Fla. Admin. Code Ann. R. 63M-2.00315 - Psychiatry Services

(1) Each Detention Center and residential commitment program shall have available, within the facility, written agreements, or contracts with on-site providers, for the provision of Psychiatric Services.

(2) Psychiatry services shall be provided by a Psychiatrist, or by a licensed and certified Psychiatric Advanced Practice Registered Nurse (APRN) under Chapter 464, F.S., who works under the clinical supervision of a Psychiatrist, as specified in the collaborative practice protocol with the supervising Psychiatrist and is maintained at the location where services are provided.

(a) The Psychiatrist or Psychiatric APRN providing psychiatric services in a departmental facility or program must comply with Chapter 63M-2, F.A.C., provisions regarding medication management whenever a youth is considered for, prescribed or receiving psychotropic medication.

(b) The Psychiatrist or Psychiatric APRN shall only prescribe psychotropic medications, which address the youth's specific diagnoses and target symptoms.

(c) If psychotropic medications are required, the lowest dose of medication necessary to achieve therapeutic effect shall be used bearing in mind potential benefits and risks.

(d) The use of more than one psychotropic medication as part of a mental health treatment regimen requires documented clinical justification for each psychotropic medication utilized by the Psychiatrist or Psychiatric APRN.

(e) Psychotropic medication shall be only one component of the therapeutic program. Additional treatment modalities such as individual, group and family therapy, behavioral therapy, substance abuse counseling and psychosocial skills training shall be utilized in conjunction with the use of psychotropic medication and must comply with Chapter 63N-1, F.A.C.

(f) Psychotropic medication shall not be used as punishment, for staff convenience, discipline, coercion, or retaliation, as a substitute for meaningful psychosocial, rehabilitative services or in quantities that lead to a loss of functional status.

(g) There shall be no pro re nata (PRN) or standing orders for psychotropic medications.

(h) There shall be no emergency treatment orders for use of psychotropic medication as a chemical restraint. Chemical restraint means a medication used to control behavior or restrict the youth's freedom of movement and is not a standard treatment for the youth's psychiatric condition.

(i) Injectable psychotropic medications shall require justification and may not be self-administered and may only be administered by a licensed nurse or practitioner.

(3) Each detention center and residential commitment program's intake screening process must determine whether a youth is taking psychotropic medications. If so, the youth is to be referred for a psychiatric evaluation to be conducted within fourteen days of the youth's admission. The psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note (HS 006), or a form developed by the program which contains all the information required in form HS 006. The Clinical Psychotropic Progress Note (HS 006, October 2014) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17126.

(4) Youth who are referred for a new psychiatric evaluation after admission must receive psychiatric evaluation within 30 days of the referral or expedited based on youth needs.

(a) The psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(b) If the youth's file contains a psychiatric evaluation which was completed within the past 6 months, the previous psychiatric evaluation may be utilized by the facility's Psychiatrist or Psychiatric APRN, to conduct an updated psychiatric evaluation. The updated psychiatric evaluation must be identified as such and documented on the Clinical Psychotropic Progress Note Form (HS 006) or a form developed by the program which contains all the information required in form HS 006.

(5) Each youth who is receiving psychotropic medication shall be seen for medication review by the Psychiatrist or Psychiatric APRN, at a minimum, every 30 days. Medication review shall include evaluating and monitoring medication effects and the need for continuing or changing the medication regimen.

(6) Psychotropic medication that is prescribed or significantly changed shall be documented on page 3 of the Clinical Psychotropic Progress Note Form (HS 006). Psychotropic medication that is continued without significant changes shall be documented either on page 3 of form HS 006 or a form developed by the program that contains all the information required on page 3 of form HS 006.

(7) Whenever a new psychotropic medication is prescribed, discontinued, or the drug dosage is significantly changed, parent/guardian/assigned custodian notification and consent must be obtained unless the youth is 18 years of age or older, or is emancipated as provided in Chapter 743, F.S., and is responsible for authorizing his or her own health care, or a physician determines that immediate treatment is needed as set forth in Chapter 985, F.S.

(8) Parent/guardian/assigned custodian consent for psychotropic medication shall be accomplished through the following action:

(a) The Psychiatrist or Psychiatric APRN must attempt to contact the parent or legal guardian by telephone to obtain his or her verbal consent for the psychotropic medication.

(b) The Psychiatrist or Psychiatric APRN must document the parent or guardian's verbal consent, when obtained, on page 3 of the Clinical Psychotropic Progress Note Form (HS 006), or a form developed by the program that contains all the information required on page 3 of form HS 006. The verbal consent must be witnessed, and the witness will sign on page 3 of the form HS 006 along with the Psychiatrist/Psychiatric APRN's signature, where indicated.

(c) A copy of the 3rd page of the Clinical Psychotropic Progress Note (HS 006) or a form developed by the program that contains all the information required on page 3 of form HS 006, and the Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001) shall be mailed to the parent/guardian/assigned custodian. The Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001, January 2024) is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17494.

(d) The parent or legal guardian's signature on the Acknowledgment of Receipt of CPPN or Practitioner Form (Parental Consent for Psychotropic Medication) (HS 001) provides written consent for the psychotropic medications as recorded on page 3 of the CPPN form HS 001 mailed to the parent, legal guardian, or assigned custodian.

(9) Where parental rights have been terminated and the youth is prescribed psychotropic medications the department or its representatives shall obtain an order of the court authorizing the treatment prior to the treatment being rendered. The department or its representative may ask the Department of Children and Families to assist with this process or confirm authorization has been given in accordance with Chapter 65C-35, F.A.C.

(10) The Psychiatrist or Psychiatric APRN must brief the facility's treatment team on the psychiatric status of each youth receiving psychiatric services who is scheduled for treatment team review. The briefing may be accomplished through face-to-face interaction or telephonic communication with a representative of the treatment team, or through a detailed progress note submitted by the Psychiatrist or Psychiatric APRN prior to the treatment team meeting.

Notes

Fla. Admin. Code Ann. R. 63M-2.00315

Rulemaking Authority 985.64(2) FS. Law Implemented 985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4), 985.64(2) FS.

Adopted by Florida Register Volume 51, Number 014, January 22, 2025 effective 2/5/2025.