How is adolescent status determined?

elkpark · Sep 10, 2005

In the settings in which I have worked over the years, more than just the (person's) age was considered -- the usual factors that are considered relate to the 18 or 19 yo's level of function. I.e., is s/he still in (high) school, still living at home (with parents, that is), still basically functioning in the world as an adolescent rather than an adult? Also, a DD 18 yo (or even a little older) who functions at a lower/younger level might be better served by an adolescent unit than an adult unit. Another consideration is the current census of the adolescent unit -- is it mostly older adolescents, or mostly younger kids? If you have an 18 yo who meets the description above, but putting that kid on the adolescent unit would mean putting her/him with a unit full of 12 and 13 yos, then the adult unit might be the better choice (esp. if the older kid would represent any kind of risk to the younger kids).

The same considerations come into play when you are looking at admitting a "tween" (12, 13) to a facility that has both a child and an adolescent unit. The typical dividing age on paper is 12 yo, but one 12 yo might be better served by the child unit, and another might be better served by the adolescent unit.

There are important paperwork and legal differences that need to be kept in mind when admitting an 18 yo (or older) to an adolescent psych unit. Of course, the staff are accustomed to dealing with the parents for all the consents, freely passing on info, etc., but, in this situation, the 18 yo is legally independent, gives (or withholds!) her/his own consents, can sign her/himself out (within the limits imposed by state law), etc., the same as any adult client on any adult psych unit. The parents do not have any right to give or withhold consent for admission or treatment, and do not have any right to any confidential, protected information unless the 18 yo client chooses to sign a ROI (release of information) consent authorizing staff to discuss the case with the parents -- this can be v. hard for parents to deal with ... Just putting a legally independent person (18+ yo) on an adolescent psych unit does not deprive that person of any of her/her legal/civil rights.

Many developmental considerations to think about in order to make the best decision in these situations. Of course, there are also places out there that divide people strictly by age, without considering any of these factors, but I think that's a very arbitrary and superficial approach that does not speak well to the clinical savvy of the professionals involved.

CharlieRN · Sep 11, 2005

My employer now uses a simple "under 18 and still in school, must be adolescent" rule. They don't want to make it a judgement call. Many adolescents want to get onto the adult units here because adults can smoke and adolscents can't. The state law here says it is illegal for under 18's to smoke, period. Ofcourse many come in smoking 2 packs per day and are less than thrilled that we enforce the law.

PRNMEDS · Sep 11, 2005

At our hospital - 18+ is automatic ADULT Unit (we only go up to 21 years of age) - regardles of any other criteriea. We have allowed 16 and 17 year olds on the Adult unit IF the treatment team decides that the patient is more suited for the adult unit and would benefit from being on that unit.

OMH (Office of Mental Health) has been givign hospital a hard time about this of late, and now the hospital must give rationale for move, and request OMH approval PRIOR to moving anyone under 18 to the unit.

PRNMEDS · Sep 11, 2005

We had the same smoking problem (18 + could, 17 or younger NO) - but last year went to a total NO SMOKING and it has worked great - less contraband, less sneaking of smokes etc.

perfectbluebuildings, BSN, RN · Sep 12, 2005

My employer now uses a simple "under 18 and still in school, must be adolescent" rule. They don't want to make it a judgement call. Many adolescents want to get onto the adult units here because adults can smoke and adolscents can't. The state law here says it is illegal for under 18's to smoke, period. Ofcourse many come in smoking 2 packs per day and are less than thrilled that we enforce the law.

Thanks for your input... what about people who are 18 and still in high school, where do they fall?

And thanks to all of you for your perspectives. It is someone I know who is 18 and still in high school and developmentally adolescent, who is not being allowed to stay on an adolescent unit and is currently on a geriatric unit basically Alzheimer's. I am having difficulty understanding what help this unit will give a suicidal angry teenager, but maybe just keeping them safe will help. I don't know... thanks for all your input.

I agree with your post elkpark... I wish these facilities also used criteria similar to yours.

Psychrich · Sep 12, 2005

You have to know the states view point on the issue and the facilities stand. Many of the places that I have worked, in multiple states, allow a 18, who is still in school, to be on an adolescent unit. Plus in some of these situations you may have to get the psychiatrist's approval.

There are some situations that have occurred, just like elkpark wrote, when a teenager, even as young as 15 years old, have to sign themselves in yet are on a adolescent unit. They have the same rights as an adult when it comes to pt rights and rights of refusal, but the parents have the financial responsibility.

With one situation, we had 19 and 20 year olds who were in a adolescent unit because they were still under court orders and would not be relased until there 21st birthday.

Good luck to the situation you are contemplating.