Chapter 3 : Section 7.5

Inpatient Psychiatric Assessment and Psychiatric Acute Services

Procedures

Considering Inpatient Psychiatric Assessment

To determine if an assessment for inpatient psychiatric is needed, consider whether any of the following circumstances exist:

• The child displays risk of harm to self or others or there is an emergent or continuance of recent, recurring or intermittent episodes of risk of danger to self or others as evidenced by:

  • suicidal ideation, behavior or intent, or

  • homicidal or significant assaultive ideation, behavior or intent, or

  • physiologic jeopardy, or

  • self-injurious behaviors.

• A psychologist, psychiatric and mental health nurse practitioner, psychiatrist or physician has determined the child requires an inpatient assessment due to a mental disorder or other personality disorder or emotional condition.

• The local crisis team has recommended an inpatient assessment.

Providing Inpatient Assessment

If the child is dually adjudicated, inform the other agency of all notices, motions, hearings or other proceedings related to the provision of inpatient psychiatric acute care services.

Consult with the health plan, as appropriate, to determine the hospital, arrangements for transportation of the child and any further instructions.

Personally admit the child to the hospital, completing all necessary paperwork, including Release of Information if necessary, and providing information on the child’s background, legal status, and reason(s) for the admission.

Complete the Motion for Inpatient Psych Eval and Addendum Report within 24 hours of the child’s admission, excluding weekends and holidays. The Addendum Report must include all of the following information for inclusion in the motion:

• name and address of the inpatient assessment facility;

• name of the psychologist, psychiatric and mental health nurse practitioner, psychiatrist or physician who will perform the inpatient assessment;

• the date and time the child was admitted to the inpatient facility; and

• a short statement explaining why the child needs an inpatient assessment. (A written report from a psychologist, psychiatric and mental health nurse practitioner, psychiatrist or physician is not required for this motion).

Provide the inpatient psychologist, psychiatric and mental health nurse practitioner, psychiatrist or physician with the Inpatient Assessment Report, CSO-1364A and obtain the completed Inpatient Assessment Report not later than 24 hours after receiving the inpatient assessment, excluding weekends and holidays. Determine what services, if any, are recommended.

Provide the Motion for Inpatient Psych Evaluation and the Addendum Report to the assigned Assistant Attorney General.

If the inpatient psychiatric assessment does not recommend inpatient acute services:

• Immediately pursue the level of care recommended by the psychologist, psychiatric and mental health nurse practitioner, psychiatrist or physician.

• Immediately arrange to discharge the child from the hospital.

Admitting a Child for Psychiatric Acute Care Services

If the inpatient assessment recommends inpatient acute care services:

• Contact the Attorney General’s Office to discuss the motion for psychiatric acute care services, if necessary. Complete the Motion for Placement Transfer Discharge in Guardian. The motion must be filed within 24 hours of completion of the inpatient psychiatric assessment or the child will be discharged from the facility. The motion shall include all of the following:

  • a copy of the written report of the results of the Inpatient Assessment Report, CSO-1364A or Outpatient Assessment Report, CSO-1363A which addresses:

    • the reason why inpatient psychiatric acute care services are in the child's best interests;

    • the reason inpatient psychiatric acute care services are the least restrictive available treatment;

    • a diagnosis of the child's condition that requires inpatient psychiatric acute care services and list of medications; and

    • the estimated length of time the child will require inpatient psychiatric acute care services (hospitalization).

  • A Statement from the Medical Director/ Designee of the Inpatient Psychiatric Acute Care Hospital, CSO-1364B that the facility's services are appropriate to meet the child's mental health needs (contact the AAG to assist in obtaining the signed statement, if necessary).

Provide the Motion for Placement Transfer Discharge, completed Inpatient Assessment Report or Outpatient Assessment Report, and the written statement from the medical director or designee to the assigned Assistant Attorney General.

Attend the hearing on the motion for inpatient psychiatric acute care services, held within 72 hours of the filing of the motion.

Pending the hearing on the motion for inpatient psychiatric acute care services, the child may remain at the inpatient assessment facility, if already hospitalized.

Upon admission of a child to an inpatient psychiatric acute care facility for inpatient treatment:

• Participate in hospital staffings, including discharge planning, in person, by telephone or through a substitute DCS representative familiar with the case.

• Seek assistance, as needed from the CHP System of Care Coordinator (SOCC) to help with the CFT process or assist with discharge/transition planning.

• Ensure hospital understands that youth are not to be discharged to a shelter facility.

If the child is expected to remain hospitalized for 60 days or longer, the court will review the child’s continuing need for inpatient psychiatric acute care services at least every 60 days after the date of the treatment order. See 60 Day Review of Residential/ Psychiatric Treatment Services, CSO-1361A. At least five days before the review, the facility will submit a written progress report to the court and to all parties, including the child’s attorney and guardian ad-litem. The progress report shall make recommendations and include the following:

• a description of the treatment provided, including any medications and the child’s current diagnosis;

• the child’s need for continued inpatient psychiatric acute care services, including the estimated length of the services;

• a projected discharge date;

• the level of care required by the child and the potential living arrangement and caregiver options available to the child on discharge; and

• a statement from the medical director of the inpatient psychiatric acute care facility or the director’s designee as to whether inpatient psychiatric acute care services are necessary to meet the child’s mental health needs and whether the facility that is providing the inpatient psychiatric acute care services to the child is the least restrictive living arrangement available.

Provide the facility with the names and addresses of all parties including the child’s attorney and guardian ad-litem.

If a copy of the written progress report has not be received at least five days prior to the hearing to review the child’s continued need for inpatient psychiatric acute care services, contact the facility and notify the assigned Assistant Attorney General.

Arranging Discharge from an Inpatient Psychiatric Acute Care Facility

Within 15 days after the child’s discharge, obtain a copy of the discharge summary. Ensure the summary includes recommendations for caregiver and services.

Contact the assigned Assistant Attorney General to file a notice of discharge with the Juvenile Court. The notice, which must be filed with the court within 20 days after discharge of the child, shall include the following:

• a statement of the child’s current caregiver;

• a statement of the mental health services that are being provided to the child and child’s family; and

• a copy of the discharge summary prepared by the mental health professional.

Contact the assigned Assistant Attorney General to file a motion for change of physical custody, if necessary.

Provide the applicable documents to the assigned Assistant Attorney General.

Contact the DCS Placement Administration if non-therapeutic living arrangement has been determined appropriate by the CFT or as part of the discharge planning process.

Documentation

Document all court hearings in the Hearings section of Guardian.

Document participation in hospital staffings using the Notes tab

Coordinate with DCS CHP to ensure Guardian is updated to reflect the needs of the child in the Health tab.

Document the child’s hospitalization using the Placements section of Guardian.

Update the child’s address and phone number to reflect any change in the living arrangement of the child.

Document Assistant Attorney General approval of all motions in Notes, AG Contact type.

DCS CHP submits a new Placement Service Request in Guardian for behavioral health placement of the child.

Effective Date: February 13, 2023

Revision History: November 30, 2012, November 17, 2017, July 31, 2019, February 1, 2021, April 1, 2021, September 24, 2022