FLORIDA S DEPENDENCY BENCHBOOK BENCHCARD: PSYCHOTROPIC MEDICATION HEARING Items in bld fnt are required by Flrida Statutes. If the child cmes int care with psychtrpic medicatin already prescribed. DCF shuld attempt t btain permissin frm the parent t cntinue the psychtrpic medicatin. 39.407(2)(a)1. If parental authrizatin cannt be btained, DCF may take pssessin f the remaining medicatin and may cntinue t prvide the medicatin as prescribed until the shelter hearing, if it is determined that the medicatin is a current prescriptin fr that child and the medicatin is in its riginal cntainer. 39.407(3)(b)1. If DCF cntinues t prvide the psychtrpic medicatin t a child when parental authrizatin cannt be btained, DCF shall ntify the parent r legal guardian as sn as pssible. The child's fficial departmental recrd must include the reasn parental authrizatin was nt initially btained and an explanatin f why the medicatin is necessary fr the child's well-being. 39.407(3)(b)2. If DCF is unable t get parental authrizatin and DCF is advised by a physician that the child shuld cntinue the psychtrpic medicatin, DCF shall request curt authrizatin at the shelter hearing t cntinue t prvide the psychtrpic medicatin and shall prvide t the curt any infrmatin in its pssessin in supprt f the request. Any authrizatin granted at the shelter hearing may extend nly: Until the arraignment hearing n the petitin fr adjudicatin f dependency, r 28 days fllwing the date f remval, whichever ccurs sner. 39.407(3)(b)3; Rule 8.355(c)(1)(A). DCF shuld then schedule a physical evaluatin with a licensed physician. 39.407(3)(b)4. DCF shuld als cnsider requesting a Cmprehensive Behaviral Health Assessment (CBHA). As a result f the required physician's evaluatin, if DCF believes it is apprpriate t cntinue the psychtrpic medicatin beynd the time authrized by the curt at the shelter hearing, DCF shall file a mtin seeking cntinued curt authrizatin at the same time as it files the dependency petitin, within 21 days after the shelter hearing. 39.407(3)(b)(4); Rule 8.355(c)(1)(B). The mtin must be supprted by the fllwing:
A written reprt prepared by DCF which describes the effrts made t enable the prescribing physician t btain express and infrmed cnsent fr prviding the medicatin t the child and ther treatments cnsidered r recmmended fr the child. The prescribing physician's signed medical reprt prviding: The name f the child, the name and range f the dsage f the psychtrpic medicatin, and that there is a need t prescribe psychtrpic medicatin t the child based upn a diagnsed cnditin fr which such medicatin is being prescribed. A statement indicating that the physician has reviewed all medical infrmatin cncerning the child which has been prvided. A statement indicating that the psychtrpic medicatin, at its prescribed dsage, is apprpriate fr treating the child's diagnsed medical cnditin, as well as the behavirs and symptms the medicatin, at its prescribed dsage, is expected t address. An explanatin f the nature and purpse f the treatment; the recgnized side effects, risks, and cntraindicatins f the medicatin; drug-interactin precautins; the pssible effects f stpping the medicatin; and hw the treatment will be mnitred, fllwed by a statement indicating that this explanatin was prvided t the child, if age apprpriate, and t the child's caregiver. Dcumentatin addressing whether the psychtrpic medicatin will replace r supplement any ther currently prescribed medicatins r treatments; the length f time the child is expected t be taking the medicatin; and any additinal medical, mental health, behaviral, cunseling, r ther services that the prescribing physician recmmends. 39.407(3)(c)(5). The medicatin may be prvided in advance f the issuance f a curt rder if the child's prescribing physician certifies in the signed medical reprt required in paragraph (c) that delay in prviding a prescribed psychtrpic medicatin wuld mre likely than nt cause significant harm t the child. The medical reprt must prvide the specific reasns why the child may experience significant harm and the nature and the extent f the ptential harm. Nte: Psychtrpic medicatins may be administered in advance f a curt rder in hspitals, crisis stabilizatin units, and in statewide inpatient psychiatric prgrams. Within 3 wrking days after the medicatin is begun, DCF must seek curt authrizatin. 39.407(3)(e)2; Rule 8.355(c)(3). DCF must submit a mtin seeking cntinuatin f the medicatin and the physician's medical reprt t the curt, the child's guardian ad litem, and all ther parties within 3 wrking days after DCF cmmences prviding the medicatin t the child.
DCF shall seek the rder at the next regularly scheduled curt hearing, r within 30 days after the date f the prescriptin, whichever ccurs sner. If any party bjects t DCF s mtin, the curt shall hld a hearing within 7 days. 39.407(3)(e)1. Nte: Access t medical recrds. Sectin 39.402(11)(b), requires the curt t request the parent s cnsent t prvide access t the child s medical recrds and further requires that when a parent is unavailable r unable t cnsent r withhlds cnsent and the curt deems access t the recrds necessary t prvide services t the child, the curt is t issue an rder granting access t the recrds. Nte: Access t educatinal recrds. Sectin 39.402(11)(c), requires the curt t request that the parents cnsent t prvide access t the child s educatinal recrds and further requires that when a parent is unavailable r unable t cnsent r withhlds cnsent and the curt deems access t the recrds and infrmatin is necessary t prvide services t the child, the curt shall issue an rder granting access. If child needs t be evaluated/prescribed psychtrpic medicatin after cming int care. DCF shuld schedule a physical evaluatin with a licensed physician. 39.407(3)(b)4. DCF shuld als cnsider requesting a Cmprehensive Behaviral Health Assessment (CBHA) and ensure that all medical reprts have been prvided t the prescribing physician. If the parents have nt cnsented, DCF shall file a mtin with the curt t authrize the administratin f the psychtrpic medicatin. The mtin shall include the fllwing infrmatin: DCF s written reprt describing the effrts made t enable the prescribing physician t btain express and infrmed cnsent fr prviding the medicatin t the child and describing ther treatments cnsidered r recmmended fr the child; and The prescribing physician's signed medical reprt, as required by law, and whether the prescribing physician has btained the child s assent t take the medicatin. Rule 8.355(a)(1). If the child declines t assent t the prpsed administratin f psychtrpic medicatin the curt shall appint an attrney t represent the child and a hearing shall be held n the department s mtin. The appintment must cnfrm t the prvisins f Rule 8.231. Rule 8.355(a)(2). The curt shall hear DCF's mtin at the next regularly scheduled curt hearing required by law, r within 30 days after the date f the prescriptin, whichever ccurs sner. Hwever, if any party files an bjectin t the mtin, the curt shall hld a hearing within 7 days. Rule 8.355(c)(2)(C).
Determine whether parties and the child s attrney were prperly served r nticed, if nt in attendance. DCF must have ntified all parties f the prpsed actin taken in writing r by whatever ther methd best ensures that all parties receive ntificatin f the prpsed actin within 48 hurs after the mtin is filed. If any party bjects t DCF s mtin, that party shuld have filed the bjectin within 2 wrking days. 39.407(3)(d)1; Rules 8.355(a)(3), 8.355(a)(4). If the child assents and n party timely files an bjectin t DCF s mtin, the curt may enter its rder authrizing the prpsed administratin f the psychtrpic medicatin withut a hearing. Rule 8.355(b)(1). Based n its determinatin f the best interests f the child, the curt may rder additinal medical cnsultatin r require the department t btain a secnd pinin within a reasnable time, nt mre than 21 calendar days. Rule 8.355(b)(1). When the curt rders an additinal medical cnsultatin r secnd medical pinin, the department shall file a written reprt including the results f this additinal cnsultatin r a cpy f the secnd medical pinin with the curt within the time required by the curt, and shall serve a cpy f the reprt as required by Rule 8.355. Rule 8.355(b)(1). If the child des nt assent t the medicatin r any party timely files its bjectin t the prpsed administratin f psychtrpic medicatin t the child, the curt must hld a hearing as sn as pssible n the department s mtin. At such hearing, the medical reprt f the prescribing physician is admissible in evidence. Rule 8.355(b)(2)(A). At such hearing, the curt must ask the department whether additinal medical, mental health, behaviral, cunseling, r ther services are being prvided t the child that the prescribing physician cnsiders t be necessary r beneficial in treating the child s medical cnditin, and which the physician recmmends r expects t be prvided t the child with the medicatin. Rule 8.355(b)(2)(B). The curt may rder additinal medical cnsultatin r a secnd medical pinin, as prvided by Rule 8.355(b)(1). Rule 8.355(b)(2)(C). After cnsidering the department s mtin and any testimny received, the curt may rder that the department prvide r cntinue t prvide the prpsed psychtrpic medicatin t the child, n a determinatin that it is in the child s best interest t d s. Rule 8.355(b)(2)(D). Verify that DCF btained a medical evaluatin t determine the need t initiate r cntinue a psychtrpic medicatin befre filing the dependency petitin. 39.407(3)(b)(4). Determine if DCF attempted t include the parents in the decisin making prcess. 39.407(3)(a)1.
Did DCF take steps t include the parent in the child s cnsultatin with the physician? 39.407(3)(a)1. Did DCF attempt t btain express and infrmed cnsent frm the parents befre filing the mtin? 39.407(3)(a)1. Cnfirm that DCF prvided the evaluating physician with all pertinent medical infrmatin knwn t DCF cncerning that child. 39.407(3)(a)2. Verify that DCF s mtin was supprted by a written reprt prepared by DCF which describes the effrts made t enable the prescribing physician t btain express and infrmed cnsent fr prviding the medicatin t the child and ther treatments cnsidered r recmmended fr the child. In additin, the mtin must be supprted by the prescribing physician's signed medical reprt prviding as described abve. NOTE: The medical reprt f the prescribing physician is admissible int evidence. 39.407(3)(d)1; Rule 8.355(b)(2)(A). Ask whether r nt the parent, legal guardian, r child cnsents t the medicatin. See 39.407(8). Determine if the mtin fr medicatin is in the child s best interests. 39.407(3)(d)1; Rule 8.355(b)(2)(D). Ask DCF whether additinal medical, mental health, behaviral, cunseling, r ther services are being prvided t the child by DCF which the prescribing physician cnsiders t be necessary r beneficial in treating the child's medical cnditin and which the physician recmmends r expects t prvide t the child in cncert with the medicatin. 39.407(3)(d)1; Rule 8.355(b)(2)(B). Be aware that the curt may rder additinal medical cnsultatin r require DCF t btain a secnd pinin within 21 calendar days. DCF must make a referral fr an appintment fr a secnd pinin with a physician within 1 wrking day. 39.407(3)(d)1. The curt may nt rder the discntinuatin f prescribed psychtrpic medicatin if such rder is cntrary t the decisin f the prescribing physician unless the curt first btains an pinin frm a licensed psychiatrist, if available, r, if nt available, a physician stating that mre likely than nt, discntinuing the medicatin wuld nt cause significant harm t the child. If, hwever, the prescribing psychiatrist specializes in mental health care fr children and adlescents, the curt may nt rder the discntinuatin f prescribed psychtrpic medicatin unless the required pinin is als frm a psychiatrist wh specializes in mental health care fr children and adlescents. The curt may als rder the discntinuatin f prescribed psychtrpic medicatin if a child's treating physician states that cntinuing the prescribed psychtrpic medicatin wuld cause significant harm t the child because f a diagnsed nn-psychiatric medical cnditin. 39.407(3)(d)1.
When the curt rders an additinal medical cnsultatin r secnd medical pinin, DCF is required t file a written reprt including the results f this additinal cnsultatin r a cpy f the secnd medical pinin with the curt within the time required by the curt. Rule 8.355(b)(1). Fllw up. The burden f prf shall be by a prepnderance f the evidence. 39.407(3)(d)2. DCF shall fully infrm the curt f the child's medical and behaviral status as part f the JRSSR and shall furnish cpies f all pertinent medical recrds cncerning the child which have been generated since the previus hearing. On its wn mtin r n gd cause shwn by any party, the curt may review the status mre frequently. 39.407(3)(f)1. The parents r legal custdian remain financially respnsible fr the cst f medical treatment prvided t the child even if either ne r bth f the parents r if the legal custdian did nt cnsent t the medical treatment. After a hearing, the curt may rder the parents r legal custdian, if fund able t d s, t reimburse DCF r ther prvider f medical services fr treatment prvided. 39.407(13). DCF may cnsent t medical treatment fr a dependent child when the child has been cmmitted t DCF and DCF has becme the legal custdian f the child. 39.407(14). General infrmatin. Fr further infrmatin regarding psychtrpic medicatins, please see: The Flrida Supreme Curt Steering Cmmittee n Families and Children in the Curt, Psychtrpic Medicatins Judicial Reference Guide, (March 2010). Daniel Castellans, The Psychtrpic Medicatin Reference fr Judges, Attrneys, Guardians ad Litem and ther Legal Prfessinals Addressing the Use f Psychtrpic Medicatins with Children in State Custdy in Flrida, (2010).