Journal of Correctional Health Care - April 2023 - 97

PRESCRIBING PSYCHOTROPIC MEDICATIONS
97
youth in foster care, those who have been living on their
own, or those who have rotated through many different
homes.
These challenges notwithstanding, attempts to determine
the youth's recent medication history, adherence,
other medical conditions, medication allergies and adverse
effects, recent substance use, and pregnancy status
(if applicable) are paramount. Documentation of efforts
made to obtain this information (including contacts
with responsible adults) is essential.
Understanding the motivation for treatment is helpful
for determining what medication, if any, is needed. Psychiatrists
should be especially careful to avoid the use of
psychotropic medications for staff benefit. Family members
and nonhealth care staff may ask that the youth be
medicated to reduce externalizing, disruptive, or assaultive
behaviors. Once entangled in the justice system, patients
themselves may seek medication as a panacea to
eliminate problem behaviors and conflicts with others.
Other youth may wish to be medicated to explain their
behavior, to appease parents or probation officers, or to
look more favorable when appearing at adjudication.
Standardized measures are excellent tools to establish
baseline symptoms and clarify diagnosis ( Jensen-Doss
et al., 2020).
It is important to understand the patient's perception of
what a particular psychotropic medication might do and
the motivation for treatment. The ''What I Want From
Treatment'' form can be supplemented by clinical interview
to clarify the youth's health care goals (Miller &
Brown, 1994).
Collateral information, including recent treatment records
when available, is an important part of the assessment
process. School records, including discipline and
attendance reports, Individualized Education Plans, and
academic performance provide important data. Collateral
from school personnel is extremely valuable, including
standardized ADHD measures if applicable. It is helpful
to review active prescription bottles, or to contact pharmacy
staff to verify prescription information. Using a
treatment team member to coordinate and report on collateral
information will streamline information gathering.
The growing use of telepsychiatry, particularly in juvenile
justice settings, means that many psychiatrists use
videoconferencing for assessment. Although telepsychiatry
typically works well in this population, it requires a
more organized system for obtaining collateral, consents,
and other information transfer (Kaliebe et al., 2011).
Medication Selection
Research suggests that psychiatric medication does not
by itself reduce delinquent behavior (ArmstrongHoskowitz
et al., 2020). Psychiatrists should use medications
for justice-involved youth in a safe and clinically
appropriate manner, carefully weighing risks and benefits,
and only as part of a comprehensive treatment
plan. Psychiatrists can also recommend behavioral interventions
and youth wellness strategies such as regular exercise,
improved sleep hygiene, encouraging available
social supports to rally around the youth, facilitation of
staff supervision and support, and the use of other correctional,
clergy, and community resources (Penn & Thomas,
2005).
It is inappropriate to prescribe psychotropic medications
in the absence of target symptoms with associated distress
or impairment of functioning, or when the availability of
follow-up services is unclear. Important considerations
for medication selection include risk in overdose, side
effects (e.g., sedation or activation, metabolic changes),
anticipated youth adherence, accessibility of family assistance
with administration and follow-up treatment, expense
to the patient or family and available prescription
coverage, and the potential for misuse or diversion.
When psychotropic medications are changed, patients
should be monitored more closely. Polypharmacy should
be avoided when possible or used judiciously with a
documented rationale. Newly detained youths on polypharmacy
will benefit from serial reassessments and, if
clinically indicated, gradual reduction of medication burden
(Anderson et al., 2022).
Informed Consent
Except in emergencies or when authorized by a court, any
use of psychotropic medications needs to be voluntary
and not coerced or forced upon a youth. Psychiatrists
should be familiar with current institutional policies
and standards regarding emergency psychotropic medications
(NCCHC, 2015; Penn & Thomas, 2005).
Although psychiatrists caring for young people are
used to seeking parental consent for medical treatments,
informed consent is more complicated in systems caring
for justice-involved youth. These patients may have different
family structures and may be involved with external
placements (e.g., Department of Children and Family
Services).
The first step is to identify who retains legal guardianship
and medical decision-making capacity for the youth.
If parents are divorced, separated, or not married, it is particularly
important to establish who this is. Appropriate informed
consent should be obtained from all parties with
legal responsibility for the patient. Parents and guardians
retain the right of medical decision-making even when
the child is in a residential placement unless the court
has determined otherwise (e.g., termination of parental
rights). Although procedures are jurisdiction specific, if
parental rights have been terminated, ordinarily a court
order is required to authorize the administration ofmedication.
Time-limited waivers may be obtained in advance of

Journal of Correctional Health Care - April 2023

Table of Contents for the Digital Edition of Journal of Correctional Health Care - April 2023

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