Client Rights: Admitting Minors to Inpatient Treatment
There are rules for admitting children to inpatient developmental disability, mental health, or substance use treatment. We provide general guidance below on these rules. This guidance is not legal advice.
May a child agree to inpatient treatment without a parent or legal guardian’s consent?
If the child needs inpatient treatment for a developmental disability, they may not agree to it without a parent or legal guardian’s consent. If the child is under the age of 14, a parent or guardian must sign the admission application. If the child is 14 or older, they and the parent or guardian must both sign the admission application.
If the child needs inpatient treatment for mental health, they may not agree to it without a parent or legal guardian’s consent. If the child is under the age of 14, a parent or guardian must agree in writing. If the child is 14 or older, they and the parent or guardian must both agree in writing.
If the child needs inpatient treatment for substance abuse, they may not agree to it without a parent or legal guardian’s consent. If the child is under the age of 14, a parent or guardian must agree in writing. If the child is 14 or older, they and the parent or guardian must both sign the admission application.
Detoxification treatment (up to 72 hours)
If the child needs inpatient treatment for detoxification and is under the age of 12, they can’t agree to treatment unless a parent or guardian can’t be found or there isn’t a parent or legal guardian. If the child is 12 or older, a child can agree to treatment without a parent or legal guardian. Any doctor or licensed facility can provide limited services. See Wis. Stat. § 51.47(1) for more information.
A parent or guardian must agree to treatment if it involves:
- Admission for detoxification if it lasts longer than 72 hours.
- Admission to an inpatient facility, unless it’s for detoxification.
- Surgical procedures, unless they’re required to save the child’s life.
- The administration of controlled substances, unless they’re for detoxification.
The doctor or facility must have the child’s agreement before billing a third party. If the child does not agree, they are responsible for paying for the services.
What if the parent or guardian is unavailable or refuses to agree?
If the child’s parent or legal guardian is unavailable or refuses to agree, the child can still receive inpatient treatment. If the child is under the age of 14, they can petition the court for inpatient admission. If they’re 14 or older, they or someone acting on their behalf can petition the court for inpatient admission. The court can temporarily approve the admission pending a petition hearing, if required.
What authority and limitations do parents or guardians have over children in treatment settings?
Parents or guardians must:
- Act and make decisions in the child’s best interests.
- Ensure a treatment plan is in place and appropriate for the child’s needs.
- Ensure basic needs (food, shelter, clothing, education) are provided by the facility.
- Participate in care and treatment planning.
Parents or guardians must give their consent for:
- Behavior treatment and support programs, and nonemergency use of restrictive management techniques like time-out.
- Experimental research and drastic treatment.
- Filming, taping, and certain releases of treatment records.
- Psychotropic medicines.
Parents or guardians have the right to give input and make requests of providers. However, the care team will have the primary role to care for the child.
Parents or guardians may influence decisions in areas including:
- Community involvement (freedom of movement).
- Friendships and associations with others (freedom of association).
- Lifestyle choices and leisure activities (freedom of expression).
- Personal preferences, such as clothes, food, drink, etc.
In these areas, personal rights and autonomy should be respected as much as possible. Providers should place the least possible restrictions on personal liberties while protecting the child from harm.
May a child refuse treatment?
Yes, a child may refuse treatment. But the child will still be admitted if:
- A hearing was requested by the child or the child’s lawyer, parent, or guardian.
- The child was admitted by an application completed by their parent or guardian, despite the child’s refusal.
Then the court must:
- Appoint a guardian to represent the child, if necessary.
- Appoint a lawyer to represent the child if they are not represented.
- Inform the child about how to contact the state protection and advocacy agency, Disability Rights Wisconsin.
- Order an independent evaluation of the child and hold a review hearing within seven days of admission or of admission application—whichever is sooner.
What if the child is under 14?
The child can refuse but will still be admitted because the parent or guardian has authority to apply for their admission for mental, developmental disability, alcohol, or drug treatment. However, if the child makes a statement or conducts an action indicating they don’t agree to admission, it must be noted on the front page of the application.
What if the child is 14 or older?
It depends on the type of service:
- If the child is receiving inpatient treatment for a developmental disability, they and the parent or guardian must agree to the admission. But the child can be admitted with the parent’s or guardian’s agreement if the child’s refusal is included on the front page of the application and in the filed petition.
- If the child is receiving inpatient treatment for mental health, they may refuse treatment. But the child can be admitted with the parent’s or guardian’s agreement if the child’s refusal is included on the front page of the application and in the filed petition.
- If the child is receiving inpatient treatment for substance use, the parent or guardian must complete the admission application and agree to treatment. But the child’s refusal must be included on the front page of the application and in the filed petition.
Can a child who is 14 or older refuse an assessment?
No. A child’s parent or guardian may agree to have the child tested for alcohol or other drugs. Or to have the child assessed by a treatment facility for abuse of alcohol or drugs. This could be outpatient or inpatient treatment. The child doesn’t have to agree to it.
On what is admission based?
A child’s inpatient admission should be based on:
- An informed, professional opinion that the child needs developmental disability, mental health, or substance use treatment.
- The results of an alcohol or other drug abuse assessment, in the case of substance use.
What should happen during admission?
Before the child is admitted or as soon as possible afterward, the child and parent or guardian must be told, verbally and in writing, of the child’s right to:
- Agree to or refuse treatment, in some cases.
- A hearing to determine if admission should continue, in some cases.
- A hearing upon request, and an appointed lawyer if a hearing occurs.
- An independent evaluation, if ordered by the court.
- Be discharged within 48 hours of the request, if nothing is filed for emergency detention, emergency or involuntary commitment, or protective placement.
- Be informed about how to contact the state protection and advocacy agency, Disability Rights Wisconsin.
- Request release, in some cases.
They also must be told their client rights.
In addition, children and their parents or guardians must always have access to writing materials in case they want to request a hearing or release. Staff members must help children prepare and submit these requests.
Children and their parents or guardians must be informed of the petition and review process, including court standards and possible court decisions:
What is a petition for treatment?
A petition for treatment is a document that can be filed with a court so a judge can review the admission of a child for treatment services.
A petition for treatment should be filed with the local circuit court when:
- The child is 14 or older and refuses to sign the admission application.
- The child wants treatment and their parent or guardian refuses to sign the application.
- The parent or guardian can’t be found.
- There is no parent or guardian.
A copy of the petition must be given to the child and, if available, to their parent or guardian within five days after admission:
What are the criteria for approving admission?
Within five days of the petition filing, the court must decide whether there is enough evidence to determine:
- The admission was made under an application completed by the child and their parent or guardian if the child is under 14 and receiving mental illness or development treatment.
- The care in the facility is the least restrictive therapy or treatment possible for the child’s needs.
- The child needs developmental disability, mental health, or substance use treatment.
- The facility offers inpatient therapy or treatment that is appropriate to the child’s needs. If all this is determined, the court must permit admission.
When must a hearing be held?
A court hearing is required if:
- A request for it is made by the child, the child’s lawyer, or the parent or guardian.
- The child is 14 or older and the parent or guardian admitted the child against their will.
- The petition notes that the child is unwilling to be admitted.
What is required in the hearing?
- A lawyer and, in some cases, a guardian, must be appointed if the child doesn’t have someone to represent them.
- Any mandatory hearings should be held within seven business days after admission or admission application—whichever is sooner.
- The child must be informed how to contact Disability Rights Wisconsin.
What does it mean if my child is admitted by petition?
It does not mean a mental illness, developmental disability, or substance abuse is present. It means a court has approved admission of a child. The court has five days to decide if treatment is needed.
Can the decision be appealed?
Yes. It can be appealed to the appeals court.
Are there special rules for short-term admission?
Yes. A child may be admitted to an inpatient facility without petition and review for diagnosis and evaluation, or for dental, medical, or psychiatric services, for up to 12 days.
- After 12 days, the child must be released unless an admission application has been filed. Or unless a petition has been filed for emergency detection, emergency or involuntary commitment, or protective placement.
- The application must be reviewed by the director and accepted only if it’s determined that admission will bring the least restrictive means of getting a diagnosis and evaluation. The child must also receive sufficient medical, dental, or psychiatric services.
- The short-term admission application must be signed by the child’s parent or guardian unless they don’t have one.