Introduction

Protocol for the Admission of Children to Psychiatric Treatment Facilities

INTRODUCTION

A self-appointed ad hoc committee in Charlotte, North Carolina, consisting of Pat Martin, Youth and Family Services Director; Katie Holliday, then Co-Director of the Children’s Law Center; Dr. Kevin Denny; Larry King, Executive Director of the Council for Children; Pat Matus, then a District Court Judge, and District Court Judge Bill Jones, began meeting to address some problems and conflicts between legal and medical professionals regarding the most appropriate treatment for the mental health problems of children and adolescents. Their efforts culminated in a two-day Symposium of the Psychiatric Hospitalization of Minors. The Council for Children provided logistical support for that event.

The Symposium was well attended by five judges, all of the Children’s Law Center attorneys, 16 psychiatrists (all but one of the psychiatrists in the community who were admitting children to hospitals at that time) and a wide range of other human services professionals.

The event far exceeded expectations. Knowledge was shared about the state of the art of child psychiatry and the law. Roles were clarified, communication improved and in general, participants were enthusiastic about both the process and the results. Perhaps most importantly, the Symposium launched a spirit of cooperation and the commitment to continue efforts to jointly address concerns about the psychiatric hospitalization of minors and the mental health hearing process. Child and Adolescent Service System Program (CASSP), a local demonstration project funded by the National Institute of Mental Health to avoid unnecessary hospitalizations, grew out of the Symposium.

Also, the Council for Children convened an interdisciplinary group to develop and implement strategies for changes recommended at the Symposium. That group divided into two committees, one of which is the Protocol Committee. Its membership consists of Rob Abramowitz, PhD; Wendy Bradford, attorney with the Children’s Law Center; Bret Burquest, MD; Kevin Denny, MD; Pleas Geyer, MD; Judge Resa Harris; District Court Judge Bill Jones; Katie Holliday, attorney with the Children’s Law Center; Ed Holscher, MD; Larry King, Executive Director of the Council for Children; Chris Petersen, MD; Marti Todd, RN, Director of Nursing at Charter Pines Hospital; Scott Wallace, MD; Byron Wilkenfeld, MD; and Candace Wilson, Advocacy Specialist, Council for Children. Others have met with the group from time to time, especially when their role was being discussed. The committee was chaired initially by Chris Petersen and more recently by Bill Jones. It has been staffed by Candace Wilson.

The Protocol Committee took as its task one of the specific recommendations made at the Symposium: to develop a protocol describing the role and responsibilities of each participant in the hospitalization/hearing process.

This document is that protocol. We intend for it to be a model or standard against which to measure good practice and procedure by each of the participants. It describes how the various players should conduct themselves. Individuals can look to it for guidance regarding both their own conduct and the conduct of other participants.

The creation of this protocol has been a laborious and challenging undertaking. Many of its provisions are subject to debate and many will need refinement. It will not eliminate all disagreements between the participants in this process, but it does represent the collective wisdom of the committee. It is published in the hope that it will indeed clarify the roles and responsibilities of participants in the psychiatric hospitalization/hearing process and that it will promote continued discussion and efforts to cooperatively improve the process to better meet the needs and rights of the children and adolescents.