Psychotropic Medication Usage (open)

1. Region (Required)

Atlanta
Boston
Chicago
Dallas
Philadelphia
San Francisco

2. Center (Required)

3. Center Contact Name (Required)

4. Contact's Job Title (Required)

5. Data collection period used by center (check one selection) (Required)

May 25-31
June 1-7
June 8-14

6. On-board strength for week indicated in Q5 (Required)

7. Total number of students on psychotropic medications during the data collection period (Required)

8. Of the total number of students reported in Q7
(Required)

How many arrived on psychotropic medications?

(Required)

How many were restarted on medications they stopped before coming to Job Corps?

(Required)

How many were placed on psychotropic medications after arrival?

9. Of the total number of students on psychotropic medications reported in Q7
(Required)

How many are on only one psychotropic medication?

(Required)

How many are on 2 or 3 psychotropic medications?

(Required)

How many are on 4 or more psychotropic?

10. Indicate the number of students prescribed psychotropic medications by category, (Click here for a list of Job Corps List of Psychotropic Medications )

Antidepressants

Antianxiety medication

Mood stabilizer medication (Note: if taking for seizures only, then do NOT include in this number)

Antipsychotic medication

Stimulant medication (usually for ADHD)

Sedatives/hypnotics (for sleep only)

Other psychotropic (identify drug name and # of students prescribed each drug)

11. If possible, please indicate the approximate total cost per week to the center for psychotropic medications in each category (in Q10)

Antidepressants

Antianxiety medication

Mood stabilizer medication (Note: if taking for seizures only, then do NOT include in this number)

Antipsychotic medication

Stimulant medication (usually for ADHD)

Sedatives/hypnotics (for sleep only)

Other psychotropic (identify drug name and # of students prescribed each drug)

12. Indicate the number of students (in Q7) using each funding source for prescribed psychotropic medications

Insurance (including Medicaid) payments

Free sources/samples

Center contract funds

Other sources (identify source and # students)

12a. Number of students who lost Medicaid coverage due to move to different state

13. Indicate the number of students (in Q7) who use each method to receive psychotropic medication (Note: If students are on multiple psychotropic medications, and receive the medications through different methods, count all methods. For example, if a student receives one medication from the Health and Wellness Center daily and another medication weekly, count the student in both Come to Health and Wellness Center daily to get medications and Come to Health and Wellness Center weekly to get medications.)

Come to Health and Wellness Center daily to get medications

Come to Health and Wellness Center weekly to get medications

Keep medications in room/on self

Receive medications at off-center service provider

Other (describe)

14. Describe role of center physician in prescribing and monitoring psychotropic medications (check all that apply) (Required)

Center physician prescribes psychotropic medication
Center physician refills psychotropic medication
Center physician monitors psychotropic medication
Consulting psychiatrist/psych NP prescribes psychotropic medication
Consulting psychiatrist/psych NP refills psychotropic medication
Consulting psychiatrist/psych NP monitors psychotropic medication
Students receive psychotropic medications from off-center psychiatrist/psych NP
Other (describe)

15. Describe role of center mental health consultant (CMHC) in prescribing and monitoring (check all that apply) (Required)

CMHC reviews medical records of all students on psychotropic medications on arrival
CMHC initiates request for student to be evaluated for psychotropic medications
CMHC is consulted prior to student being placed on psychotropic medications
CMHC monitors all students on psychotropic medications
CMHC does not monitor/provide support to students on psychotropic medications
Other (describe)

16. Does the center have a contract or letter of agreement with psychiatrist/other practitioner for prescribing psychotropic medications? (Required)

Yes
No (skip to Q19)

17. If yes to Q16, is the contract/agreement with

Psychiatrist
Psychiatric nurse practitioner
Psychiatric residents
Other

If Other is checked, please describe below

If Psychiatric residents is checked, please enter year of residency

18. If yes to Q16, indicate (complete all that apply):

Number of hours per month students are seen by psychiatrist/psych NP on-center

Number of hours per month students are seen by psychiatrist/psych NP at off-center location

Number of hours per month psychiatrist/psych NP provides consultation to staff by phone/email

Other (describe and indicate # hours)

19. Provide any comments you may have about the use of psychotropic medications on Job Corps centers

Your Email Address (Required)

For confirmation only

Thank you for taking to the time to complete this form. Your responses and insights will be helpful in future planning.

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Psychotropic Medication Usage (open)