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).
