As defined in Section 24.2.2, non-routine medical treatment includes any health intervention that falls outside the definition of standard or routine care. This includes, but is not limited to any surgery, inpatient hospitalization, extraordinary dental treatment, invasive or extensive medical testing, behavioral therapy or mental health services and psychiatric treatment, including administration of psychotropic medication. Only Children’s Division and contracted case management staff may grant informed consent for non-routine treatment; resource providers are not authorized to consent for non-routine treatment, excepted in the limited circumstances described below.
Children who have experienced abuse, neglect or separation may show negative behaviors or signs of emotional stress that are normal responses. Support from caregivers who are knowledgeable about trauma-informed care can help children heal. Not all children need therapy or other formal intervention to address such behaviors or stressors. Sometimes, children just need time to adjust and will be able to do so with consistent support. If a child is exhibiting severe symptoms or sustained negative effects of trauma, therapy should be considered. If a child has not achieved significant change with consistency, support and therapeutic intervention, medication should be considered.
Some children need medication to cope with the trauma of abuse, neglect or separation. Other children need medication to treat behavioral health disorders that they inherited or developed, such as Attention Deficit Hyperactivity Disorder (ADHD), severe depression, or psychosis.
These medications, known as psychotropics, may help children function at home, in school, and in their daily lives. Psychotropic medications are prescribed to treat symptoms of psychosis or another mental, emotional, or behavioral disorder. They affect the central nervous system to influence and modify behavior, cognition, or affective state. As used here, the term includes the following categories:
- psychomotor stimulants;
- antipsychotics or neuroleptics;
- mood stabilizers;
- antianxiety agents; and
- sedatives, hypnotics, or other sleep-promoting medications.
- A case manager shall not consent to the use of psychotropic medications without first having sought alternative interventions to aid the child, resource provider or parents. Those may include, but are not limited to, mental health assessment, therapy, skills building, parenting assistance or family therapy. A mental health professional must make a recommendation for a child to be assessed by a qualified prescriber to determine if psychotropic medications would be of benefit for the child prior to the case manager pursuing this type of intervention.
- Informed consent for a specific psychotropic medication may not be used to imply informed consent for another medication. Thus, the case manager should follow this process each time an additional medication is recommended.
- Procedure: When a healthcare provider recommends any mental health treatment or other non-routine medical care, the assigned case manager will make at least two attempts, on different days, to contact the parent (and both parents if practicable) to confer with them, review any pertinent historical health information, and to inquire about their position regarding the recommended treatment. Each attempt must be documented in FACES and should include a conversation about the recommended treatment, such as: diagnosis, purpose, names and dosages of any medications, possible side-effects, required follow-up or monitoring, availability of alternatives, and prognosis without an intervention. Parent(s) should be provided the contact information for the child’s treating healthcare provider in order to communicate with them directly, if desired. The following exceptions apply:
- Parent(s) Not Available: If, after two attempts, the assigned case manager is not able to reach either parent, then the case manager may provide consent or refusal to the recommended treatment. Documentation of this decision must be completed in FACES.
- Parental Rights Terminated/Court Order Restricted Access: If the parental rights of both parents have been terminated, or the court has otherwise restricted a parent’s access to medical information about the child, the case manager may consent for non-routine care without attempting parental notification. The case manager remains the consenter until the child is adopted or until the court issues an order authorizing an alternate person, such as the pre-adoptive parent, to provide consent.
- Parent(s) Opposed to Proposed Course of Treatment: If a parent(s) is opposed to pursuing the recommended course of non-routine treatment, the case manager should attempt to ascertain why the parent(s) is in disagreement. The parent(s) should be offered the opportunity to consult with the youth’s healthcare provider. If the recommendation is for mental health treatment, including psychotropic medication, the parent(s) should also be offered an opportunity to consult with a mental health specialist identified by the Children’s Division.
If the parent(s) remains opposed to the recommended treatment after consultation, and the case manager, after consideration of the parental concerns, continues to believe that the treatment is in the child’s best interest, then the case manager shall consult with a Children’s Division statewide clinical consultant. Conversely, the same process must be followed if the parent approves of the recommended treatment but the case manager believes the treatment would be contrary to the child’s best interest. Only after the case manager has conferred with the statewide clinical consultant, is the case manager authorized to consent to or refuse the recommended treatment, in accordance with the statewide clinical consultant’s recommendations. In both scenarios, the assigned case manager must notify the parent(s) of the decision and document the process in FACES. If the parent(s) continues to disagree with the case manager’s consent to the recommended treatment after those consultations, they may pursue a service delivery grievance pursuant to Section 1.1 of the Child Welfare Manual. Parent(s) may also broach the child’s healthcare needs in the underlying Juvenile Court case.
- Parents Disagree: On occasion, a child’s parents may disagree with one another about the recommended course of treatment that is in the best interest of their child. If that occurs, both parents should be offered the opportunity to consult with the child’s healthcare provider as well as with a mental health specialist identified by the Children’s Division, if the recommendation is for mental health treatment. If one parent remains opposed, the case manager is authorized to consent to or refuse the recommended treatment, after consulting with a Children’s Division statewide clinical consultant. Documentation of this decision must be completed in FACES. The parent whose position is not aligned with that of the recommended course of treatment may pursue a service delivery grievance pursuant to Section 1.1 of the Child Welfare Manual or address the youth’s healthcare needs in the underlying Juvenile Court case.