Saturday, October 8, 2016

Bucks County seeks to streamline process to help parents force children into drug treatment

Valerie Fiore holdng picture of son, Anthony
Posted Oct. 2, 2016
Cris and Valerie Fiore would have done anything to keep their son alive. Even if that meant putting him in drug treatment against his will.
Anthony Fiore struggled with an opiate addiction starting in high school, and died of a heroin overdose in 2014 at age 24. His parents never knew court-ordered treatment outside the criminal justice system was an option.
“And I would have had to force him (into rehab)," said Cris Fiore, of Warrington. "I would have — if I knew about it.”
Like the Fiores, many parents struggling to get their underage children into drug treatment don't know the law is on their side. Since 1998, a little-known piece of Pennsylvania legislation called Act 53 has allowed parents or guardians to obtain court-ordered drug treatment for children between the ages of 12 and 18, removing teens' ability to refuse treatment or sign themselves out of rehab early.
Only a handful of counties, however, have put into place the necessary court and behavioral health coordination to seamlessly and quickly move families through the commitment process, according to state and local drug treatment professionals. Bucks County is the latest to do so.
State and local drug and alcohol professionals say there's a lack of knowledge statewide about the law's existence, as well as a lack of infrastructure to manage requests and move them through the process. Counties need coordination and cooperation not only from the court system, but local law enforcement and schools, advocates said. The expense involved with involuntary commitments also can be a burden for families. 
Act 53 is one of many state laws involving drug and alcohol treatment that people don’t know about because counties lack resources to get them fully implemented, said Gary Tennis, secretary of the Department of Drug and Alcohol Programs. His department does not track how many counties have Act 53 policies in place or how many are using the law regularly, but he said to his knowledge, few are taking advantage of the law.
"The reason Act 53 doesn’t get used is because it’s difficult,” Tennis said.
Montgomery County has had a policy in place since 2005 outlining the steps for an involuntary commitment of minors to drug and alcohol treatment, but it has not held any Act 53 court proceedings and does "not foresee that changing anytime soon,” spokeswoman Jessica Willingham said. She added that the county's Office of Drug and Alcohol Services receives a handful of calls annually about Act 53, but it has been successful in offering families alternatives that can be tried first. 
Under its policy, Montgomery County parents can petition the court for an involuntary commitment of up to 45 days. Parents are responsible for costs including legal representation for the minor, court fees, assessment and treatment, and related fees. Families without financial means can apply for funding through the county.
Until recently, Bucks County didn't offer any guidelines on how parents could apply for an Act 53 hearing, and there were no readily available court applications, which slowed down the commitment process, newly appointed Bucks County District Attorney Matt Weintraub said. It could take several weeks before a child appeared before a judge, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.
“It doesn’t do any good if you have to wait a month for treatment,” Weintraub said.
The new, streamlined process is expected to shorten the wait to a week from start to finish, Rosati said.  
To ease the financial burden, the Drug and Alcohol Commission will pay for initial drug and alcohol assessment and legal representation for the minor, Rosati said. Parents or guardians will be responsible for court-related fees and treatment costs if they have insurance coverage, Medicaid or county funding. If a private insurer denies the recommended level of care, the county would consider funding the treatment, Rosati said. The length of treatment varies.
Bucks County’s decision to update its Act 53 policy was largely in response to increasing calls from parents with concerns and questions about what options they have for a child showing signs of substance abuse, said Rosati.
In the past, her office received a few calls a year from parents asking about involuntary commitments for juveniles, but none reached the petition stage, she said. Since the new policy was rolled out in August, three families started Act 53 proceedings, but in each case the juvenile eventually entered treatment voluntarily, Rosati said.
Under the revamped process, Bucks County Drug and Alcohol Commission social workers take the initial call and determine if the involuntary commitment route is necessary or if other, voluntary options are viable, Rosati said. If social workers determine the parents have been unsuccessful with other methods, they are directed to complete an online Act 53 court petition available through the Bucks County government website. 
After the petition form is completed, a court hearing can be scheduled. Act 53 cases will be heard once a week. Counselors from Aldie Counseling and Penn Foundation will perform the post-application drug and alcohol assessment on-site the day of the court hearing at the Bucks County Justice Center, Rosati said. At any point in the process the family can change its mind and cancel the court hearing, she added.
As a Bucks County judge overseeing juvenile and adult proceedings, Rea Boylan can’t think of a day when she hasn’t seen at least one defendant who is a substance abuser. On one day while serving in juvenile court, three of 20 teen defendants before her were addicted to opiates, she said. 
“I see it every day. All day long,” Boylan said. “Parents ask if they can take their child home. They don’t recognize it as a life-threatening disease. They still think a heroin addict is an unattractive, smelly bum on the street, not their beautiful daughter or handsome son who played football.”
Boylan, who was part of the committee that streamlined the policy and will hear Act 53 petitions, hopes it will get more young people into treatment early.
Mary Lynn Keyte, a therapist with Rehab After Work in Warwick Township, has worked with addicted adolescents for decades. She, too, only recently learned about Act 53.
“It’s so hard to watch kids self-destruct and not be able to do anything about it,” she said. “When adolescents get to a point that they are so out of control and parents are at their wit's end after trying everything, it’s a great idea that there is another way to get them placed in treatment.”
Keyte sees the law as a way for parents to get their kids help without involving the juvenile court system, a route that parents turn to as a last resort.
“There they don’t always get what they need, and it becomes more punitive than therapeutic,” she said.
Rosati pointed to Allegheny, Beaver and Berks counties as those with the most active Act 53 programs in place.
Beaver County revised its policy and commitment process in 2014. The goal is to have the child placed in treatment within 24 hours after initial contact, said Kate Lowery, who heads the Beaver County Behavioral Health, Drug and Alcohol Program. It has required a “monumental” coordination effort with local police and schools for locating and transporting children to commitment hearings.
“With each case we learn more and more what to do to smooth the process for the next time it happens,” Lowery said.
Over the last two years, the county has received 21 applications under Act 53 that resulted in 16 commitments. The other juveniles entered drug treatment voluntarily, Lowery said.
“Sometimes it’s the legal hook that keeps them compliant,” she said. “These are good, good parents that are trying so hard to stop the trajectory of addiction for their children. By the time you come to the court to petition for an Act 53 hearing, these are parents that have exhausted all other efforts.”
One reason that Lowery suspects more counties aren’t using the law is that drug and alcohol treatment is often considered a client-driven process; treatment is seen as less effective if the addict is not motivated to get sober.
“In the drug and alcohol world historically there is not a process of involuntary commitment the way it is in the mental health field,” she said.
But DDAP Secretary Tennis noted that people who voluntarily enter substance abuse treatment frequently do so under duress. 
“When someone goes into treatment, they don’t usually feel that hopeful they’ll get better. Usually they are going in because the judge said, 'Go in or I’ll lock you up,' or a spouse said, 'Go in or I’ll leave you.' They’re kind of coerced,” he said. “Commitment has to be there, but it usually isn’t there when they walk in the door.”
Cris Fiore doesn't think involuntary treatment will solve the addiction problem, but it could give parents and juveniles more time.
“At least you give them 30 more days of life to maybe come around,” he said. “It’s a chance.”
Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @JoCiavaglia

The Act 53 process in Bucks County

ACT 53 allows a parent/legal guardian to get a drug and alcohol assessment for their child, and if warranted, compel the child to enter treatment.
Criteria:
  •  The parent/legal guardian believes that their child has a drug or alcohol problem;
  •  The child is unwilling to participate in a treatment program;
  •  The child must be a resident of Bucks County; and between the ages of 12 and 18.
If the above criteria are met, The Bucks County Drug and Alcohol Commission will guide the parent/legal guardian through the Act 53 process. The ACT 53 hearing and assessment process can be completed within a week.
The first step is for parents to call Renee or Joseph at BCDAC Inc. at 215-773-9643, for guidance and resources.
Information on how to access Act 53 will be provided, along with direction on how to complete applications and the two court hearings to be conducted. A confidential drug and alcohol assessment will be conducted by credentialed staff from Aldie Counseling Center or Penn Foundation. The assessment will occur at the Bucks County Justice Center. If the child is found in need of treatment, a court order will be written and arrangements will be made for the child's treatment to begin as soon as possible.
Parents/legal guardians are responsible for court-related fees, including a $58 sheriff fee and $28.50 filing fee. Funding for legal representation for the child will be through the Bucks County Drug and Alcohol Commission. Treatment costs are through parent/guardian private insurance, Medical Assistance or county funding. Guidance on funding process will be provided to parent/legal guardian.

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