What does it mean to involve families in our children’s behavioral health care and why is it important? 6 mothers of struggling Washington State children, who were failed by our community safety net, met on December 26 and drafted a bill proposal. These values became the first draft of the Family Cares Act, SB 5412.
[REMINDER: this is a draft. The resulting bill, SB 5412 can be found here.]
Proposed bill name:
Behavioral Health Family Rights Act
Reason for Bill:
Every patient has the right to have a caring, compassionate family member involved in and advocating for their best treatment, based on their lifelong role in the person’s life and their personal knowledge of their past and present welfare.
Families who desire to be engaged in their children’s Behavioral Health Care should be included wherever possible. Parents should be encouraged to be actively engaged in their children’s BH care including decision-making and have appropriate decision-making rights.
The State should not bring harm (trauma) to the family. The family is in fact a community of persons whose proper way of existing and living together is a basic human right.
Parents/Guardians are the foundation for decision-making about Education and Healthcare, regardless of whether those decisions relate to physical, mental, behavioral or substance use disorder (SUD) treatment.
The Liberty of a Parent to direct the upbringing, education, care, and welfare of the parent’s child is a fundamental right.
All members of a family have an equal right to safety and the right to participate in family life on a basis of equality without fear of loss of safety or residence. (Not a CPS involved system)Although perhaps unintended, a consequence of current regulations and practices has divided families and created barriers to family engagement to such an extreme that parental rights and responsibilities sometimes are severed without any evidence of abuse or neglect in order for children to access an appropriate level of services.
This bill intends to encourage and support well bonded families.
Through the support of State Agencies, family rights and responsibilities of parents should be instrumental in establishing the residence of the child, supervision of the child, schooling and education of the child, and decision-making in Physical Health, Mental/Behavioral Health, SUD, and Medication Management matters for the child.
Definitions:
Parent: as referenced in Adolescent Behavioral Health Care Act (Parent/Caregiver)
Children: Minor adolescents ages 13-17, young adults 18-25, dependent adults 26+ who are under a parent/caregiver guardianship.
[Comment: High needs adults with disabilities, such as those in DDA Supported Living , may lack emotional self regulation skills until age 30. Yet they may not have a guardianship that long. Is guardianship the right avenue to cover those in this situation?]
Family member: any person living under the same roof who is either dependent upon or contributing care for the safety and welfare of the group.
Behavioral healthcare symptoms for minor children 0-18 includes mental illness, substance use or abuse, and developmentally-based emotional regulation challenges that may or may not resolve with maturity.
Behavioral health early intervention and prevention includes occupational and physical therapy, as well as educational supports, evidence-based mental health and SUD interventions, as well as basic health supports for diet and exercise.
Essential bill components:
- Unless there are formal findings of abuse or neglect, all service systems, including those related to behavioral health, should support a family’s decision-making process, including the execution of existing parenting plans. Family Rights are supported by all state agencies that touch children’s behavioral health, including but not limited to: HCA, DDA, JR, DCYF, OSPI, CPS, Commerce Department, Office of Insurance Commissioner.
- All child-serving departments must evaluate their policies and identify and eliminate those that undermine the integrity and health of the family or discourage family engagement with service providers.
- No policy should encourage division of families in order for an appropriate level of service to become available.
- One size does not fit all in treating children’s behavioral health. The children’s system must not be modeled on adult system assumptions (ex. Richelle’s DDA electronics policy) (???–not sure how this will be worded in the final proposal?)
- Children, Youth, and Family treatment decisions must be based on the best information available as part of an evidence-based intervention (EBI) system. That includes full disclosure or “transparency” of existing clinical information, parental/guardian input, and Mental/Behavioral SUD services.
- Broad education is needed about early warning signs of behavioral health problems in children, especially as they appear in the school setting.
- Parents must be supported by physicians and other child-serving professionals in making decisions on the use of psychotropic medications through informed consent, based on a careful weighing of risks and anticipated benefits.
- Medication use by children must be closely monitored and frequently evaluated, as well as other Mental and BH treatment.
- Child-serving system policies should not interfere with rights of access to treatment or communication between parents, physicians, schools, and other potential support partners.
- Legislative or regulatory actions must be guided by sound scientific research and testimony from well-qualified medical and mental health professionals and families.
- Develop accountability standards and data collection standards to measure prevalence of need for service, gaps, etc.
- The legal system should be employed only as a last result. ex. Medication management should not be handled via At Risk Youth Petitions. Families should not have to engage lawyers to receive behavioral health special education interventions or to prevent the disruption of a family member’s residence by the legal system (ex restraining orders issued against family members by the court in behavioral health situations).
- Foster Care should never be used as a substitute for involuntary inpatient treatment.
- Replace Court-based involvement for youth, such as Juvenile Rehabilitation and At Risk Youth/CHINS, with family-centered behavioral healthcare treatment interventions. All service systems must collaborate to find the best placement and state-supported funding strategy when residential care is medically and/or educationally necessary in light of child and family circumstances. Safety of all family members and the child’s holistic needs for safety, healthcare treatment, and education, must be considered.