Building Blocks: Create a Crisis Plan for Your Minor or Adult Child

Introduction

How do we know when a problem has become a crisis? When it comes to substance use disorder and/or mental health challenges, parents or caregivers may point to when they found substances or empty bottles hidden in a bedroom. Perhaps there was a call about an arrest, an accident, or a call from an emergency room. It can also be what one parent described as, “When you know, you know.”

For anyone who is a parent, spouse, caregiver, or even a friend, it helps to know what you’ll need if that crisis hits, how to plan for it, as well as understanding your rights — or your child’s — when managing the care of a child, teen, or young adult.

You can’t always see a crisis coming, but you can plan ahead using SAFE Project’s Building Blocks Plan.

LET’S GET STARTED: Go in order or simply choose which section you need first. Download SAFE Project’s Crisis Building Blocks Checklist to help create your Crisis plan.

What’s a Crisis or Demands Immediate Attention?

A crisis is any situation when:

• A person’s behavior puts them at risk of hurting or being a threat to themselves or others.
• A person is unable to care for themselves or function.
• You, as the parent, guardian, or caregiver are no longer able to handle the situation and need help.
• You believe they need emergency services, an assessment, require treatment, or require in-patient care.

How Do I Know What To Do Or How To Prepare?

As family members and caregivers, the best thing we can do is prepare for the unexpected. That means knowing where all your important information is for the affected family member.

While many of us keep paper files, it’s smart to also have a digital copy on hand that you can keep on your phone – even if it’s just an email to yourself with their diagnosis, medical history, and important contact information. If you have an adult child, consider sharing a copy with them as well.

Download your SAFE Project Crisis checklist to map out the building blocks for your crisis planning, in case of a crisis or emergency.

One critical tip for you: please make sure you have support during this time. Many parents and caregivers participate in support or fellowship groups, either in person or online. There are many respected peer-led groups or nonprofit organizations available to help support families like yours. Note: you’ll find them in the “Resources for Families” link.

What Are My Rights As A Parent Of A Minor?

Parents or guardians generally have a right to seek medical treatment for a minor child. Under the Health Information Portability and Accountability Act (HIPAA), parents (or a designated guardian) are entitled to know their minor child’s protected health information as well as get copies of their child’s medical records and ask for corrections. In fact, under HIPAA, parents are considered to be their children’s personal representatives.

In most cases: If your child is under the age of 18, you can take them for hospitalization or rehab involuntarily. However, some states allow for the minor’s consent for medical services without parental permission and to protect their privacy. This can apply to services including substance use disorder or mental health services, among other services.

If the minor is legally emancipated or over the age of 18, parents no longer have the right to seek medical treatment for that child or have access to medical records. In fact, emancipated minors can legally consent to or refuse medical care without parental permission.

What Can I Put In Place For My Adult Child Before There Is A Crisis?

Crises are difficult to predict. If you have an adult child or one about to turn 18, there are tools you can put in place ahead of time so that you can work together on their treatment decisions.

When your child turns 18, your legal rights to their medical records and decisions end — whether or not they are still covered under your health insurance plan or if they are still in high school. If you and your adult child agree, they can sign a HIPAA waiver form (see the previous section) which then permits you to see their records. Adult children can sign a medical power of attorney or health care proxy document when they turn 18, which appoints a parent, guardian, or another individual to make health care decisions on their behalf should they become incapacitated due to serious injury or illness.

Many parents who have navigated medical decision-making for an adult child highly recommend that other parents start having open conversations before your child turns 18. That means engaging your minor children before they become adults so they don’t see you as a threat or trying to usurp their authority if there is a crisis. If the minor or adult child agrees, you can work together to consider also adding a Psychiatric Advance Directive,  Supported Decision-Making, or a combination of planning tools such as WRAP.

• Psychiatric Advance Directive (PAD)
  A psychiatric advance directive allows your child over the age of 18 to provide specific instructions or preferences regarding future mental health treatment, especially when they are unable to advocate for themself.
• Supported Decision-Making:
  If your adult child does not want to have a PAD and prefers more autonomy, supported decision-making may be a viable alternative. A person with substance use disorder and/or mental health challenges can ask for support where and when they need it while giving them the ability to make decisions about their life. It can be either an informal or formal agreement.

  With this model, the adult child works in partnership with their parents and/or other trusted adults to help them make choices and decisions about care. The individual could include different people to support their decision-making in different areas, such as medication, finances.

  They ultimately benefit by having a more active role in their treatment or therapy, and families benefit by working together to a joint solution. Additionally, parents or caregivers don’t need to support all the roles.

• Wellness Recovery Action Plan (WRAP®)

This option supports both families and individuals identify the tools they need in place to stay well and create action plans to put them into practice.  While WRAP may have had its beginnings in mental health, it is also a tool and process for anyone trying to manage physical health or substance use challenges, situational challenges including incarceration or re-entry, family issues, or other life challenges.

They can be used individually or together. For example, a family could begin with a planning tool like WRAP. When it is complete, the family can incorporate their action plan in a Supported Decision-Making Plan.  For an individual over the age of 18, parents or caregivers can use these planning tools to discuss putting in place a Psychiatric Advance Directive, medical power of attorney, and/or a health care proxy document.

How Do We Decide Where To Go For Care In A Crisis?

When it comes to crisis care, emergency departments are often the first stop for children or adults experiencing mental health emergencies and substance use disorders. While an ER is not a permanent solution, it may well be the only option when other services are either inaccessible or unavailable. The dilemma is that the pandemic has greatly increased the sheer number of ER visits, causing critical shortages of both hospital staff and beds.

There’s no simple solution, so thinking ahead is especially critical. Generally, no one wants to think their child will end up in crisis, but knowing what’s available helps you make a plan.

• If your child of any age is already working with a therapist or treatment provider, plan ahead for where they would go in case of an emergency.
• If you don’t have a provider, start with your health insurance company. They can provide referrals to a variety of in-network providers for either substance use and/or mental health. Additionally, you’ll know what is and isn’t covered.
• You can also use Treatment Locators to see what’s available and will provide what is needed for their care.

Ages:

• In most cases: If your child is under the age of 18, you can take them for hospitalization or rehab involuntarily. As mentioned previously, some states allow for a minor’s consent for medical services without parental permission and to protect their privacy. This can apply to services including substance use disorder or mental health services, among other services.
• For a person over the age of 18, it must be voluntary. Generally, the parent/caregiver would have to seek court-ordered treatment or emergency hospitalization.

Where Can I Get Help Right Now?

National Hotlines operate on a 24/7 basis for crises or emergencies. Specialists will help connect you to crisis resources.

For a life-threatening emergency: Call 911

Crisis Text Line: Text HOME to 741741

National Suicide Prevention Lifeline: (800) 273-TALK or (800)-SUICIDE

Nacional de Prevención del Suicidio: (888) 628-9454

SAMHSA National Helpline for Substance Use & Mental Health Services: (800) 662-4357

• SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

Veterans Crisis Line: (800) 273-8255, press 1  OR  Text 838255  OR Chat online

SAFE Treatment & Family Support Locator

Partnership to End Addiction:

• https://drugfree.org/treatment-and-recovery/
• https://drugfree.org/article/get-one-on-one-help/

American Psychological Association:  More Crisis Hotlines

Warmlines often operate on a specific schedule and are available to help whether you just need to talk to someone, or need more specific help. In most cases, specialists are also able to connect you to additional resources including crises. If you can’t reach the Warmline you want, go directly to the Hotline numbers.

State Warmlines

• Warmline.org Directory
• Mental Health America Warmline Directory

Additional Resources

• SAFE Project: Resources for Diverse Populations