Section 7.1

Introduction to Children and Youth Services Psychotropic Prescribing Practices Resource Manual

Children and Youth Services provides mental health services to a wide range of children and adolescents, with a wide range of needs. These clients require extensive mental health services, including psychopharmacological treatment. Psychotropic medications should be prescribed in conjunction with an individualized treatment plan which is developed by an interdisciplinary mental health team. Psychotropic medications should be part of a comprehensive treatment approach.

Psychotropic medications offer a chance for a positive outcome for some clients of CYS. However, psychotropic medications may cause short-term uncomfortable side effects, rare adverse (and even fatal) reactions, and a potential for long-term adverse effects. Clinicians should be familiar with and use available research, knowledge, and clinical expertise in prescribing psychotropic medications.

During the past three decades there has been much use of FDA approved drugs to treat children and adolescents who are below the recommended age for use (in an adult), and to treat minors for non-FDA approved (off-label) indications. Because of legal, ethical, and moral considerations regarding biological research on minors, there continues to be a dearth of useful information from carefully controlled research studies. Thus, it can be difficult for clinicians to determine the therapeutic efficacy and/or incidence and significance of many of the adverse side effects, in some of the newer psychotropic medications.

The Children and Youth Services Psychotropic Prescribing Practices Resource Manual (which is a living document that will be updated on an ongoing basis) is designed to assist the clinicians in the appropriate selection and effective use of psychotropic medications. It is a compilation of information from several sources including guidelines from Los Angeles and San Francisco Counties, from faculty at medical schools, and from textbooks of psychopharmacology. The information in this manual has been reviewed by clinicians and revised and updated as appropriate. As new medications or new uses become known, they will be added to the manual.

Clinicians must use their knowledge, experience, and clinical judgment in choosing from a combination of diagnoses and target symptoms when selecting appropriate drugs that could be used to treat their clients. Sometimes this is relatively easy, as a particular psychotropic medication may be appropriate for both a client?s diagnosis and his/her target symptoms. However, this is often not the case. The clinician should use this manual as part of the evaluation process. Also, the clinician must rely on his/her own clinical judgment and the specifics of each individual client. Clinicians should evaluate each prescription on the basis of the benefits expected versus the risks to be incurred - both the risks from the possible side effects of the medication and risks from not using the medication. The treating clinician has the authority for making the decision as to the choice of the medication, route and schedule of the administration, dosage, duration, and integration with the complete treatment plan - based on the clinical assessment and clinical needs of the client.

This manual, therefore, does not represent one definitive standard of care. Instead, this manual attempts to offer reasonable considerations in the prescription of psychotropic medication for children and adolescents. CYS expects the clinician to document his/her own choice of medication, the rationale for the choice of that medication, and the effectiveness of that medication for each and every client.