WHY IS THE LAW IMPORTANT? 1. Involuntary confinement for mental health purposes = deprivation of liberty. 2. Triggers due process rights

Transcription

1 MENTAL HEALTH (23 minutes) STATUTES and PROCEDURES PROTECTIVE SERVICES SECTION CHILD AND FAMILY PROTECTION DIVISION ARIZONA ATTORNEY GENERAL S OFFICE WHY IS THE LAW IMPORTANT? 1. Involuntary confinement for mental health purposes = deprivation of liberty 2. Triggers due process rights 3. Mental health statutes balance individual rights vs the need to protect the public Due Process Rights Triggered for Child 1. A child placed in a mental health facility will receive education 2. Children should be placed in the Least Restrictive Environment (LRE) 3. The court will appoint an attorney for a child who is subject to mental health confinement proceedings if the child only has a GAL Mental Health Motions Addressing a CPS Child s Mental Health Issues: 4 Steps Mental Health Services A.R.S Motion for Inpatient Assessment Motion for Psychiatric Acute Care Services Motion for Residential Treatment Services Some Motions for Change of Physical Custody 3 1. Identify Behavior indicating: mental disorder danger to self or others disabled, gravely or acutely 2. Arrange for Psychiatric Assessment Outpatient - no court order Inpatient - court order and timeframes 3. Treat per Assessment 4. Place after Treatment 4 Outpatient Assessments: Clinical interview/testing 1. Review - child's medical, social and psychological records 2. Diagnosis of condition and determination regarding appropriate services 3. Recommendations & explanation of least restrictive alternatives available 4. Written report with recommendations for follow-up care *No court involvement necessary 5 1

2 Inpatient Assessments Assessments: Possible Recommendations Motion for Inpatient Assessment A.R.S (D) Same as Outpatient Plus: 1. Additional assessment, CM must complete & fax an Inpatient Assessment Worksheet/Ct Rpt to AG Commitment to a restrictive (locked) facility Administration and monitoring of psychotropic medication 24-hour observation of child s behaviors Must Contact AG s Office to file a Motion for Inpatient Assessment 6 2. Outpatient treatment services, 3. Residential treatment, 4. Inpatient psychiatric acute care services, or 5. Discharge without further services - child is not diagnosed with mental disorder or acute disability & not a danger to self/ others. 7 Facility s Name/address Assessing doctor s name Admission date and time Justification for inpatient assessment. Does child have an attorney (not just a GAL)? Position of all parties Court report explaining why inpatient assessment needed AG files an Inpatient Assessment Motion w/in 24 workday hours 8 Inpatient Assessment Reports for Acute Care Treatment Other Mental Health Services A.R.S Mental Health Services A.R.S Prepared by Mental Health Professional w/in 72 hours of assessment & must include: Why commitment is in the child's best interests Why acute care services are the least restrictive alternative Psychiatric Acute Care Emergency & crisis behavioral health services, Extensive psychiatric and psychological assessments, Short-term intensive behavioral health counseling and treatment, Residential Treatment Center (RTC) Includes services, other than psychiatric acute care services, that a child receives at a Level One Behavioral Health Facility Diagnosis Medication stabilization, and Estimated length of commitment 9 Twenty-four hour a day care

3 RTC Services Inpatient Assessments, RTC & Acute Care Treatment Inpatient Psychiatric Acute Care Flow Chart Assessment Complete Level One Behavioral Health Facility Licensed by DHS, Provides psychiatric acute care, Structured, intensive treatment, & 24-hour supervision 12 REMEMBER - As soon as a child enters a facility for assessment or treatment longer than 24 hrs The clock is ticking! Contact AG ASAP usually the duty AG! 13 ADES must file a Notice of Transfer 5 days before a child is transferred from one acute care facility to another. Contact AG s office for assistance If assessment recommends ACUTE CARE SERVICES File: Motion for Psychiatric Acute Care Services within 24 hours of completed assessment or child is discharged Hearing within 72 hours of the filing of motion. Clear & convincing evidence needed to support placement Review of Placement hearing held every 60 days Within 20 days after discharge from an AC facility, ADES must file a Notice of Discharge with the court If Inpatient Psychiatric Acute Care Needed A.R.S (F) Inpatient Psychiatric Acute Care A.R.S (F) 60 Day Court Review Inpatient Treatment A.R.S (K) CM must Fax to AG: 1. A completed CHILDS Mental Health Worksheet; 2. A written Assessment; 3. A written statement from the medical director or designee that the facility's services are appropriate AG -will file a Motion within 24 hours (workday) after Assessment After motion filed, Court will hold a hearing within 72 workday hours - child stays in facility pending ruling 2. At the hearing, Court will appoint an attorney for the child order inpatient treatment if it finds by clear and convincing evidence that: o The child has a mental disorder or is a danger to self or others, o Requires inpatient psychiatric acute care services, & o Inpatient psychiatric acute care services are the least restrictive alternative available If No motion and order - discharge! 16 5 Days before 60-day Review Hearing, CM must provide AG, Court, & Parties: 1. Written Report from facility that includes: Type of treatment & medications provided, Child's current diagnosis, Child's need for continued inpatient services & projected discharge date, Level of care required by child and the available placement options upon child s discharge 2. A medical director or designee s statement that acute care services are necessary, least restrictive alternative 17 3

4 Inpatient Treatment - Notice of Transfer from Acute Care to Acute Care A.R.S (L) Before child may be transferred, AG must file a Notice of Transfer with Court at least five days prior to transfer stating: Name of new facility, Statement from new facility that the new facility is appropriate and LRE, Child s attorney or GAL s position regarding the transfer Inpatient Treatment Notice of Discharge A.R.S (N) Within 15 days after child s discharge, facility must prepare discharge summary (see Form) Within 20 days after discharge, AG s Office must file Notice of Discharge that includes: A statement of the child's current placement, A statement of the mental health services that are being provided to the child and the child's family, A copy of the discharge summary that is prepared by a mental health professional Residential Treatment Center Flow Chart Assessment Complete Recommends RESIDENTIAL TREATMENT File: Motion for Residential Treatment Services within 24 hours after assessment completed. Court may waive written assessment for good cause No required hearing, but must have clear & convincing evidence to support residential treatment Review of Placement - every 60 days Any party may request a hearing to review the transfer request Motion for Change in Physical Custody must be filed before discharge Residential Treatment (RTC) A.R.S If RTC recommended, CM must complete worksheet and fax to AG 1. Mental Health Professional s written report stating: Why RTC is in the child's best interests. Why RTC is the least restrictive treatment available. Why RTC is needed. Estimated length of treatment. 2. RTC s medical/clinical director or designee s statement that RTC s services are appropriate to meet the child's needs Motion for Residential Treatment (RTC) AG must file a Motion for RTC within 24 workday hours If a Motion is not filed, child will be discharged and CM must find a placement for child Residential Treatment (RTC) A.R.S After Motion filed: Court will appoint an attorney for the child. If all parties, including child s attorney, are in agreement, hearing is not required. Court will order RTC if it finds by clear and convincing evidence that: 1.Child requires RTC. 2. RTC is least restrictive alternative

5 60 Day Court Review of RTC Discharge from RTC Dually Adjudicated Wards 5 days before every 60-day Review Hearing, RTC must provide court and parties with: Before child is discharged from an RTC, CM must : Same mental health procedures apply to dependency and delinquency proceedings. 1. Progress report stating: Nature of treatment, diagnosis, and current medications; Need for continued RTC and length of treatment; Projected discharge date; Level of care required by the child and the available placement options upon child s discharge. 1. Contact AG s Office to file a Motion for Change of Physical Custody (CPC) 2. Fax AG copy of Discharge Summary from RTC to be attached to Motion The Juvenile Probation Department can also file mental health motions. If mental health motion filed by JPO, do not need additional motion in dependency. Court may order ADES to share costs. 2. A director or designee statement that RTC is needed and least restrictive alternative 24 Must get Court s permission before moving child 25 If child has JPO, provide copies of reports and obtain JPO s position on any motion 26 Court Authority Over Service Providers A.R.S Another Option: Appeal of RBHA Decisions QUIZ The Court may order a non-party service provider to provide a service to a dependent child or parent who is entitled to services If child is denied mental health treatment, ADES may choose to appeal the decision with the RBHA - discuss denial with your supervisor The following is a review quiz. There will be no voice for the quiz. Provider must be given proper notice and a hearing, Service must be medically necessary, Child or parent must qualify for service Contact the Mental Health Specialist for your District for further information and assistance Discuss options with AG Please write down any questions you have and bring them to class for discussion. Thank you. Discuss Issue with AG to decide whether to ask for Court Hearing

6 Review Questions 1. What are the 4 Basic Steps? 2. What behaviors/ psychological conditions may require mental health treatment? 3. Mental health timeframes: 24 hours, 72 hours, 5 days, 60 days, and 20 days? 4. Attachments to motions for Inpatient Acute Psychiatric Services or RTC? 5. Legal standard for assessment? For treatment? 1. What are the 4 basic steps? 1. Identify behavior 2. Arrange for Assessment 3. Treat per Assessment 4. Place after Treatment 2. What behaviors/mental health conditions may require treatment? When the child: may be suffering from a mental disorder may be a danger to self or others is persistently, acutely, or gravely disabled a. Timeframe 3b. Timeframe 3c. Timeframe How soon must a Motion for Inpatient Assessment be filed? How soon must the assessment be completed? When must a Motion for Psychiatric Acute Care Services/RTC be filed? Within 24 hours of placing child for assessment 72 hours Within 24 hrs of assessment being completed

7 3d. Timeframe 3e. Timeframe 3f. Timeframes How soon must a PAC/RTC hearing be held? When must a Notice of Transfer be filed? How often does the Court review PAC and RTC placements? Within 72 hours of motion being filed 5 days prior to transfer from one facility to another Every 60 days g. Timeframes 3h. Timeframes 4. Attachments for PAC/RTC Motion? What must be filed with the Court 5 days before review hearing? When must a Notice of Discharge from a PAC facility be filed? What must be attached to a Motion for Inpatient Psychiatric Acute Care or RTC Services? Written report from facility 39 Within 20 days after discharge and must include facility s Discharge Summary 40 Written Assessment Report and Statement from Medical Director or Designee that facility s services are appropriate 41 7

8 5. Legal Standard? Acknowledgements The End What is the legal standards/burden of proof for Inpatient Treatment? Sara Wisdom, Assistant District Attorney, Protective Services Section Richard Hinz, Lead Attorney, Litigation Support Team, Protective Services Section. In collaboration with Ann E. MacEachron, Professsor, ASU School of Social Work Clear and Convincing Evidence