Ready for Work: Vocational Rehabilitation Provides Guidance and Tools

A Brief Overview

  • Vocational rehabilitation (VR) is a federal right. Pre-Employment Transition Services (Pre-ETS) are one way to get support. Another is through 1:1 counseling and an Individualized Plan for Employment (IPE).
  • In Washington State, the Division of Vocational Rehabilitation (DVR) provides Pre-ETS and VR services. To seek support for a student still working toward a diploma, contact the DVR counselor assigned to the student’s school. DSHS maintains an interactive map: Find a School Transition Counselor.
  • Individuals with vision impairment and blindness are served through a separate vocational rehabilitation agency in Washington State, the Department of Services for the Blind (DSB).
  • After graduation, a student with a tribal affiliation may be eligible for support from Tribal Vocational Rehabilitation (TVR). Each TVR agency operates independently. Contact information is listed on a TVR website page, within DVR’s website.
  • Graduating seniors can seek DVR, TVR, or DSB services now!

Full Article

Teenagers and young adults with disabilities have additional considerations when deciding what life looks like after high school. The transition planning process begins in middle school, when all Washington State students work with counseling staff to begin their High School and Beyond Plan.

For students with disabilities, that lengthy planning process is enhanced when the Individualized Education Program (IEP) adds a Transition Plan, required by the school year when a student turns 16.

Vocational rehabilitation agencies can be part of that process and support a warm hand-off into the world of work. PAVE provides an infographic Transition Triangle with more about the way these services can wrap around a student as they move through school and beyond.

Vocational Rehabilitation services are a civil right

The right to vocational rehabilitation (VR) services is an aspect of Title 1 of the amended Rehabilitation Act of 1973. In 2014, the Rehabilitation Act, which guarantees equitable access to public spaces and programs, was further amended to include the Workforce Innovation and Opportunity Act (WIOA).

Pre-Employment Transition Services (Pre-ETS) were already an aspect of the Rehabilitation Act, but WIOA further defines Pre-ETS and requires that VR agencies set aside 15 percent of their funding to provide or arrange for the provision of Pre-ETS.

Note that Section 504 is also a feature of the Rehabilitation Act. Section 504 guarantees the right to accommodations for equitable access in public facilities and programs.

Section 504 is the basis for a student’s “504 Plan” that provides accommodations, modifications, and anti-discrimination measures for educational access. Section 504 protections aren’t limited to school: Like the Americans with Disabilities Act (ADA), Section 504 protects a person in higher education, work, and elsewhere throughout the lifespan. Students with IEPs also have Section 504 protections.

In other words, the accommodations from a student’s 504 Plan or IEP travel with them into higher education, work, and more. Section 504 and the ADA protect an individual with disabilities throughout their life. Denial of accommodation is considered discrimination under these civil rights laws.

In Washington State, vocational rehabilitation services are provided by the Division of Vocational Rehabilitation (DVR), which is housed within the Department of Social and Health Services (DSHS).

After graduation, a student with a tribal affiliation may be eligible for support from Tribal Vocational Rehabilitation (TVR). TVR agencies operate with sovereignty; contact information is included within DVR’s website, on a TVR website page.

Individuals with vision impairment and blindness are served through a separate vocational rehabilitation agency in Washington State, the Department of Services for the Blind (DSB).

Pre-ETS help students look ahead to their job options after graduation

Pre-Employment Transition Services (Pre-ETS) include job exploration, work-based learning, counseling about further educational options, workplace readiness and self-advocacy training.

Summer programs are available in some areas. To find the forms to enroll in Pre-ETS and for information about programs and regional counselors in your area, visit DVR’s website page called High School Transition.

Pre-ETS include five required services. Each service in this list is linked to a resource for further investigation. DVR counselors can provide additional resources to suit an individual’s unique circumstances:

  1. Job exploration counseling: career speakers, interest and ability inventories, investigation of labor market statistics and trends, and more
  2. Work-based learning experiences: in-school or after school opportunities, including internships, provided in an integrated environment to the maximum extent possible. According to the Brookings Institution, work-based learning is predictive of future job quality.
  3. Counseling on opportunities for further education: How to complete the Free Application for Federal Student Aid (FAFSA®) and how to locate disability resource centers at colleges and universities are part of college readiness.
  4. Workplace readiness training to develop social skills and independent living
  5. Instruction in self-advocacy, which may include peer mentoring, training in disability disclosure, and more

Order of Selection impacts access to 1:1 DVR support

The Individualized Plan for Employment (IPE) is a DVR program that is separate from Pre-Employment Transition Services (Pre-ETS). The IPE is supported 1:1, whereas pre-employment services are generally provided to groups of students.

DVR operates with Order of Selection when clients apply for individualized vocational rehabilitation (VR) counseling. Through Order of Selection, individuals with the highest needs for support are prioritized.

When developing an IPE, the client and counselor establish a goal for employment; the counselor provides coaching, logistical and sometimes financial support to help make that happen. The case remains open until the employment goal is met if the client remains meaningfully engaged in the process. IPE services might include educational support if further education is needed to achieve a job goal.

Can a student get Pre-ETS and 1:1 help?

A student might receive services through both programs—Pre-ETS and the Individualized Plan for Employment (IPE). However, families should be aware that there are some specific rules related to Order of Selection.

  • If a student is already participating in Pre-ETS, the student can apply for an IPE and Order of Selection will not impact the student’s ongoing engagement in Pre-ETS.
  • If the student applies for an IPE first and is put on a waiting list, then the student also will have to wait to begin Pre-ETS.
  • A student will have more access to DVR services by engaging with the Pre-ETS first and then considering whether to also apply for individualized support.

Resources for more information

Research shows that access to an array of collaborative services during high school improves post-secondary outcomes, especially when school staff and service providers get to know one another and there are “warm hand-offs” between individuals who develop trusted relationships with the young person, according to data shared by the National Technical Assistance Center on Transition (NTACT). Another place for data and detail about WIOA is the Workforce Innovation Technical Assistance Center (WINTAC).

Engagement with vocational rehabilitation services is supported by initiatives endorsed by the U.S. Department of Labor and its Office of Disability Employment Policy (ODEP). These federal agencies promote the concept of Employment First, a framework for systems change centered on the premise that all citizens, including individuals with significant disabilities, are capable of full participation in integrated employment and community life. 

The PACER Center, a Minnesota-based agency founded in 1977 to promote a “parents helping parents” philosophy, supports the National Parent Center on Transition and Employment, which offers a collection of materials with more information about vocational rehabilitation and how to benefit from pre-employment and employment services. Included in the PACER Center’s materials is a booklet for parents to help young people prepare for college and careers.

Washington’s DVR program provides a video about the school-to-work transition with young people talking about their experiences with the agency and how it helped.

Glossary of Key Terms for Life After High School Planning

ADA: Americans with Disabilities Act. Prohibits discrimination against individuals with disabilities in all public and private places open to the general public.

Adult Services: Programs available to support individuals after they become legal adults at 18.

Age of Majority: In Washington, 18. An adult is responsible for educational, vocational, financial, and other decisions unless other arrangements are made through legal means.

Aging Out: The process of ending the school year in which a student turns 21 and is no longer eligible for special education (IEP) services.

Compensatory Services: Extra educational services provided because an IEP team or another agency with authority determines that a student with a disability did not receive a Free Appropriate Public Education (FAPE).

DDA: Developmental Disabilities Administration. A state agency that provides a variety of employment, personal care, supportive housing, and other services based on eligibility. Transition-age youth may be eligible for a school-to-work program if one is available in their region.

DSB: Department of Services for the Blind. A state agency that provides vocational services and orientation and mobility training for individuals with visual impairments.

DVR: Division of Vocational Rehabilitation. A state agency that provides employment services to individuals with a wide range of disability circumstances. Students still enrolled in school might receive Pre-Employment Transition Services (Pre-ETS), and young adults also might apply for 1:1 support with an Individualized Plan for Employment (IPE). The agency has a wait list, called Order of Selection, for 1:1 IPE support but not for Pre-ETS.

Educational Evaluation: Used to determine eligibility for school-based services. A wide variety of assessments, questionnaires, and other tools determine how disability impacts a student’s ability to access academic and non-academic areas of education and whether specially designed instruction is needed to access FAPE.

Equity: A quality of fairness that is present when someone with a disability has appropriate, individualized help to enable the same access to opportunities that are available to individuals without disabilities.

ESSA: Every Student Succeeds Act. A 2015 law that reauthorized the 50-year-old Elementary and Secondary Education Act (ESEA), the nation’s education law that provides equal opportunity for all students.

FAPE: Free Appropriate Public Education. Learning that is equitable, accessible, and meaningful. FAPE is what a student with a disability is entitled to receive from the school, based on documented, individualized needs.

High School and Beyond Plan (HSBP): a future planning tool that is required for all Washington State students, beginning no later than 8th grade.

IDEA: Individuals with Disabilities Education Act. Federal law that grants funding to states to support educational programming for eligible students with disabilities. IDEA Part B supports children 3-21, and Part C supports children Birth-3.

IEP: Individualized Education Program. A unique school services plan for a student who is eligible based on disability circumstances, managed and documented by a team that includes family members and professionals.

IEP Transition Plan: A component of the IEP that is required by age 16 but can be added any time the student and IEP team are ready to discuss future goals and incorporate them into the student’s program, with goals and progress monitoring that consider life plans.

Inclusion: An environment where individuals with disabilities and without disabilities are learning or working together. The IDEA requires schools to deliver FAPE in the Least Restrictive Environment to encourage the inclusion of all students in general education spaces.

Individualized Plan for Employment (IPE): A service plan with support from a vocational rehabilitation agency.

Kevin’s Law: A Washington State law stating that a student receiving special education services has the right to participate in commencement ceremonies with same-age peers, regardless of when a diploma is earned.

LRE: Least Restrictive Environment. IDEA requirement that students receive special education services in general education settings to the maximum extent appropriate. Schools document why a student is unable to access FAPE within LRE (general education) before placing a student in a restrictive setting.

OCR: Office for Civil Rights. An enforcement agency that manages formal complaints and provides information about civil rights that protect individuals from discrimination based on race, gender, disability, and other factors. The U.S. Department of Education Office for Civil Rights is a federal agency with the responsibility of ensuring equal access to education through the enforcement of civil rights.

OEO: WA Governor’s Office of the Educational Ombuds: State agency that provides free online resources and 1:1 support for families navigating educational systems. 

OSEP: Office of Special Education Programs. Federal agency within the US Department of Education that is responsible to administer the Individuals with Disabilities Education Act (IDEA).

OSERS: Office of Special Education and Rehabilitative Services. US Department of Education program with a mission “to provide leadership to achieve full integration and participation in society of people with disabilities by ensuring equal opportunity and access to, and excellence in, education, employment and community living.”

OSPI: Office of Superintendent of Public Instruction. Washington’s educational agency that partners with the state’s nine Educational Service Districts (ESDs) to provide guidance to Local Education Agencies (LEAs) that include 295 districts and 6 state-tribal education compact schools.

PAVE: Partnerships for Action, Voices for Empowerment. A non-profit agency that supports Washington families impacted by disability. A PAVE program is Parent Training and Information (PTI), which provides information, training, resources, and technical assistance to help family caregivers, students and professionals understand rights and responsibilities within education systems.

Person Centered Planning (PCP) : A method for helping an individual explore and celebrate life goals while building specific action steps and gathering people to offer support.

Pre-Employment Transition Services (Pre-ETS): Provided for groups of students by a vocational rehabilitation agency. In Washington DVR provides Pre-ETS for many disabilities, and DSB provides Pre-ETS for students with visual impairment. Included are job exploration, work-based learning experiences, counseling about educational opportunities, workplace readiness training, and instruction in self-advocacy.

Prior Written Notice (PWN): A required document that schools provide families after formal meetings. The PWN summarizes what was discussed and any agreements, disagreements, action items, or amendments to a student’s Individualized Education Program (IEP). A family/school communication plan can be designed at a meeting and documented in the PWN.

Procedural Safeguards: Written description of special education process, student/family rights, and options for dispute resolution.

Recovery Services: Additional educational opportunities considered to support students significantly impacted by the national health emergency caused by COVID-19.

School-to-Work: Programs available in many counties for students eligible for support from the Developmental Disabilities Administration (DDA).

Secondary Transition: Planning for and progressing through the change from high school to adult life.

Section 504: Part of the Rehabilitation Act of 1973.  Provides anti-discrimination protections for individuals with disabilities throughout the lifespan.

Self-Advocacy: Ability to share thoughts and feelings, understand rights and responsibilities, make independent choices, and ask for help when needed.

SMART Goals: Specific, Measurable, Achievable, and Relevant goals set within a specific span of Time.

Synchronous/Asynchronous Instruction: Educational methods during distance learning. Synchronous instruction is provided when school staff directly interact with students in “real time,” whereas asynchronous instruction is recorded, independent, or parent-supported learning without school staff directly present.

Transition Services: Programming uniquely designed to support a student in preparation for adult life. Needs,  strengths, preferences, and interests are considered for development of specially designed instruction, related services, community experiences, employment and other postschool adult living objectives. If appropriate, services include acquisition of daily living skills and provision of a functional vocational evaluation.

TVR: Tribal Vocational Rehabilitation. TVR is available for people with tribal affiliations in some areas of the state. Each TVR program operates independently. Contact each agency, listed on DVR’s website, for complete information about program access, service area, and eligibility.

You can download this information below:

Transition Triangle

The transition triangle talks about the relationship between the High School and Beyond Plan , the IEP transition plan and Agency supports from DDA, DVR and DSB. within that triangle of support is the student asking themselves: Who they are, what is their future and their goals.

The planning process to support a student with disabilities toward their adult life plans requires coordination and organization. This graphic provides a visual overview of the work and who is responsible to help.

The center upside down triangle describes key questions for a student as they move through school and toward adulthood:

  1. Who am I? Answers include what the student is interested in, what they are good at, what they struggle with, and how they see themselves.
  2. What’s my future? Students can begin to imagine where they might work, whether higher education will be part of their future, and how they might live.
  3. How do I reach my goals? The answers are a long-term project. A good planning process ensures that work done today is moving the student toward their vision for adult life.

The three colored triangles on the corners of the graphic represent three tools that help students ask and answer these questions.

The purple triangle on the bottom left represents the High School and Beyond Plan. Washington State requires schools to begin supporting all students with a High School and Beyond Plan before they leave middle school. The plan includes questions to help the student think about where they might work someday and how much education they will need to get that job. The plan is designed to make sure time spent in school is moving the student toward adult goals. The High School and Beyond Plan addresses the same questions that are listed in the center of our triangle and is often managed by staff in a school’s counseling center.

The blue triangle on the bottom right represents the transition plan, which is required in a student’s Individualized Education Program (IEP) by the school year when they turn 16. Goals in the IEP Transition Plan include further education/training, employment, and independent living as parts of a student’s program. A student with disabilities has the right to a Free Appropriate Public Education (FAPE) until they earn a diploma or turn 21. The IEP includes a target graduation date, determined by the IEP team. The state requires the IEP Transition Plan to align with the High School and Beyond Plan. School staff and the family collaborate to make sure these two tools match up to best support a student’s progress.

The teal triangle on top of the pyramid represents agencies that might provide Vocational Rehabilitation (VR) services. The Developmental Disabilities Administration (DDA) has a variety of school-to-work programs for eligible students: A DDA case manager can provide information about options. The Division of Vocational Rehabilitation (DVR) provides Pre-Employment Transition Services (Pre-ETS) for students still in school as well as vocational rehabilitation services for adults with disabilities. As they transition out of school, members of some Native American tribes may access Tribal Vocational Rehabilitation (TVR) services. The Department of Services for the Blind (DSB) is a separate agency providing Pre-ETS for youth and vocational rehabilitation services for individuals who are blind or low vision. Staff from these agencies may work with an IEP team and counselors at school to make sure everyone is working together to support the student in the center.

Ideally a student with disabilities has people supporting all of the features on this transition triangle. Best practice is for all agencies and supporters to collaborate as they help a student move toward a successful adult life.

For direct assistance from PAVE, click Get Help. The Office of Superintendent of Public Instruction (OSPI) provides information about graduation requirements for a student in Washington State

How to Navigate School for Youth with Mental Health Concerns

Staff from PAVE’s Parent Training and Information (PTI) program provided a workshop as part of the statewide virtual conference hosted by NAMI Washington October 16, 2021.

This recorded training provides a general overview of student rights in education. Some information is specific to students impacted by mental health conditions.

The formal content begins about four minutes into the video and ends at about 46 minutes.

Here are a few examples of topics addressed:

  • Does my student have the right to be evaluated for special education if they refuse to go to school because of anxiety?
  • What accommodations are reasonable to ask for?
  • What services might be possible for my student who struggles with emotional regulation?
  • Can counseling be a related service?
  • Are there protections for a student because of suicidal thoughts or attempts?
  • What support is available for a student with a disability condition who isn’t prepared for adulthood because high school got interrupted by the pandemic?

Additional information about mental health education and services at school, the overall layout of youth behavioral health in Washington State, and where to find family support is included in a PAVE article: Mental Health Education and Support at School can be Critical.

To seek education, training, and support from the National Alliance on Mental illness, look for a virtual training or information about a local affiliate near you, listed on the NAMI WA website.

One place to access behavioral health services for children and youth anywhere in Washington is through the Seattle Children’s Hospital Mental Health Referral Service: 833-303-5437, Monday-Friday, 8 a.m. to 5 p.m.

Families and young people can reach out for individualized assistance from PAVE’s Parent Training and Information (PTI) staff at PAVE. Click Get Help or call 800-572-7368.

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Support for Youth Whose Post-High School Plans were Impacted by COVID-19

A Brief Overview

  • Students who did not make adequate progress on IEP goals due to COVID-19 may be eligible for Recovery Services. IEP teams are responsible to make individualized, student-centered decisions about this option for additional educational services.
  • Students who turned 21 and “aged out” of their IEP services during the pandemic may be eligible for Transition Recovery Services. Read on for information and resources.
  • Transition Recovery Services are funded through a combination of state and federal sources, including through the American Rescue Plan. Transition Recovery will be an option for several years—beyond Summer 2021.

Full Article

For students with disabilities, getting ready for life after high school can include work-based learning, career cruising, job shadowing, college tours, training for use of public transportation, community networking, agency connections, and much more. A student’s Individualized Education Program (IEP) is built to guide a student toward unique post-graduation goals.

COVID-19 halted the high-school transition process for many students. IEP teams are required to consider Transition Recovery Services to help those students get back on track toward post-secondary goals, including if they “aged out” by turning 21.

Transition Recovery Services are funded through a combination of state and federal sources, including through the American Rescue Plan. Transition Recovery will be an option for years—beyond summer 2021.

Keep in mind that Transition Recovery Services are uniquely designed for a specific student, and the “school day” may look quite different than traditional high school.

Eligibility for Transition Recovery Services is an IEP team decision

To consider Recovery Services, the IEP team reviews what a student was expected to achieve or access before COVID-19. The team then compares those expectations to the student’s actual achievements and experiences. If a service was “available,” but not accessible to the student due to disability, family circumstances, or something else, the team considers that.

Recovery Services are provided to enable students to get another chance on their transition projects and goals. According to guidance from Washington’s Office of Superintendent of Public Instruction (OSPI), IEP teams are responsible to discuss these topics in good faith and not rely solely on specific data measures for decision-making:

“Recovery Services should focus on helping the student achieve the level of progress on IEP goals expected if the pandemic had not occurred. These services should not be based on a percentage or formula calculation; the timeline and amount of recovery services should be an individualized decision for every student with an IEP.”

Keep in mind that schools are required to include family members on the IEP team. OSPI’s guidance also states, “Parents and families are key partners in identifying the need for Recovery Services, as they generally have current information about the student from the time of the school facility closures and since. As with all special education processes, school districts must provide language access supports, including interpretation and translation as needed, to support decisions about recovery services.

“School districts must ensure parents have the information and supports necessary to participate in the decision-making process.”

Here’s a set of questions for IEP teams to consider:

  1. What did we hope to accomplish?
  2. What did we accomplish?
  3. What was the gap, and how can we fill that gap?

OSPI’s guidance was shared with families at a May 26, 2021, webinar. OSPI shares its webinars publicly on a website page titled Monthly Updates for Districts and Schools.

Every IEP team should talk about Recovery Services

OSPI makes clear that school staff are responsible to discuss Recovery Services with every family that is part of an IEP team. “Families should not have to make a special request for this process to occur,” according to Washington’s Roadmap for Special Education Recovery Services: 2021 & Beyond.

The urgency of the discussion depends on a student’s circumstances. IEP teams supporting students at the end of their high-school experiences may need to meet promptly. Other teams may wait until the new school year or until the annual IEP review.

According to state guidance, “To be clear, OSPI is not requiring districts to immediately schedule and hold IEP meetings for every student with an IEP. These decisions may need to take place prior to the start of the 2021–22 school year, prior to the annual IEP review date, or could happen at the upcoming annual review date if the district and parent agree.”

The key question to bring to the meeting

TIP: Families and schools will consider this big-picture question, so write this one down and carry it into the IEP meeting:

“How will the school provide the services that the individual student needs to complete all of the experiences and learning that the IEP team had planned before a pandemic interrupted the high-school transition process?”

Transition Recovery Services are documented with PWN

OSPI guides IEP teams to document a support plan for a post-21 student through Prior Written Notice (PWN), which is a way schools notify families about actions related to a special education program. The school is responsible to provide PWN to family participants after any IEP meeting.

TIP: Review the PWN carefully to ensure that the discussion, decisions, and action steps are accurate. Family members can submit amendments to a PWN.

The IEP document itself cannot be amended to include post-21 services because federal law supports the right to a Free Appropriate Public Education (FAPE) for eligible students only through age 21.

What can families do?

  1. Reach out to the IEP case manager to discuss when to meet to discuss Recovery Services as part of a team meeting. If there is urgency, make that clear in a written request.
  2. Ask for documentation about progress made toward IEP annual and post-secondary goals during COVID-impacted school days. If there is no documentation, ask for a review of pre-pandemic data and an evaluation to determine present levels of performance.
  3. Share observations about what worked or didn’t work during remote or hybrid learning, and any missed opportunities caused by the pandemic. Ask for the school to formally document family and student concerns as part of the IEP team record.
  4. Procedural Safeguards include family rights to dispute resolution, including the right to file a formal complaint when there is reason to suspect a special education student’s rights were violated.

What if my student’s Transition Plan wasn’t fully formed?

An IEP can include transition planning any time the student, family, or teachers decide that life planning needs to be considered as an aspect of IEP services. The IEP Transition Plan aligns with a student’s High School and Beyond Plan, which Washington requires to begin before a student leaves Middle School. Therefore, some IEPs include a transition plan by about age 14.

Federal law (Individuals with Disabilities Education Act/IDEA) requires an IEP to include a Transition Plan by age 16. Although students aren’t required to participate, schools are required to invite students to participate in IEP meetings once transition is part of the program. PAVE provides an article to encourage youth participation on the team.

If the Transition Plan didn’t get built in a timely way due to the pandemic, IEP teams can begin that process and then consider whether Transition Recovery Services are warranted.

How are graduation requirements impacted by COVID?

On March 2, 2021, Governor Jay Inslee signed into law HB 1121, which allows for individual students to waive credit or testing requirements if their ability to complete them was disrupted by the pandemic. Temporary waivers were granted in 2020, and the new law gives the State Board of Education (SBE) permanent authority to grant school districts emergency waivers for cohorts of graduating seniors into the future. Schools are expected to help students meet requirements before falling back on the emergency waiver as a last resort.

To meet graduation requirements in Washington State, students choose from Graduation Pathways. For a student receiving special education services, the IEP team (including student and family) determines which pathway a student will follow and the target graduation date.

All students have the right to participate in Commencement

Students with disabilities have the right to participate in commencement ceremonies with same-age peers regardless of when they complete requirements for a diploma: See information about Kevin’s Law.

Adolescent Health Care Act Provides Options for Families Seeking Mental Health and Substance Use Help for Young People Resistant to Treatment

A Brief Overview

  • The Adolescent Behavioral Health Care Access Act, passed into law by the Washington Legislature in 2019, gives parents and providers more leverage in treating a young person who won’t or can’t independently seek medical help for mental illness and/or substance use disorder.
  • The Washington State Health Care Authority (HCA) in March 2020 launched several website links with information about the new law, which includes an option for Family Initiated Treatment (FIT).
  • The Washington State Hospital Association on July 9, 2019, provided a slide presentation describing the law’s history and its primary features.
  • A place to connect with other families concerned about adolescent mental healthcare access in Washington State is a group called Youth Behavioral Healthcare Advocates (YBHA-WA) on Facebook. Included on the page are handouts that summarize key aspects of the new law. 

Full Article

Getting mental health help for a youth in crisis can be complicated, frustrating and frightening.

Mental Health America ranks states based on the incidence of mental illness and access to services. The agency’s 2020 rankings list Washington in the 43rd position, based on various measures that indicate a higher prevalence of mental illness and lower rates of access to care.

Often a barrier to treatment is the youth, who may not be able to see a problem or want to get professional help. Parents often struggle to navigate systems that must balance a young person’s autonomy with concern that they may not be able to make good decisions because of their development, specific illness circumstances or symptoms that impact the brain.

In Washington State, the age of medical consent is 13. That means that a person 13-17 years old can independently seek medical treatment, without the consent or knowledge of parents.

Age of consent laws also have meant that Washington youth could say no to mental health or substance use treatment, regardless of whether parents and providers agreed that such treatment was necessary to protect the safety and well-being of the adolescent.

A law passed by the Washington legislature in 2019 gives parents and providers more leverage when a young person is struggling with a mental illness or substance use disorder and won’t independently engage with treatment. The law does not limit an adolescent’s ability to initiate treatment on their own.

A January 8, 2020, article in Crosscut profiles several families impacted by the new law. “Until the new law,” the article states, “parents often were shut out of their teenager’s care and treatment plans and couldn’t push a teen toward necessary outpatient or inpatient care without their consent.”

The Adolescent Behavioral Health Care Access Act enables parents/caregivers to bring a child for inpatient or outpatient treatment without requiring consent from the child, ages 13-17. The law includes elements introduced by the state Senate and House of Representatives, which originally titled the bill as HB 1874.

Passage of the law was a win for the Children’s Mental Health Work Group, which studied and reviewed recommendations from a stakeholder advisory group authorized by the 2018 legislature. The final version of the law included input from family members, youth, clinicians, hospital staff and many others who met dozens of times. A June 13, 2019, slide presentation available online provides additional history and detail about the work group and its recommendations: Family Initiated Treatment and Engaging Families in Treatment of Youth. The webinar with sound is available on YouTube.

The 2020 legislature is considering amendments to the law, and the Children’s Mental Health Work Group continues to meet to consider proposals to clarify provisions that relate to residential treatment and referrals for Wraparound with Intensive Services (WISe).

“Parent” is broadly defined

The 2019 law expands the definition of parent to include a wide range of family caregivers, guardians and others who have authority to initiate treatment. The Revised Code of Washington (RCW 9A.72.085) provides standards for “subscribing to an unsworn statement” that can apply to a caregiver initiating treatment. 

Note that parents retain the right to make medical decisions for children younger than 13, and adults 18 and older are responsible for medical decision-making if there is no guardianship.

A substantive change with the 2019 law is that providers may share mental health information with parents without an adolescent’s consent, if the provider determines that information sharing with family is in the best interests of the adolescent patient. A list of information-sharing guidelines is included below.

How Family-Initiated Treatment Works

If a parent/caregiver believes that an adolescent requires mental health or substance use disorder treatment, the adult can escort the young person to an inpatient or outpatient treatment facility even if the adolescent doesn’t readily agree to go.

A provider will assess the adolescent and consider information from the family to determine whether treatment is medically necessary. An adolescent’s refusal to engage with the provider cannot be the sole basis for refusing to treat.

An inpatient facility can detain the adolescent under Family-Initiated Treatment (FIT) if medically necessary. Note: another option could be detention under the Involuntary Treatment Act (ITA), if the adolescent is determined to be gravely disabled or at imminent risk of self-harm or harm to others.

If medical necessity is found by an outpatient provider, a counselor is limited to 12 sessions over 3 months to attempt to work with the adolescent. If the young person still refuses to engage with treatment, then the period of Family-Initiated Treatment with that provider ends.

State laws continue to encourage autonomy for young people, but family engagement is encouraged. According to the Revised Code of Washington (RCW 71.34.010):

 “Mental health and chemical dependency professionals shall guard against needless hospitalization and deprivations of liberty, enable treatment decisions to be made in response to clinical needs in accordance with sound professional judgment, and encourage the use of voluntary services. Mental health and chemical dependency professionals shall, whenever clinically appropriate, offer less restrictive alternatives to inpatient treatment. Additionally, all mental health care and treatment providers shall assure that minors’ parents are given an opportunity to participate in the treatment decisions for their minor children.”

Guidance for Information Sharing

Federal law, 42 CFR Part 2, restricts information sharing related to substance use, and clinicians cannot share that information without a patient’s written consent, regardless of whether the substance use co-occurs with mental illness.

Providers have discretion in determining what information about mental health diagnoses and treatment is clinically appropriate to share with parents of an adolescent 13-17. A provider retains discretion in withholding information from family/caregivers to protect an adolescent’s well-being. In general, the Adolescent Behavioral Healthcare Access Act encourages sharing information to support collaboration between the clinical setting and home. Specifically, providers and families are encouraged to discuss:

  • Diagnosis
  • Treatment Plan and Progress
  • Recommended medications, including risks, benefits, side effects, typical efficacy, dosages and schedule
  • Education about the child’s mental health condition
  • Referrals to community resources
  • Coaching on parenting or behavioral management strategies
  • Crisis prevention planning and safety planning

Information about state laws related to Behavioral Health Services for Minors is available through the Washington State Legislature website under RCW 71.34.

Information about child and youth behavioral health services in Washington State is available from the Health Care Authority (HCA).