Consent for Mental Health and/or Developmental Assessments and Services

0600-501.09 | Revision Date: 05/12/15

Overview

This policy guide provides information on obtaining consent for mental health and/or developmental (Regional Center) assessments and services, including steps to take when consent is declined or unavailable, and steps to take when a child/youth refuses services.

TABLE OF CONTENTS

Policy

Consent for Mental Health and/or Developmental Assessment and Services

Youth Twelve (12) Through Seventeen (17) Providing Consent

Nonminor Dependent (NMD) Consent

Withdrawal of Consent

Protected Health Information (PHI)

Procedure

Consent for Newly Detained Child/Youth with Court Ordered FR Cases or Youth with New Court Supervised FM Cases, a Positive MHST, Observation of Behavioral Indicator, or Potential Developmental Delay

ER/ERCP CSW Responsibilities

ER SCSW Responsibilities

Consent for Child/Youth with New or Existing VFM/VFR Cases, a Positive MHST, Observation of Behavioral Indicator, or Potential Developmental Delay

ER/ISW/Case-Carrying CSW Responsibilities

Consent for Child/Youth in Existing Court Cases with a Positive MHST, Observation of Behavioral Indicator, or Potential Developmental Delay

ISW/Case-Carrying CSW/DI (Pre-Dispo) Responsibilities

ISW/Case-Carrying SCSW Responsibilities

Parent/Legal Guardian Withdraws Consent on a Court Supervised Case

Case-Carrying CSW/DI (Pre-Dispo) Responsibilities

Case-Carrying SCSW Responsibilities

Child/Youth Refuses to Participate in Mental Health and/or Developmental Services

Case-Carrying CSW Responsibilities

Approvals

Helpful Links

Attachments

Forms 

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version, to add "Qualified Relatives" who may consent; change the age requirement for consent from 12 to 15 for emancipated minors and; added CSW authorization to inform 12+ youth of their legal rights re: consent to treatment. Added information regarding nonminor dependent (NMD) consent, use of DMH ACCESSLos Angeles County Department of Mental Health's (DMH) 24 hour, 7 (seven) day a week hotline: Emergency psychiatric services are coordinated through ACCESS. ACCESS offers information regarding all types of mental health services available in Los Angeles County. CSWs may request a joint response with FRO by contacting ACCESS at (800) 854-7771. hotline for emergencies and Health & Education Passport requirements and notifications.

POLICY

Consent for Mental Health and/or Developmental Assessment and Services

Children/youth receiving ongoing child welfare services from DCFS (voluntary or court) who have a positive Mental Health Screening Tool (MHST), or Observation of a Behavioral Indicator, must be referred to appropriate mental health services, per the Katie A. settlement. Multidisciplinary Assessment Teams (MAT) and Coordinated Services Action Teams (CSAT) are available to CSWs in all Regional Offices to ensure that these services can be accessed.

Consent is required for all children/youth that have a positive MHST result, or children/youth, who, through the MAT assessment or medical examination, are referred to a Regional Center. CSWs are responsible for obtaining consent from a parent/legal guardian via their signature on the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental ServicesServices provided by the Regional Centers, which include diagnostic evaluation, coordination or resources such as education, health, welfare, rehabilitation and recreation for persons with developmental disabilities. Additional services include program planning, admission to and discharge from state hospitals, court-ordered evaluations and consultation to other agencies.. In some cases, if the child is twelve (12) years or older, the mental health services provider may obtain consent directly from the youth in lieu of parental consent.

Children/youth receiving child welfare services may need early intervention, developmental and/or special education assessments and services as well as mental health assessments and services.

The parent/legal guardian is legally responsible for making decisions on the child's behalf regarding early intervention, developmental and educational assessments and services. If the parent/legal guardian is unable or unwilling to fulfill this responsibility, the court may limit the parent's educational and/or developmental services decision-making rights, and appoint a Holder of Education Rights (HER) and/or Developmental Services Decision-Maker (DSDM). If the child has a HER and/or DSDM, this person provides consent for early intervention, developmental and/or educational assessments and services.

Parent(s)/legal guardian(s) do not have the legal authority to consent to mental health and/or developmental assessment and services when:

• Parental rights have been terminated

• The child/youth is under legal guardianship

• There is a prior court order/family law order, taking away the parent's right to consent.

Foster parents, caretakers, the child/youth’s attorney, and social workers do not have legal authority to provide consent for mental health/and or developmental assessment and services for a child/youth.

However, if the parent(s)/legal guardian(s) are unwilling or unable to provide consent, the court may issue an order allowing the social worker to provide consent.

Also, a caregiver who is a "Qualified RelativeFor the purpose of placement and foster care payments: An adult who is related to the child by blood, adoption or affinity within the fifth degree of kinship, including stepparents, stepsiblings, and all relatives whose status is preceded by the words, "great," "great-great" or "grand" or the spouse of any of these persons even if the marriage was terminated by death or dissolution." as defined by Family Code (FAM) Section 6552 who meets all requirements specified in FAM Sections 6550-6552 may provide consent for mental health and/or developmental assessments and services for the child.

Parents cannot consent to:

• Psychotropic MedicationMedications used as tools for producing certain chemical and physiological effects in the central nervous system. They are usually classified according to the types of disorders they are primarily used to treat. for a dependent child/youth in out-of-home care (post-disposition), unless permitted by the court.

• Psychiatric Hospitalizations for a dependent child/youth.

• Psychosurgery, as defined in WIC 5325(f)(g).

• Convulsive Treatment, as defined in WIC 5325(f)(g).

Youth Twelve (12) Through Seventeen (17) Providing Consent

A youth can consent to mental health treatment in the following situations:

• Youth, twelve (12) years or older can consent to mental health services or counseling on an outpatient basis, or to residential shelter services if, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient or residential shelter services.

• The youth is fifteen (15) or older, but under eighteen (18), and is independently living separate from parents who are not liable for the youths health care, and managing his/her financial affairs.

The CSW is legally authorized to inform the youth of his/her right to consent to and receive mental health treatment and or treatment for alcohol and drug abuse.

The mental health provider is responsible for obtaining consent from the child on the applicable forms(s) used by that provider. If the provider determined that the child does not have the requisite ability to give informed consentInformed consent requires the asking of a question and the receiving of an affirmative answer. However, informed consent involves a greater discussion and more information. For example, to obtain informed consent, a doctor must fully discuss a patient's options and how a procedure will affect them. If a patient is considering a surgery, a doctor will explain the surgical procedure, possible complications and other possible courses of action., the child’s consent will not be valid. For DMH providers, the forms are: Consent of Minor, Consent for Services, and Authorization for Disclosure of Protected Health Information.

Nonminor Dependent (NMD) Consent

Youth who are 18 years old or older and are dependents of the court are defined as nonminor dependents (NMD) and can consent to their own mental health or developmental care without court authorization, unless there is a court order stating the contrary (e.g., conservatorship). If a NMD refuses treatment that places him/her in serious danger of harm to self or other, contact the DMH ACCESS hotline at 800-954-7771 and request a response (joint response if possible) with DMH Field Response Operations (FRO). Inform all appropriate parties of the outcomes.

Information about known mental health or developmental problems, medication and other relevant health information for NMDs must be documented in the Health and Education Passport (HEP). Information in the HEP is confidential, but must be provided to the caregiver of any NMD placed in a licensed and approved setting (except for SILPs). The CSW must advise the NMD of the CSWs obligation to provide the HEP summary to the caregiver.

The HEP may be included in the court report only if the NMD provides written consent. the CSW must discuss with the NMD, the benefits and liabilities of sharing that information.

Withdrawal of Consent

A parent/legal guardian can withdraw their consent for mental health and/or developmental (Regional Center) assessment and services at any time by signing and submitting the “Revocation of Consent” on the DCFS 179-MH and providing it to the CSW. When the parent/legal guardian withdraws consent on a voluntary case, the CSW, in consultation with the SCSW, must consider whether or not it is still appropriate for the case to be voluntary.

Protected Health Information (PHI)

CSWs are also responsible for obtaining authorization for disclosure of Protected Health Information (PHI)As defined by Health Insurance Portability and Accountability Act (HIPAA), is health (including mental health) information created or maintained by a health care provider that identifies or can be used to identify a specific individual. PHI relates to an individual’s health, health care or payment for care – in the past, present or future. via the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (PHI), on all newly detained children/youth in out-of-home care to enable referral to MAT for comprehensive assessments or referral to a Regional Center.

Back to Policy

PROCEDURE

Consent for Newly Detained Child/Youth with Court Ordered FR Cases or Youth with New Court Supervised FM Cases, Positive MHST, Observation of Behavioral Indicator or Potential Developmental Delay

Within this policy, “newly detained” is defined as a child/youth removed from the custody of his/her parent(s)/legal guardian(s) under a WIC 300 petition, placed in out-of-home care, and not named on a currently open case. This does not include children/youth removed from one parent and placed with another parent under a Court FM case or a failed VFM.

ER/ERCP CSW Responsibilities

1. Prior to the detention hearing, explain to the parent/legal guardian that their consent is needed to provide the child/youth with necessary and appropriate mental health and/or developmental (Regional Center) assessment and services. Explain that signing the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental Services is their agreement to have the child/youth receive mental health and developmental assessment and services, as the service provider deems appropriate. Parent/legal guardian must sign a service plan with the Regional Center authorizing needed services.

1. If the parent/legal guardian does not agree to sign the DCFS 179-MH, it will not be held against them, but consent will be sought through the court at the detention hearing.

2. If the parent/legal guardian completed and signed both sides of the DCFS 179-MH, place the original in the Psychological/Medical/Dental/School Folder (purple) and provide a copy to:

• The parent/legal guardian

• The service provider/Regional Center responsible for providing mental health or developmental services.

• Any caregiver responsible for obtaining mental health and/or developmental services for the youth, and/or the CSAT Screening Clerk along with the MHST.

2. If the DCFS 179-MH and DCFS 179-PHI were signed by the parent, document the following in the “REASONABLE EFFORTS AND/OR PRIOR INTERVENTIONS/SERVICES OFFERED” section of the Detention Report:

• “Parent/Legal Guardian (enter parent’s name) signed the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Development Services, and the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information.”

3. If consent was not obtained from the parent/legal guardian before the Detention Hearing, include the following in the Court Report:

1. REASONABLE EFFORTS AND/OR PRIOR INTERVENTIONS

2. SERVICES OFFERED: Describe the efforts made to obtain the parent’s signature on the forms, and the reason why it was unsuccessful.

3. RECOMMENDATIONS: Add the language contained in Recommendation for Court Order of Mental Health and/or Developmental Assessment, Services, and Release of Information.

4. When the minute order is received with the court consent, provide a copy of the redacted minute order to the mental health provider to initiate mental health treatment for the child/youth and/or Regional Center to complete the developmental assessment and to provide services.

ER SCSW Responsibilities

1. Review and approve the Detention Report.

• If not approved, instruct the CSW to make changes as needed.

Back to Procedure

Consent for Child/Youth with New or Existing VFM/VFR Cases, Positive MHST, Observation of Behavioral Indicator or Potential Developmental Delay

ER/ISW/Case-Carrying CSW Responsibilities

1. Prior to, or at the signing of the VFM or VFR Case Plan, explain to the parent/legal guardian that their consent is needed to provide the child/youth with necessary and appropriate mental health and/or developmental (Regional Center) assessment and services. Explain that signing the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental Services is their agreement to have the child/youth receive mental health and developmental assessment and services, as the service provider deems appropriate. Parent/legal guardian must sign a service plan with the Regional Center authorizing needed services.

1. If the parent/legal guardian does not agree to sign the DCFS 179-MH, it will not be held against them, but consent will be sought from the child/youth, if the child is twelve (12) years or older.

• If a parent(s) declines to sign the DCFS 179-MH, the family may not be an appropriate candidate for a VFM or VFR case.

2. If the parent/legal guardian signed the DCFS 179-MH, place the original in the Psychological/Medical/Dental/School Folder (purple) and provide a copy to:

1. The parent/legal guardian

2. If a VFR case, the service provider/Regional Center responsible for providing mental health or developmental services and/or any caregiver responsible for obtaining mental health and/or developmental services for the youth

3. The CSAT Screening Clerk along with the MHST.

2. If the parent declined to sign the DCFS 179-MH, document efforts made to obtain consent from the parent/legal guardian in the Contact Notebook.

1. Attempt to obtain consent from the youth if he/she is twelve (12) years or older.

1. Have the service provider determine if the youth can legally consent to his/her own mental health and/or developmental services.

2. If the youth can provide consent, advise the service provider that he/she must obtain the signature of the youth on the applicable form(s) utilized by that provider.

3. Request copies of the documents and file them in the Psychological/Medical/Dental/School Folder (purple).

Back to Procedure

Consent for Child/Youth in Existing Court Cases with a Positive MHST, Observation of Behavioral Indicator or Potential Developmental Delay

ISW/Case-Carrying CSW/DI (Pre-Dispo) Responsibilities

1. Explain that signing the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental Services (Regional Center). Is their agreement to have the child/youth receive necessary & appropriate mental health and developmental assessment and services, as the service provider deems appropriate. Parent/legal guardian must sign a service plan with the Regional Center authorizing needed services.

1. If the parent/legal guardian does not agree to sign the DCFS 179-MH, it will not be held against them, but consent will be obtained through the court or sought from the child/youth, if the child is twelve (12) years or older.

2. If the parent/legal guardian signed the DCFS 179-MH, place the original in the Psychological/Medical/Dental/School Folder (purple) and provide a copy to:

1. The parent/legal guardian

2. The service provider/Regional Center responsible for providing mental health or developmental services

3. Any caregiver responsible for obtaining mental health and/or developmental services for the youth, and/or the CSAT Screening Clerk along with the MHST.

2. If the parent declined or is unavailable to sign the DCFS 179-MH, and it is more expedient to obtain consent from the court, complete the following steps:

1. Within three (3) business days of the parent/legal guardian declining to sign the DCFS 179-MH, walk on an Ex-Parte report requesting an appearance hearing for the court to consent for the youth’s mental health and/or developmental assessment and services. Include the following information in the Ex-Parte:

1. Explain that the parent/legal guardian is not available to provide consent or declines to provide consent.

2. Describe efforts made to obtain consent from the parent/legal guardian.

3. Explain that court consent is necessary to meet the mental health and/or developmental needs of the child/youth.

4. Include the language contained in the Recommendations section of the Court Report.

2. When the minute order is received with the court consent, provide a copy of the redacted minute order to the mental health provider to initiate mental health treatment for the child/youth and/or Regional Center to complete the developmental assessment and to provide services, and to CSAT.

3. If the parent declined or is unavailable to sign the DCFS 179-MH, and it is more expedient to obtain consent from the youth (if they are twelve (12) or older), attempt to obtain consent from the youth.

1. Have the service provider determine if the youth can legally consent to his/her own mental health and/or developmental services.

2. If the youth can provide consent, advise the service provider that he/she must obtain the signature of the youth on the applicable form(s) utilized by that provider.

3. Request copies of the documents and file them in the Psychological/Medical/Dental/School Folder (purple).

4. Document all efforts made to obtain consent from the youth and/or efforts to obtain consent from the parent/legal guardian in the Contact Notebook.

ISW/Case-Carrying SCSW Responsibilities

1. Review and approve the Ex-Parte report.

• If not approved, instruct the CSW to make changes as needed.

Back to Procedure

Parent/Legal Guardian Withdraws Consent on a Court Supervised Case

Case-Carrying CSW/DI (Pre-Dispo) Responsibilities

1. Inform the service provider that the parent/legal guardian withdrew their consent for mental health and/or developmental (Regional Center) assessment and services.

1. If the child is twelve (12) years or older, determine with the service provider, which course of action will facilitate the continuity of services: obtaining consent from the youth, or obtaining consent through the court.

2. If the youth can provide consent, advise the service provider that he/she must obtain the signature of the youth on the applicable form(s) utilized by that provider.

3. Request copies of the documents and file them in the Psychological/ Medical/Dental/School Folder (purple).

4. If it is determined that obtaining consent through the court is the best route, within three (3) business days of “Revocation of Consent” from the parent, walk on an Ex-Parte report requesting an appearance hearing for the court to consent for the youth’s mental health and/or developmental assessment and services. Explain the following in the Ex-Parte Report and attach a copy of the parent/legal guardian signed “Revocation of Consent”:

• Parent/legal guardian has withdrawn their consent for mental health and/or developmental assessment and services

• The court’s consent is necessary to meet the mental health needs and/or developmental needs of the youth

• Include the language contained in the Recommendations section of the Court Report.

5. When the minute order is received with the court consent, provide a copy of the redacted minute order to the mental health provider to initiate mental health treatment for the child/youth and/or Regional Center to complete the developmental assessment and to provide services, and to CSAT.

Case-Carrying SCSW Responsibilities

1. Review and approve the Ex-Parte report.

• If not approved, instruct the CSW to make changes as needed.

Back to Procedure

Child/Youth/NMD Refuses to Participate in Mental Health and/or Developmental Services

Case-Carrying CSW Responsibilities

1. Document all efforts made to provide the youth/NMD with the appropriate mental health and/or developmental (Regional Center) services.

2. Obtain a letter from the service provider stating that the youth/NMD is refusing treatment.

3. Using the next court report, inform the court of the youth’s/NMDs refusal to participate in mental health and/or developmental services and attach the letter from the service provider.

4. Call the youth’s/NMDs attorney and inform him/her that the youth/NMD is refusing to participate in mental health and/or developmental services.

• Document this phone call in the Contact Notebook.

5. During monthly face-to-face visits with the child/youth/NMD, encourage him/her to participate in mental health and/or developmental services, and remind them that these services are always available.

• Document these efforts in the Contact Notebook.

Back to Procedure

APPROVALS

SCSW Approval

• Detention Report

• Ex-Parte Report

HELPFUL LINKS

Attachments

Recommendation for Court Order for Mental Health and/or Developmental Assessment, Services, and Release of Information

Forms

LA Kids

DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental Services (also available in Spanish)

DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (PHI) (also available in Spanish)

Referenced Policy Guides

0070-547.14, Expedited Joint Response Protocol with the DMH Field Response Operations (FRO)

0080-505.20, Health and Education Passport (HEP)A document that is generated on CWS/CMS that contains a summary of a child's health and education information. The caregiver keeps a current copy of the Passport, along with the health and education forms in a binder provided by DCFS. This binder shall follow the child to all placements. The Passport shall accompany the child to all medical, dental and educational appointments. The Passport binder in its entirety is given to the child upon emancipation.

0300-503.94, Set-On/Walk-On Procedures

0600-501.05, Psychological Testing of DCFS-Supervised Children

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

0600-514.10, Psychotropic Medication: Authorization, Review, and Monitoring for DCFS Supervised Child

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

0700-507.10, Appointment of Responsible Adult or Educational Surrogate Parent for the Purpose of Making Educational Decisions

Statutes

Family Code (FAM) Section 6550 - Defines a qualified relative caregiver and specifies requirements that must be met for a qualified relative caregiver to consent to medical, dental or mental health treatment of a child/youth in his/her care.

FAM Section 6552 - States what form the qualified relative caregivers authorization affidavit must take and what information must be included.

FAM Section 6922 - States the requirements allowing an emancipated minor to consent to his/her medical and dental treatment.

FAM Section 7002 – States that a person under the age of eighteen (18) is an emancipated minor under certain conditions.

Health & Safety Code Section 124260 – States, in part that a minor who is twelve (12) years or older may consent to mental health treatment or counseling services if, in the opinion of the attending professional person, the minor is mature enough to participate intelligently.

Welfare & Institutions Code (WIC) Section 319(g) and 361(a) – Sets forth the requirements regarding temporary (319(g)) limitation or limitation (361(a)) of parent or legal guardian educational and/or developmental services decision making rights and assignment of a responsible adult to make educational decisions on the child’s behalf or for the court to make educational decisions on the child/youth’s behalf if no responsible adult is available.

WIC Section 369(h) - Provides authorization for the social worker to inform children 12 throught 17 years of age of their right to consent to and receive mental health and substance abuse treatment.

WIC Section 5325 – States in part that all psychiatric patients have the right to refuse convulsive treatment and psychosurgery and lists what is considered convulsive treatment.

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