csp

FAQ's

FAQ’s - General

Who can give consent to start a psychotropic medication?

DCFS is the legal guardian of all wards of the state of Illinois and is responsible for providing consent for all medical, surgical, and psychiatric treatments.  Even if they are related to the child, foster parents cannot grant permission for surgical or medical procedures or for the use of psychotropic medication. 

What is the foster parent’s role in consenting for medication?

Foster parents play an important role in assisting the prescribing physician in reporting the symptoms and behaviors a child is demonstrating, his or her response to the prescribed medication, side effects and negative reactions.

Can foster parent refuse to give a DCFS ward psychotropic medication if they are not in agreement with it?

No, this would violate their role as a foster parent caring for a DCFS ward. When DCFS has approved a psychotropic medication, foster parents cannot make the decision to withhold the use of a psychotropic medication. If a foster parent or caseworker disagrees, share your concerns with the prescribing physician. You can request a second opinion.

When should the caseworker be notified of a prescription change?

The caseworker should be made aware of all prescription changes and new prescription requests. Keeping the caseworker aware of medication changes assists in continuity of care, accurate records and can facilitate the consent procedure.

What should I do if a foster child experiences side effects?

If a foster child experiences side effects to medications, you should notify the prescribing physician, if possible, and the caseworker.  If the side effects appear to be serious, please take him or her to the nearest emergency room with a list of all currently prescribed medications.

It is my understanding that medications are to be reviewed every 6 months for their continued use, who can give input?

Per DCFS Policy, the safety, appropriateness, and effectiveness of psychotropic medications must be reviewed every 6 months and consent for continued administration renewed.  Foster parent and caseworker input are valuable.  As the foster child’s caregiver it is very important to inform the prescriber about his or her behavior, response to medications and side effects. The child’s teacher also holds valuable information.  You can also help by providing the prescriber any and all information and feedback provided by the school. 

If I forget to give a dosage of medication, can I double the next dose? 

If a dosage is skipped, do not double the next dosage unless the child’s doctor tells you to.  This could cause dangerous side effects and even overdose.  Notify the physician for instructions on what to do with the missed dose and to explore the cause of the missed dosage.  If it is a scheduling problem, the schedule can often be changed.

What should I do if a foster child refuses to take prescribed medications?

Caretakers can do several simple things if a child refuses to take the prescribed medication. For example, remind him or her again why the medication was prescribed to help them understand its purpose, discuss their reason for not wanting to take it, and help the child identify and understand medication side effects. Remind them that the side effects may ease as their bodies adjust to the medication, and that you will help them report these unpleasant side effects to the doctor.  It may help to monitor your child when he or she takes their medications. Count the number of pills in the bottle to evaluate whether they are throwing them away, hiding them in their mouth or skipping doses.  Always contact the prescribing physician and caseworker if a child refuses to take a medication. WARNING: Medications Should Not Be Stopped Abruptly.

Where should I store the medications since they are controlled substances?

Not all psychotropic medications are controlled substances.  There is no need to lock them up if they are in a secure place. However, children should not have access to the medications if you suspect that he or she may abuse them, give or sell them to friends, or use them in an overdose attempt.

Where can I obtain information regarding the usage, dosage and potential side effects of medications?  

There are several sources for information. The prescribing physician and your pharmacist are valuable resources in understanding the risks and benefits of a prescribed medication.  In addition, you can obtain some medication information on this website.

Keep in mind: Psychotropic medications can be used for various symptoms as well as for medical purposes, so please consult with the prescribing physician or pharmacist for specific usage, dosage and side effects of prescribed medication.

Do these medications cause abuse or dependence? 

When properly prescribed, psychotropic medications do not cause drug abuse or dependence and may actually prevent it.  However, many medications cause tolerance.  Tolerance results when a child needs higher and higher doses to get the same beneficial effects.  Some people may experience withdrawal side effects when the medications are stopped suddenly. Examples of withdrawal side effects include feelings of depression, headache, and stomach ache seen when certain antidepressants are stopped suddenly, and anxiety and seizures when certain sedatives, such as Ativan and Valium, are stopped suddenly.

Keep in mind: Some medications can cause side effects of lethargy or blank affect. These side effects should not be confused with drug dependency.

Is it a normal practice for children to be on more than one psychotropic medication?

It is not uncommon for a child to be prescribed more than one psychotropic medication at a time.  The deciding factors for using one or more medications are the minor’s diagnosis and presenting symptoms.  Multiple medications are sometimes used to treat medication side effects. 

Are these medications to be used on a long-term basis? 

Some psychiatric illnesses are acute (short-term) and some are chronic (long-term).  For acute illnesses and symptoms, medication treatment usually coupled with psychotherapy may be used for a short period.  For chronic psychiatric illnesses, medication treatment may need to be used long-term to help maintain the patient's safety and functioning. 

I have heard the term; “build up in his /her system & therapeutic level”. What exactly does that mean?

When a medication is started the body gets rid of it through the liver or kidneys.  When a patient takes in more medication than his or her body can get rid of it “builds up” in the blood.   About 5 days after an increase in the dose (more for some drugs and less for others) the patient’s body gets rid of the same amount of drug that he or she takes in each day.  That is known as being at “steady-state”.  For some drugs doctors can use blood tests to tell when the patient is getting enough medication.  The amount of the drug in the blood at which it works is the “therapeutic level”.  For those drugs, your child’s doctor will measure the amount of drug in his or her blood after about 5 days to determine if the drug is at a “therapeutic level”.  If the drug level is too low the doctor will increase the dose, if it is too high the doctor will lower it. Once a drug is at a “therapeutic level”, it still may take about a month before you see response to treatment.

FAQ’s - Requesting Guardian Consent for Psychotropic Medication

Who is responsible for submitting a request for guardian consent for psychotropic medication?

It is preferred that prescribing physicians fill out the clinical information.  Caseworkers should always assist with this process.  If a child’s prescriber is available to fill out the request form you should provide them with a copy of the form with demographic information completed.  Plan ahead and allow ample time for the clinician to complete the form.  If the clinician is not available to fill out the form personally, always consult with the prescriber to provide the most up to date and accurate information. Incomplete, inaccurate information will slow down the consent process.

Where should I submit the psychotropic medication request form CFS 431-A?

For non-emergency medication requests and for medication requests that can be processed during regular business hours (Monday – Friday, 8:00 – 4:30 PM except for state holidays) completed consent request forms should be sent to:

The DCFS Consent Unit
Fax number: 312-814-7015

Routine, non-emergency medication consent requests may be sent at any time and will be processed during normal business hours.

For emergency after hours requests (state holidays, weekends, and Monday – Friday 4:30 PM – 8:00 AM).

The Emergency Reception Center (ERC)
Phone: 773-538-8800
Fax: 773-538-8835

Where do I go to get the correct form?

The DCFS Psychotropic Request Form: CFS 431- A. It is also available on the DCFS website under forms. 

Where can I go to get help in completing the psychotropic medication request form?

The following link will assist you in understanding what pertinent and essential information is necessary to complete this form.

Is it appropriate to copy completed forms and send them in every six months (180 days) for renewals?

No. It is required that all clinical data is current and up to date. 
Keep in mind:

    • It is helpful to know that the regimen prescribed has controlled the symptoms that the medication was started for. You can indicate this by stating “history of” a stated symptom, i.e. history of psychosis or history of aggression. 
    • It is valuable information to report when tapering a medication was attempted and failed.   This assists in justifying ongoing use of psychotropic medications. 
    • Accurate and current weights are essential.
    • If the previous consent asks for additional information upon renewal, you should include the information that was requested (i.e. lab work, clinical updates, additional rationale). Failure to provide this information can cause delays. See 'reason for delays' section for more information.

Should I remind the prescriber that it is time to renew a medication?

Yes, assisting the physician in monitoring the time of renewals helps ensure that proper medications are continued without disruption.  You may submit for a renewal up to one month prior to the expiration of consent.

 

Consent Process and Policies

 

Do I need consent to switch between the immediate release formulation of a medication and the extended release?  What about between a liquid or tablet?

In most cases, you are no longer required to submit for separate consent for different formulations of a medication.  The consent you receive is valid up to the approved maximum dose for the active ingredient of either IR or XR formulation, or a combination of the two.  There are several exceptions to this policy that will still require a separate consent with a rationale for the extended-release formulation:

    • Ditropan and Ditropan ER
    • Tenex and Intuniv
    • Clonidine and Kapvay
    • Any patch preparations (Daytrana, Clonidine patch, etc.).
    • DDAVP oral and DDAVP spray
    • Prolixin and Prolixin decanoate
    • Haldol and Haldol decanoate

How does the Consent Process work?

Step 1, UIC Clinical Services in Psychopharmacology:  The requests are faxed to the DCFS Consent Unit.  The CSP staff reviews the form for completion. If any information is missing, a call is placed to the provider to obtain additional information. Once all the information is obtained the CSP Nurse evaluates if the clinical information provided is sufficient for full consultation and forwards the information to the consulting physician. Once the CSP psychiatric consultant has responded, the CSP staff forwards the CSP consultant’s recommendation to DCFS.

Step 2, DCFS Consent Unit:  The DCFS Authorized Agent reviews the recommendation and then creates consent. The DCFS Authorized agent faxes the consent to the provider, caseworker and person submitting the request.

What is the policy on prescribing PRN’s or as 'needed medications'?

DCFS does not give consent for standing PRN (pro re nata - meaning “as needed”) medications.  DCFS recognizes that emergency medications are sometimes necessary.  As stated in DCFS Rule 325, psychotropic medications cannot be administered to children for whom DCFS is responsible without consent of the Department except in an emergency.  An emergency is defined as a circumstance in which a child poses a threat of imminent serious harm to self or others.  When an emergency medication is given to a child, the treating facility must report it to the DCFS Centralized Psychotropic Medication Consent Line the next business day on Form CFS 431-A, as an Emergency Medication with the date and time it was administered.

What should I do if I don’t get a response within 48 hours or if I have a question regarding consent for psychotropic medication?

If it has been more than 48 hours and no one has contacted you or the prescribing physician with additional questions, please contact the CSP team at 312-413-1233.

What are the reasons for delays in receiving consents?

DCFS attempts to process psychotropic medication request consents within 24-48 hours. However, many situations will delay this process. Some common reasons for this delay include:

    • insufficient information
    • incomplete and illegible forms  
    • The CSP Consultants could have follow-up questions to the specific rationale for the requests.
    • “phone tag” between the requestor and CSP team or CSP Consultants

What if there is a mistake on the consent I receive back?

If there is a mistake on the consent you receive (i.e., the medication or dosage is incorrect) please fax the form back to the consent unit with the problems/corrections on the cover page.  An updated request will be faxed back to you once the changes have been made and approved.  If you requested the wrong dosage or range you must submit a new request asking for an increase, indicate on the form that there was an error on the previously submitted request.

When should I send a court order?

A court order is necessary when a child is age 18 or older or when the child’s legal status is not up to date in the system and is listed as "NO", "TW" or "PC". This can occur when the child is a recent new ward. DCFS requires documentation stating that the child is under DCFS custody and there is authorization to consent to major medical care.

Should caseworkers and foster parents keep a record of all medication changes that occur?

It would be ideal if a thorough medication history was kept and reported to the child’s physician.  Other helpful information to report are responses to medications, side effects, maximum doses tried and duration of medication trial.   This information can assist in providing the best possible care and most effective medication changes for the wards in your care.

Do I need to get a renewal for a refill or a new consent when the placement or physician has changed?

No. Consents are good for 180 days or the duration specified on the consent regardless of the number of refills or change in placement or physician. 

How do I obtain a copy of a consent if I’ve lost mine, a child has come to a new placement or is hospitalized without a copy of the consent?

Copies of medication consents should be provided by the caseworker when a child moves to a new placement.  All requests for copies of consents must FIRST be made to the child’s caseworker/supervisor.  If the copy is not received in a timely manner, please complete this request form and fax to the Consent Unit at (312) 814-4128.  Requests will be processed within 5 business days of receiving the form.

What is the policy on continuing a psychotropic medication for a child who is new to DCFS, arriving at a new placement or admitted to a hospital without a copy of the consent?

Requests for medication should be submitted as soon as you are aware that a new ward is taking a psychotropic medication.  Medications should not be stopped abruptly. Children should be seen by a physician as soon as possible to determine if the current medication regimen is appropriate or whether to discontinue a medication.  If a child is new to your placement and you are unsure if there is consent in place, please contact the Consent Unit Supervisor at 312-793-6127. They will assist you in deciding if a new request form or a request for a copy of a prior approval needs to be submitted.

 If a physician prescribes a medication not on the Medicaid Prescription Program Preferred Drug List, do I need to get approval from DCFS and the Department of Healthcare and Family Services?

Yes. The two systems are completely separate and serve different purposes.  In 2002 the Illinois Department of Healthcare and Family Services (HFS) created a preferred drug list (PDL) “to promote clinically appropriate utilization of pharmaceuticals in a cost-effective manner”.  Prior HFS approval is necessary before Medicaid will authorize payment for non-preferred psychotropic medications.  DCFS approval is required for the process of obtaining informed consent for treatment.

It is important to note that while treatment of outpatients with a non-preferred drug cannot begin until HFS approval is obtained, non-preferred drugs can be started on psychiatrically hospitalized children and adolescents without prior authorization because hospital pharmacy costs are included in the per diem rate.  This can potentially present a problem for psychiatrically hospitalized youth upon discharge.  Hospitals discharge patients with prescriptions that need to be filled at an outpatient pharmacy rather than with a supply of medications.  Since pharmacies will not fill these prescriptions until payment has been authorized by HFS, the prescriptions cannot be filled until the outpatient clinician obtains prior authorization.  Discharged patient may not see their outpatient clinician for several days or even several weeks after discharge resulting in a potentially catastrophic disruption in care.  For this reason, consent for requests with an adequate rationale for non-preferred drugs from inpatient settings may be approved on the condition that the inpatient physician obtains prior authorization for the medication.

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