs).
NMD caregivers must keep all medical information confidential and cannot release information without the written consent of the NMD.
The CSW must advise the NMD of the CSW’s obligation to provide the HEP summary to the new caregiver and the court. The CSW must discuss with the youth the benefits and liabilities of sharing that information.
A child may submit an objection to the court on the JV-218 form, Child's Opinion About the Medicine. The JV-218 form must be filed within four (4) judicial days of receipt of the notice of a PMA application, or before (or at) any Status Review Hearing or PMA Progress Hearing. A child can obtain assistance completing the JV-218 form, or in lieu of submitting a JV-218 form, also has the option to talk to the judge at the hearing, write the judge a letter, ask their attorney, CSW, DPO or CASA to tell the judge how they feel. A child’s objection to, or noncompliance with, the approved psychotropic medication, is a treatment issue to be resolved by the physician prescribing the medication. A child cannot be forced to take psychotropic medication unless they are subject to an involuntary hospitalization or have a court appointed conservator.
The parent/legal guardian, child, caregiver, CASA, or tribal representative may use the JV-219 form, Statement About Medicine Prescribed, to tell the court how they feel about the psychotropic medication application, the effectiveness of the medicine, and any side effects of the medicine.
Although the JV-218 form and JV-219 form are optional, voluntary forms, some hearing officers may order one or both to be submitted to court along with the JV-224 form. In such instances, CSWs should follow up with the caregiver and/or child to inquire about the status of those forms and consult with County Counsel .
A person who opposes the proposed medication (or who wants to give the court more information) may document their objection on the JV-222 form, Input on Application for Psychotropic Medication form, and submit it to court. The JV-222 form must be completed, signed and filed with the Juvenile Court within four (4) judicial days of service of notice of the pending PMA application.
The California Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) are required to share with the MBC data (with personal identifiers removed) regarding children in foster care who have been prescribed three (3) or more concurrent psychotropic medications for a period of ninety (90) days or longer. The MBC must review this data for any potential violations of law or excessive prescribing of psychotropic medication to children in foster care. During its review, the MBC may identify cases where further review is warranted, and the MBC may need to request the personally identifying information and medical records for a foster child relevant to their investigation.
At the time a JV-220 form is filed with the court, the applicant (the prescribing physician, medical office staff, child welfare services staff, probation officer, or the child's caregiver) must review the JV-220(A) or JV-220(B) form to determine if the request would result in the child being prescribed three (3) or more concurrent psychotropic medications for ninety (90) days or more. If so, the applicant is responsible to provide the child's attorney with blank copies of the JV-228, JV-228-INFO, and JV-229 forms. The child's attorney may review the JV-228 form with the child and obtain the child’s opinion on their authorization to release their medical information of prescribed psychotropic medication to the MBC. The attorney has the option to file the JV-228 form with the court.
A child who is found by the court to be of sufficient age and maturity to consent may sign the JV-228 form. Sufficient age and maturity to consent is presumed if the child is twelve (12) years of age or older, unless rebutted by clear and convincing evidence. If the child does not want to sign the form, the child’s attorney may not sign it. In the event that a child wishes to stop their authorization for the CDSS and DHCS to provide their name and contact information to the MBC for the review of their medical records of prescribed psychotropic medication, the child or their attorney must complete the JV-229 form.
Psychotropic Medication Authorization (PMA) Unit Responsibilities
Residential Care Liaison (RCL) CSW Responsibilities
None
Children's Bureau et al. (2012). Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care. Washington, DC: Author.
JV-220 Application for Psychotropic Medication Process (chart)
Foster Youth Mental Health Bill of Rights (PUB 488) (SP)
Psychotropic Medication Youth Engagement Worksheet
Regional PMA In-Box Contact List
JV-220, Application for Psychotropic Medication
JV-224, County Report on Psychotropic Medication (includes JV-220 tutorial)
JV-217-INFO SP, Guide to Psychotropic Medication Forms
JV-218 SP, Child's Opinion About the Medicine
JV-219 SP, Statement About Medicine Prescribed
JV-220, Application for Psychotropic Medication
JV-220(A), Physician’s Statement -- Attachment
JV-220 (B), Physician's Request to Continue Medication -- Attachment
JV-221, Proof of Notice of Application
JV-222 SP Input on Application for Psychotropic Medication
JV-223, Order on Application for Psychotropic Medication
JV-224, County Report on Psychotropic Medication
JV-228, Position on Release of Information to Medical Board of California
JV-228-INFO, Background on Release of Information to Medical Board of California
JV-229, Withdrawal of Release of Information to Medical Board of California
0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)
0080-505.20, Health and Education Passport (HEP)
0100-535.60, Youth Development: The 6-Month Transition Plan, the 90-Day Transition Planning Conference, and Transitioning to Independence
0300-503.15, Writing a Status Review Hearing Report for a WIC Section 364, 366.21(e) or (f), 366.22, or 366.25 Hearing
0600-500.20, Health and Medical Information
0600-501.09, Consent for Mental Health and/or Developmental Assessments and Services
0600-501.10, Consent for Routine Medical Care
0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children
0600-508.00, Foster Youth Substance Abuse Treatment Protocol and Program
0600-515.09, Exodus Recovery Pediatric Urgent Care Center
0100-535.25, Extended Foster Care (EFC) Program
CW-3007, Department of Public Health's Children's Medical Services (CMS) Child Welfare Public Health Nursing Program (CWPHNP) Policy and Procedure: Psychotropic Medication -- Role of the Public Health Nurse (PHN)
All County Letter (ACL) 21-59 – Discusses the JV-228, JV-228 INFO and JV-229 forms that allow a foster child or their attorney to authorize the release of the child’s medical records to the Medical Board of California for the purpose of investigating prescribing practices of psychotropic medication that are inconsistent with the standard of care.
Los Angeles County Superior Court Psychotropic Medication Authorization -- Section 7.7 outlines court rules regarding authorization for prescribing and administering psychotropic medications to children under Dependency or Delinquency Court jurisdiction.
Civil Code (CIV) Section 56.103 -- Addresses the release of medical and mental health information to county social workers and other individuals.
Rule of Court 5.640 - Provides instructions for Hearing Officers regarding the authorization of psychotropic medication.
Welfare and Institutions Code (WIC) Section 369 - Outlines the provisions under which a court order is required in order to provide medical treatment to a child in temporary custody.
WIC Section 369.5, - Outlines the provisions under which a court order is required in order to provide medical treatment to a child who is adjudged a dependent of the court and has been removed from the physical custody of their parent(s).
WIC Section 739.5, - Outlines the provisions under which a court order is required for administration of psychotropic medications for a ward who has been removed from the physical custody of their parent.
WIC Section 5000-5550 -- Outlines the Lanterman-Petris-Short (LPS) Act, which provides guidelines for handling involuntary civil commitment of individuals to mental health institutions in the State of California.
WIC Section 14028(a)(2) - Requires the California Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) to share data with the Medical Board of California (MBC) regarding children in foster care who have been prescribed three (3) or more concurrent psychotropic medications for a period of ninety (90) days or longer.