Psychiatric Provider Responsibilities
Acute Psychiatric Hospital Admissions
The Division of Juvenile Justice (DJJ) provides pertinent clinical information on DJJ youths referred to an acute psychiatric hospital for admission. DJJ faxes the referral packet, which includes the Referral to Inpatient Psychiatric Programs (PDF) and Inpatient Medical Screening (PDF) forms. Pertinent clinical information includes, but is not limited to:
- Principal psychiatric diagnosis
- Recent and past history of aggressive or self-abusive behavior
- Existing medical conditions, including alerts for contagious diseases
- Current medications
- Dietary restrictions
In the case of emergency admissions, where some pertinent clinical information is not prepared or available, DJJ provides the information as soon as possible.
On admission, and during the hospital stay of a DJJ youth, participating psychiatric hospitals and staff work with the DJJ chief psychiatrist and the DJJ program administrator to ensure appropriate treatment and discuss clinical status as necessary.
Within 24 hours of admission to an acute psychiatric hospital the hospital must assign a gender-matched nursing staff to provide constant, one-to-one supervision of the youth. Unless contraindicated by the youth's history or behavior, one-to-one supervision may be decreased to line of sight observation, by a physician's order, after the first 24 hours.
If necessary, seclusion and seclusion with restraints (four-point or five-point Velcro-type restraints) are options for youths, for brief periods of time, during their hospital stay. If seclusion or seclusion with restraints are used, the hospital must send an email to the DJJ with an explanation of the behavior that led to the need for seclusion, the date and time seclusion began, extent of injuries (if any), and medications and dosage used (if any). The email must be sent on the same business day if possible, but no later than 9:00 a.m. the next business day.
Participating psychiatric facilities must immediately notify the Division of Juvenile Justice (DJJ) program administrator, by telephone, if a youth is injured, becomes ill or dies while in their care. The telephone call must include a summary of the circumstances leading to the injury, illness or death. A written report must be submitted to the DJJ program administrator by fax within 24 hours.
Participating providers must immediately notify the institution chief executive officer/chief medical executive/chief medical officer (CEO/CME/CMO) or designee in the event of a CDCR patient, parole agent or UM team for a medical parolee, or facility chief medical officer (FCMO) of a DJJ youth death while under their care or in the hospital. The attending provider(s) will discuss with the Institution CEO/CME/CMO or designee and/or the DJJ FCMO, or his or her designee the appropriateness and need for a post-mortem. Both parties must mutually agree upon the decision for an autopsy, prior to or in conjunction with the coroner’s office. The coroner’s office has the final decision on whether an autopsy is necessary.
If a Division of Juvenile Justice (DJJ) youth requires emergency medical care while in a psychiatric hospital due to a life-threatening illness or injury, the hospital must:
- Call for an ambulance to transport the youth to the nearest emergency room (ER). The youth must be restrained for transportation in the ambulance
- Call the nearest DJJ facility and advise the youth is going to the ER and request the DJJ medical watch personnel are sent to that ER location
- Notify the ER's hospital police or security staff that a DJJ youth is arriving in the ER and obtain the emergency telephone number of hospital police or security
- Assign a staff member to accompany the youth in the ambulance and provide one-to-one supervision at the ER until DJJ medical watch personnel arrives. The staff member must have a working cellular telephone and immediately notify hospital police or security, via emergency telephone number, if the youth attempts to leave the ER. The assigned staff member must not try to stop the youth if the youth tries to escape
- Notify the DJJ program administrator by telephone of the situation and a hospital physician must contact the DJJ chief psychiatrist to discuss medical aspects of the situation and proposed treatment
The DJJ medical watch personnel will notify hospital police or security upon arrival at the ER and assume responsibility for the youth. The assigned staff member is free to return to regular duties upon arrival of DJJ medical watch personnel.
Participating psychiatric facilities must immediately notify the local police department if a youth escapes during a stay. The hospital must also call the nearest Division of Juvenile Justice (DJJ) facility and provide details regarding the escape. Additionally, the hospital must call the DJJ program administrator and provide a summary of the escape.
Psychiatric hospitals must not perform any experimental or investigational treatment, therapy or procedures, or administer any experimental or investigational medications to Division of Juvenile Justice youths. Experimental and investigational treatment is prohibited under Penal Code, Section 3502. Hospitals agree to perform or administer only those medical services that are recognized as accepted professional medical standards or as safe and effective for use in treating an illness or injury.
If a youth receives a non-emergent injury, including but not limited to, a broken bone or cut that requires sutures, the hospital must immediately notify the Division of Juvenile Justice (DJJ) program administrator regarding the need for non-emergent medical care. In most cases, the DJJ transports the youth to the urgent care center or other facility for assessment and treatment. Once stable, DJJ transports the youth back to the psychiatric hospital.
Hospitals must provide status reports regarding the treatment and clinical state of youths receiving acute and sub-acute psychiatric care. Status reports for acute psychiatric care must be provided to the Division of Juvenile Justice (DJJ) program administrator three times a week, on Mondays, Wednesdays and Fridays, during normal business hours (8:00 a.m. to 5:00 p.m.). Status reports for sub-acute psychiatric care must be provided to the DJJ program administrator once a week, preferably on Wednesday, during normal business hours.
Division of Juvenile Justice (DJJ) youths are allowed visitors from a pre-approved list provided by DJJ on the youth's arrival at the psychiatric hospital. Visitation rights may be denied if the visits are contraindicated due to the possibility of an adverse impact on the youth's mental welfare.
Participating psychiatric hospitals must allow staff physicians, registered nurses and casework specialists from the DJJ facility to visit youths and review clinical records; however, DJJ staff may not make any entries in the clinical records.
The psychiatric hospital must provide a locked and secured living environment for youths undergoing treatment. Additionally, youths must not smoke in or out of the secure living unit. The hospital must serve meals to youths in the locked unit.
Within three days of a youth's discharge from a psychiatric hospital, the hospital must issue a written discharge summary (PDF). The discharge summary must include significant findings and events, the provider's recommendations for psychotropic medication regimen, the youth's condition on discharge, and recommendations for continuing care. If laboratory or other test results are pending, providers must provide an updated report within 72 hours of receiving the results.