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Mental Health and Legal Issues for Children and Adolescents Back to Course Index

 

Mental Health and Legal Issues

For Children and Adolescent

 

Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. These problems, often called “disorders,” are sources of stress for children and their families, schools, and communities.

 

The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in five children and adolescents may have a mental health disorder that can be identified and requires treatment.

 

Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person.

 

Half of all lifetime mental illnesses begin by age 14.  In 2013 more than 11% of youths experienced at least one major depressive episode in the past year.  Fifty percent of students age 14 and older who have mental illness drop out of high school. Children with mental illness are more than three times as likely to be arrested before leaving school than other students. These same children fail more courses, earn lower GPAs, miss more days of school, and are retained more often than other students with disabilities.

 

Families and communities, working together, can help children and adolescents with mental disorders. A broad range of services is often necessary to meet the needs of these young people and their families.  Knowledge regarding the legal aspects of providing mental health services to this population is crucial.

 

 

Mental Health

 

Diagnosable mental illness in young people is about one in five at any point in time, and almost 50 percent of young people meet the criteria for at least one psychiatric disorder during childhood and adolescence.

 

Identifying what promotes and in turn harms young people’s mental health is important.  Although there are specific risk factors for certain illnesses, mental illness may ensue when those factors that promote mental health become insufficient to maintain it.

 

 

The risk factors fall into three main categories. Factors intrinsic to the child, for example, are:

 

Genetic influences

  •         low IQ, learning disabilities (although mental illness in this group is by no
  •         means inevitable – see below) and academic failure
  •         developmental delay
  •         communication problems
  •         physical illness

 

 

Family and close relationship problems:

       

  •         overt parental conflict
  •         family breakdown
  •         inconsistent/unclear discipline
  •         hostile and rejecting relationships
  •         failure to adapt to young people’s changing developmental needs
  •         abuse – physical/sexual/emotional
  •         parental mental illness, including parental criminality, alcoholism, personality disorder
  •         death and loss – including loss of friendship – often from moving house/town etc.

 

 

External/environmental factors:

  •         socioeconomic disadvantage
  •         homelessness
  •         disaster
  •         discrimination
  •         poor education/school support

 

Stress can also play a role in mental health issues. In the age group these stresses most often relate to family, relationships and school, exams are a key example of this, and the problems that occur when peer support turns to peer pressure.  This is frequently seen in relation to eating disorders and drug and alcohol abuse.

 

Conversely, research has identified the following relationships and strengths as indicators for a lower risk of mental health issues. 

 

  •         self-esteem
  •         sociability and autonomy
  •         family compassion
  •         warmth and parental harmony
  •         strong social supports
  •         encouraging and enabling young people to make efforts and to have confidence in their ability to cope.

 

 

The Disorders 

 

Below are descriptions of the more common mental, emotional, and behavioral disorders that may occur during childhood and adolescence. All can have a serious impact on a child’s overall health.

 

Some disorders are more common than others, and conditions range from mild to severe. Often, a child has more than one disorder.

 

*This list of disorders must not be used for the purpose of making a diagnosis.  It is to be used only as a reference about behavior encountered with this age group.

 

 

Anxiety Disorder

 

The most  common anxiety disorders are:

 

  •         Generalized: extreme, unrealistic worry unrelated to recent events. They are often self-conscious and tense; they may suffer from aches and pains that appear to have no physical basis.
  •         Phobias: unrealistic and excessive fears. Specific phobias center on animals, storms, or situations such as being in an enclosed space.
  •         Panic Disorder: repeated attacks of intense fear w/o apparent cause. They may be accompanied by pounding heartbeat, nausea or a feeling of imminent death. Some may go to great lengths to avoid the attacks (such as refusing to attend school).
  •         Obsessive Compulsive Disorder: being trapped in a pattern of repetitive thoughts and behaviors. These may include hand washing, counting, or arranging and rearranging objects.
  •         Post Traumatic Stress Disorder: experiencing strong memories, flashbacks, or troublesome thoughts of traumatic events. These may include events of abuse, violence and/or disaster. They may try to avoid anything associated with event. They may over-react when startled or have sleep disorders. 

 

 

Aspergers Syndrome

 

Aspergers is a subset of the autism spectrum disorders.  It is a neurobiological disorder that impacts behavior, sensory systems, and visual and auditory processing.  The disorder impacts cognition, language, socialization, sensory issues, visual processing and behavior. There is often a preoccupation with a single subject or activity. They might also display excessive rigidity (resistance to change), nonfunctional routines or rituals, repetitive motor movements, or persistent preoccupation with a part of an object rather than functional use of the whole (i.e. spinning the wheels of a toy car rather than driving it around). The most common characteristic occurs with impairment of social interactions, which may include failure to use or comprehend nonverbal gestures in others, failure to develop age-appropriate peer relationships and a lack of empathy.

 

Attention-Deficit Hyperactivity Disorder (ADHD)

 

Youth with AD/HD may be overactive and be unable to pay attention and stay on task. They tend to be impulsive and accident-prone.

 

They may answer questions before raising their hand, forget things, fidget, squirm or talk too loudly. On the other hand, some students with this disorder may be quiet and spacey or inattentive, forgetful and easily distracted.

 

Symptoms may be situation-specific. For example, students with AD/HD may not exhibit some behaviors at home if that environment is less stressful, less stimulating or is more structured than school. Or students may stay on task when doing a project they enjoy, such as art.

 

 

Bipolar Disorder

 

Also know as manic-depressive illness, bipolar disorder, is a brain disorder that causes unusual shifts in a persons mood energy, and ability to function. The symptoms are severe and can result in damaged relationships, poor job or school performance, and even suicide. 

 

 

Conduct Disorder

 

Youth with conduct disorder are highly visible, demonstrating a complicated group of behavioral and emotional problems. Serious, repetitive, and persistent misbehavior is the essential feature. These behaviors fall into 4 main groups:
 

  •         aggressive toward people or animals
  •         destruction of property
  •         deceitfulness/theft
  •         serious violations of rules

To receive a diagnosis, the youth must have displayed 3 or more characteristic behaviors in the past 12 months. At least 1 must have been evident during the part 6 months. Diagnosing can be a dilemma because youth are constantly changing. Many children with CD also have learning disabilities and about 1/3 are depressed.  Many stop exhibiting the behavior problems when treated for depression.

 

 

 

Depression

 

All children feel blue or sad at times, but feelings of sadness with great intensity that persist for weeks/months may be a symptom of major depressive disorder or dysthymic disorder (chronic depression). These disorders affect a young persons thoughts, feeling, behavior, body and can lead to school failure, alcohol/drug abuse and even suicide.

 

Eating Disorders (ED)

 

The two most common are anorexia nervosa and bulimia nervosa. Once seen in teens and young adults, these disorders are increasingly seen in younger children as well. 

 

Individuals with anorexia fail to maintain minimally normal body weight. They engage in abnormal eating behavior and have excessive concerns about food. They are intensely afraid of even the slightest weight gain, and their perception of their body shape and size is significantly distorted. Many individuals with anorexia  are compulsive and excessive about exercise. Children and teens with this disorder are perfectionists and overachieving. In teenage girls with anorexia, menstruation may cease, leading to the same kind of bone loss suffered by menopausal women.

 

Youth with bulimia go on eating binges during which they compulsively consume large amounts of food within a short period of time. To avoid weight gain, they engage in inappropriate compensatory behavior, including fasting, self-induced vomiting, excessive exercise, and the use of laxatives, diuretics, and enemas.

 

 

Fetal Alcohol Spectrum Disorder (FASD)

 

Fetal Alcohol Spectrum Disorder refers to the brain damage and physical birth defects caused by women drinking alcohol during pregnancy. Fetal Alcohol Syndrome (FAS), can include growth deficiencies, central nervous system dysfunction that may include low IQ or mental retardation, and abnormal facial features (e.g. small eye openings, small upturned nose, thin upper lip, small lower jaw, low set of ears, and an overall small head circumference).

 

 

Obsessive Compulsive Disorder (OCD)

 

Children with OCD may have obsessive thoughts and impulses that are recurrent, persistent, intrusive, and senseless- they may, for instance, worry about contamination from germs. They may also perform repetitive behaviors in a ritualistic manner- for example, they may engage in compulsive hand washing. An individual with OCD will often perform these rituals, such as hand washing, counting, or cleaning, in an effort to neutralize the anxiety caused by their obsessive thoughts.

 

 

Oppositional Deviant Disorder (ODD)

 

Children with ODD generally have poor peer relationships. They often display behaviors that alienate them from their peers.

They are quick to blame others for mistakes and act in negative, hostile, and vindictive ways.

 

 

Pervasive Developmental Disorders (PDD) (also known as autisim)

 

PDD, the acronym for pervasive developmental disorders, includes Retts Syndrome, childhood disintegrative disorder, and Aspergers Syndrome.  Pervasive developmental disorder not otherwise specified (PDD-NOS) also belongs to this category.

 

Development may appear normal in some children until age 24-30 months; in others, development is more unusual from early infancy. Delays may be seen in the following areas:

 

  •         Communication: Language develops slowly or not at all. Children use gestures instead of words or use words inappropriately. Parents may also notice a short attention span.
  •         Social Interaction: Children prefer to be alone and show little interest in making friends. They are less responsive to social cues such as eye contact.
  •         Sensory Impairment: Children may be overly sensitive or under-responsive to touch, pain, sight, smell, hearing, or taste and show unusual reactions to these physical sensations.
  •         Play: Children do not create pretend games, initiate others, or engage in spontaneous or imaginative play.
  •         Behavior: Children may exhibit repetitious such as rocking back and forth or head banging. They may be very passive or overactive; lack of common sense and upsets over small changes in the environment or daily routine are common. Some children are aggressive and self-injurious. Some are severely delayed in areas such as understanding personal safety.

 

 

Post Traumatic Stress Disorder (PTSD)

 

Children who are involved in or who witness a traumatic event that involved intense fear, helplessness, or horror are at risk for developing PTSD. The event is usually a situation where someones life has been threatened or severe injury has occurred, such as a serious accident, abuse, violence, or a natural disaster. In some cases, the event may be a re-occurring trauma, such as continuing domestic violence.

 

Students with PTSD often have persistent frightening thoughts and memories of the experience. They may re-experience the trauma through flashbacks or nightmares. These occur particularly on the anniversary of the event or when a child is reminded of it by an object, place, or situation. During a flashback, the child may actually lose touch with reality and reenact the event.

 

PTSD is diagnosed if the symptoms last more than 1 month. Symptoms usually begin within 3 months of the trauma, but occasionally not until years after; they may last from a few months to years. Early intervention is essential, ideally immediately following the trauma. If the trauma is not known, then treatment should begin when symptoms of PTSD are first noticed. Some studies show that when children receive treatment soon after the trauma, symptoms of PTSD are reduced.

 

A combination of treatment approaches is often used for PTSD. Various forms of psychotherapy have been shown effective, including cognitive-behavioral, family, and group therapies. To help children express their feelings, play therapy and art therapy can be useful. Exposure therapy is a method where the child is guided to repeatedly re-live the experience under controlled conditions and to eventually work through and cope with their trauma.  Medication may also be helpful in reducing agitation, anxiety, depression or sleep disturbances.

 

 

Reactive Attachment Disorder (RAD)

 

The essential feature of reactive attachment disorder (RAD) is a markedly disturbed and developmentally inappropriate social relatedness with peers and adults in most contexts. RAD begins before age 5 and is associated with grossly inadequate or pathological care that disregards the childs basic emotional and physical needs. In some cases, it is associated with repeated changes of a primary caregiver.

 

The term attachment is used to describe the process of bonding that takes place between infants and caregivers in the first 2 years of life, and most important, the first 9 months of life. When a caregiver fails to respond to a babys emotional and physical needs, responds inconsistently, or is abusive, the child loses the ability to form meaningful relationships and the ability to trust.

 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes two types of RAD: inhibited and disinhibited. Inhibited RAD is the persistent failure to initiate and respond to most social interactions in a developmentally appropriate way. Disinhibited RAD is the display of indiscriminate sociability or a lack of selectivity in the choice of attachment figures (excessive familiarity with relative strangers by making requests and displaying affection).

 

Aggression, either related to a lack of empathy or poor impulse control, is a serious problem with these students. They have difficulty understanding how their behavior affects others. They often feel compelled to lash out and hurt others, including animals, smaller children, peers, and siblings. This aggression is frequently accompanied by a lack of emotion or remorse.

 

Children with RAD may show a wide range of emotional problems such as depressive and anxiety symptoms or safety seeking behaviors. To feel safe these children may seek any attachmentsthey may hug virtual strangers, telling them, I love you. At the same time, they have an inability to be genuinely affectionate with others or develop deep emotional bonds. Students may display soothing behaviors such as rocking and head banging, or biting, scratching, or cutting themselves. These symptoms will increase during times of stress or threat.

 

Schizophrenia

 

Schizophrenia is a medical illness that causes a person to think and act strangely. It is rare in children less than 10 years of age and has its peak age of onset between the ages of 16 and 25. This disorder affects about 1 percent of the population, and thus middle and high school teachers will likely see children who are in the early stages of the illness.

 

Schizophrenia can be difficult to recognize in its early phases, and the symptoms often are blurred with other psychiatric disorders.

 

Schizophrenia usually comes on gradually in what is known as the prodrome, and teachers are often the first to notice the early signs.

 

The early signs are usually non-specific. For example, students who once enjoyed friendships with classmates may seem to withdraw into a world of their own. They may say things that dont make sense and talk about strange fears and ideas. Students may also show a gradual decline in their cognitive abilities and struggle more with their academic work.

 

Some children show difficulties with attention, motor function, and social skills very early in life, before the prodrome, whereas others have no problems at all before the illness sets in.

 

The symptoms of schizophrenia include hallucinations (hearing and seeing things that are not there), delusions (fixed false beliefs); and difficulties in organizing their thoughts. A student may talk and say little of substance or the child may have ideas or fears that are odd and unusual (beyond developmental norms). Many, but not all individuals with schizophrenia may show a decline in their personal hygiene, develop a severe lack of motivation, or they may become apathetic or isolative. During adolescence the illness is not fully developed, and thus it is at times difficult to differentiate schizophrenia from a severe depression, substance abuse disorder, or bipolar affective disorder. Students who show signs of schizophrenia need a good mental health assessment.

 

 

Tourettes Disorder

 

Tourettes disorder is a neurological disorder that has dramatic consequences.  Boys identified with Tourettes disorder outnumber girls 3 to 1; the disorder affects all races and ethnic groups.

 

Researchers have traced the condition to a single abnormal gene that predisposes the individual to abnormal production or function of dopamine and other neurotransmitter in the brain. Although Tourettes disorder is classified as a mental health disorder, it is usually treated by a neurologist as well as a psychiatrist.

 

Indicators of Tourettes disorder include:

  •         The presence of multiple motor and vocal tics, although not necessarily simultaneously
  •         Multiple bouts of tics every day or intermittently for more than a year
  •         Changes in the frequency, number, and kind of tics and in their severity
  •         Marked distress or significant impairment in social, occupational, or other areas of functioning, especially under stressful conditions
  •         Onset before age 18

 

Tics may be simple (for example, eye blinking, head jerking, coughing, snorting) or complex (for example, jumping, swinging objects, mimicking other peoples gestures or speech, rapid repetitions of a word or phrase). In fact, the range of tics exhibited by people with Tourettes disorder is so broad that family members, teachers, and friends may find it hard to believe that these actions or vocalizations are not deliberate.

 

Like someone compelled to cough or sneeze, people with Tourettes disorder may feel an irresistible urge to carry out their tics. Others may not be aware of the fact they are ticking. Some people can suppress their tics for hours at a time, but this leads to stronger outbursts of tics later on. Often, children save up their tics during school hours and release them when they return home and feel safe from harassment or teasing.

 

Somewhere between 50 to 70 percent of students with Tourettes disorder have related learning disabilities, attention-deficit or attention-deficit hyperactivity disorder, obsessive-compulsive disorder or difficulties with impulse control. Sensory integration problems may explain some behaviors. Depression and anxiety may underlie more visible symptoms.

 

Legal Issues

Treating children with mental health issues often brings with it the agendas and opinions of many other interested parties.  In the best case scenario the family is very involved also frequently the school faculty, social services and potentially the court system will be too.  The Florida Legislature has outlined several guiding principles to help protect the children with mental health issues. 

 

The following in italics are taken directly from the Florida Statues.  Please make yourself comfortable with the contents.

394.491  Guiding principles for the child and adolescent mental health treatment and support system.

It is the intent of the Legislature that the following principles guide the development and implementation of the publicly funded child and adolescent mental health treatment and support system:

(1)  The system should be centered on the child, adolescent, and family, with the needs and strengths of the child or adolescent and his or her family dictating the types and mix of services provided.

(2)  The families and surrogate families of children and adolescents, including, but not limited to, foster parents, should be active participants in all aspects of planning, selecting, and delivering mental health treatment services at the local level, as well as in developing statewide policies for child and adolescent mental health services.

(3)  The system of care should be community based, with accountability, the location of services, and the responsibility for management and decision making resting at the local level.

(4)  The system should provide timely access to a comprehensive array of cost-effective mental health treatment and support services.

(5)  Children and adolescents who receive services should receive individualized services, guided by an individualized service plan, in accordance with the unique needs and strengths of each child or adolescent and his or her family.

(6)  Through an appropriate screening and assessment process, treatment and support systems should identify, as early as possible, children and adolescents who are in need of mental health services and should target known risk factors.

(7)  Children and adolescents should receive services within the least restrictive and most normal environment that is clinically appropriate for the service needs of the child or adolescent.

(8)  Mental health programs and services should support and strengthen families so that the family can more adequately meet the mental health needs of the family’s child or adolescent.

(9)  Children and adolescents should receive services that are integrated and linked with schools, residential child-caring agencies, and other child-related agencies and programs.

(10)  Services must be delivered in a coordinated manner so that a child or adolescent can move through the system of services in accordance with the changing needs of the child or adolescent.

(11)  The delivery of comprehensive child and adolescent mental health services must enhance the likelihood of positive outcomes and contribute to the child’s or adolescent’s ability to function effectively at home, at school, and in the community.

(12)  An older adolescent should be provided with the necessary supports and skills in preparation for coping with life as a young adult.

(13)  An adolescent should be assured a smooth transition to the adult mental health system for continuing age-appropriate treatment services.

(14)  Community-based networks must educate people to recognize emotional disturbances in children and adolescents and provide information for obtaining access to appropriate treatment and support services.

(15)  Mental health services for children and adolescents must be provided in a sensitive manner that is responsive to cultural and gender differences and special needs. Mental health services must be provided without regard to race, religion, national origin, gender, physical disability, or other characteristics.

394.492  Definitions.

As used in ss. 394.490-394.497, the term:

(1)  “Adolescent” means a person who is at least 13 years of age but under 18 years of age.

(2)  “Case manager” means a person who is responsible for participating in the development of and implementing a services plan, linking service providers to a child or adolescent and his or her family, monitoring the delivery of services, providing advocacy services, and collecting information to determine the effect of services and treatment.

(3)  “Child” means a person from birth until the person’s 13th birthday.

(4)  “Child or adolescent at risk of emotional disturbance” means a person under 18 years of age who has an increased likelihood of becoming emotionally disturbed because of risk factors that include, but are not limited to:

(a)  Being homeless.

(b)  Having a family history of mental illness.

(c)  Being physically or sexually abused or neglected.

(d)  Abusing alcohol or other substances.

(e)  Being infected with human immunodeficiency virus (HIV).

(f)  Having a chronic and serious physical illness.

(g)  Having been exposed to domestic violence.

(h)  Having multiple out-of-home placements.

(5)  “Child or adolescent who has an emotional disturbance” means a person under 18 years of age who is diagnosed with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, but who does not exhibit behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community. The emotional disturbance must not be considered to be a temporary response to a stressful situation. The term does not include a child or adolescent who meets the criteria for involuntary placement under s. 394.467(1).

(6)  “Child or adolescent who has a serious emotional disturbance or mental illness” means a person under 18 years of age who:

(a)  Is diagnosed as having a mental, emotional, or behavioral disorder that meets one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association; and

(b)  Exhibits behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community, which behaviors are not considered to be a temporary response to a stressful situation. 

The term includes a child or adolescent who meets the criteria for involuntary placement under s. 394.467(1).

(7)  “Child or adolescent who is experiencing an acute mental or emotional crisis” means a child or adolescent who experiences a psychotic episode or a high level of mental or emotional distress which may be precipitated by a traumatic event or a perceived life problem for which the individual’s typical coping strategies are inadequate. The term includes a child or adolescent who meets the criteria for involuntary examination specified in s. 394.463(1).

(8)  “Department” means the Department of Children and Family Services.

394.493  Target populations for child and adolescent mental health services funded through the department.

(1)  The child and adolescent mental health system of care funded through the Department of Children and Family Services shall serve, to the extent that resources are available, the following groups of children and adolescents who reside with their parents or legal guardians or who are placed in state custody:

(a)  Children and adolescents who are experiencing an acute mental or emotional crisis.

(b)  Children and adolescents who have a serious emotional disturbance or mental illness.

(c)  Children and adolescents who have an emotional disturbance.

(d)  Children and adolescents who are at risk of emotional disturbance.

(2)  Each mental health provider under contract with the department to provide mental health services to the target population shall collect fees from the parent or legal guardian of the child or adolescent receiving services. The fees shall be based on a sliding fee scale for families whose net family income is at or above 150 percent of the Federal Poverty Income Guidelines. The department shall adopt, by rule, a sliding fee scale for statewide implementation. Fees collected from families shall be retained in the service district and used for expanding child and adolescent mental health treatment services.

(3)  Each child or adolescent who meets the target population criteria of this section shall be served to the extent possible within available resources and consistent with the portion of the district substance abuse and mental health plan specified in s. 394.75 which pertains to child and adolescent mental health services.

394.494  General performance outcomes for the child and adolescent mental health treatment and support system.

(1)  It is the intent of the Legislature that the child and adolescent mental health treatment and support system achieve the following performance outcomes within the target populations who are eligible for services:

(a)  Stabilization or improvement of the emotional condition or behavior of the child or adolescent, as evidenced by resolving the presented problems and symptoms of the serious emotional disturbance recorded in the initial assessment.

(b)  Stabilization or improvement of the behavior or condition of the child or adolescent with respect to the family, so that the child or adolescent can function in the family with minimum appropriate supports.

(c)  Stabilization or improvement of the behavior or condition of the child or adolescent with respect to school, so that the child can function in the school with minimum appropriate supports.

(d)  Stabilization or improvement of the behavior or condition of the child or adolescent with respect to the way he or she interacts in the community, so that the child or adolescent can avoid behaviors that may be attributable to the emotional disturbance, such as substance abuse, unintended pregnancy, delinquency, sexually transmitted diseases, and other negative consequences.

(2)  Annually, pursuant to 1s. 216.0166, the department shall develop more specific performance outcomes and performance measures to assess the performance of the child and adolescent mental health treatment and support system in achieving the intent of this section.

394.495  Child and adolescent mental health system of care; programs and services.

(1)  The department shall establish, within available resources, an array of services to meet the individualized service and treatment needs of children and adolescents who are members of the target populations specified in s. 394.493, and of their families. It is the intent of the Legislature that a child or adolescent may not be admitted to a state mental health facility and such a facility may not be included within the array of services.

(2)  The array of services must include assessment services that provide a professional interpretation of the nature of the problems of the child or adolescent and his or her family; family issues that may impact the problems; additional factors that contribute to the problems; and the assets, strengths, and resources of the child or adolescent and his or her family. The assessment services to be provided shall be determined by the clinical needs of each child or adolescent. Assessment services include, but are not limited to, evaluation and screening in the following areas:

(a)  Physical and mental health for purposes of identifying medical and psychiatric problems.

(b)  Psychological functioning, as determined through a battery of psychological tests.

(c)  Intelligence and academic achievement.

(d)  Social and behavioral functioning.

(e)  Family functioning. 

The assessment for academic achievement is the financial responsibility of the school district. The department shall cooperate with other state agencies and the school district to avoid duplicating assessment services.

(3)  Assessments must be performed by:

(a)  A professional as defined in s. 394.455(2), (4), (21), (23), or (24);

(b)  A professional licensed under chapter 491; or

(c)  A person who is under the direct supervision of a professional as defined in s. 394.455(2), (4), (21), (23), or (24) or a professional licensed under chapter 491. 

The department shall adopt by rule statewide standards for mental health assessments, which must be based on current relevant professional and accreditation standards.

(4)  The array of services may include, but is not limited to:

(a)  Prevention services.

(b)  Home-based services.

(c)  School-based services.

(d)  Family therapy.

(e)  Family support.

(f)  Respite services.

(g)  Outpatient treatment.

(h)  Day treatment.

(i)  Crisis stabilization.

(j)  Therapeutic foster care.

(k)  Residential treatment.

(l)  Inpatient hospitalization.

(m)  Case management.

(n)  Services for victims of sex offenses.

(o)  Transitional services.

(5)  In order to enhance collaboration between agencies and to facilitate the provision of services by the child and adolescent mental health treatment and support system and the school district, the local child and adolescent mental health system of care shall include the local educational multiagency network for severely emotionally disturbed students specified in s. 1006.04.

394.496  Service planning.

(1)  It is the intent of the Legislature that the service planning process:

(a)  Focus on individualized treatment and the service needs of the child or adolescent.

(b)  Concentrate on the service needs of the family and individual family members of the child’s or adolescent’s family.

(c)  Involve appropriate family members and pertinent community-based health, education, and social agencies.

(2)  The principals of the service planning process shall:

(a)  Assist the family and other caregivers in developing and implementing a workable services plan for treating the mental health problems of the child or adolescent.

(b)  Use all available resources in the community, particularly informal support services, which will assist in carrying out the goals and objectives of the services plan.

(c)  Maintain the child or adolescent in the most normal environment possible, as close to home as possible; and maintain the child in a stable school placement, which is consistent with the child’s or adolescent’s and other students’ need for safety, if the child is removed from home and placed in state custody.

(d)  Ensure the ability and likelihood of family participation in the treatment of the child or adolescent, as well as enhancing family independence by building on family strengths and assets.

(3)  The services plan must include:

(a)  A behavioral description of the problem being addressed.

(b)  A description of the services or treatment to be provided to the child or adolescent and his or her family which address the identified problem, including:

1.  The type of services or treatment.

2.  The frequency and duration of services or treatment.

3.  The location at which the services or treatment are to be provided.

4.  The name of each accountable provider of services or treatment.

(c)  A description of the measurable objectives of treatment, which, if met, will result in measurable improvements of the condition of the child or adolescent, as specified in s. 394.494.

(4)  For students who are served by exceptional student education, there must be consistency between the services prescribed in the service plan and the components of the individual education plan.

(5)  The department shall adopt by rule criteria for determining when a child or adolescent who receives mental health services under ss. 394.490-394.497 must have an individualized services plan.

(6)  A professional as defined in s. 394.455(2), (4), (21), (23), or (24) or a professional licensed under chapter 491 must be included among those persons developing the services plan.

(7)  The services plan shall be developed in conference with the parent or legal guardian. If the parent or legal guardian believes that the services plan is inadequate, the parent or legal guardian may request that the department or its designee review and make recommended changes to the plan.

(8)  The services plan shall be reviewed at least every 90 days for programmatic and financial compliance.

394.497  Case management services.

(1)  As used in this section, the term “case management” means those activities aimed at:

(a)  Developing and implementing a services plan specified in s. 394.496.

(b)  Providing advocacy services.

(c)  Linking service providers to a child or adolescent and his or her family.

(d)  Monitoring the delivery of services.

(e)  Collecting information to determine the effect of services and treatment.

(2)  The department shall adopt by rule criteria that define the target population who shall be assigned case managers. The department shall develop standards for case management services and procedures for appointing case managers. It is the intent of the Legislature that case management services not be duplicated or fragmented and that such services promote the continuity and stability of a case manager assigned to a child or adolescent and his or her family.

394.4985  Districtwide information and referral network; implementation.

(1)  Each service district of the Department of Children and Family Services shall develop a detailed implementation plan for a districtwide comprehensive child and adolescent mental health information and referral network to be operational by July 1, 1999. The plan must include an operating budget that demonstrates cost efficiencies and identifies funding sources for the district information and referral network. The plan must be submitted by the department to the Legislature by October 1, 1998. The district shall use existing district information and referral providers if, in the development of the plan, it is concluded that these providers would deliver information and referral services in a more efficient and effective manner when compared to other alternatives. The district information and referral network must include:

(a)  A resource file that contains information about the child and adolescent mental health services as described in s. 394.495, including, but not limited to:

1.  Type of program;

2.  Hours of service;

3.  Ages of persons served;

4.  Program description;

5.  Eligibility requirements; and

6.  Fees.

(b)  Information about private providers and professionals in the community which serve children and adolescents with an emotional disturbance.

(c)  A system to document requests for services that are received through the network referral process, including, but not limited to:

1.  Number of calls by type of service requested;

2.  Ages of the children and adolescents for whom services are requested; and

3.  Type of referral made by the network.

(d)  The ability to share client information with the appropriate community agencies.

(e)  The submission of an annual report to the department, the Agency for Health Care Administration, and appropriate local government entities, which contains information about the sources and frequency of requests for information, types and frequency of services requested, and types and frequency of referrals made.

(2)  In planning the information and referral network, the district shall consider the establishment of a 24-hour toll-free telephone number, staffed at all times, for parents and other persons to call for information that concerns child and adolescent mental health services and a community public service campaign to inform the public about information and referral services.

394.499  Integrated children’s crisis stabilization unit/juvenile addictions receiving facility services.

(1)  Beginning July 1, 2001, the Department of Children and Family Services, in consultation with the Agency for Health Care Administration, is authorized to establish children’s behavioral crisis unit demonstration models in Collier, Lee, and Sarasota Counties. As a result of the recommendations regarding expansion of the demonstration models contained in the evaluation report of December 31, 2003, the department, in cooperation with the agency, may expand the demonstration models to other areas in the state after July 1, 2005. The children’s behavioral crisis unit demonstration models will integrate children’s mental health crisis stabilization units with substance abuse juvenile addictions receiving facility services, to provide emergency mental health and substance abuse services that are integrated within facilities licensed and designated by the agency for children under 18 years of age who meet criteria for admission or examination under this section. The services shall be designated as “integrated children’s crisis stabilization unit/juvenile addictions receiving facility services,” shall be licensed by the agency as children’s crisis stabilization units, and shall meet all licensure requirements for crisis stabilization units. The department, in cooperation with the agency, shall develop standards that address eligibility criteria; clinical procedures; staffing requirements; operational, administrative, and financing requirements; and investigation of complaints for such integrated facility services. Standards that are implemented specific to substance abuse services shall meet or exceed existing standards for addictions receiving facilities.

(2)  Children eligible to receive integrated children’s crisis stabilization unit/juvenile addictions receiving facility services include:

(a)  A person under 18 years of age for whom voluntary application is made by his or her guardian, if such person is found to show evidence of mental illness and to be suitable for treatment pursuant to s. 394.4625. A person under 18 years of age may be admitted for integrated facility services only after a hearing to verify that the consent to admission is voluntary.

(b)  A person under 18 years of age who may be taken to a receiving facility for involuntary examination, if there is reason to believe that he or she is mentally ill and because of his or her mental illness, pursuant to s. 394.463:

1.  Has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or

2.  Is unable to determine for himself or herself whether examination is necessary; and

a.  Without care or treatment is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or

b.  There is a substantial likelihood that without care or treatment he or she will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.

(c)  A person under 18 years of age who wishes to enter treatment for substance abuse and applies to a service provider for voluntary admission, pursuant to s. 397.601.

(d)  A person under 18 years of age who meets the criteria for involuntary admission because there is good faith reason to believe the person is substance abuse impaired pursuant to s. 397.675 and, because of such impairment:

1.  Has lost the power of self-control with respect to substance use; and

2.a.  Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm on himself or herself or another; or

b.  Is in need of substance abuse services and, by reason of substance abuse impairment, his or her judgment has been so impaired that the person is incapable of appreciating his or her need for such services and of making a rational decision in regard thereto; however, mere refusal to receive such services does not constitute evidence of lack of judgment with respect to his or her need for such services.

(e)  A person under 18 years of age who meets the criteria for examination or admission under paragraph (b) or paragraph (d) and has a coexisting mental health and substance abuse disorder.

(3)  The department, in cooperation with the agency, is authorized to adopt rules regarding standards and procedures for integrated children’s crisis stabilization unit/juvenile addictions receiving facility services.

394.4995  Conversion of specified facilities to children’s behavioral crisis units; not required.

Nothing in 1s. 394.499 shall be construed to require an existing crisis stabilization unit or juvenile addictions receiving facility to convert to a children’s behavioral crisis unit.

 

 

394.4784 Minors; access to outpatient crisis intervention services and treatment.For the purposes of this section, the disability of nonage is removed for any minor age 13 years or older to access services under the following circumstances:

 

(1)OUTPATIENT DIAGNOSTIC AND EVALUATION SERVICES.When any minor age 13 years or older experiences an emotional crisis to such degree that he or she perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive mental health diagnostic and evaluative services provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. The purpose of such services shall be to determine the severity of the problem and the potential for harm to the person or others if further professional services are not provided. Outpatient diagnostic and evaluative services shall not include medication and other somatic methods, aversive stimuli, or substantial deprivation. Such services shall not exceed two visits during any 1-week period in response to a crisis situation before parental consent is required for further services, and may include parental participation when determined to be appropriate by the mental health professional or facility.

 

(2)OUTPATIENT CRISIS INTERVENTION, THERAPY AND COUNSELING SERVICES.When any minor age 13 years or older experiences an emotional crisis to such degree that he or she perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive outpatient crisis intervention services including individual psychotherapy, group therapy, counseling, or other forms of verbal therapy provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. Such services shall not include medication and other somatic treatments, aversive stimuli, or substantial deprivation. Such services shall not exceed two visits during any 1-week period in response to a crisis situation before parental consent is required for further services, and may include parental participation when determined to be appropriate by the mental health professional or facility.

 

(3)LIABILITY FOR PAYMENT.The parent, parents, or legal guardian of a minor shall not be liable for payment for any such outpatient diagnostic and evaluation services or outpatient therapy and counseling services, as provided in this section, unless such parent, parents, or legal guardian participates in the outpatient diagnostic and evaluation services or outpatient therapy and counseling services and then only for the services rendered with such participation.

 

4)PROVISION OF SERVICES.No licensed mental health professional shall be obligated to provide services to minors accorded the right to receive services under this section. Provision of such services shall be on a voluntary basis.

 

 

394.4785  Children and adolescents; admission and placement in mental facilities

 

(1)A child or adolescent as defined in s. 394.492 may not be admitted to a state-owned or state-operated mental health treatment facility. A child may be admitted pursuant to s. 394.4625 or s. 394.467 to a crisis stabilization unit or a residential treatment center licensed under this chapter or a hospital licensed under chapter 395. The treatment center, unit, or hospital must provide the least restrictive available treatment that is appropriate to the individual needs of the child or adolescent and must adhere to the guiding principles, system of care, and service planning provisions contained in part III of this chapter.

 

(2)A person under the age of 14 who is admitted to any hospital licensed pursuant to chapter 395 may not be admitted to a bed in a room or ward with an adult patient in a mental health unit or share common areas with an adult patient in a mental health unit. However, a person 14 years of age or older may be admitted to a bed in a room or ward in the mental health unit with an adult if the admitting physician documents in the case record that such placement is medically indicated or for reasons of safety. Such placement shall be reviewed by the attending physician or a designee or on-call physician each day and documented in the case record.

 

 

 

In Summary

 

Florida has adopted principles that require a community-based system that is child centered and family driven.  The system requires that services are individualized, culturally competent, integrated, coordinated, and provide a smooth transition to the adult system for continued age appropriate services and supports. 

 

Children, families and the professionals that serve them need to be aware of the legal issues involved with legal, judicial and forensic proceedings.

 

 

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