“The mission of the Mental Health Division is to promote recovery and safety.”

Answers to Questions Parents Frequently Ask

OUTPATIENT SERVICES

How do I access mental health treatment through the publicly funded system for my child or adolescent?

Call the Regional Support Network (RSN) that serves the county you reside in and request the name and phone number of the mental health agency that serves your area.

Call the mental health agency for an appointment. They may do a screening over the phone and schedule an intake appointment.

Outpatient mental health services are provided by community mental health agencies. Services could be provided at the mental health agency, in your home, or elsewhere in the community.

What is a mental health assessment?

An assessment is a process performed by a clinician to determine if treatment is necessary, functioning level, the diagnosis and if your child meets the Access to Care Standards . Additional information will be gathered to determine medical necessity, the length and level of care. This is done through an interview with the youth and could include parents and other family members. The clinician will also ask for historical and family information. In this process, it is important to remember that this is about exploring solutions and not about blaming.

Information and records with the consent of the parent, legal guardian or youth if appropriate might be gathered from other sources. These could be medical, mental health, school, juvenile justice and other types of records.

The assessment also includes the child and family's strengths, needs and situation. The clinician might also perform diagnostic tests.

Based on the assessment, a determination of whether the individual meets all the following requirements to be considered for a level of care assignment:

The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the list of Covered Childhood Disorders.

The individual's impairment(s) and corresponding need(s) must be the result of a mental illness.

The intervention is deemed to be reasonably calculated to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness.

The individual is expected to benefit from the intervention.

The individual's unmet need would not be more appropriately met by any other formal or informal system or support

If a level of care is assigned, a decision on the appropriate course of treatment will be made by the parents or legal guardian, the child or adolescent if appropriate, and the clinician.

What is outpatient mental health treatment as provided by the public mental health system?

Community mental health agencies provide mental health services through contracts with the Regional Support Networks. Services could be provided at the mental health agency, in your home, or elsewhere in the community.

Treatment services should be individualized and tailored to meet the needs of your child and family.

Treatment modalities could be:

Brief intervention or individual treatment: A solution focused, outcomes oriented, time limited intervention designed to achieve goals identified in the treatment plan.

Medication management: The prescribing and/or administering and reviewing of medications and their side effects.

Medication monitoring: Cueing, observing, and encouraging consumers to take their medication as prescribed and reporting back to persons licensed to perform medication management services.

Psychoeducation: A set of activities that teach and explore the provision of emotional support, education, reducing stressors, resources, and problem solving skills to consumers and their family members.

Group treatment: Face-to-face activities provided by one or more staff to two or more individuals under the supervision of a mental health professional.

Family support: Support groups and advocacy to families to which there is a seriously disturbed child or adolescent.

Other services and supports as defined in the treatment plan.

What is the age of consent for outpatient treatment?

Youths age 13 and older can request outpatient services without the consent of the minor's parent. RCW 71.34.500

Parental authorization is required for outpatient treatment of a minor under the age of thirteen. RCW 71.34.500

Can a parent take a minor to a community mental health agency for an assessment without the consent of the minor?

YES: A parent may bring his or her minor child to a provider of outpatient mental health treatment and request that the minor be examined to determine whether the minor has a mental disorder and is in need of treatment. The consent of the minor is not required for evaluation. RCW 71.34.600

The professional person may do an assessment to determine whether the minor has a mental disorder and is in need of outpatient treatment. RCW 71.34.600

Community mental health centers primarily serve publicly funded clients. If you have private insurance, you may be eligible for services at a community mental health agency or one of your insurer's preferred providers.

For publicly funded services, an appointment is necessary.

Should my child or adolescent enter mental health treatment without my consent, what assurances do I have as a parent that he or she is seeing someone who has been trained to treat the concerns that my child is voicing?

All mental health professionals have to be licensed by the State Department of Health. There are licensing standards such as education, training, and experience.

Based on their education, training, and experiences, mental health professionals would know what appropriate course of treatment that best meets your child's needs.

If my child over thirteen is in treatment and believes his or her rights as a consumer has been violated, whom does my child contact?

Your child should first try to resolve the problem through the agency from which he or she is receiving service. Your child should request a copy of the agency's complaint/grievance procedures.

If the problem cannot be resolved at the agency level, your child should then contact the Mental Health Ombuds Service operating in the RSN through which your child is receiving services. The Ombuds will assist your child in filing a complaint or a grievance.

If your child or adolescent is not satisfied with the outcome of the grievance, your child can file for a fair hearing.

If I feel that the rights of my child over thirteen have been violated, can I file a complaint with the Ombuds? What are my other options?

Yes: you can file a complaint with the Ombuds. Prior to filing a complaint with the Ombuds, you should first speak with the person or the agency that is providing services to your adolescent.

You may speak with a person at the RSN.

You can also apply for a fair hearing.

Before you obtain information or can have information released to you, your adolescent will need to sign a release.

If my child has a substance abuse problem and mental health issues, can one treatment center help my child with both?

Both the public mental health and chemical dependency (Division of Alcohol and Substance Abuse) systems have specialists able to assess and diagnose a range of disorders. In the past few years, there has been an increase in the number of mental health providers that are also chemical dependency providers.

What is a crisis triage?

Crisis triage is a continuum of activities and services that provide a coordinated, integrated and multi-disciplinary approach to the assessment and stabilization of persons who are experiencing behavioral health crisis and the linkage of these persons to other needed supportive services.

If my child engages in treatment without my consent, am I financially liable?

No, you are not financially liable if you have not given consent. Once you give consent, you may be financially liable unless your child or adolescent is eligible for Medicaid.

INPATIENT SERVICES

What is acute psychiatric inpatient treatment?

Acute psychiatric inpatient treatment is provided in a community hospital or a certified freestanding Evaluation and Treatment facility (E&T facility) when a child or adolescent is in need of immediate inpatient mental health services due to the acuity of their mental illness.

For publicly funded services, a medical necessity determination is made by the RSN/PHP or Designated Mental Health Professional (DMHP). For privately funded services, the family's insurance company makes that determination. The length of stay in the hospital is variable, depending upon the child's needs.

The primary providers of acute inpatient services in Washington are:

Fairfax Hospital in Kirkland

Lourdes Counseling Center in Richland

Children's Hospital and Regional Medical Center in Seattle

Sacred Heart Medical Center in Spokane

Adolescent Treatment Unit in Bremerton

Services provided include stabilization, evaluation, psychiatric treatment and discharge planning.

What is long-term inpatient mental health treatment?

Washington State funds ninety-six beds in five inpatient treatment facilities referred to as the Children's Long-Term Inpatient Programs (CLIP).

Child Study and Treatment Center (CSTC) located in Lakewood is the only state operated hospital for children and youths.

The state also contracts with four other residential treatment facilities.

Tamarack Center in Spokane

Martin Center in Bellingham

McGraw Center in Seattle

Pearl Street Center in Tacoma

The CLIP Administration makes the determination of medical necessity for voluntary long-term inpatient care.

Adolescents committed for 180 days of involuntary inpatient treatment under RCW 71.34.750 are eligible for admission to any of the five CLIP facilities.

Depending upon the child's needs, services might include:

Individualized evaluations, assessments and care plans

Twenty-four hour psychiatric & nursing care

Medication

Safe, structured environment

Crisis stabilization

Behavior management

Family, group, and individual therapy

Full educational program on site

Social work/case management

Recreational, expressive, and leisure therapy

Social skills development

Dietary assessments & monitoring

Parent support and advocacy

Chemical dependency assessments & treatment

What is required to meet the condition of "medical necessity" for inpatient mental health treatment?

The state of Washington defines medical necessity for inpatient care as "a requested service which is reasonably calculated to diagnose, correct, cure or alleviate a mental disorder or prevent the worsening of a mental condition that endanger life or cause suffering and pain or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction and there is no adequate less restrictive alternative available." RCW 71.34.020 (12)

For publicly funded admissions, the RSN or the DMHP determines medical necessity for acute psychiatric care.

The CLIP Administration makes determination of medical necessity for voluntary long-term inpatient care regardless of whether the child has public or private insurance.

For both levels of care, adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet medical necessity through the detention and commitment process as defined in RCW 71.34.750

Federal requirements apply to all inpatient services provided to Medicaid clients.

Who can give consent for minors to be admitted to acute or long-term inpatient care?

Admission to any inpatient setting requires a determination of medical necessity, financial eligibility, and willingness of the program to admit the youth.

The following are referred to as voluntary admissions:

For all minors under 13 years of age, a parent must give consent.

A minor 13-18 years of age and their parents may jointly give consent.

A minor 13-18 years of age may give consent for admission without parental agreement.

The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.044

Involuntary admission:

In the event of any minor 13 years of age or older (and/or his/her parent) refuses admission, the minor may be evaluated and detained involuntarily by a DMHP (DMHP) in accordance with RCW 71.34.

If the DMHP makes a decision that the minor does not require inpatient treatment, the parent can seek review of that decision made by the DMHP in court. RCW 71.34

Parent initiated admission (an option created in 1995 through legislation known as the At Risk Youth or "Becca" bill):

A parent may give consent for admission of their minor child. The consent of the minor is not required. RCW 71.34

A parent may give consent for continued in patient care in the event his/her previously unwilling minor child requests discharge during an inpatient stay. RCW 71.34

Providers are not obligated to provide treatment to a minor under the provisions of this section. RCW 71.34 (4)

This is NOT considered an “involuntary admission” in spite of the fact it is against the minor's will.

Can a parent take a minor to an inpatient mental health treatment facility for an assessment without the consent of the minor?

YES: A parent may bring a minor in acute need of inpatient care to an evaluation and treatment (E&T) facility and request that the professional person examine the minor to determine whether the minor has a mental disorder and is in need of inpatient treatment. RCW 71.34.600-660 (1) NOTE: There are very few acute inpatient evaluation and treatment facilities in Washington State. A parent may NOT bring a minor to a CLIP facility for an assessment because CLIP facilities do not provide emergency or urgent care. They only provide long-term inpatient care.

The consent of the minor is not required for admission, evaluation, and treatment if the parent brings the minor to the facility. RCW 71.34.600-660(2)

A minor cannot be admitted to inpatient treatment unless it is medically necessary as a result of a mental disorder. RCW 71.34.052 (4)

Prior approval by the RSN is necessary for all admissions for publicly funded treatment in acute inpatient facilities.

What if a parent is unable to bring a minor child to a mental health treatment facility due to severe behavior problems?

While the law states that a parent can authorize the bringing of his or her minor child to an evaluation and treatment facility, it does not establish specific procedures, responsibilities or funding for transporting minors to an evaluation and treatment facility for evaluation of medical necessity for admission. It does not require law enforcement to transport or apprehend minors in these circumstances.

When called upon to assess whether a minor needs involuntary treatment, a DMHP may take the minor or cause the minor to be taken into custody and transported to an Evaluation and Treatment facility providing inpatient treatment. RCW 71.34.600-660

If the minor is not taken into custody for evaluation and treatment, the parent can seek review of the decision made by the DMHP in court. RCW 71.34.600-660

If my adolescent is involuntarily detained and I am not in agreement, what are my options?

Parents have the right to participate in hearings and be represented by counsel when decisions are made to involuntarily commit their minor. After the hearing, the final decision of the court is binding.

How can minors admit themselves to inpatient mental health treatment?

A minor thirteen years or older may admit himself or herself to an evaluation and treatment facility for inpatient mental health treatment without parental consent. RCW 71.34.500-530

The professional person in charge of the facility must agree that inpatient treatment is necessary because of a mental disorder and that it is not feasible to treat the minor in any less restrictive setting or the minor's home. RCW 71.34.500-530

Written renewal of voluntary consent must be obtained every twelve months and the need for continued inpatient treatment shall be reviewed and documented every one hundred and eighty days. RCW 71.34.500-530. NOTE: Given the short stays in acute inpatient care, this rule only applies to minors being served in CLIP facilities. Even in a CLIP facility, this type of admission rarely, if ever occurs.

What notification responsibilities does the treatment facility have when an adolescent admits him or herself to the facility without the consent of the parent?

The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.500-530

Can someone from another system refer a minor for mental health inpatient treatment?

YES: The referral process, the prior authorization process, and the process of obtaining consent are the same regardless of who initiates the referral.
o School district personnel who refer minors to an inpatient treatment program must notify the parents within forty-eight hours. RCW 71.34.500-530.

A child in the legal custody of the Division of Children and Family Services may be referred by their Department of Social and Health Services (DSHS) social worker. However, the child's parent must provide the consent for the admission. In an emergency and if the parent is unavailable, the social worker may give consent for an inpatient admission. However, a court hearing must occur by the next judicial day and a judge must authorize that emergency consent. A judge cannot order any child into inpatient treatment except in accordance with RCW 71.34.

Can youths sign themselves out from an inpatient mental health facility without the consent of their parents?

Any minor thirteen years or older who voluntarily admitted to an evaluation and treatment facility with the consent of his/her parents may give notice of intent to leave at any time.

The notice has to be written and intent discerned.

The professional person must discharge the minor from the facility immediately upon receiving the notice of intent to leave. RCW 71.34.500-530

Any minor thirteen years or older who voluntarily admitted to an evaluation and treatment facility without the consent of his/her parents may give notice of intent to leave at any time.

The notice has to be written and intent discerned.

Copies of the notice shall be sent to the minor's attorney if any, the DMHP and the parent.

The professional person shall discharge the minor by the second judicial day following receipt of the minor's notice of intent to leave. RCW 71.34.500-530

Under a “parent-initiated” admission :

A minor receiving inpatient treatment cannot be discharged from the facility based solely on his or her request. RCW 71.34.052.

The minor admitted under this section may, however petition the superior court for release from the facility. RCW 71.34.052 (6)

Minors involuntarily committed for 180 days of inpatient treatment cannot legally sign themselves out of treatment.

Do youth sometimes run away from inpatient mental health treatment facilities?

Youths may be able to run from inpatient facilities despite the best efforts of facility staff.

If this happens, extensive efforts are made by the treatment program to contact parents, police, probation and other entities to work to support the safe return of the youth to the inpatient treatment program.

In CLIP facilities, the treatment bed can be held open for a short time in order to provide immediate re-admission for a youth who is expected to return.

Is there financial assistance to help pay for inpatient mental health treatment?

To be eligible for public funds to help pay for acute inpatient treatment, the family must qualify for public assistance through the local DSHS Community Service Office.

All minors certified for admission to publicly funded CLIP beds are eligible for Medicaid funding for that inpatient stay based upon his/her own income.

Is there financial assistance to help with the transportation of a youth to an inpatient residential treatment facility?

DSHS and/or the RSN may be able but are not required to assist with transportation costs to an inpatient residential treatment facility.

Necessary transportation for minors committed to a state facility for 180 days of involuntary treatment shall be provided by the DSHS in the most appropriate and cost-effective means. RCW 71.34.790

If a minor is not accepted for admission or is released by an inpatient evaluation and treatment facility, the facility shall release the minor to the parents or other responsible person. If not otherwise available, the facility shall furnish transportation for the minor to the minor's residence or other appropriate place. RCW 71.34.780 (3)

Are there waiting lists for inpatient treatment?

YES: Given the scarcity of acute inpatient beds for minors, there may not be a bed available immediately.

For long-term inpatient care, CLIP has the capacity to serve ninety-six children and adolescents at any one time. There is always a waiting list for admission to CLIP. However, the amount of time a child or youth waits varies greatly depending upon many factors. The RSN involved in assisting the family with a referral to CLIP can get more up to date information about current availability at the time of referral to CLIP.

Your mental health provider and other supports and services may continue to provide outpatient services to your child until he or she is admitted to an acute inpatient or CLIP facility.

If my adolescent is in inpatient treatment and feels that his/her rights have been violated, whom can they contact?

Your adolescent can:

File a grievance with the inpatient provider.

File a grievance with the Mental Health Ombuds service from his/her home region.

Apply for a fair hearing.

The adolescent may seek the assistance of his or her attorney.

What is a Less Restrictive Alternative (LRA)?

A less restrictive alternative (LRA) is outpatient treatment provided to a minor who meets criteria for commitment but is not residing in a facility providing inpatient treatment. If the court finds that the minor meets the criteria for commitment, the court can either authorize commitment of the minor for inpatient treatment or for a less restrictive alternative treatment. Release under a less restrictive alternative is subject to conditions set by the court.

If the professional in charge of the outpatient treatment program or a DMHP determines that a minor is failing to adhere to the conditions of the court for a less restrictive alternative treatment or conditions for the release or if there is deterioration in functioning, the child can be taken into custody and transported to an inpatient evaluation and treatment facility. The DMHP must then file a petition with the court for revocation of less restrictive alternative treatment. RCW 71.34.740 (5), RCW 71.34.740 (10).

Can a minor in inpatient treatment be sent to a juvenile detention center because of destructive or assaultive behaviors?

Yes: Laws still apply in hospital facilities. Law enforcement can be called if the behavior of the child or adolescent is beyond the staff's ability to control the child.

Safety of other clients and staff is of primary concern.

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For more ways to get in touch with the Department of Mental Health Services, go to the DSHS Contact Information Web page. Mental Health Related Questions Contact: