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Department of Juvenile Justice Implements Enhanced Safety Guidelines in Response to Inspector General's Report on Administration of Medications

Feb. 22, 2013

Meghan Speakes
850.921.5900 or 850.544.5387

Department of Juvenile Justice Implements Enhanced Safety Guidelines in Response to Inspector General’s Report on Administration of Medications Report finds no evidence of psychotropic meds used as chemical restraints.

Tallahassee – Today, the Florida Department of Juvenile Justice (DJJ) released a DJJ Office of Inspector General (OIG) report on administration of medications and announced enhanced safety guidelines for DJJ facilities and contractors to improve communication and accountability in administering medication to children in DJJ’s care.

“While youth are in our custody, we have a tremendous opportunity to positively impact the trajectory of their lives,” DJJ Secretary Wansley Walters said. “That’s why we are constantly searching for ways we can improve the services we provide. In addition to DJJ policies, there are state laws in place to ensure the youth in our facilities receive top-notch care so they have the greatest chance of success. I am proud that we are further strengthening our policies and procedures to protect Florida’s most vulnerable youth.”

In May 2011, Secretary Walters requested the DJJ OIG conduct a comprehensive investigation of DJJ’s medical processes. After an impartial and rigorous review, the OIG has presented the attached report. The investigation included a thorough review of DJJ’s documents, practices, policies, rules and statutory requirements related to the use of psychotropic medications among youth, as well as doctors’ backgrounds, work histories and employment eligibility and facilities’ medical records.

Additionally, DJJ contracted with the University of South Florida (USF) to study psychiatric care of youth in DJJ state-run and contracted programs and facilities. USF child and adolescent psychiatrists conducted the review to provide an expert opinion of DJJ’s psychiatric practices, policies and procedures regarding psychotropic medications management.

“I commend the department’s OIG staff for their thorough review and thank the DJJ Office of Health Services for their recommendations. I am now more confident than ever that we have the right policies and procedures in place to assure the health and safety of the youth in our care.” Walters added.

Psychotropic medications are used to treat symptoms of mental illness and disorders. When the Office of Health Services was established, extensive measures were built into the procedures and reporting requirements to protect youth from their unnecessary use. (Click here for the DJJ Health Services Manual<http://www.djj.state.fl.us/docs/partners-providers-staff/health-services-complete-manual.pdf?sfvrsn=0> and click here for the DJJ Mental Health and Substance Abuse Services Manual<http://www.djj.state.fl.us/docs/partners-providers-staff/mental-health-substance-abuse-manual-complete.pdf?sfvrsn=0>.)

Therefore, the following measures were in place to protect youth prior to the investigation:

·         DJJ Mental Health and Substance Abuse Policy expressly prohibits the use of psychotropic medications as chemical restraints.

·         DJJ policy requires that each youth receiving psychotropic medications receive regular mental health counseling and assessments by a team of professional medical and mental health staff tasked with monitoring the child’s progress and alerting the designated health authority of any complications or side effects.

·         DJJ’s Office of Health Services conducts comprehensive training and on-site technical assistance regarding all aspects of medication management, including psychotropic medications, to state facility staff and contracted providers of medical services. Medication management training has been an integral part of annual training. State-operated facilities also receive on-site technical assistance and training on a quarterly basis. Contracted facilities receive on-site technical assistance and training on an as-needed basis (as indicated by corrective action) and as requested by the facility and/or DJJ regional staff.

·         The Health Services Manual specifies that only specially trained staff is authorized to assist youth with medications when medical staff is absent.

·         Staff is required to report any instance in which they suspect a failure in the treatment or care of a youth to the Central Communications Center (CCC).

·         The Office of Health Services monitors each medication incident reported to the CCC to ensure that the appropriate actions are taken by the facility to address the incident.

·         Each program participates annually in a review of compliance with requirements related to youth on psychotropic medications by DJJ Quality Improvement (QI) staff or independent monitors.

·         Background screening is performed prior to physicians’ employment, and they are rescreened every five years.

Since the initiation of the investigation, the following additional measures have been taken:

·         Additional training by the Office of Health Services focusing on medication management and the training curriculum for non-licensed direct care staff providing medications will be conducted in collaboration with the DJJ program areas to verify that only trained direct care staff is providing medications to youth when medical staff is not on-site.

·         A memorandum was issued December 17, 2012, reminding all employees and contracted staff of the requirement to notify the CCC if they believe a youth is being improperly or excessively medicated.

·         To support a continuous process of improvement, the Office of Health Services will form a workgroup composed of DJJ staff, stakeholders and providers to address the recommendations of the USF report, specifically addressing documentation of parental consent for psychotropic medication, and psychiatric evaluation and progress notes.

·         The review process used for youth crisis shelter services is being re-examined to ensure that contracted independent monitors include an assessment of health services and medication following DJJ quality improvement guidelines. The Office of Prevention is working closely with the Office of Health Services to monitor medication error incidents and corrective actions.

·         Background re-screening requirements for contracted medical health professionals was reviewed. Those individuals whose background screenings had expired were rescreened.

The investigation included a review of all medication errors and it found that most errors were made when medical staff was off-site and non-medical personnel were tasked with providing medications. Therefore, the Office of Health Services is working with the offices of Residential, Detention and Prevention services to verify that only trained direct care staff is providing medications to youth when medical staff is not on-site.

Each incident in which youth received incorrect dosages of medication required individual review. Appropriate corrective actions are taken for each incident, ranging from training to termination.

Walters said, “The kids are the center of everything we do. We are committed to providing the right service to each youth at the right time. The improvements resulting from this investigation as well as other reforms we are making through Roadmap to System Excellence<http://www.djj.state.fl.us/roadmap-to-system-excellence> will help us reach that goal. I encourage further participation among the public and stakeholders as we reform DJJ to be a national leader in the humane and effective administration of juvenile justice.”


The Florida Department of Juvenile Justice strives increase public safety by reducing juvenile delinquency, strengthening families and turning around the lives of troubled youth. To learn more about DJJ, visit www.djj.state.fl.us and follow DJJ onwww.twitter.com/fladjjwww.facebook.com/fladjj, andhttp://www.youtube.com/FLDJJ.