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.

What’s Next? High School Transition Planning Timeline

High School Transition Planning Timeline

Click to print out this graphic

Description of the above graphic:

What’s Next?

High School Transition Planning

Mapping the Future

Check these milestones to ensure high school paves a pathway for young adult success and achievement!

Ages 13-14
Student begins High School and Beyond Plan in Middle School—a WA State requirement for all students.

Ages 15-16
IEP includes a Transition Plan, aligned with High School and Beyond Plan. Student is a member of the IEP team, which plans a pathway toward a diploma and target graduation date.

Age 16
Get state identification card. Consider Pre-Employment Transition Services from DVR/DSB or School-to-Work planning with DDA.

Ages 17-18
Coursework, IEP, High School and Beyond Plan, DDA/DVR all support student’s life goals and progress toward a diploma.

Age 18
Register to vote! Participate in Commencement and senior year activities, regardless of when diploma is earned.

Ages 18-19
Student may continue education in a high school transition program.

Ages 20-21
Student earns a diploma. May apply for individualized employment support from DVR/TVR/DSB or DDA.

DVR: Division of Vocational Rehabilitation

TVR: Tribal Vocational Rehabilitation

DSB: Department of Services for the Blind

DDA: Developmental Disabilities Administration

Download this graphic to print and keep handy!

Need more information? Consider reading the article School to Adulthood: Transition Planning Toolkit for High School, Life, and Work

Supported Decision Making is an Option for Adults with Disabilities

A Brief Overview

  • In Washington State, Supported Decision Making (SDM) is a legal option for supporting a person with a disability after their 18th birthday.
  • The format for an SDM agreement is up to the individual and their supporters. A sample form is available for download from WashingtonLawHelp.org.
  • The final section of this article provides information about other options to support and protect a loved one with a disability.
  • Help is available from the Developmental Disabilities Ombuds.

Full Article

When a young person turns 18, most decisions are now up to them. In Washington State, age 18 is the “age of majority,” which means a person 18 or older has the right to make their own decisions about education, work, money matters, voting and more.

Note: In Washington the age of independence for health care decisions is 13, with some behavioral healthcare exceptions related to Family Initiated Treatment (FIT).

When a person 18 or older has a disability, family members may want to stay involved in helping them make decisions. Supported Decision Making (SDM) is the formal name for one legal option.

Washington law (Chapter 11.130 in the Revised Code of Washington) includes Supported Decision Making as an option under the Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act. The law changed in 2020 when the state passed Senate Bill 6287. The changes took effect Jan. 1, 2022.

The law includes Supported Decision Making as an alternative to more restrictive arrangements that put limits on an individual’s rights. The final section of this article includes information about other options, such as guardianship.

What is Supported Decision Making?

Supported Decision Making (SDM) is an agreement to make sure an adult with disabilities has trusted helpers watching out for their well-being. An SDM agreement does not remove the adult individual’s rights but creates a way for the individual and their supporters to make choices together.

For example, a student older than 18 who receives special education services at school might agree to have their parent continue to participate in decisions about their Individualized Education Program (IEP). Parent and student then work together as members of the IEP team.

Supported Decision Making may be combined with a Person Centered Plan to ensure that a person has circles of support as they work toward adult life goals. Like Person Centered Planning, SDM changes with the needs of the individual and their supporters.

What should be included in the agreement?

An agreement for Supported Decision Making is written to meet an individual’s needs and preferences. For example, a person might choose support in one or more of these areas:

  • Medical care
  • Dating or sexual intimacy
  • Living arrangements
  • Employment
  • Education
  • Finances

The agreement includes the names of supporters and their relationship to the person. Supporters might be:

  • Parent
  • Other family member
  • Friend
  • Trusted professional
  • Someone else

The agreement is signed in front of a Notary Public by the adult with disabilities and all selected supporters. Everyone must provide picture identification for an in person signing or follow alternative identity verification methods for an online signing.

How to document their SDM agreement is up to the individual and their supporters. A sample form is available for download from WashingtonLawHelp.org. The sample form offers the following suggested language:

“My supporter is not allowed to make decisions for me. To help me with my decisions, my supporter may:

Help me access, collect, or obtain information that is relevant to a decision, including medical, psychological, financial, educational, or treatment records;

Help me understand my options so I can make an informed decision; and

Help me communicate my decision to appropriate persons.”

The suggested format includes options for the individual to choose whether selected supporters will have access to protected health information under the Health Insurance Portability and Accountability Act (HIPAA) or educational records under the Family Educational Rights and Privacy Act (FERPA).

Is Supported Decision Making free?

There may a small cost to get a document signed in front of a Notary Public.

TIP: If someone on the agreement has a bank account, their bank may provide free Notary services. Public libraries and county courthouses are additional places to ask about free options to have a document notarized.

The SDM agreement does not have to be filed with a court, but it is a legal agreement.

Resources for Supported Decision Making

What if my family wants another choice for support and protection?

Supported Decision Making is one option when a family wants to support and protect a loved one with a disability. Below are options that may involve legal assistance and/or a court process. Washington Courts provides information about various types of courts and how to find them within the state.

Guardianship of an Adult: A court-appointed person makes decisions for the adult with disabilities. Guardianship may be combined with Conservatorship (see below). Guardianship is the most restrictive option and may not be granted unless there is evidence that less restrictive alternatives are unworkable.

Conservatorship of an Adult: A court-appointed person makes property and/or financial decision for the adult with disabilities. Like guardianship, the petition may be denied if less restrictive options are not tried first.

Informed Consent: This is a limited option for supporting medical decisions when a health care provider determines that an individual is unable to properly understand their condition or make fully informed decisions (RCW 7.70.065). Note that an individual with a Supported Decision Making (SDM) agreement may be able to demonstrate they can make their own decisions about healthcare with the help of their supporter.

Power of Attorney: An individual can sign a legal document to give someone else power to make decisions in their behalf under limited or general circumstances. A Mental Health Advance Directive, to be invoked if someone with a mental illness loses capacity, is an example of a limited Power of Attorney document that an individual might choose to sign. Washington Law Help provides a Q and A on Powers of Attorney.

Special Needs Trust: An account can protect funds for individuals receiving Supplemental Security Income (SSI) and/or Medicaid. A Trustee is appointed to manage the funds, which commonly are used to pay for things that SSI or Medicaid benefits do not cover. Trustees are legally responsible if they do not use the Trust for the benefit of the individual. Washington Law Help provides information on Special Needs Trusts.

Representative Payee: The Social Security Administration (SSA) may determine that an individual receiving benefits needs a payee to manage their income. If an individual disagrees with the administration’s decision to appoint a payee, they must present evidence of their ability to manage their money. Disability Rights Washington (DRW) provides information about how to change, remove or report a representative payee.

Protective Arrangement: A court-appointment person makes decisions for the person with disabilities related to specific and limited conditions, such as specific medical decisions or contact with a specific individual who might cause harm. The Vulnerable Adult Protection Act provides protection to adults in Washington State who meet one or more of these criteria:

  • 60 or older and functionally, mentally, or physically unable to care for themselves
  • Have a court-appointed guardian
  • Have a developmental disability
  • Live in a nursing, adult family, or boarding home or other facility
  • Served by home health, hospice, or home care agencies
  • Receive services from an individual care provider or personal aide

NOTE: Anyone who suspects physical harm, someone being held against their will, sexual abuse, neglect, financial exploitation, or abandonment can call Adult Protective Services: 1-877-734-6377 or Report Online.

Additional Resources

Legal Disclaimer: It is the policy of PAVE to provide support, information, and training for families, professionals, and interested others on a number of topics. In no way do these activities constitute providing legal advice. PAVE is not a legal firm or a legal services agency and cannot provide legal advice. The information within this article is not intended as legal advice and should not be used as a substitution for legal advice.

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.

After you view the video, please take a quick moment to complete our survey. Your feedback is valuable!

Healthcare Transition and Medical Self-Advocacy

When young people turn 18, a lot happens. Adult responsibilities and decisions can feel scary and confusing for the unprepared. Becoming responsible for medical care is part of growing up, and that process is so critical that there’s a specific name for it: healthcare transition.

For example, at age 18 a young adult is responsible to sign official paperwork to authorize procedures or therapies. They must sign documents to say who can look at their medical records, talk to their doctors, or come to an appointment with them. Those rules are part of HIPAA, which stands for the Health Insurance Portability and Accountability Act. HIPAA is a federal law that protects confidentiality, regardless of disability.

In this video, young adults living with various disability and medical conditions talk about their journeys in the adult healthcare system. They talk about how they make decisions and how they ask for help. Their ability to explain their needs, make decisions, and speak up for themselves is called self-advocacy. Take a look and listen to what they have to say in their own words!

For more information and resources around healthcare transition and self-advocacy, follow these links to the Family to Family Health Information website.

Another place for information is the Informing Families website, which includes a section called got transition.

Special Education Process Demystified in 10 Steps

Here is basic guidance about how special education works. For a bit more detail, visit the 10-Step Guide to the Special Education Process provided by Washington’s Office of Superintendent of Public Instruction (OSPI). Procedural Safeguards protect family and student rights throughout the process.

  1. Referral: Is there a known or suspected disability condition that may significantly impact educational access? If yes, family or anyone with knowledge of the student can request an evaluation from the school district in writing.
  2. Consent to evaluate: The school district has 25 school days to consider the referral and whether to evaluate. Family signs consent for an evaluation to begin.
  3. Initial Evaluation: The district has 35 school days to conduct an evaluation that comprehensively addresses all areas of suspected disability.
  4. Initial Evaluation Report: Family and school meet to review the findings. Discussion includes:
    • What did the evaluation find?
    • Is the student eligible?
    • What category of disability is the right fit for eligibility?
    • What services is the student eligible for?
    • Does the family have suggestions for goal areas or accommodations that school staff can consider for the initial IEP draft?
  5. Eligibility and Consent: For special education and related services to begin, family signs consent.
  6. Creating an Individualized Education Program (IEP): An IEP team meets within 30 days of the eligibility determination to write the IEP. 
    • A DRAFT IEP may be reviewed and discussed. Family can request a copy of the DRAFT before meeting.
    • The team decides what the final IEP includes.
    • School provides family with Prior Written Notice after the meeting to reflect the discussion and actions being taken.
    • Family has an opportunity to request further changes or more meetings.
  7. Special Education Begins: All teachers and service providers receive a copy of the IEP and implement the services, accommodations, and other elements of the program.
  8. Progress Monitoring and Annual IEP Review: The IEP team meets to discuss the program at least once a year. Changes can be made then or any time a team meeting is called because of concerns raised by the family or school.
  9. Reevaluation: The student is re-evaluated at least every 3 years to determine ongoing eligibility and to assess any needed changes to the program. If a student’s needs change, reevaluation can happen sooner.
  10. Transition: By the time a student turns 16, the IEP must have a plan in place for when the student will either graduate from high school or continue to receive school-based services, an option through age 21. Postsecondary goals drive the IEP process from that point forward.

Transition Training Series: Preparing for High School and Beyond (In English and Spanish)

English Video

Last month, PAVE partnered with Clark County to start the Family Training Series for families and educators supporting individuals with disabilities.  It is offered by the Clark County Developmental Disabilities Program, the Clark County Parent Coalition, the Vancouver, Camas, and Evergreen School Districts, PAVE, and ESD 112. While the information in the sessions are targeted for families and educators, it is valuable information for any county you find yourself in! Below is this training in Spanish.

Additional ideas and information are provided by ReadyWA.org, a coalition of state education agencies, associations, and advocacy organizations focused on student success beyond graduation. The agency provides an article: High School and Beyond Planning: What’s New for 2020-21. The article includes a section about aligning general education future planning with the IEP transition planning process and includes links to key documents in English and Spanish.  

Video en español

El mes pasado, PAVE se asoció con el Condado de Clark para iniciar la Serie de Capacitaciones para familias y educadores que apoyan a las personas con discapacidades.  Este entrenamiento fue ofrecido por el Programa del condado de Clark para discapacidades del desarrollo, la Coalición de Padres del Condado de Clark, los Distritos Escolares Vancouver, Camas y Evergreen, así como organizaciones como PAVE y ESD 112. ¡Aunque que la información de las sesiones está dirigidas a familias y educadores, es información valiosa para cualquier condado en el que usted se encuentre! Este video está en español para el apoyo de familias latinas.

Usted puede encontrar sugerencias e información en ReadyWA.org, que es una coalición de agencias estatales de educación, asociaciones y organizaciones que tienen como propósito ayudar a los padres de familia a defender a los derechos de sus hijos. También les ayuda a enfocarse en el éxito estudiantil que va más allá de la graduación de secundaria. Esta misma, proporciona un reportaje llamado:  High School and Beyond Planning: What’s New para 2020-21. Este reportaje incluye una sección que prepara a las familias en como planificar el proceso de transición del IEP e incluye enlaces o links claves proporcionados en inglés y español.

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).