Section - QUALITY ASSURANCE Effective: 8/10/2010

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1 ADMINISTRATIVE/FISCAL/CLINICAL/PHF POLICY AND PROCEDURES COUNTY OF SANTA BARBARA ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES Section - QUALITY ASSURANCE Effective: 8/10/2010 Policy - #46 CONSENT FOR TREATMENT OF MINORS Revised: Date /o --so ~/a Deputy Di rector's Approval ~...;.'l~ji::wi:~~~..,z:;:;..+.::::.::.::;:;..:;,;~j,.<---- Form Ref. Reviewed: POLICY: It is the policy of the Santa Barbara County Mental Health Plan (SBCMHP) to comply with relevant laws and regulations regarding consent for the treatment of minors, including treatment of minors without consent of the parent or legal guardian. In general, a person who has current legal responsibility for a minor should sign a document indicating informed consent for treatment before the minor receives any treatment. These persons typically include a parent with current right to consent to treatment, a non-parent legal guardian who has been given the right to consent to treatment, a court which is empowered to authorize treatment, a CWS or Probation employee who has been delegated the right to consent, a foster parent, or a caregiver authorized by law. An emancipated minor or a "self-sufficient minor" may consent to his or her own treatment in the same manner as an adult, and there are specific circumstances defined by law in which a minor can consent to his or her own treatment. Two separate informed consents are required. Informed consent for psychiatric medications is separate from informed consent for psychotherapy and other non-medication services. Legal Citation: California Family Code 6550, 6920 et seq., 7002, 7050 DEFINITIONS: A. Clinician is an individual employed by the MHP or an organizational provider contracted with the MPH who meets one or more of the criteria below: 1. Holds a valid California license as an MD, DO, NP, PA, PSY, LCSW, or MFT. 2. Holds a valid California license as an RN and earned a Master's degree, and is listed as a Psychiatric/Mental Health Nurse (PMH) by the Board of Registered Nursing.

2 3. Holds a valid California registration as an ASW or IMF. 4. Holds a valid waiver from DMH to perform the duties of an MFT, LCSW, or Psychologist. B. Emancipated Minor: A person under the age of 18 years is an Emancipated Minor if any of the following conditions is satisfied: 1. The person has entered into a valid marriage, whether or not the marriage has been dissolved. 2. The person is on active duty with the armed forces of the United States. 3. The person has received a declaration of emancipation from a court. C. Self-Sufficient Minor: A minor who satisfies all of the following conditions, as required by Family Code 6922, is a Self-Sufficient Minor: 1. The minor is 15 years of age or older. 2. The minor is living separate and apart from the minor's parents or guardian, whether with or without the consent of a parent or guardian and regardless of the duration of the separate residence. 3. The minor is managing the minor's own financial affairs, regardless of the source of the minor's income. D. Qualified relative: A person related to a minor as spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix "grand" or "great," or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution [Family Code 6550]. E. Parent or Other Guardian: For purposes of this P&P only, the phrase "parent or other guardian" means a biological or adoptive parent, foster parent, Court or individual or agency appointed by a court, or Qualified Relative. PROCEDURE: A. Consent By Parent 1. Either parent of a minor may generally consent to the minor's treatment. a. If any staff of a program providing services is informed by any individual or agency that the minor's parent(s) do not have the legal right to consent, the manager or supervisor of the program will be informed as soon as possible. The manager or supervisor will take reasonable steps to determine whether or not parental rights to consent to treatment have actually been suspended or terminated by a court. 2. If any staff of a program providing treatment becomes aware of a disagreement between parents having the right to consent to treatment, the manager or supervisor of the program will be informed as soon as possible. The manager or 2

3 supervisor will notify the manager or supervisor of any other program to which the minor has an open admission. a. Non-crisis services will be suspended until the program determines, through examination of documents issued by a court, which parent has the right to make health care decisions regarding the minor. i. If the program is not able to obtain such documentation, or if a parent asserts that documents presented to the program are not valid, the manager or supervisor will consult with the MHP Compliance Officer. ii. If only one parent has the right to consent to mental health treatment, the consent of that parent will be required before any further outpatient services are provided. iii. If both parents have the right to make such decisions jointly, only services to which both parents consent will be provided. B. Consent by Legal Guardian 1. Before non-crisis outpatient services can be provided, the legal guardian of a minor must present documentation from a court to verify guardianship, and a copy of the documentation must be placed in the minor's medical record. a. The guardian cannot consent to any service which is outside the scope of the guardianship documents. 2. If an individual claims to be a minor's legal guardian but is unable to produce documentation from a court, the manager or supervisor of the program will be notified as soon as possible. a. The manager or supervisor will take reasonable steps, based on the specific circumstances involved, to determine legal guardianship and the identity of individuals or agencies who may give valid consent for treatment. C. Consent by Foster Parent 1. A foster parent must present a placement agreement or documentation from a court before being allowed to consent to services to the minor. A copy of this documentation will be placed in the minor's medical record. a. A foster parent cannot consent to any service which is outside the scope of the placement agreement or court documentation. b. In general, a foster parent can consent to outpatient mental health services when the minor has been placed by court order, or with the consent of the child's legal guardian. However, when the minor has been placed on a temporary basis pending a. court hearing, the foster parent generally has no authority to consent to treatment. 3

4 D. Consent by CWS, Probation, or Group Home 1. A Court may assign the right to consent to treatment to an individual, government agency, or group home. Therefore, before any program provides services to a minor who is a ward or dependent of a court, the program must obtain written verification showing who may consent to medical treatment. A copy of the verification will be placed in the minor's medical record. 2. Once a program has determined who may authorize treatment, that individual, or an authorized agent of that agency, must consent to treatment. 3. If a dependent or ward of a Court is a Medi-Cal beneficiary, and the minor's Medical County is not Santa Barbara, no services may be provided until written authorization has been obtained from.the Mental Health Plan of the Medi-Cal County. E. Consent by Qualified Relative 1. If a minor's caretaker is a Qualified Relative as defined by Family Code 6550 (see "Definitions" in this P&P), and the Qualified Relative completes and signs the Caregiver's Authorization Affidavit (attached) including all of items 1 through 8, the Qualified Relative may consent to treatment for the minor. A copy of the affidavit will be placed in the minor's medical record. 2. Consent by a Qualified Relative ceases to be valid in either of the following circumstances: a. The Qualified Relative notifies the program providing services that the minor no longer resides with the relative, or b. The minor's parent or legal guardian notifies a program that he or she does not consent to treatment. F. Treatment Without Consent of Parent or Guardian: 1. Emancipated Minor: An Emancipated Minor is considered an adult for purposes of mental health services and may consent to his or her treatment. No parent or other guardian of an Emancipated Minor is responsible for payment for mental health services. 2. Self-Sufficient Minor: A Self-Sufficient Minor may consent to his or her own medical treatment, including outpatient mental health treatment. a. When services are provided without the consent of a parent or other guardian, the parent or other guardian has no financial responsibility for those services. b. The rights of a Self-Sufficient Minor are subject to the limitation below: i. A Physician may, with or without the consent of the minor patient, advise the minor's parent or guardian of the treatment given or needed if the physician has reason to know, on the basis of the information given by the minor, the whereabouts of the parent or guardian. 4

5 3. Evidence: a. An individual claiming to be an Emancipated Minor or Self-Sufficient Minor is responsible for providing evidence of his or her status. b. Evidence of Emancipated or Self-Sufficient status must be reviewed and approved by an ADMHS Program Manager or Team Supervisor (for services provided by a county-operated program), or by an administrator approved by the legal entity (for services provided by a contracted program). c. Evidence of Emancipated. or Self-Sufficient status will be documented in a progress note in Clinician's Gateway, and copies of any documentation will be placed in the minor's medical record. 4. Family Code 6924: a. An SBC MHP County-operated or contracted mental health program may choose to provide specialty mental health services to a minor when the following requirements are met in advance: i. The minor is 12 years of age or older, AND ii. A Clinician determines that: (A) The minor is mature enough to participate intelligently in the services, AND (B) The minor either: would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or residential shelter services, or is the alleged victim of incest or child abuse. iii. Any program which decides to provide services to a minor under Family Code 6924 will assign a Clinician to coordinate those services. (A) The Clinician assigned to coordinate services will contact the parent or other legal guardian and seek involvement of the parent or guardian in the minor's treatment, unless the Clinician decides that such involvement is inappropriate. (B) This decision and any attempts to contact parents must be documented in Clinician's Gateway. (C) While the Clinician may inform and involve parents or legal guardians in treatment, the Clinician and other program staff do not have a right to disclose the minor's medical records to parents or legal guardians without the minor's consent. 5

6 G. Confidentiality 1. If a minor is provided mental health services without consent of a parent or other guardian, staff of the MHP County-operated or contracted agency may share or release the minor's medical information only with a written consent signed by the minor which complies with HIPAA and other legal requirements. 2. Staff of programs providing services to the minor may share medical information for treatment or referral purposes with other qualified professionals treating the client. However, "psychotherapy notes" (as defined by HIPAA) cannot be shared without written client authorization. a. "Psychotherapy notes" (as defined by HIPAA) are notes of a Clinician documenting or analyzing the contents of a conversation during a private counseling session or a group, joint or family counseling session which are separate from the rest of the individual's medical records. 3. If the parent or other guardian consents to services, the parent or other guardian has a right to access the minor's medical information, and staff of MHP Countyoperated or contracted programs can only share or release the minor's information with others with a written consent signed by the parent or legal guardian, which complies with HIPAA and other legal requirements. H. Psychiatric Medications Assistance: Reference: Replaces: 1. No psychiatric medications may be prescribed without the specific consent of the parent or other guardian, except to an Emancipated minor. When the right to consent to a minor's treatment has been granted by a court, the court must specify the right to consent to psychotropic medications. 6

7 Caregiver's Authorization Affidavit Use of this affidavit is authorized by Part 1.5 (commencing with Section 6550) of Division 11 of the California Family Code. Instructions: Completion of items 1-4 and the signing of the affidavit is sufficient to authorize enrollment of a minor in school and authorize school-related medical care. Completion of items 5-8 is additionally required to authorize any other medical care. Print clearly. The minor named below lives in my home and I am 18 years of age or older. 1. Name of minor: 2. Minor's birth date: 3. My name (adult giving authorization): 4. My home address: 5. D I am a grandparent, aunt, uncle, or other qualified relative of the minor (see back of this form for a definition of "qualified relative). 6. Check one or both (for example, if one parent was advised and the other cannot be located): D I have advised the parent(s) or other person(s) having legal custody of the minor of my intent to authorize medical care, and have received no objection. D I am unable to contact the parent(s) or other person(s) having legal custody of the minor at this time, to notify them of my intended authorization. 7. My date of birth: My California driver's license or identification card number: Warning: Do not sign this form if any of the statements above are incorrect, or you will be committing a crime punishable by a fine, imprisonment, or both. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: Signed: Notices: 1. This declaration does not affect the rights of the minor's parents or legal guardian regarding the care, custody, and control of the minor, and does not mean that the caregiver has legal custody of the minor. 2. A person who relies on this affidavit has no obligation to make any further inquiry or investigation. 7

8 Additional Information: TO CAREGIVERS: 1. "Qualified relative," for purposes of item 5, means a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half brother, half sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix "grand" or "great," or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution. 2. The law may require you, if you are not a relative or a currently licensed foster parent, to obtain a foster home license in order to care for a minor. If you have any questions, please contact your local department of social services. 3. If the minor stops living with you, you are required to notify any school, health care provider, or health care service plan to which you have given this affidavit. The affidavit is invalid after the school, health care provider, or health care service plan receives notice that the minor no longer lives with you. 4. If you do not have the information requested in item 8 (California driver's license or l.d.), provide another form of identification such as your social security number or Medi-Cal number. TO SCHOOL OFFICIALS: 1. Section of the Education Code provides that this affidavit constitutes a sufficient basis for a determination of residency of the minor, without the requirement of a guardianship or other custody order, unless the school district determines from actual facts that the minor is not living with the caregiver. 2. The school district may require additional reasonable evidence that the caregiver lives at the address provided in item 4. TO HEAL TH CARE PROVIDERS AND HEAL TH CARE SERVICE PLANS: 1. A person who acts in good faith reliance upon a caregiver's authorization affidavit to provide medical or dental care, without actual knowledge of facts contrary to those stated on the affidavit, is not subject to criminal liability or to civil liability to any person, and is not subject to professional disciplinary action, for that reliance if the applicable portions of the form are completed. 2. This affidavit does not confer dependency for health care coverage purposes. 8

9 Family Code (a) A minor may consent to the minor's medical care or dental care if all of the following conditions are satisfied: (1) The minor is 15 years of age or older. (2) The minor is living separate and apart from the minor's parents or guardian, whether with or without the consent of a parent or guardian and regardless of the duration of the separate residence. (3) The minor is managing the minor's own financial affairs, regardless of the source of the minor's income. (b) The parents or guardian are not liable for medical care or dental care provided pursuant to this section. (c) A physician and surgeon or dentist may, with or without the consent of the minor patient, advise the minor's parent or guardian of the treatment given or needed if the physician and surgeon or dentist has reason to know, on the basis of the information given by the minor, the whereabouts of the parent or guardian. 9