I presented this to Maryanne Lindenblad and Keri Waterland of the Health Care Authority. HCA policies support interventions that disproportionally lead to foster care, jail, and other serious public health concerns in the families of BIPOC and disabled children.

1. Improving Behavioral Healthcare in WA State
3/5/21 notes

2. Key issues
 1874/2883 implementation: HCA’s approach to consent in WISe & CLIP is
harming children and their families more than helping youth access care
 WISe isn’t intensive: the highest risk children in Grant, King & Snohomish
Counties are falling through the cracks. Basic family skills training and
supports are not available in most areas
 Inadequate system of care: little or no resources statewide especially for
highest risk children needing residential care, partial hospitalization, or
intensive outpatient services
 Intake & referral: Overwhelming, confusing, multiple intake processes (by silos)
that cause repeated trauma to families and delays care
 Workforce development: inadequate pay & training
 FYSPRT Failure: duplication with BHAC?

3. 1874 & 2883 Implementation consequences
 Disproportionally harms children with emotional regulation issues due to Autism, ADHD,
reactive attachment disorder, adoption, trauma, FAE (JK, RS, JJ)
 Parent health expenses – emergency room visits, absenteeism, job loss (all)
 Broken families –- CPS threats, CPS removals, foster care offered as “treatment” -- system
inflicted trauma endorsed by HCA (Jones family)
 Negative health impact on other children in family (Jones family)
 Early youth drug and alcohol usage escalated and gang involvement (LD)
 Youth incarceration with HCA endorsing “jail as being a good thing” (RS, Jones family)
 Consequences to others – death (Taafulisia killings), kidnapping (RS)
 Wasted resources when child is admitted with FIT & discharged 2 weeks later (JJ)
 Revolving door emergency room and PBMU (Jones family, LD)
 Lack of “soft” landing places for families in crisis (Jones family, LD)
 Lack of family respite (Jones family, LD)
 Lack of school attendance, poor truancy interventions (RS, JK)
 911 & police become core safety plan (all)

4. 1874 & 2883 Quality Improvement Issues
 HCA sets the tone for the state: intent of the bill is not clearly communicated
to the system
 1874 is more than FIT:
complete information on the law is lacking
 Information sharing
 Parent involvement
 Caregiver definition
 Eliminating barriers to access
 One training was inadequate
 Survey not publicized to families (use YBHA-WA) and didn’t include all aspects
of 1874 & 2883 (i.e. information sharing)

5. Steps to address 1874 & 2883
 HCA embraces the value that jail and foster care are not appropriate
pathways to behavioral healthcare and communicate that across the system
 Use jail and foster care placement as KPI for HCA success/failure
 Add “family centered care” to HCA client values
 Put in place a “dropped from WISe due to lack of participation” protocol
 Add trainings to address consent issues
 Work with all Medicaid agencies (MCOs, WISe & CLIP) to ensure adolescents
remain in care after FIT admission

6. WISe isn’t intensive
What about a menu of services?

7. Identify family goals Supports
Better school attendance and achievement  Increased recreation excursions & opportunities for AJ
 Request IEP evaluation
 Develop graduation plan
 Ensure appropriate social media/internet usage balance with school
Reduce concerning behaviors at home  Collaborative problem solving techniques
 Agreed upon rewards/consequences
 Family skills training (DBT, co-dependency, boundaries, polyvagal
system response,
 AJ establish personal safety goals
 Family group skills practice
 Peer supports in establishing family routine during stress points (ex.
Dinner time, weekends, bed)
Create safe environment for AJ’s Sisters  Carve out 1:1 time for younger sisters
 Identify sibs-support group opportunities
Mom time for self-care & nurture relationship with husband ?
Eliminate ARY (AJ’s goal)
Eliminate false CPS complaints (Mom’s goal)
Hearing March xx
Identify steps towards showing adults confidence ARY is not needed
Improve mother/daughter relationship Weekly family therapy sessions
Assess medication & ensure compliance ?
Eliminate suicide attempts Create a better safety plan that does not involve ER visits
Family plan for when AJ is in a psychotic episode Safety plan beyond calling 911
Address truth telling and reporting consequences (esp CPS) Identify consequence for AJ when she doesn’t tell the truth
Electronics usage disagreements Need family electronics use agreement
AJ doesn’t practice self-care Provide functional daily living support
Struggling in school when in active psychosis, not on time for graduation Create graduation plan and secure special education supports and
accommodations
Not taking medication consistently (in the past) Establish 6 week base line of medication maintenance and determine if it’s
the appropriate medication
Substance use SUD assessment and services if appropriate
Sample WISe Service Array Menu

8. More WISe Training
 Attachment disorder, adoption, trauma, and how this impacts consent
 Working with consent, defiance, and developmental delays and attachment
issues (1874 & 2883)
 Motivational interviewing
 Working with school system when truancy or an IEP are involved
 How to engage parents
 Advanced peer skills for developmentally delayed, non verbal, or disabled
children
 Basic parent behavioral health skills: DBT; co-dependency boundaries;
polyvagal nervous system, trauma and de-escalation; beyond 911

9. Inadequate System of Care
 Improve intake: Develop central database for 988 call center that includes all
child-serving systems (CPS, JR, OSPI, HCA, DCYF, DD, etc)
 Identify 5 year plan to build out system partial hospitalization and intensive
outpatient services
 Continuous improvement of WISe, including earlier admissions when problems
are fewer and less severe
 Identify circumstances when residential treatment is required
 Eliminate barriers and traumatic CLIP intake process (parents should not have
to present to a team of 25 people)
 Determine how many residential beds our state needs (including foster care,
NPAs (IEP), JR, and HCA placements and inform legislature
 Create basis family skills training materials (beyond what Patty King currently
developed, see Parenting Wisely, Changes, etc.)
 Develop BH Career Pathway and increase Medicaid reimbursement rate
(resource: Annie Laurie Armstrong)

10. “We can’t advocate”
 HCA has institutional practices that disproportionally impact BIPOC families,
adoptive families, and families of disabled children.
 How are new projects selected to put energy into (ex COVID hotline)? How are
others (1874 & 2883) ignored or minimized? Is this not in itself advocacy?
 Redefine advocacy vis-à-vis lobbying
 Where do you include parent voices? Where do stakeholders overrule parent
voices? How do you address parent concerns that conflict with your dearly
held assumptions? BIPOC voices solicited but not incorporated into the work.
 There are resources we could use to expand access to residential care, but
you don’t explore them because it doesn’t fit your values.
 Improve communications with families – FIT Survey not seen by families

11. Behavioral Health in Children & Adolescents
Behavioral
Health