A change in Washington law helps parents address mental-health needs of their teenage children ... .

Seattle Children's Hospital

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When Hollie Kelly first started running away at age 13, her mother filed police runaway reports. But when police brought Hollie back to her Enumclaw home, the teenager never stayed for long.

Eventually her mother, Karen Kelly, stopped filing reports, instead cultivating eyes on the ground to help find her daughter, who struggled with a methamphetamine addiction she’d developed on the streets. Soon she was getting texts from drug dealers and homeless people saying, “Hey, Hollie’s passed out at the library right now,” or, “Hollie was just picked up at Safeway stealing.”

But as Kelly would soon learn, knowing her daughter’s whereabouts was one thing; being able to help her was something else entirely.

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A three-decades-old Washington state law had rendered Kelly powerless to initiate substance-abuse or mental-health treatment for Hollie against her will unless deemed medically necessary. The law gave young people 13 and older the right to initiate that treatment without their parents’ permission.

An unintended consequence of the measure quickly became clear: If minors had the right to consent to treatment, they also had the right to reject it.

“The age of consent became the age of refusal,” said Kathy Brewer, a therapist and manager at Seattle Children’s department of psychiatry.

When the Kellys tried to get Hollie to agree to treatment, she said no.

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“Everything with me at that time was about power,” said Hollie, now 19. “If I had control, I would take it and do the opposite of what everybody wanted me to do.”

Finally last year, more than three decades after the state Legislature adopted the so-called age-of-consent law, legislators passed a new law aimed at ensuring that parents like the Kellys can get their minor children the help they need.

Still, the bill was a compromise, and experts say big obstacles remain: namely, the lack of an available mental-health and substance-abuse treatment infrastructure that can actually address the needs of every young person in the state. Even months after the law was passed, the state has yet to publish any written materials for providers or parents explaining the new rules.

Saying no

The law that prevented the Kellys from being able to help their daughter as they saw fit was passed in 1985 in response to an increase in schools operating mental-health clinics.

Providers soon realized they were unable to release important information to the people with whom their patients lived and who were responsible for their care.

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They also thought the law blocked the progress of patients who, like Hollie, resisted treatment. Parents lost the right to initiate treatment once a patient was stabilized. If, after being discharged, their child refused to consent to the provider’s recommended treatment plan, parents were out of options. As a result, said Brewer, “Patients would decompensate. There was no way to override their refusal for outpatient care.”

Many frustrated parents in Washington had to look for help out of state, going so far as to hire transport companies that essentially kidnap youth in the middle of the night and whisk them off to locked treatment centers they can’t leave.

At one point, the Kellys drove Hollie to a secure residential treatment program in Oregon. “That was really good,” Hollie said, “because I couldn’t say no.”

Families also turned to the courts out of desperation. By filing an At-Risk Youth (ARY) petition, parents can request court-ordered support and assistance for children who are beyond their control. If youth disobey a judge’s order the judge can hold them in contempt of court. In 2017, judges detained 691 minors for violations related to ARY petitions. Detention triggers services.

The Kellys filed an ARY petition when Hollie was 14, but detention for noncriminal behavior varies widely among counties and Hollie was able to ignore the judge’s orders without consequence.

The adversarial process and the risk of detention make the ARY petition process unappealing for many families.

Peggy Dolane, an advocate for children’s mental-health services, steered clear of the ARY process when it came to finding help for her own two children, who had behavioral health issues.

“I have African American kids, and I didn’t want to use jail to enforce what they needed,” she said.

Changing the law

So Dolane decided to take up the fight against the age-of-consent law.

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It was a leap of faith: There had been 11 attempts to raise the age of consent between 1989 and 2009. All had failed.

Dolane pressed on anyway, building a movement of parents. After she reached out to her state representative, Noel Frame, D-Seattle, in 2017, asking for legislative action, Dolane wound up on a subcommittee of the state’s Children’s Mental Health Work Group.

“I said, ‘Find a solution everyone can agree with,’ ” said Frame, the group’s co-chair. “And they did it.”

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Dolane worked closely in the group with Brewer, the Seattle Children’s therapist, and other parent and youth advocates. This time, instead of launching another effort to raise the age of consent, they focused on increasing the opportunity for parents to consent.

Ultimately, the Legislature passed HB 1874 last spring, which went into effect in July. Under the law, adolescents can still obtain treatment without their parents’ consent, but they can no longer refuse it if a provider agrees with their parents or caregivers that treatment is necessary. The law limits involuntary outpatient treatment to 12 sessions or three months with any given provider.

“Clinicians said if we can’t engage a youth to consent by then, either they don’t need the therapy or we’re not the right therapist,” Brewer said. If the latter turns out to be the case, the parent can start treatment over again with another provider.

HB 1874 represents a cultural shift for therapists by centering families in their efforts to help young people. The new law provides guidelines, encouraging providers to use discretion but to inform parents about things a caregiver ought to know, such as diagnoses, medications and treatment plans.

Brewer said the message HB 1874 sends to youth is: “If you need help and you’re not willing to get it, parents can now get it for you. We don’t want you to die.”

However, Dolane emphasized the new law is only a “a first step” and a compromise. Providers still can deny treatment if the young person is uncooperative or not compliant.

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The state is “working on public and private partnerships to develop a robust and sustainable system of adolescent behavioral health care,” Dolane said in a webinar she gave with Brewer in August, but “we have a long way to go.”

Few early interventions and services exist to help families in crisis in the absence of abuse and neglect, according to an April 2019 joint report to the Legislature by the Department of Children, Youth, and Families and the Office of Homeless Youth. State-funded crisis residential centers offer young people refuge along with evaluations and referrals for services, but they’re in only nine of Washington’s 39 counties and have a total of 106 beds.

The Children’s Long-term Inpatient Program (CLIP), the most intensive inpatient treatment option for youth in Washington, has only 84 beds across the state through five programs and requires a psychiatric diagnosis, among other eligibility criteria.

There are no secure long-term residential centers for youth with intense behavioral health care needs.

“Without a public system clearly responsible for supporting youth and families experiencing a crisis, that crisis can intensify,” the report warned. “In some cases, this can be serious: familial violence, court involvement and youth homelessness. ”

Brewer suspects the lack of a robust infrastructure of treatment options may be tied to the old age-of-consent law. Why build it, if they won’t come?

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“Out of options”

It’s too early to tell what new measures related to family-initiated treatment may pass out of this current legislative session, though a bill was filed to update the Children’s Mental Health Work Group, out of which HB 1874 grew. There are plans to add more youth representation on the group, said Frame, the state representative.

“We want to ensure young people have a seat at the table in determining public policy that affects them directly,” she said.

A new bill, HB 2883, has also been filed this session to update HB 1874 so families can admit their adolescent children specifically to residential treatment centers without the child’s consent if it’s deemed medically necessary, an option Frame said was inadvertently left out of the original legislation.

Unfortunately for the Kellys, changes to the age-of-consent law came too late to help their daughter.

Hollie’s parents eventually enrolled her in the intensive CLIP program. On the day a bed became available, Karen Kelly hadn’t seen Hollie in a week. She turned to her contacts on the street. A drug dealer led Kelly to a grassy area behind an industrial park, where Hollie had been living in some bushes. When she learned a bed was waiting for her, she ran.

The next day, police found her at a library and brought her home where the Kellys were waiting to drive her to the treatment center.

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Hollie gave in. “I felt out of options,” she said.

In her own life, Hollie has had successes but still struggles. She spent nine months in youth detention but earned her GED, continued to undergo intensive counseling, and gained some work experience. Recently, she worked in a fast-food restaurant and rented a room in Renton.

She has since relapsed again. She and her boyfriend were most recently sleeping at a young adult shelter in Seattle, preparing to go into detox and then rehab but Kelly hasn’t heard from Hollie in recent days.

Kelly believes if Hollie had been compelled to receive trauma-informed treatment early on and in the community, she might have gained the tools to help her self-regulate in a real-world setting.

“I don’t think she’d be homeless right now,” Kelly said. She’s frustrated too, hearing about parents who are still being turned away because providers aren’t informed about the new law and the rights it affords them. Diana Cockrell, a section manager with the Washington State Health Care Authority’s behavioral health and recovery division, said the state has been working with providers to come up with written materials that provide clarity on the new rules. The state hopes to release those in mid- to late March.

In an interview before her relapse, Hollie agreed the new law is a good one.

“Back in my 13-year-old head, I was like, ‘I want to be able to have my own say.’ But giving a kid that say? Whether they get to choose treatment or not? Obviously, if that’s the only power they have, they’re going to choose not to go if that’s what everyone wants them to do.”

This story was produced with Youth Today, the national news source for youth service professionals, including those who work in juvenile justice and out-of-school-time programming.

Seattle Times Project Homeless editor Vianna Davila contributed to this report.