Excerpts from THE ROLE OF PSYCHOTROPIC MEDICATION IN THE TREATMENT OF CHILDREN
IN NYS MENTAL HEALTH INPATIENT SETTINGS ( NYS COMMISSION ON QUALITY OF CARE), NOVEMBER 1992
The Commission found that the majority of parents/guardians neither are adequately informed, nor is their permission sought before their children are administered psychiatric drugs in state-operated children's psychiatric facilities.To protect patient rights and involve families in treatment planning, the Commission report strongly recommends to the State Office of Mental Health (OMH) that parents and guardians be given comprehensive information about psychoactive medication, and their written informed consent be obtained by psychiatric facilities before such medication is given to minor children.
...they do not comply with existing OMH guidelines to provide children with "medication-free" periods to verify the continued need for such drugs. They also often resort to additional doses of medication to suppress outbursts of undesirable behavior, rather than involving clinical staff to manage children in crisis through individualized treatment plans...
the study also revealed that the structure lacks a solid foundation: parents/guardians often have not given informed consent for the use of psychotropic medications with their children; physicians have not ensured medication-free periods to verify the children's continued need for medication; and there is a heavy reliance on medications to control the children's behavior with few effective individualized plans for behavior management and apparently little assistance from clinicians in dealing with crisis behaviors."
The Commission studied a sample of 94 children from 8 State-operated children's psychiatric centers and children and youth units at adult psychiatric centers. Nearly two-thirds had been victims of sexual or physical abuse or neglect prior to hospitalization, and many had histories of multiple abuse/neglect. Nearly 80 percent of the children studied were adolescents, and most had experienced previous out-of-home placements, which is common for abused children with dysfunctional family backgrounds.
In only 8 of the 94 cases reviewed (9%), appropriate written informed consent to give medication to minor children was obtained from parents or guardians. Many cases lacked adequate or accurate information, or omitted details on how consent was obtained and what information was provided. In almost half the cases sampled, there was no evidence in the case record that parents/guardians had been given such information;
contrary to the advice in OMH's Psychotherapeutic Drug Manual, facilities in the study failed to use drug-free periods to determine whether medication was still necessary, and over half the children studied lacked individualized behavior management plans. The use of "stat" (immediate) or "PRN" (as needed) medication orders to deal with agitated and assaultive behavior occurred in 80 percent of the cases studied, and direct care staff bore the brunt of dealing with agitated children, without the guidance of behavior plans developed with clinical staff; and
systems to reward positive behavior and punish negative behavior were primarily used in facilities as "ward management tools" and did not address children's treatment goals or specify appropriate staff responses to children's problem behaviors.
