navigating the mental health rights of children · to self, others, or gravely disabled as result...
TRANSCRIPT
Navigating the Mental Health Rights of ChildrenJessie Conradi Slafter, J.D., M.S.W.East Bay Children’s Law Offices
Introductions & Objectives The Age of Maturity – Pop QuizBasic Principles of Mental Health Services The Right to Adequate Mental Health Care Zoom In: Medi-Cal, School-Based Services, & Juvenile CourtsZoom In: Psychiatric HospitalizationsZoom In: Parents’ & Children’s RightsFinal Thoughts: Psychotropic Medications & Teamwork
Overview
Understand different systems & funding streams through which a youth can receive inpatient or outpatient services.
Describe the underlying legal principles of adequate mental health treatment
Plan stronger collaborative efforts with providers in other fields that are contiguous to psychiatry, including law, education, public health, child welfare, behavioral health, and others.
Objectives
Know different age limits for youth rights to treatment, mental health services, and other autonomy-related activities.
Differentiate between different categories of hospitalization for minors and what rights are triggered by increasing levels of hospitalization.
Educate our peers and minor clients on their rights in different systems.
Objectives
POP QUIZ!How old does a child need to be to….
How old does a child need to be to…
1. Rent a car without an extra fee?
2. Consent to mental health treatment?
3. Apply for emancipation?
4. Must be interviewed by a dependency attorney?
5. Fly alone?
6. Object to termination of parental rights?
7. Apply for a work permit?
8. Invoke privilege?
9. Have Prefrontal cortex fully developed?
10. Refuse medication?
1. 25
2. 12, if….
3. 14
4. 4
5. Age 5…
6. 12
7. 14, finished 7th grade…
8. 12
9. 25
10. Trick Question!
Basic Principles of Mental Health Services
Least Restrictive Environment
Community-Based Services
Non-pharmacological services before pharmacological services
Team Based Decision Making/Youth Voice
Targeted and Evidenced Based Services
The more acute, the more limited the rights
Let’s Get Some Services!Where do we begin?
What Kind of Help Do I Need? Where are the issues?
Assessment, Screening, and Diagnosis
Outpatient therapy
Developmental Services
School-based services
Psychotropic medication
Inpatient Psych Services
Residential Treatment
Locked facility
Right to Adequate Mental Health Care
EPSDT/Medicaid (insurance, medical necessity, need, diagnosis)
Katie A. Services: Intensive Care Coordination, Intensive Home Based Services, Child and Family Team, strength-based and trauma informed.
IDEA (IEP)
Americans with Disabilities Act (504 plan)
Regional Center Services
Other services
Who are the Players?Child
Parents and Legal Guardians
Public Health Nurse
Therapists, Case Managers, Other Providers
Psychiatrists
Other Caregivers
Schools
Community Supports
In Court Systems:
Child Welfare Worker/Probation Officer
Child’s Attorney (Dependency or Public Defender)
County Counsel/District Attorney
Parents’ Attorneys
Court
Court Reviewers
Who is paying?
School
Private Insurance
Medi-Cal
Foster Care
Probation
Mental Health Services Act
Out of Pocket
Free Services
Others?
Zoom InMedi-Cal, School-Based Services, System-Involved Youth
Medical Necessity for SMHS
Full Scope Medi-Cal
Diagnosis (Medical Provider)
TargetedTreatment
Medi-Cal
School-Based Services
504 Plan• Section 504 of the Americans with Disabilities Act
(ADA)• Team is familiar with the child, less specific players• Less formal requirements for notice, evaluation, goals
Individualized Education Program (IEP)• Individuals with Disabilities Education Act (IDEA)• Specific rules about who is involved in
assessment/team• Stricter notice and evaluation requirements
Juvenile Court SystemsChild Welfare
When a child is identified under WIC 300 as an abused or neglected child, a case will initiate in the dependency court.Varying degrees of supervision, restriction of parental rights, delegation of consent, confidentiality, and authorization to release records.Parens Patriae (parent of the nation): The court has the power to intervene on behalf of an abused or neglected child.
DelinquencyWhen a child is charged with an offense or agrees to participate in a diversion program, a case will be opened in the delinquency court.Child may be placed on probation, made a ward of the court, and may be removed from the custody of the parent depending on the circumstances of the case.
In which system is the child?
Child Welfare or Delinquency System (a court finding has been made that the child needs assistance)
Other Systems (guardianship, education, psychiatric facility) or no system
Where is the child?
When the child has been placed out of home, it is more likely that the parents’ rights have been limited
The more acute the child’s mental health crisis, the more limited the process
Foster Youth Bill of RightsThe right to be treated with respect.
The right to adequate living conditions.
The right to adequate voluntary medical, dental, and psychiatric care.
The right to fair treatment in administering rewards and punishments.
The right to contact with family members, county social workers, other supportive adults.
Education, job, clothing, allowance, social contacts and community involvement.
No comparable bill of rights for wards committed to the probation system.
Zoom InPsychiatric Hospitalizations
Psychiatric HospitalizationLanterman Petris Short Act
5585•72 hour hold for a minor for treatment and/or evaluation.
5150•72 hour hold for any person, includes many rights. Standard: danger
to self, others, or gravely disabled as result of mental health disorder.
5250•Up to 14 day hold under same standard. Additional rights to
hearing and patients’ rights advocate.
TCon•30 days with court date set, public defender and conservator
appointed. Can be in locked facility – only one in California.
Psychiatric HospitalizationGrave Disability
“Gravely disabled minor” means a minor who, as a result of a mental disorder, is unable to use the elements of life that are essential to health, safety, and development, including food, clothing, and shelter, even though provided to the minor by others. Intellectual disability, epilepsy, or other developmental disabilities, alcoholism, other drug abuse, or repeated antisocial behavior do not, by themselves, constitute a mental disorder.
Psychiatric Hospitalization
Parent or conservator can voluntarily hospitalize a minor, allowing that they may leave if they request it of the hospital administrator.
Minors can refuse medications. A psychiatrist may request a medication capacity hearing, or a ReiseHearing, to determine whether the minor has capacity to make medication decisions. If the minor does not have capacity, they may be forced to take medication.
Patients Rights (NAMI)To keep and use his/her own personal possessions including toilet articles and clothing;
To keep and be allowed to spend a reasonable sum of his/her own money (a conservator shall be appointed as required);
To have access to individual storage space for private use;
To see visitors each day;
To have reasonable access to telephones;
To have ready access to letter writing materials, including stamps & mail;
To receive unopened mail;
To refuse convulsive treatment;
To refuse psychosurgery;
To see a patients’ rights advocate;
To be assisted by an attorney at the certification review hearing.
Zoom InParents’ & Children’s Rights
What is the Age and Maturity of the Child?
Children 12 or older can consent to treatment, drug treatment, assessment, and may also be able to authorize release of medical information IF, in the opinion of the attending medical person, the child is mature enough to intelligently participate in the services (Fam Code §6924; H&S Code §124260).
Children 12 or older can consent to treatment for an STD (Fam Code §6926).
Minors can consent to medical care related to the prevention or treatment of pregnancy (Fam Code §6925).
Balancing Act
Maturity
Highly Personal Information
Age
Crisis
General Information
Development
Privilege vs. Confidentiality
Confidentiality is a duty of a practitioner (legally and ethically) to keep information disclosed by a patient private unless consent is provided by the patient.
Privilege is the right of a patient to prevent disclosure of confidential communications to/for use in court.
Even if a patient authorizes sharing of confidential information, a waiver of privilege may still be required.
Privilege holder is patient, though patient’s attorney and patient’s medical provider are required to also assert the privilege unless waived by the patient.
For children under 12, attorney is privilege holder.
Who Can Consent?
Consent for TreatmentReproductive health or birth control
Consent for Psychotropic Medication
Authorization to Release Medical Information
Authorization for Routine Medical Decision
Authorization for Major Medical Decision (surgery, anesthesia)
Release of Education Information
A Note on Psychotropic Medications
• Foster youth with mental health needs are prescribed psychotropic medications at a higher rate than non-foster youth with mental health needs.
• Psychotropic medications can have serious short and long-term side effects on the body.
• Foster youth are more vulnerable to over/under/mis-medicating due to the increased likelihood of changing caregivers, disconnected services, prescribers that don’t know the child’s history, and placement changes.
• Foster youth of color are prescribed medications at a higher rate than white foster youth.
Why is Oversight Needed for Foster Youth?
Final Thoughts From Jessie
• Trust your relationship & know your value
• Self-care, self-care, self-care
• Don’t take it personally
• Keep on fighting
