Psychotropic Medication: Authorization, Review, and Monitoring for DCFS Supervised Children
0600-514.10 | Revision Date: 11/3/2023

Overview

This policy reviews the administration of psychotropic medications when prescribed by the child’s physician or psychiatrist, as well as the authorization, review, and monitoring processes required.

Table of Contents

Version Summary

This policy guide was updated from its 7/05/22 version to address Senate Bill (SB) 528 (2021-2022) and ACL 23-22, which require DCFS to provide a copy of the JV-223, JV-220, and the last two (2) pages of the JV-220 (A) or JV-220(B) forms, and all attached medication information sheets to the child’s caregiver within two (2) business days of receipt of the JV-223 order; to clarify the Public Health Nurse (PHN)’s role as it relates to psychotropic medication; and to update Juvenile Court protocols.

 

POLICY

Summary of Psychotropic Medication Authorization (PMA) Forms

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), SB 377 (2019) and SB 528 (2022).


Form Number

Form Name

Completed By

Description


JV-216

 

Order Delegating Judicial Authority Over Psychotropic Medication

Hearing Officer

This optional form allows the court to delegate its authority to approve or deny the administration of psychotropic medication for a child in foster care to a parent or guardian upon making findings on the record that the parent poses no danger to the child and has the capacity to authorize psychotropic medications

JV-217-INFO

JV-217-INFO S

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)

JV-218,

JV-218 S

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).

JV-219,

JV-219 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).

JV-220

Application for Psychotropic Medication

For Group Home/Short-Term Residential Therapeutic Program (STRTP) placements:

Residential Care Liaison (RCL) CSW

For all other placements:

PMA Unit (#1-4); Case-Carrying CSW (#5-13)

 

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.

JV-220 (A),

JV-220 (A) S

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 [JV-220 (A) S].

JV-220 (B)

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.

JV-221,

JV-221 S

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).

JV-222,

JV-222 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).

 

JV-223,

JV-223 S

Order on Application for Psychotropic Medication

Hearing Officer

This lists the court’s findings and orders about the child’s psychotropic medication. A copy must be provided to the caregiver; it is also available in Spanish (JV-223 S).

JV-224

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.

JV-228

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

 

 

 

JV-228 INFO

JV-228 INFO S

 

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; it describes the process to withdraw their authorization for the release of their information to the MBC

 

JV-229

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

 

Youth Engagement Worksheet

 

Refer to Procedures for the role of Public Health Nurses (PHNs) and DCFS 

This is a 1-page checklist designed to ensure that youth ages 14 to 17 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

Psychotropic Medication Review and Monitoring Process

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 PHNs assess and document the medication information in 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).

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.

Psychotropic Medication Authorization Process

  1. Physician/Psychiatrist
    • The physician completes the JV-220(A) or JV -220(B) form, making sure to write in their correct return fax number in the "phone numbers" field (#4c on the JV-220A and #3c on the JV-220B),and faxes the form to the DCFS PMA Unit at (562) 941-7205 or emails it to PMA@dcfs.lacounty.gov.
    • Illegible or incomplete JV-220(A) or JV-220(B) forms submitted by physicians to the PMA Unit will be returned to the physician the same day or no later than the next business day for resubmission. Forms received for children with a Family Maintenance (FM) service component / Home of Parent (HOP) court order, for nonminor dependents (NMDs) or for dependent children from county jurisdictions other than Los Angeles, will also be returned.
    • If the PMA desk rejects a PMA application, they will notify the CSW and SCSW via email and include a scanned copy of the rejected JV-220 (A) or JV-220(B) along with any lab results or other documentation that was sent with the application, and a copy of the fax confirmation rejection document.
  2. DCFS PMA Unit – Upon receipt of the completed JV-220(A) or JV-220(B) form:
    1. For children placed in group homes/STRTPs: sends the JV-220 , Application for Psychotropic Medication form to the RCL CSW for completion.
    2. For children in non-group home/STRTP placement: fills in information in questions 1 through 4 on the JV-220, Application for Psychotropic Medication form. Scanned copies of the JV-220 form and JV-220(A) or JV-220(B) form are emailed to the assigned CSW, SCSW, ARA, regional PMA In-Box and PHN Supervisor, and a request is made for the completion of the JV-220 form pages 2-4 (questions 5 through 13) by the CSW within two (2) judicial days of receipt.
    3. Mailed to the child: the JV-217-INFO form, Guide to Psychotropic Medication Forms, the JV-218 form, Child's Opinion About the Medicine, is mailed to the child (with a stamped return envelope addressed to the court), plus a cover memo requesting voluntary completion of the JV-218 form and its return to court within four (4) judicial days after receipt of notice.
    4. The JV-219, Statement About Medicine Prescribed, and the JV-217-INFO form, is mailed to the parents/guardians, caregivers, CASA (if any), and tribal representative (if applicable), along with the Notice of Hearing and a cover memo requesting voluntary completion of the JV-219 form and its return to court within four (4) judicial days of notice.
      • The DCFS parental notification cover letter (of which there are separate versions for the Edelman’s Children’s Courts, and the Lancaster Children’s Courts) including the list of planned medications, and the JV-222, Input on Application for Psychotropic Medicationform , is sent to the child's parents/legal guardians (for all cases) and to the Tribal Chair/ICWA Coordinator (for ICWA eligible youth).
    5. Items 1 through 5 (and item 9, if applicable) of the JV-221 form, Proof of Notice of Application is completed.
    6. If the request will result in the child being prescribed three (3) or more psychotropic medications for a period of ninety (90) days or longer, an email is sent to the child's attorney with blank copies of the JV-228, JV-228-INFO, and JV-229 forms.
  3. DCFS Case-Carrying/RCL CSW:
    1. For children in group home/STRTP placements, the RCL CSW completes and submits the JV-220  form within two (2) judicial days.
    2. For children in non-group home/STRTP placement, the Case-Carrying CSW:
  4. DCFS PMA Unit -- Upon receipt of the completed JV-220 form from the CSW:
    1. Sends electronic copies of the JV-220 (A) or JV-220(B), the completed JV-220 form (pages 1-3), and page 1 of the JV-221 form to the Dependency Court Psychotropic Desk Clerk within three (3) court days of receipt of the JV-220(A) or JV-220(B) form.
    2. Emails the assigned CSW and SCSW to notify them that a PMA has been sent to court, and attaches a scanned copy of the PMA request.
  5. Dependency Court Psychotropic Desk Clerks – Days 1-2:
    1. Receive e-filed forms, electronically date-stamp their receipt in the Court Case Management System, and validate case information in that system  
    2. Enter information into psychotropic medication tracking system and validate case information in Justice Partner Portal (JPP)
    3. Complete page 2-3 (items 6-7, and item 8, if applicable) of JV-221 form
    4. Using the table below, distribute copies of the relevant documents in the mail bin designated for each court location:
      Document Distribution

      JV-217 INFO

      JV-218

      JV-219

      JV-220

       
      JV-220(A or B)

      JV-222 Parent's Cover Letter

      Child's Attorney

      X X X X X X  

      CASA (if on weekly case list)

      X   X    

      X

       

      Parents’ Attorneys

      X   X    

      X

      X

      Juvenile Court Mental Health Services

           

      X*

      X

         
      *Label with name of child’s attorney and firm
  6. Juvenile Court Mental Health Services (JCMHS) – Days 2-4: Upon receipt of the JV-220 form, JV-220 (A) or JV-220 (B) form and recommendations/comments:
    • Reviews the JV-220 form and JV-220 (A) or JV-220(B) form and returns to Psychotropic Desk Clerk with recommendations/comments.
  7. Dependency Court Psychotropic Desk Clerks – Days 2-4:
    1. Logs information into the Court Case Management System to reflect receipt
    2. Provide the Court with the following forms:
      • JCMHS recommendation/comment form (including a copy to the child's attorney and DCFS PMA unit)
      • JV-220 form
      • JV-220(A) or JV-220(B) form
      • JV-221 form (pages 1-3)
      • Any JV-218, JV-219 or JV-222 forms received thus far
      • JV-223 form
    3. The Dependency Court Psychotropic Desk Clerks e-file the above forms to the Lancaster, Pomona or Compton Court Clerk’s office.
  8. Judicial Officer – Day 7:
    1. Reviews forms/files and completes the JV-223 form (to grant, deny, grant with modifications or set a hearing).
      1. JV-223 form must be completed by the first available:
        • Judicial officer
        • As-needed judicial officer
        • Buddy court judicial officer
        • Supervising Judge
    2. The judicial officer must complete the JV-223 form even if the matter is set for hearing.
      1. Following the hearing, the judicial officers must complete a new JV-223 form.
    3. Orders a 45-Day Progress Report for new medications or increased dosages that are approved by the court.
    4. The Court must wait until Day 7 to rule on the request in order to allow sufficient time for any JV-218, JV-219, and/or JV-222 form to be submitted.
  9. Court Assistant/Judicial Assistant – Day 7:
    1. After the court completes and signs the JV-223 form, enters the orders into JPP and sets the next hearing, makes one (1) copy of the completed and signed JV-223, and delivers it to the Psychotropic Desk Clerk in the Children’s Court.
    2. Places the JV-218, JV-219, JV-220, JV-220(A) or JV-220 (B), JV-221, JV-222, JV-223 forms, and JCMHS recommendation/comment forms in the child’s confidential legal envelope in the court file.
    3. Returns file to courtroom or file shelf.
    4. If the Court sets the matter for a hearing, the Court Assistant/Judicial Assistant notices all parties, JCMHS, and CASA (if applicable) with the JV-223 form.
    5. For Lancaster Court cases:
      1. After the JV-223 form is completed in Lancaster Dependency Court, delivers the file to the Lancaster Court Clerk’s office.
      2. The Lancaster Dependency Court Clerk’s office responsibilities:
        • Puts the original forms in the child’s confidential envelope in the court file.
        • Faxes the JV-223 form to the Psychotropic Desk Clerk at Children’s Court to (323) 260-5082.
        • Provides copies of the JV-223 form to all attorneys on the case and CASA (if applicable).
  10. Dependency Court Psychotropic Desk Clerks – Days 7-8:
    1. Electronically track the date the JV-223 form is received from the courtroom and the Lancaster Dependency Court.
      1. For Children’s Court cases:
        • Provide copies of the JV-223 form to the child’s attorney, parents attorneys, County Counsel, and CASA (if applicable) and tribal representative (if applicable) via designated mail bins
      2. For all cases:
        • Fax copies of the JV-223 form to the prescribing physician
        • Provide access to the JV-223 form to the DCFS PMA Unit via the Court Case Management System
  11. DCFS PMA Unit – Days 7-8:
    1. If the JV-223 form indicates that the child is being prescribed three (3) or more concurrent psychotropic medications for ninety (90) days or more, emails the child's attorney blank copies of the JV-228, JV-228-INFO, and JV-229 forms.
    2. Imports the completed JV-223 into CWS/CMS and notifies the CSW, SCSW, and PHN Supervisor via email that the child's PMA has been imported into CWS/CMS.
    3. Mails a copy of the JV-223, JV-220, and the last two (2) pages of the JV-220 (A) or JV-220(B), and all attached medication information sheets to the child’s caregiver within two (2) business days.
  12. DCFS RCL CSW (regarding PMAs for children in group homes/STRTPs only) - ongoing:
    1. Completes the JV-224 form, 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:
      • The initial 45-Day PMA Progress Hearing, and
      • The subsequent Status Review Hearings that occur while the child remains in group home/STRTP care
    2. If the child leaves the group home/STRTP (and is replaced into a less restrictive placement) with forty-five (45) or more days remaining before the next Status Review Hearing date, the Case-Carrying CSW is responsible for the JV-224 form.
  13. DCFS Case-Carrying CSW (upon receipt of completed PMA) - ongoing:
    1. If the child is residing in any placement other than a group home/STRTP:
      • Completes the JV-224  form, County Report on Psychotropic Medication
      • Attaches the Psychotropic Medication Youth Engagement Worksheet to the back of the JV-224 form, if applicable
      • Submits both to the court at least ten (10) days prior to the initial 45-Day PMA Progress Hearing, and each Status Review Hearing
    2. If the child moves placement from a group home/STRTP to a non-group home/STRTP setting with forty-five (45) or more days remaining before the next Status Review Hearing, the RCL CSW is responsible for the JV-224 form.

Dependency Court Authorization Required

Court authorization is required to prescribe non-emergency psychotropic medication in the following circumstance:

  • The court has made disposition orders on a child who resides in out-of-home care.
    • This does not apply in cases where the court has issued specific orders delegating authority to a parent/legal guardian (after determining that the parent/legal guardian poses no danger to the child and has the capacity to authorize psychotropic medications).

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 Not Required

Court authorization is generally not required to prescribe psychotropic medication in the following circumstances:

    • Pre-disposition – The court has not yet made disposition orders on behalf of the child (in these cases the parent/legal guardian consent is required)
    • Home-of-parent – The court has made disposition orders and the child resides in the home of a parent or legal guardian (in these cases the parent/legal guardian consent is required).
    • Physician Determined Emergency – The physician has made a determination that an emergency exists, finding that due to a mental disorder, the child requires immediate psychotropic medication, and the purpose of the medication is to:
      • Protect the life of the child or others
      • Prevent serious harm to the child or others (It is not necessary for the harm to actually take place or become unavoidable)
      • To treat current or imminent significant suffering when it is impractical to obtain consent (i.e., waiting for the court's authorization would put the child or others at substantial risk)
    • Youth who are NMDs -- see Nonminor Dependent Consent for more information
    • When Probation is the lead, the PMA process is handled by Probation and the hearings are held in the Juvenile Justice court.
    • Youth who are under LPS Conservatorship have their psychotropic medication approved by their conservator.
    • When youth are under legal guardianship (i.e. when legal guardianship is granted by court but the case remains open – excluding youth who were removed from a legal guardian's care), the legal guardian can make decisions about their psychotropic medication.

Emergency PMA Requests

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.

Juvenile Court Authorization

The Juvenile Court authorizes psychotropic medication for children in the following circumstances:

  • Children under either Juvenile Court or Mental Health Court (Department A) jurisdiction who are involuntarily detained under the Lanterman-Petris-Short (LPS) Act but who are not under permanent LPS conservatorship
  • Children with suitable placement orders both with and without a voluntary hospital commitment
  • Children who are pre-disposition or under a home of parent order where the parent will not consent to psychotropic medication for the child

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. 

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).

  • A copy of the HEP may be included in the court report only if the NMD consents.  The caregiver of an NMD is not responsible for obtaining and maintaining the NMD’s health and educational information, but may assist the NMD with any record keeping that the NMD requests of the caregiver.

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.

Objection/Noncompliance

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.

Medication Monitoring by the Medical Board of California

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.

PROCEDURE

Physician/Psychiatrist Treatment Plan Includes Psychotropic Medication

CSW Responsibilities

  1. Instruct the caregiver to provide the JV-220(A) or JV-220(B) form to the physician.
  2. If the child has been adjudged a dependent of the court and has been removed from the physical custody of the parent/legal guardian, the CSW should:
    1. Consult with the regional PHN to review the proposed treatment
    2. Contact the physician/psychiatrist and explain that court approval is required, unless the court has issued specific orders delegating psychotropic medication decision-making authority to a parent or legal guardian, etc.
      1. The PHN will assess and determine when additional information is needed from the physician/psychiatrist and will communicate the findings with the CSW.
    3. Inform the physician/psychiatrist of responsibilities:
      • The physician/psychiatrist is responsible for explaining to the child (in age appropriate language), caregiver, and/or the parent/legal guardian the recommended course of treatment, the basis for the treatment, and the possible results of taking the medication, including possible side effects.
      • The physician/psychiatrist is responsible for completing the “Clinical Information” section of the JV-220(A) or JV-220(B) form.
      • The physician/psychiatrist is responsible for completing the “Medications” section of the JV-220(A) or JV-220(B) form, listing all prescribed medications the child currently takes and will be taking if the request is granted, whether or not these were prescribed by the requesting physician and indicating the range of dosages to be authorized (If the physician/psychiatrist does not indicate a range of dosages, a new JV-220(A) or JV-220(B) will be required for each change in the dosage schedule.
  3. Inform the physician/psychiatrist to fax a copy of the signed and completed JV-220(A) or JV-220(B) to the DCFS PMA Unit at (562) 941-7205.
    • When a JV-220 (A) or JV-220(B) is received for a child placed in a group home/STRTP, the PMA unit will forward it to the RCL CSW for completion of the JV-220 within two (2) judicial days.
    • When a JV-220 (A) or JV-220(B) is received for a child in a non-group home/STRTP placement, the PMA unit will generate the JV-220 form, answer questions #1-4 on the JV-220 form, then forward it to the case-carrying CSW (and the regional PMA Inbox) for completion.
  4. Upon the receipt of the emailed JV-220 form from the PMA unit, complete questions #5-13, and return the completed and signed JV-220 form via email to the PMA unit at PMA@dcfs.lacounty.gov within two (2) judicial days.
  5. Document all communications with the child, caregiver, physician/psychiatrist, parent/legal guardian, and PHN regarding the PMA process in the child’s CWS/CMS Contact Notebook.
  6. Upon receipt of a copy of the JV-223 form (Court’s order) from the DCFS PMA Unit, review the court’s order:
    1. Note the next hearing date, type of hearing, and any special court orders.
    2. For any upcoming Progress Hearing to address psychotropic medication, or any Status Review Hearing, complete the JV-224 form and:
      1. Write in the Department number and hearing date just below the Case Number box on the JV-224 form.
      2. Attach the completed Youth Engagement Worksheet to the back of the JV-224 form, if applicable.
      3. Submit the JV-224 form, along with the Justice Partner Portal (JPP) barcode for the child, the Psychotropic – County Report on Psychotropic Medication – JV-224 Coversheet, and any attachments, to court no later than ten (10) calendar days before the scheduled hearing date.
        • Due to confidentiality requirements, the JV-224 form and Youth Engagement Worksheet must not be attached to any court reports (including the DCFS 4216, Last Minute Information for the Court).
    3. If the court approves the psychotropic medication authorization:
      1. Notify the caregiver and child of the approval. Verify with the caregiver that the prescription has been filled and that the medication is being administered.
      2. For new medications, encourage the caregiver to consult the prescribing psychiatrist to determine whether a follow-up visit is needed within 30 days.
      3. Document this information in the child’s CWS/CMS Contact Notebook utilizing information provided on both the JV-220 (A) or JV-220(B) and the JV-223 form.
    4. If the court denies the psychotropic medication authorization request:
      1. Contact the child’s physician/psychiatrist to verify that they have determined the plan to titrate the child off the medication (in accordance with proper medical practice) or has submitted a new JV-220(A) or JV-220(B) form.
      2. Notify the caregiver and child of the denial. Verify that they are following the plan to discontinue the medication as prescribed by the physician/psychiatrist (in accordance with proper medical practice as instructed by the child’s physician/psychiatrist).
      3. Notify the court immediately if the order is not being followed.
  7. Update the Case Plan incorporating the child’s treatment plan, including the use of psychotropic medication.
  8. File copies of the completed JV-220 form, JV-220 (A) or JV-220(B) form initialed by the physician/psychiatrist, and the JV-223 (Court’s order) in the child’s Psychological/Medical/Dental folder.
  9. Provide the caregiver with a new, unsigned JV-220 (A) or JV-220(B) for future use; you may offer the child a copy of Making Healthy Choices: A Guide on Psychotropic Medication for Youth in Foster Care, if appropriate given the child's age (i.e., 12-17; the guide is not intended for NMDs) and developmental level.
    • If providing a copy to the child, also attach a copy to the next court report.
  10. At each face-to-face contact with the child:
    1. Discuss with the child and the caregiver:
      1. The child's responses to the psychotropic medication, including behavior, mood, and cognitive functioning
      2. The caregiver's and child's observations about the medicine's effectiveness/benefits and any side effects
      3. The caregiver's and child's concerns about the medication, if any
      4. Any medication management or other follow-up appointments with medical and/or mental health practitioners
    2. Document the discussion on the JV-224 form (to be submitted to court at the next hearing addressing psychotropic medication) and in CWS/CMS.
      • Do not alter or "cut and paste" the CWS/CMS data entered by the PHN in order to prevent deleting that information.
  11. If the child is having adverse side effects, instruct the caregiver to seek medical attention as soon as possible and follow up with the prescribing physician/psychiatrist.
  12. For any identified problems or concerns, consult with the PHN for assistance with contacting the prescribing physician/psychiatrist (and requesting a reevaluation of the child, if indicated). For any challenges in contacting the physician/psychiatrist, consult the PHN.
  13. If caregiver/child does not indicate any concerns/complaints, obtain the date and time of the follow-up appointment with the prescribing physician/psychiatrist.
  14. Consult with the regional Multidisciplinary Assessment Team (MAT)+Service Linkage Specialist (SLS) Children Services Administrator (CSA) for assistance in linking the caregiver with any mental health services needed.
  15. If the authorization is within one month of expiring, notify the child's caregiver and prescribing physician/psychiatrist that a new PMA is needed.
  16. If the same prescribing physician/psychiatrist believes the psychotropic medication continues to be necessary (and at the same dosage), remind the physician/psychiatrist to fax a JV-220( B) to the DCFS PMA Unit at (562) 941-7205.
  17. If the child is no longer taking the medication but that medication remains prescribed, initiate contact with the child and caregiver and offer support for any assistance needed, including linking the caregiver with the prescribing physician/psychiatrist and consult the PHN with concerns.
  18. If the child is no longer taking the medication because the prescription has been discontinued, review the JV-220(A) to see if the physician/psychiatrist documented this stoppage on page three (3), question 11c. Inform the PHN that the medication is no longer being taken so the PHN can follow-up as needed to confirm the medication has been discontinued and assess whether to end date the medication in CWS/CMS. 
  19. If the physician/psychiatrist submits a new JV-220(A), verify with the PMA unit to ensure that a new JV-220(A) has been received.
  20. For review and monitoring of initial administration, increased dosage, or ongoing administration of a current psychotropic medication, work collaboratively with the PHN to:
    1. Address identified concerns with the prescribing physician/psychiatrist.
      • If a child's/youth's prescribed psychotropic medication was not authorized by court, notify your SCSW and inform the court at the next hearing.
    2. Address the child's/youth's concerns or questions about the medication(s)
    3. Assess the youth's ability (for ages 14-17) to make decisions about their ongoing medical care and medication regimen, should they choose to continue them upon reaching the age of majority.
      • The PHN will attempt to document this information on the Youth Engagement Worksheet (YEW)
      • Assist the PHN with making contact with the youth, as needed. If the PHN is unsuccessful after two (2) attempts, they will reach out to the CSW to attempt to reschedule a time for the PHN and youth to discuss the YEW.  
      • At the next court hearing, inform the court on the JV-224 form about any barriers to obtaining the completed Youth Engagement Worksheet (if applicable)
  21. Document all communications with the child, caregiver, physician/psychiatrist, parent/legal guardian and PHN regarding the psychotropic medication authorization request process in the child's CWS/CMS Contact Notebook.
  22. To inquire about the status of a PMA, email the PMA Unit at PMA@dcfs.lacounty.gov

Psychotropic Medication Authorization (PMA) Unit Responsibilities

  1. Receive the approved JV-223 form, coinciding JV-220 form and JV-220(A) or JV-220(B) from the Juvenile Court.
    • Provide a copy of the JV-223, JV-220, and the last two (2) pages of the JV-220 (A) or JV-220(B), and all attached medication information sheets to the child’s caregiver (or to the facility administrator, for children in group homes/STRTPs) within two (2) business days of when the JV-223 order is received by the PMA Unit.

    • If the JV-223 form indicates that the child is being prescribed three (3) or more concurrent psychotropic medications for ninety (90) days or more, email the child's attorney blank copies of the JV-228, JV-228-INFO, and JV-229 forms.
  2. Notify the case-carrying CSW, SCSW and PHN Supervisor of the Progress Report date, Hearing Officer, and Court Room via email.
  3. Notify the CSW, SCSW, and PHN Supervisor via email when the child's PMA (JV-223) has been imported into CWS/CMS.
  4. Notify the designated contact person at the FFA or group home/STRTP via email by attaching a scanned copy of the child's PMA and a copy of the "Information for Parents and Caregivers About Psychotropic Medications" pamphlet.

Residential Care Liaison (RCL) CSW Responsibilities

  1. For children in group homes/STRTPs only:
    • Upon receipt of the JV-220 (A) or JV-220 (B) from the PMA desk, complete and return the JV-220 form within two (2) judicial days.
  2. Receive the 45-Day PMA Progress Report or Status Review court date from the Dependency Court Psychotropic Desk Clerk.
  3. Upon receipt of the court date, initiate contact with the child and caregiver and offer support for any assistance needed, including linking the caregiver with the prescribing physician/psychiatrist or consulting the PHN about any concerns.
  4. Help the caregiver make a follow-up appointment within 30 days with the treating physician/psychiatrist to assess the effects of any new medication(s).
  5. Two (2) weeks after the initial contact, call the caregiver and child to address any concerns. Ask the caregiver the questions from the JV-224 form, County Report on Psychotropic Medication.
    • If the caregiver/child indicates concerns/complaints, initiate follow up by assisting the caregiver with contacting the prescribing physician/psychiatrist for a follow-up appointment, or by contacting the prescribing physician/psychiatrist directly.
    • If the child is having adverse side effects, instruct the caregiver to seek medical attention as soon as possible and to follow up with the prescribing physician/psychiatrist.
    • Request a reevaluation of the child, if indicated.
    • If the caregiver/child does not indicate any concerns/complaints, obtain the date and time of the follow-up appointment with the prescribing physician/psychiatrist.
  6. Update CWS/CMS as appropriate.
  7. Document all the caregiver's responses from the JV-224 form in the CWS/CMS Contact Notebook.
  8. Complete the JV-224 form, based on the caregiver's feedback in consultation with the Case-Carrying CSW, no more than 35 days after court has authorized the medication(s).
  9. Submit the JV-224 form, along with the JPP barcode for the child, the Psychotropic – County Report on Psychotropic Medication – JV-224 Coversheet and any attachments (including the Youth Engagement Worksheet, if completed) to court no later than ten (10) calendar days before the scheduled hearing date.
    • Inform the court on the JV-224 form about any barriers to obtaining the completed Youth Engagement Worksheet.
  10. Write the date the JV-224 form was sent to court on the PMA Tracking Report Log.
  11. Provide a copy of the completed JV-224 form to the Case-Carrying CSW.

PHN Responsibilities

  1. PHNs will follow 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).
APPROVALS
None
HELPFUL LINKS

Attachments

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)

JV-224 Assignment When a Child is Replaced Between 45-Day PMA Progress Hearing and Status Review Hearing (chart)

Foster Youth Mental Health Bill of Rights (PUB 488)

Psychotropic Medication Youth Engagement Worksheet

Regional PMA In-Box Contact List

Forms

LA Kids

DCFS 6009, Nonminor Dependent Informed Consent

JV-217-INFO (Spanish), Guide to Psychotropic Medication Forms

JV-218 (Spanish), Child's Opinion About the Medicine

JV-219 (Spanish), 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 (Spanish) 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 (Spanish), Background on Release of Information to Medical Board of California

JV-229, Withdrawal of Release of Information to Medical Board of California

REFERENCED POLICY GUIDES

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

0600-500.05, Multidisciplinary Assessment Team (MAT) Assessments and Meetings

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 Psychiatric 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)

STATUTES AND OTHER MANDATES

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.

ACL 23-22 – Provides information regarding Senate Bill (SB) 528 (Chapter 812, Statutes of 2022), which codifies the existing requirement that a child’s caregiver must be provided a copy of a court order approving a request for the administration of psychotropic medication that includes the last two (2) pages of form JV-220(A) or JV-220(B) and all attached medication sheets.

Los Angeles County Superior Court Local Court Rules  - Section 7.7 outlines the process for prescription and administration of psychotropic medications for dependents and wards of the Juvenile Court.

Rule of Court 5.640 - Provides instructions for Hearing Officers regarding the authorization of psychotropic medication.

Senate Bill (SB) 528 – Requires the social worker or probation officer to provide a child’s caregiver with a copy of the JV-223 court order approving the prescribed psychotropic medication, including the last two (2) pages of form JV-220(A) or the last two (2) pages of JV-220(B), and the medication information sheets that were attached to form JV-220(A) or form JV-220(B).

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 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.