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Consent for Psychotropic Medication

Consent for Psychotropic Medication . Connecticut’s Model for Children and Youth in Foster Care Lesley Siegel, MD Chief of Psychiatry CT Dept. of Children and Families. CT Department of Children and Families (DCF): A Multi-Mandate Agency. State-Wide Advisory Committee began in 1999.

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Consent for Psychotropic Medication

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  1. Consent for Psychotropic Medication Connecticut’s Model for Children and Youth in Foster Care Lesley Siegel, MD Chief of Psychiatry CT Dept. of Children and Families

  2. CT Department of Children and Families (DCF):A Multi-Mandate Agency

  3. State-Wide Advisory Committee began in 1999 • Psychotropic Medication Advisory Committee (PMAC) meets monthly • Members include private and public APRNs, Child Psychiatrists, Pharmacists, Pediatricians, Medicaid Agency Representatives, Parents • Initially set-up by former DCF Chief of Psychiatry, Dr. Pat Leebens • Reviews “Best Practice” for evaluation and treatment of foster care children and youth, including all aspects of evidence-informed care

  4. CT adapts Illinois Model • Former Chief of Psychiatry, Dr. Pat Leebens, worked with Dr. Mike Naylor (from U of Illinois) on AACAPPractice Standards for Prescribing in Foster Care Population • Used Illinois state/university partnership when proposing CT informed consent model and new legislation • Given small size of state and multi-mandate child welfare agency, decision made to developunit within DCFfor consultations/consent instead of partnership with a university

  5. Connecticut Law passed 2004 Sec. 17a-21a. Guidelines for use and management of psychotropic medications. Database established. The Department of Children and Families shall, within available resources and with the assistance of The University of Connecticut Health Center, (1) establish guidelines for the use and management of psychotropic medications with children and youths in the care of the Department of Children and Families, and (2) establish and maintain a database to track the use of psychotropic medications with children and youths committed to the care of the Department of Children and Families.      (P.A. 04-238, S. 2; P.A. 06-196, S. 112.)

  6. Centralized Medication Consent Unit (CMCU)

  7. Stakeholders in Informed Consent

  8. CT Guidelines for Consent/Assent

  9. Shared Decision-Making • Shared decision-making is a description of the process that should be happening regarding psychotropic medication prescribing and has been associated with better outcomes due to increased youth and other stakeholder involvement and compliance. • Components include agreement with what is being prescribed, knowledge about side effects and necessary monitoring, and alternatives to medication. • Similar principles to team decision making which child welfare staff in CT and many other states are currently being trained on.

  10. Consent Procedure

  11. Consent Decisions Based On:

  12. Consent Decisions, cont.

  13. Other factors informing decision: • Past psychiatric history available in LINK(SACWIS) • Child’s setting (PRNs and more than one change at once might be approved for hospitals) • History with prescriber • Other ongoing treatment, especially trauma-informed modalities • Over-arching goal of least number of meds long-term

  14. Consent Process Practice Changes

  15. Quarterly Consent Data

  16. CMCU Website • Readily available on CT DCF home page and user-friendly, with frequent updates. • Link to the website on all CMCU members’ electronic signatures. • Information about meds, prescribing doses, monitoring protocols, risk in pregnancy, links to NIMH and NYU information on all psychotropic medications, handbook written for families and DCF workers by PMAC, etc.

  17. 18

  18. Pros and Cons of Centralized Process • Pros: Standardized system; quick turn-around; providers are happy; Medical team enters note directly in LINK; Medical team aware of need for medical information prior to starting med; doses; monitoring. Centralized unit can review past psychotropic med history easily as available in LINK notes since CMCU began in 2007.

  19. Pros and Cons, cont. • Cons: Area office CPS staff feel disconnected from process; may have information from the foster family or the child/adolescent that is different from what the prescriber is told; may feel they don’t have the authority or access to question the APRN/Physician. Also, area office staff may feel they can’t alter or undo the official CMCU consent. • Children/Youth may feel they don’t have a voice in the process, may feel they have no choice about taking prescribed medication.

  20. “Crisis of Credibility” • Training developed to address “crisis of credibility” between CPS workers and prescribers; includes Diane Sawyer’s 20/20 segment with foster children describing their experiences on psychotropic medication. • Purpose is to increase collaboration so that CPS workers don’t feel prescribers just “over-medicate” foster kids and prescribers don’t feel that child welfare is “black hole” of information (i.e. multiple requirements to produce documents with no information given out).

  21. Next Steps

  22. Consent data 2011 23

  23. Examples:

  24. Questions? Lesley Siegel, MD DCF Chief of Psychiatry, State of Connecticut Lesley.Siegel@ct.gov 860-560-5020 (w); 203-530-0351(c) www.ct.gov/dcf/

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