What is the Guardian Request for Consent Portal?
The DCFS Guardian Consent Portal is a user-friendly website designed for the electronic submission of consent requests for youth in care. The online portal allows for easier request submission and more efficient consent processing, enhancing the overall care and support for Illinois youth.

How do I submit a consent request?
• Now that the portal is live, you can choose which consent request you need to submit, read the instructions, fill out the form fields through the portal and click submit. We take care of the rest!

Am I required to use the portal/can I still submit request via fax or email?
• At this time, it is not required that you use the portal, however we strongly encourage you to use it as there are many benefits and it allows for the most efficient processing. In the future, requests will no longer be accepted via fax or email.

Do I need to fill out the CFS form prior to filling out the information on the portal?
• Simply fill out the online form, and the information you entered will be used to automatically generate the CFS form. You will receive a copy of the CFS form with the confirmation email.

To find out more visit the DCFS Guardian Consent Portal: guardianconsent.dcfs.illinois.gov

Questions? Please email: DCFS.IllinoisConnect@Illinois.gov

When submitting CFS 431-A Psychotropic Medication Request Forms, it is important to include all relevant contact information for the party who wishes to receive a hard copy of the finalized consent. On the first page of the CFS 431-A, under the heading “Prescriber Information,” there are two fields where the submitter can indicate the fax number and email address of the intended recipient. Providing multiple locations to which the completed consents can be sent increases the likelihood that relevant consent information will be received in a timely manner. In addition, receiving hardcopies via email may allow submitters to retain record of the completed consents more easily. This may obviate the need to request new copies in the future if consent records are stored electronically.

If a prescriber or the prescriber’s representative wishes to request a replacement hard copy, they must fax a CFS 431-D (add hyperlink to form) form to 312-814-4128. It is important to note that staff members of the CSP team cannot provide consent hard copies to the field. DCFS must receive a fax submission of the CFS 431-D form in order for hard copies to be redistributed.

The psychiatric consultants of DCFS provide three types of recommendations for psychotropic medication consent: Approval, Modified Approval, and Denial. Each type of recommendation may include accompanying MD comments to provide context for the consultant’s assessment. These MD comments are placed within the Recommended Action segment of the CFS 431-B Form, which is the legal document that grants or removes consent to administer psychotropic medication. If written, MD comments are located within each numbered description of the requested medication, including the medication name, dose, dose timing, daily maximum dose (range), the expiration date of an approved or modified consent, and the type of consent recommendation.

A sample MD comment might read: “If the plan is to increase the dose above 0.2 mg, please submit plans for TID or QID administration; monitor vital signs.” It is important for the prescriber and their team to review the MD comments on the CFS 431-B Form, as these comments help guide the prescriber in submitting their next request for consent efficiently. Furthermore, attending to MD Comments helps prescribers remain within the limits of a consent, especially modified consent which may approve medications on a contingency (e.g., relating to labs, specific rationale, etc.).

There are several ways for prescribers and their team to evaluate and respond to MD comments, which helps streamline the collaborative process of requesting and obtaining consent. One option is to call the DCFS psychiatric consultant’s mainline (312-413-1233) for clarification of the comments or an associate’s feedback on whether the prescriber has adequately addressed the consultant’s concerns. If the prescriber prefers to discuss the medication request with the consultant in real-time, they can call the mainline and request to schedule a peer-to-peer call. This option is more time intensive. Alternatively, the prescriber can respond to the MD comments through the Additional Rationale segment of the CFS 431-A: Psychotropic Medication Request Form. In any case, a resubmission of the CFS 431-A form is required to process a potentially different consent outcome.

Q: If my patient experienced significant side effects while taking Adderall, would Vyvanse be a viable next course of treatment?

A: Adderall is a mixture of four amphetamine salts, one of which is dextroamphetamine. Vyvanse (lisdexamfetamine) is a prodrug related to dextroamphetamine. Lisdexamfetamine is relatively inactive until it comes into contact with red blood cells, at which point the hydrolytic activity of the blood cells converts lisdexamfetamine into dextroamphetamine and l-lysine. If the negative side effects of Adderall are caused by dextroamphetamine, then the use of Vyvanse may result in the same or similar side effects for that patient. Since Adderall contains four amphetamine salts, it would be impractical to determine which of the four salts independently caused the negative side effects. It is recommended that youth try a different CNS stimulant that does not contain dextroamphetamine if they have a negative reaction to Adderall. ^{1, 2}

Q: If Ritalin and Focalin are similar forms of methylphenidate, why do patients require smaller doses of Focalin to achieve similar therapeutic effect?

A: Ritalin is a racemic formulation of methylphenidate, meaning it contains equal parts of both the d-MPH and l-MPH isomers. Focalin, by contrast, only contains the d-isomer, which is considered to be the primary pharmacological contributor to the efficacy of both medications. When Ritalin is metabolized, the l-isomer is rapidly processed during the first pass through the liver and converted into ritalinic acid, an inactive metabolite. This is why the d-isomer is considered to be the pharmacologically relevant isomer. D-methylphenidate is the primary isomer that is not denatured during the first pass through the hepatic circulation. As a result, it is the primary isomer found in plasma as the d-isomer takes longer to denature. As previously mentioned, Ritalin formulations contain both the l-isomer and the d-isomer, whereas Focalin formulations contain only the active d-isomer. A 10mg dose of Focalin is thought to be roughly twice as potent as a 10mg dose of Ritalin because Focalin contains only the active d-isomer, while Ritalin contains both isomers, one of which is largely irrelevant due to how the medication is metabolized.^{3, 4}

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