Frustration, concerns as education on law delayed

by EMRY DINMAN
Staff Writer | February 10, 2020 10:51 PM

Many providers are still unaware of new law allowing parents to force teens into mental health treatment A long time coming A long way to go

OLYMPIA – In July of 2019, a new law came into effect that allowed parents to initiate mental health or substance abuse treatment for their children age 13-17 without their consent.

House Bill 1874, or the Adolescent Behavioral Health Care Access Act, passed through the legislature in 2019. It gave a teen’s legal guardian the right to request “Family-Initiated Treatment” for mental health or substance abuse disorders without the consent of the minor, whether for admission, evaluation or treatment for inpatient care or counseling for outpatient care.

It also meant that providers could, at their discretion, give certain information to the parents about their children. This included a diagnosis, treatment plans, recommended medications and their potential risks or benefits, and coaching on parenting strategies tailored to the child’s needs.

Youths older than 13 still have rights to their medical records, and providers would have to disclose to the adolescent that they intended to provide information to their parents. Those teenagers would have the right to object to that disclosure, but a provider could overrule that objection.

For Ephrata mom Penny Quist, whose teenager’s mental health issues had become severe enough to require an inpatient long-term mental health bed, the change in law was a godsend. For starters, it allowed her to overrule any objections her child might have to treatment, but perhaps more important, it meant she was being taught by providers how to best help her son.

“It’s saving my child’s life, it’s saving my family’s life,” Quist said. “You can’t treat the individual without training the family.”

Yet, despite the substantial improvement that Quist and other advocates believed HB 1874 to be, its passage presented another challenge.

Though the law came into effect last July, many providers are still unaware about the provisions of HB 1874, said Quist.

Quist has become connected in an informal network of parents trying to stay abreast of the state’s changing mental health system. Through that, she said she has heard from a number of parents of teenagers turned away by providers, including Grant Integrated Services, claiming they couldn’t admit a child older than 13 without the child’s consent, despite the legal change.

Grant Integrated Services did not respond to a request for comment.

The Washington Health Care Authority, or HCA, was tasked last year with educating providers about their rights under the new law, and the legislature funded a full-time staff member to oversee the rollout of that outreach. To date, parents and providers say they’ve seen little from the agency to provide information about their rights under HB 1874.

“They have not published anything that describes the new law,” said Peggy Dolane, who has two adult children with mental health needs and who led the charge to get HB 1874 passed.

For decades, families had little recourse if their teenage children refused treatment.

In 1985, the state passed a law allowing children age 13-17 to access mental health services without parental consent. But the law would soon also be construed in the reverse: If a 13-year-old refused treatment, a parent or guardian either had to turn to the courts to involuntarily confine the child or else lose control of the child’s treatment.

Various attempts to mitigate what were characterized as unintended effects of the law came and went in years that followed, including as provisions to the 1995 Becca Bill, but were struck down in court, were vetoed or died in committee.

In 1998, a new system called “Parent-Initiated Treatment,” a precursor to “Family-Initiated Treatment,” was established, allowing parents to bring their teenage children for behavioral health evaluations and treatment. But “the provider community failed to respond with enthusiasm,” wrote state Senate Committee Services staff counsel in 2018, and between the bill’s passage and 2011, only two children were placed in treatment under the new law.

Though further bills would be enacted that would eventually increase the number of children admitted to mental health services under Parent-Initiated Treatment, many providers raised concerns about potential liability.

For some, the distinction between Parent-Initiated Treatment and court-ordered involuntary treatment was not clear enough. Others were also concerned about providing the child’s medical information to parents, possibly in violation of federal privacy laws.

The new law was supposed to ease the concerns of providers when it passed in 2019, said Diana Cockrell, section manager of Child Youth and Family Behavioral Health & Adult Substance Use Treatment Services, which is part of the Washington Health Care Authority.

Given providers’ concerns in years past regarding liability and unclear legal language for the now-defunct Parent-Initiated Treatment system, the HCA is waiting to see if the legislature will make any more changes to the new system before informing providers.

Providers can still decline Family-Initiated Treatment, Cockrell said, and clear and concise guidance from the state could make the difference for providers in making that decision.

For instance, HB 2883, currently under consideration, would extend Family-Initiated Treatment to residential treatment centers, and could substantially change the information the HCA would need to give to providers, Cockrell said.

Telling providers about one new set of rules, only to turn around a year later and inform them about a new set of changes, could create additional confusion and discourage providers from taking part in Family-Initiated Treatment, Cockrell added.

“We didn’t want providers to feel burned by this,” Cockrell said.

But HB 2883 is likely not to be the only tweak made to Family-Initiated Treatment, said Dolane, who noted that changes to intensive outpatient services would likely be up for consideration in 2021. Instead of waiting for all of those tweaks to take place, Dolane said she’d prefer that the state found a sequential approach to informing providers about changes as they cropped up.

“It’s taking the system a long time to get their head around it.” Dolane said.

Meanwhile, Quist said, children turned away by providers who haven’t been educated about Family-Initiated Treatment are put at risk.

“Every time they delay any of this education, we aren’t just waiting to get the information out there, we are losing children’s lives,” Quist said.

“I haven’t heard of a horrific example yet,” Dolane said, “but it’s still challenging to get information, because families get so isolated when they’re in the middle of their crisis.”

Despite the challenges, there have been some attempts to fill the information vacuum, both among advocates and state institutions, Dolane noted.

“There’s some really good things happening.“ Dolane said. “I’m doing my best to get the word out, and parents are getting the word out, and there is the beauty of Facebook.”

She also pointed to Family Youth System Partner Round Tables, or FYSPRT, established in recent years as a part of the settlement of a 2009 lawsuit against the state, as a particularly bright spot in what can otherwise be an opaque system.

The round tables bring parents, youth, service providers and other parties together to collaboratively address issues in the state mental health system writ large or in individual cases.

“If people want to get involved, FYSPRT is where they can go to get involved in their community,” Dolane said.

The next meeting of the North Central Regional FYSPRT, which serves four counties, including Grant County, will be held Feb. 20 from 5:30 to 7 p.m. at Parkview Medical Group, 615 S. Division St., Suite A, in Moses Lake.

Emry Dinman can be reached via email at edinman@columbiabasinherald.com.