“The mission of the Mental Health Division is to promote recovery and safety.”
Parents' Guide to the Mental Health System
2007 A Parents Guide (MS Publisher)
Does my Child Need Mental Health Treatment?
Mental health problems or issues affect the way we think, how we feel and what we do. Symptoms vary and are sometimes difficult to identify. Pay attention if your child:
Is troubled by feeling:
- Really sad and hopeless without good reason
- Worthless or guilty a lot and the feelings don't go away
- Very angry most of the time
- Anxious or worrying more than others of similar age
- Extremely fearful-has unexplained fears or more fears than most kids
- Constantly concerned about physical problems or appearance
- Frightened that his or her mind is controlled or is out of control
Experiences big changes such as:
- Doing much worse in school
- Crying a lot and overreacting to things
- Losing interest in things usually enjoyed
- Having unexplained changes in sleeping or eating
- Avoiding friends or family and wanting to be alone all the time
- Feeling life is too hard to handle or considers suicide or doing things that are life threatening
- Hearing voices that cannot be explained
Is limited by:
- Poor concentration; inability to sit still or focus
- Thoughts that race; almost too fast to follow
- Worrying about being harmed or hurting others
- Inability to get over a loss or death of someone important
Behaves in a way that causes problems such as:
- Eating large amounts of food then making self vomit or diets excessively
- Constantly violating rights of others or disregards rights of others
- Performing same actions repeatedly or obsessing on a thought or idea
How do I Access Public Mental Health Services?
Crisis Services
Crisis services are available to everyone through the public system at no cost. If your child is in a mental health crisis, call the crisis line for your region. Help is available 24 hours every day. Crisis line staff will assess the situation and if necessary, send someone out to evaluate your child. Crisis services may include an assessment of the need for hospitalization. If there is a life threatening emergency, call 911.
Public Mental Health Services
If you are on Medicaid, you have medically necessary mental health benefits. You can only access public mental health services from licensed agencies authorized by Regional Support Networks. Outpatient and acute inpatient services must be authorized by the RSN. If you access services from a provider not authorized by the RSN, you may be responsible for the cost of the services.
Outpatient Services
If you receive public services, where you live will determine which mental health agency will provide services to your child. Contact your local RSN listed on the back cover and request the name and phone number of the mental health agency serving your area. Call the mental health agency for an appointment. Your child will have to go through a screening and assessment process to determine whether he or she is eligible for services through the public system.
Acute Inpatient Services
Acute inpatient services are provided in an emergency situation when your child is gravely disabled or is likely to do serious harm to self or others as a result of a mental illness. A Mental Health Professional must evaluate your child's condition to make this determination. To access this service, call the Regional Support Network, or if there is a life-threatening situation, 911. For more information, contact your local mental health crisis line.
Long-term Inpatient Services
Long-term inpatient care is the most restrictive psychiatric setting for children in this state. Before pursuing this type of care, other less restrictive options must be considered. This type of care is only for children with the most severe and intensive needs. The child must meet state and federal guidelines for admission to a long-term inpatient facility. Contact your RSN for information regarding the admission process.
Private mental health services
We are including information about private mental health services in this section should your situation change and you obtain other insurance.
Washington Basic Health Plan: Washington Basic Health Plan has some mental health benefits. Check your plan for coverage.
Private insurance: You can purchase services directly from a private therapist, psychiatrist, community mental health center, or an acute inpatient facility.
Managed Care Organizations: Contact your customer service representative.
Military: Contact your Tri-Care representative at 800-404-5076.
Sliding fee scale: If your coverage has reached its limit or you have no insurance, you may be able to obtain services on a sliding fee scale. For more information, call the Regional Support Network or a mental health agency directly.
Other: Even if you have private insurance, your child's stay in a Children's Long-term Inpatient Programs facility will be publicly funded. The process to access this services is identical to that of the public system. See the CLIP Administration web site for more details.
It is important that you check with your insurer for required authorizations before seeking any type of care for your child.
Assessments and Service Plans
If your child is eligible for services through the public mental health system, the assessment process becomes even more extensive. The agency may gather records (school, medical, etc.), possibly perform diagnostic tests and interview family members. An individualized service plan will be created based on this assessment.
The assessment process must also look at your child's and family's strengths and needs. If the diagnostic process pays attention to only what is wrong and attaches a label to it in order to figure out how to fix it, children and families are then viewed as the problems they have. If the process pays attention to strengths and capabilities, the view becomes very different. Your child's and family's strengths should be the foundation on which the individualized service plan is developed. Your family's knowledge, interests, and abilities must be utilized in the plan.
You, your child, the clinician, and possibly a team of your choosing develops an individualized service plan. When developing services plans, remember that your child should be included in the community to the maximum extent possible. The service plan must be supportive of your family and contain goals that will help meet your family's unique needs. It should reflect the belief that you and your family know your needs best. The plan should be written in a way that is easily understandable to you and your child if applicable. The plan needs to be culturally competent, incorporating the religious customs, regional, cultural and ethnic values and beliefs of your family. The plan should contain objectives that share the workload among all involved to help your family reach your goals.
It is important for all involved to know if progress is being made. The plan must also include a way to measure progress toward the goals specified in the service plan. This will tell you if the plan is working or needs to be modified.
What is outpatient mental health treatment?
The vast majority of all mental health services is provided in the community on an outpatient basis. Increasingly, outpatient mental health treatment for children and youths is moving away from the traditional office visit.
- Therapy for children is more effective in familiar settings or while involved with other leisure time activities.
- Service plans should meet the needs of families across different areas such as family, living situation, educational/vocational, social/recreational, medical, legal, spiritual, and safety/crisis.
- Services plans should not only include services through the formal service system but also utilize resources within the community. This is part of helping your child have a lifestyle similar to that of other children. For example, instead of respite, your child might take an art class so you can have a break.
- Strengths of the family and child must be woven into the service plan.
- Although professionals can offer a great deal of assistance, they also recognize that the support of other parents who have faced similar circumstances is vital. They are increasingly referring parents to parent groups for support, information, and training.
Treatment could also include:
- Individual, family, or group therapy
- Prescribing and monitoring medications
- Education on the disorder, reducing stress, resources, problem-solving, and other subjects of interest to families
- Support groups and advocacy for families
- Case management to help coordinate services
- Referral to organizations in your community
Treatment is only effective if it is individualized and tailored to meet the needs of your child and family.
What if my child needs acute (emergency) psychiatric hospitalization?
Acute psychiatric hospitalization is to evaluate, diagnose and stabilize your child's acute symptoms and is of very short duration. If you feel your child needs acute inpatient mental health care, you will need to obtain an evaluation to determine if inpatient treatment is medically necessary. Call your RSN crisis line to request an evaluation or call one of the facilities listed below. If a Mental Health Professional (MHP) determines that your child cannot be treated safely in an outpatient setting, the MHP will assist you in locating an appropriate treatment facility.
Your child age thirteen or older, has the right to make decisions concerning his/her treatment and to give consent for that treatment.
The primary specialty providers of acute inpatient care for children are:
Facility Telephone Children's Hospital Regional Medical Center
4800 Sand Point Way NE. Seattle, WA 98105(206) 987-2195
(866) 987-2000Fairfax Hospital
10200 NE 132nd Street, Kirkland, WA 98034(425) 821-2000
(800) 435-7221Lourdes Counseling Center
1175 Carondelet Drive, Richland, WA 99352(509) 943-9104 Sacred Heart Medical Center
101 West Eighth Avenue Spokane, WA 99220(509) 474-4818 There are no magical places or magic fixes. Your participation is vital in the stabilization process and discharge planning to return your child to the community. Recovery and building resilience is hard work for your child, your family and you. There will be setbacks, feelings of hopelessness and isolation, successes, joy, and satisfaction. Find other parents who can help you through the rough times and celebrate successes with you. They can give you ideas and strategies based on their experiences. They can also provide you with information on resources in your community. Contact a parent group for assistance.
What if my child needs long-term inpatient care?
The Children's Long-term Inpatient Programs (CLIP) has the capacity to care for ninety-six children at any one time in five facilities. These facilities are not a residential solution or for emergency use. The focus is evaluation, diagnosis and stabilization so your child will be able to live a lifestyle as close to that of other children in your community. Since capacity is limited, there maybe a waiting period before admission.
CLIP is the most restrictive psychiatric setting for children in this state. You must give careful consideration before pursuing placement.
- Are there other ways to get my child's needs met in the community?
- Can I get what I need to keep my child at home and everyone safe?
- Will the benefits of residential treatment outweigh the negative effects an out-of-home placement will have on my child?
- What outcomes do I want for my child? Will a CLIP stay facilitate these outcomes?
Admitting your child to a CLIP facility is an overwhelming experience. Most CLIP facilities employ Parent Advocates who are parents of children with emotional, behavioral or mental disorders. Request a Parent Advocate at intake. The Parent Advocates provide information, emotional support, and can assist with resolving differences.
Call a parent organization and ask to speak to other parents who have had children in CLIP facilities. Ask them about their experiences and what impact it had on their child and family. Arrange a visit to the facility and ask to talk with staff. Make it a point to speak with the Parent Advocate either by phone or in person. Discuss whether the outcomes you are looking for are realistic. Do your homework; ask questions.
What are my rights and those of my child?
You and your child have a right to confidentiality of all treatment records. However, information can be released only to individuals and agencies as specified in writing through a signed Release of Information except under the following conditions:
- By a court order
- If abuse and/or neglect is suspected
- In a mental health or medical emergency (danger to self/others)
Parents can sign a Release of Information for any child under thirteen years of age. If records concern anyone over the age of thirteen, that individual must sign the Release of Information.
Here are examples of rights you and your child have:
Grievances
- Be treated with respect and dignity
- Have your privacy protected
- Help develop a plan of care with services that meet your needs
- Participate in decisions regarding your mental health care
- Receive services in a barrier-free location (accessible)
- Request information about names, location, phones and languages for local agencies
- Receive the amount and duration of services you need
- Request information about the structure and operation of the RSN
- Services within 2 hours for emergent and 24 hours for urgent care
- Be free from use of seclusion or restraints except when three is imminent danger to self or others and other less restrictive measure have been ineffective
- Receive age, linguistically and culturally appropriate services
- Be provided with a certified interpreter and translated material at no cost to you
- Refuse any proposed treatment
- Understand available treatment options and alternatives
- Be free of any sexual exploitation and harassment
- Receive an explanation of all medications prescribed and possible side effects
- Receive quality services that are medically necessary
- Have a second opinion from a mental health professional
- File a grievance with your agency or RSN
- Choose a mental health care provider or choose one for your child who is under thirteen years of age
- Change mental health care providers during the first 30 days, and sometimes more often
- File a request for an administrative (fair) hearing
- Receive a copy of your medical records and request changes
- Be free from retaliation
Try to resolve differences at the lowest level possible. Be specific about what you are dissatisfied with and clear about what you consider to be an acceptable solution. First, try to work things out with the person directly. If that doesn't work, agencies have their own grievance processes.
If you are unable to resolve differences at the agency level, the RSN has a grievance process. Ombuds services are available to assist you with resolving differences and filing grievances at the agency and RSN levels.
If you are not satisfied with the outcome of the grievance, under certain circumstances you can have your grievance heard by the MHD.
You can request an Appeal at the RSN/PIHP concerning denial, reduction, termination or suspension of services by the RSN/PIHP. You also have the right to file for an administrative (fair) hearing with the Office of Administrative Hearings (OAH) for violations of state regulations. You can contact the OAH at 1-800-583-8271.
Each CLIP facility also has its own complaint and grievance processes. You can obtain copies of these processes from the facility. The Parent Advocate at the facility can assist you with resolving conflicts.
Common Acronyms Used in Mental Health
Diagnostic classifications can be found in a book called the Diagnostic & Statistical Manual, Fourth Edition, more commonly known as the DSM IV. This is one resource you can use to learn more about your child's diagnosis. The DSM IV can be found at mental health centers or in libraries.
Tips from parents for parents
- Take care of yourself; your child needs you
- You are your child's best advocate; be assertive, not aggressive
- You are the expert on your child; professionals are experts on children
- Make educated choices: listen, ask questions, read your child's records and then learn everything you can about your child's disability, medications, treatment, etc.
- Start your own file on your child: gather your child's records, keep notes from meetings and telephone calls, copies of written communication, etc.
- Don't go to meetings alone
- Don't expect systems and professionals to do it all, do it together
- Get involved in a way that is meaningful to you and your child
- Stop playing the blame game and trying to figure out who's right, who's wrong; build partnerships and focus on strengths
- Anger consumes too much time and energy; put the time and energy into more constructive uses
- Keep an open mind; there are different ways to look at the same situation, different answers to the same question and different paths to the same place
- What are you willing to contribute to the partnership?
- If the language is too technical, ask for definitions; if you don't understand, ask questions. Have your own advocate.
- More isn't better; focus on your child's needs, not what you can get for your child
- Follow through
- Sometimes you need to let go of dreams you had for your child so you can dream new dreams with renewed hope
- If you are waiting for someone to give you what your child needs, it may not happen in his/her lifetime
Other Services for Children and Families
Children's Administration 1-800-723-4831
Within the Children's Administration (CA), the Division of Children and Family Services (DCFS) is the provider of client services. Children and families enter DCFS through three primary programs, Child Protective Services (CPS), Child Welfare Services (CWS) and Family Reconciliation Services (FRS). DCFS is responsible for the investigation of child abuse and neglect complaints, child protection, family preservation, family reconciliation, foster care, group care, independent living, and adoption services for children age 0 to 18 years. Listed below are a few of the services. For more information about services, contact your local DCFS office listed in the blue pages of your phone directory.
Family Reconciliation Services (FRS)
Phase I (Intake and assessment) and Phase II (fifteen hours of in-home crisis counseling) focused on resolving family differences and preventing out of home placement.Crisis Residential Centers (CRC)
A short-term placement (average 72 hrs.) with counseling services to resolve family differences and reunite the family.At Risk Youth Petition (ARY)
Parents petition the juvenile court to assist them in keeping their child at home and setting reasonable rules that the youth must comply with.Children In Need of Services Petition (CHINS)
Petition filed with the court for a 90-day out of home placement while the family tries to work out their differences.Child Protective Services (CPS)
CPS seeks to assure the safety of children. This can be accomplished by educating parents, helping families obtain services needed to build better family relationships or removing the child from the home.Division of Developmental Disabilities (360) 902-8444
Any person with a developmental disability that starts before age 18 and is expected to continue indefinitely may be eligible for services. Developmental disabilities include mental retardation, developmental delay (ages birth to six), cerebral palsy, epilepsy, autism, and or other neurological conditions similar to mental retardation. Contact your local office for information.
Services that may be provided include:
- Case management which includes development of an individual service plan
- Family Support
- Employment and day programs
- Early intervention services
- Therapeutic and other professional services
- In-home nursing through the Medically Intensive Program
- Array of in-home and out-of home residential support services including voluntary foster care, group homes, supported living, Medicaid personal care and Residential Habilitation Centers (residential institutions).
Division of Alcohol & Substance Abuse 1-877-301-4557
The Division of Alcohol and Substance Abuse (DASA) contracts with local providers to address chemical abuse and dependency issues, which may be related to a mental health concern. Chemical dependency treatment can be in an inpatient or outpatient program dependent upon the needs of the child and family. Other services include:
- Vocational/employment programs
- Transitional housing
- Outreach
- Childcare
- Case management
Parents have the right to request an inpatient program for their child without the child's consent. If you feel your child is in need of treatment, call a treatment program directly for an assessment. State funding may be available for low-income families for some treatment costs. Individual programs determine eligibility. Youth/families on medical coupons are eligible for DASA funded treatment. For information about treatment programs, contact the 24-Hour Alcohol/Drug Helpline at 800/562-1240.
Division of Vocational Rehabilitation 1-800-637-5627
An individual is eligible for services if they have a physical or mental impairment that keeps them from working and they require vocational rehabilitation services to prepare for, obtain, or retain employment. Contact your local office for information.
Services that may be provided include:
- Medical evaluation to determine strengths and vocational limitations
- Vocational assessment
- Treatment for physical and mental disabilities that impede employment
- Job preparation, training and placement
- Job site analysis and rehabilitation technology
- Follow-up services
- Employment support
- Assistance with independent living
- Transition from school to work
- Counseling and guidance
- Support services
Office of the Superintendent of Public Instruction (360) 725-6000
The Office of the Superintendent of Public Instruction (OSPI) allocates available resources to local school districts which provide programs for students with disabilities.
Through local school districts, the public education system provides Special Education Services to students who meet the eligibility criteria of the federally authorized Individuals with Disabilities Education Act (I.D.E.A.). Services are provided according to each student's Individualized Education Plan (IEP) which is jointly developed by educational staff and parents. Local schools are also required to provide accommodations to students with disabilities under Section 504 to aid students in achieving success in learning.
The Readiness to Learn program is a link between education and social services. The goal of the Readiness to Learn program is to coordinate and/or provide community resources for children and families in order to remove barriers to learning that may limit their engagement in the public school system.
For further information contact your local school district.
Other Resources
SAFE WA 866-300-1998
Statewide Family NetworkA Common Voice for Pierce County Parents (253) 537-2145
Pierce County Parent GroupARC of Washington State 360-357-5996
A Village Project Parent Partners (253) 670-3480
King County Parent GroupBRIDGES to Parent Voice (360) 698-4668
Contact: Pat Lovett Clallam, Jefferson, & Kitsap Counties Parent GroupsCLIP Parent Steering Committee (253) 229-1990
Contact: Paulena PerryCommunity Connectors 800-446-0259 extension 3
Statewide Parent networkFamily Voices 360-866-8254
Parent groupFetal Alcohol Syndrome Family Resources Institute 800-999-3429
NAMI WA (360) 647-4950
Whatcom CountyOffice of Consumer Affairs 1-800-446-0259
Washington State Mental Health DivisionParent Navigators 509-527-3278
Walla Walla County Parent groupParent Partners 360-397-2130
Clark County ProgramSpokane Parent Coalition (509) 892-9241
Spokane County Parent groupR.A.E.S.(509) 664-3223
Chelan and Douglas Counties Parent groupUnited Voices - Tammy Walker (206) 220-6873
King County Parent groupWashington PAVE 800-572-7368
(Assistance with school issues)Washington Protection and Advocacy Agency 800-562-2702
