§4 ch24: Medical/Mental Health Planning
24.5 Custody Diversion Protocol
The following protocol has been developed to divert youth from entering state custody solely to access mental health services. This protocol is predicated on the belief that no parent should voluntarily have to relinquish custody of their child to access mental health services, if clinically appropriate services and supports, either within or outside the home setting, can be provided to the youth and family.
Families may be experiencing a great deal of stress at these times, due to conflicting information or information that encourages them to relinquish custody to obtain treatment for their child. Many facilities may not be aware of community based alternatives available to the family. Professionals must recognize the families’ need for help and provide them with objective information and realistic treatment options. This protocol is not meant to replace or detract from the standard referral process to a community mental health center, Regional Center or CSTAR Provider. If CD or the Juvenile Office is contacted to obtain information regarding mental health services, the CD or JO should simply provide the individual with the community resources available including the appropriate telephone numbers to call.
Strategies to be considered to further advance this protocol include:
- Advance notice regarding discharge from facilities will be important in these situations.
- Courts cannot be eager to relieve the family of custody to obtain mental health services.
- Public and private agencies must understand alternatives to long term residential treatment.
- Resources to address the need for emergency placements should be developed.
- Targeted education should be provided to professional staff within private psychiatric hospitals.
A parent/legal guardian contacts a representative of a Juvenile Court or Children’s Division/Dept. of Social Services (CD) noting that they wish to voluntarily relinquish custody of their child to the state. CD or the juvenile office staff should assess the basis of the voluntary relinquishment and if it is solely to access mental health services a referral to the Custody Diversion protocol may be made if the following conditions are met.
- The parent/legal guardian is a legal resident of the state of Missouri;
- The parent does not receive adoption subsidy on behalf of the child;
- There is no allegation of abuse and/or neglect;
- There is no current referral to the juvenile office on which the juvenile office will be taking any level of action besides making a referral for mental health services;
- The parent has already contacted the appropriate DMH provider (community mental health center, Regional Office, Adolescent CSTAR provider) in an attempt to obtain services but continue to want to relinquish custody of their child. If they have not contacted a DMH provider, CD or the juvenile office staff will provide contact information for the appropriate provider, and a referral to the protocol is not made;
- The child is currently residing in the parents’ or legal guardian’s home (this excludes an acute psychiatric admission);
- The parent/legal guardian commits to allowing the child, if placed out of the home, to return to their home when deemed clinically appropriate.
- If a recent referral had been made to the appropriate DMH provider and the legal guardian still wants to voluntarily relinquish custody, the JO or CD staff should provide the parent/legal guardian with the contact name and information for the community mental health center’s designated contact for the protocol in their area AND explain that custody will not be accepted at this time and an assessment process must first occur. If the child is currently in a psychiatric hospital they should be informed that no decisions will likely occur for 3-7 days. To initiate the Custody Diversion Protocol process the juvenile office or CD must complete the top half of the Screening Form and forward it to the custody diversion designee at the community mental health center.
- If a parent/legal guardian comes in person to the local CD or Juvenile Office with the child the process should be explained and the parent encouraged to contact the CMHC with the child returning home at this time. If the parent/legal guardian refuses to take the child home, the agency initially contacted should immediately call an emergency meeting (in person or by phone) with the contacts of the other two agencies and develop an emergency plan for placement. The assessment process outlined below should then continue.
- It is the responsibility of the CD or JO staff receiving the initial call to ensure that utilization of the Custody Diversion Protocol is appropriate. The Custody Diversion Protocol is to be utilized only in those circumstances where the parent has made the decision to voluntarily relinquish custody of their child. The agency receiving the initial call shall complete and forward to the contact person identified by the CMHC the screening information after obtaining witnessed oral permission from the legal guardian. The screening information ensures that the protocol is being applied under appropriate circumstances. The Diversion Protocol is initiated by completion of the Screening/Feedback form by the CD or JO and receipt of the Screening/Feedback Form by the CMHC. If this is not completed by the CD or JO the protocol will not have been initiated.
- Staff from the local juvenile office, local CD office, community mental health center, Regional Office, or Adolescent CSTAR program shall not recommend a custody diversion protocol to the parent without the parent first initiating relinquishment of custody. Rather they should assist the family within the means of their respective agency to meet the child and family’s needs through the provision of services or making referrals to other agencies for services.
- When the community mental health center receives a Custody Diversion Protocol Screening Form from the juvenile office or CD, the Administrative Agent/CMHC will arrange with the parent/guardian of the child for a level of care assessment to be completed as soon as possible or no later than within 2 business days of the receipt of the Screening/Feedback Form. The CMHC will determine if there are psychiatric, developmental and/or substance abuse issues to be addressed. If there is a psychiatric history, then the CMHC should do an assessment. If there is no psychiatric history or indicators of a mental illness, the CMHC will forward the Screening form to the appropriate division provider in their area.
- If there is information that the youth is a client of a DMH Regional Center and/or has a diagnosis of mental retardation or a significant developmental disorder, the Regional Center shall be contacted by the CMHC to participate in the assessment process. If there is information that the youth requires substance abuse assessment and treatment, the CMHC should contact the local Adolescent CSTAR provider to participate in the assessment process.
- If the child is currently in a psychiatric hospital, the DMH assessment will likely occur at the hospital.
- The DMH assessment shall examine the child/youth’s current mental health needs, the family’s perceptions of the child’s needs and identify any risk factors through conducting a clinical interview with the child, obtaining a history of past needs and services and obtaining information from past and current caretakers to establish the level of care needed for the child related to mental health issues. The parent/legal guardian and the child (if age appropriate) should be actively involved in the assessment and development of the plan.
- If abuse and neglect is suspected the CA/N Hotline should be contacted as required by law, RSMo 210.115.
- Upon completion of the assessment and/or if there is a significant delay in arranging the assessment the CMHC/Regional Center/Adolescent CSTAR provider should complete the lower half of the received Screening/Feedback Form and forward it to the appropriate referring party. This is to notify the referring party if there is a significant delay in completing the assessment and identify any safety concerns in the interim AND/OR to notify the referring party of the outcome of the assessment. If the assessment has not yet been completed within 2 working days but the referring agency notified the referring party of the delay, the assessment and recommendations should be forwarded to the referring party as well as DMH Central Office when the assessment and recommendations are completed. (see screening form for details).
- A meeting should be conducted with the parent/guardian, outlining the results of the level of care assessment, service options, and fiscal resources necessary to implement the plan. If the parent/guardian is in agreement with the assessment and services offered, such services may then be accepted by the parent and implemented with no need for a change in custody.
- If through the assessment it appears that a temporary placement outside of the family home would be clinically appropriate, a Voluntary Placement Agreement (VPA) through the CD can be explored. The CMHC/Regional Center/Adolescent CSTAR provider should provide a brief explanation of a VPA to the parents and explain that a referral could be made to the CD to provide a review to determine if CD has additional resources to keep the child in the home and if needed to access this agreement. If the parent is agreeable, the CMHC/Regional Center should contact the CD requesting a screening for a VPA and a meeting set up with the parents, CD and CMHC/Regional Center/Adolescent CSTAR provider to review the assessment, discuss the proposed plan and identify any additional resources and/or to access the VPA.
- If the parent/guardian rejects the services outlined through the level of care assessment after an attempt to obtain consensus on a plan and continues to request out-of-home placement and/or plans to give up custody of their child to CD, then the local CD representative should be contacted.
- The CMHC/Regional Center/Adolescent CSTAR provider should attempt to obtain voluntary authorization from the parent/guardian to share information with CD and contact the CD designee in that county to initiate a screening by CD. If the parent refuses to have information shared and continues to choose to give up custody, it should be explained to the parent that a CA/N hotline call will be placed.
- If a child is currently in a hospital outside of their county of residence, the CMHC, Regional Center or Adolescent CSTAR provider can elect to contact the CMHC, Regional Center or Adolescent CSTAR provider that serves the county in which the hospital operates and request a courtesy evaluation. However, it is the responsibility of the CMHC, Regional Center or Adolescent CSTAR provider in the county of residence for making the final determination and developing, implementing, and coordinating the service plan unless specifically agreed to otherwise.
- CD, upon notification from the CMHC/Regional Center/Adolescent CSTAR provider representative, with appropriate consents for information release, or via the Hotline, will initiate a screening to be completed as soon as possible or no later than within 2 business days.
- This screening will determine child safety and risk, any indicators of abuse/neglect and the family’s perception of the mental health needs of the child. CD policy and statute should be followed relating to the observation of the child. This screening will determine whether there is a need for services through the CD either for the VPA as DMH has recommended a temporary out-of-home placement or if there are community-based services CD can add to the plan OR if there is evidence of abuse or neglect whether CD should become involved and if any court action is required.
- Upon completion of the CD screening, the CD designee, CMHC and/or Regional Center and/or Adolescent CSTAR provider designee and parent/legal guardian will meet to discuss the screening and to develop a plan.
- This plan can take one of three paths:
- If DMH has recommended a temporary out-of-home placement and the VPA is needed, the CD may approve the use of the VPA and enter into an agreement with the parents.
- CD is able to provide additional community supports to add to DMH services with support from the parents and the child can be maintained in the community.
- CD screening found reason to suspect abuse or neglect and CD policy related to abuse/neglect is instituted.
- The Voluntary Placement Agreement is to be used only in conjunction with the Custody Diversion Protocol and in those circumstances where the child clinically requires a placement out-of-the home due to their behaviors, the instability of the home environment or lack of access to intensive community-based services. In consideration of the child’s and family’s needs short-term out-of-home placements may be considered such as emergency respite, crisis beds, out-of-home in-depth assessments in addition to residential treatment. The Voluntary Placement Agreement is an agreement between the parent/legal guardian and the Children’s Division.
- If the parent accepts the services offered, the CMHC, Regional Center, and/or Adolescent CSTAR provider should implement the plan through the Family Support Team process.
- If the VPA is utilized, the DMH provider is responsible for locating an appropriate out-of-home placement and for monitoring that placement. The DMH provider will work closely with the child and family in continuing to assess the need for services and accessing appropriate services. The DMH should notify the CD mental health liaison of any outstanding issues related to the child and/or family while the VPA is in place. After the VPA has been in place for 100 days, the CD will arrange for a Family Support Team meeting to begin planning for the child’s needs in preparation for the termination of the VPA after 180 days of initiation. Issues to be addressed would be the child’s progress in services, the family’s involvement in the treatment, the need for the child to continue in an out-of-home placement or the plan to transition that child back into their home community. CD will also contact the CMHC, Regional Center and/or CSTAR provider at 150 days and a FST meeting will be held to again review the child’s progress and plan for transition from the out-of-home placement.
- If the parent/guardian rejects the services offered and refuses to take the child home, or find alternative means to care for the child, CD will initiate a referral to the court based on 211.031.1(1) (d) (depending on the finding of the CD screening).
Court Involvement/Early Reunification
- CD will notify the juvenile/family court of the need to obtain temporary custody of the child based on the CD screening and/or meeting outcome cited above.
- CD, Juvenile Office, CMHC, Regional Center and/or Adolescent CSTAR provider will develop a temporary plan for placement and services that best meets the child’s needs.
- Within 72 hours of the child placed in the temporary custody of CD, CD shall convene a meeting with all involved/interested parties, including the parent/guardian, to examine the child’s and family’s needs and identify service options.
- If the court has ordered custody pursuant to 211.031. (1)(d)**, then pursuant to 211.181.1(5)*** this team will propose a plan and submit it to the court within 30 days, per current CD policy. The court will then determine whether to return the child to the custody of the parent or adjudicate.
*Note: CD policy currently requires a multidisciplinary approach with a 72 hour meeting and 30 day meeting consistent with the above protocol, irrespective of 211.031(1)(d).
Juvenile court to have exclusive jurisdiction, when--exceptions.
211.031.1. Except as otherwise provided in this chapter, the juvenile court or the family court in circuits that have a family court as provided in sections 487.010 to 487.190, RSMo, shall have exclusive original jurisdiction in proceedings:
(d) The child or person seventeen years of age is a child in need of mental health services and the parent, guardian or custodian is unable to afford or access appropriate mental health treatment or care for the child;
(1) Involving any child or person seventeen years of age who may be a resident of or found within the county and who is alleged to be in need of care and treatment because:
(2) The child or person seventeen years of age is a child in need of mental health services and the parent, guardian or custodian is unable to afford or access appropriate mental health treatment or care for the child;
Order for disposition or treatment of child--suspension of order and probation granted, when--community organizations, immunity from liability, when--length of commitment may be set forth--assessments, deposits, use.
211.181. 1. When a child or person seventeen years of age is found by the court to come within the applicable provisions of subdivision (1) of subsection 1 of section 211.031, the court shall so decree and make a finding of fact upon which it exercises its jurisdiction over the child or person seventeen years of age, and the court may, by order duly entered, proceed as follows: …
(5) The court may order, pursuant to subsection 2 of section 211.081, that the child receives the necessary services in the least restrictive appropriate environment including home and community-based services, treatment and support, based on a coordinated, individualized treatment plan. The individualized treatment plan shall be approved by the court and developed by the applicable state agencies responsible for providing or paying for any and all appropriate and necessary services, subject to appropriation, and shall include which agencies are going to pay for and provide such services. Such plan must be submitted to the court within thirty days and the child’s family shall actively participate in designing the service plan for the child or person seventeen years of age.