Children’s Long-Term Inpatient Program (CLIP) Provides Residential Psychiatric Treatment

A Brief Overview

  • CLIP serves children ages 5-17 by providing mental-health treatment and school in a secure, residential facility. Read on for more information about CLIP eligibility and how to initiate a referral.
  • Young people placed in CLIP could not recover adequately with the most intensive outpatient services available, which in Washington are provided through Wraparound with Intensive Services (WISe).
  • Family caregivers of young people with intensive behavioral health needs can request support from A Common Voice, staffed by lead parent support specialists. Find their contact information on the Center of Parent Excellence (COPE) page of the Health Care Authority’s website.

Full Article

Families have few options to help a child with a psychiatric illness that makes in-home, community-based care unworkable. Local hospitals are designed to provide crisis care and generally do not keep a patient for mental health treatment and recovery beyond a few days or weeks. Sometimes those short hospitalizations are not long enough for lasting stability.

One choice for children 5-17 is the Children’s Long-Term Inpatient Program (CLIP), which provides intensive mental health services and school in a secure residential setting. A CLIP stay is usually about 6 months long. Eligibility for CLIP ends on the child’s 18th birthday.

Most CLIP referrals are for children with Medicaid—public health insurance, which is called Apple Health in Washington State. Families with private health insurance have access to CLIP but may be referred first to private facilities for long-term, inpatient care. Medicaid is the payer of last resort.

Who is Eligible for CLIP?

  • Youth ages 5 to 18
  • Legal residents of Washington State
  • Youth diagnosed with a severe psychiatric disorder
  • Youth at risk to themselves or others or gravely disabled due to a psychiatric condition
  • Youth who are not successfully treated through community-based mental health resources

Families are involved and children get school at CLIP

Parents/legal guardians engage with the treatment team while a child is at CLIP. The goal is to help the child stabilize and provide the family with skills and tools for a successful return to the home, school and community.

Children attend school while at CLIP. Teachers at the residential facility manage the student’s Individualized Education Program (IEP), or Section 504 plan, and help with transitions from and back into the student’s local school.

CLIP referrals may be voluntary or involuntary

Parents and legal guardians can refer children to CLIP. The first step is to know whether the referral is voluntary or involuntary. Parents can volunteer their children younger than 13 for residential treatment. Youth 13 and older must voluntarily go to CLIP unless they meet criteria for involuntary commitment.

The Revised Code of Washington (RCW 71.34.010) establishes that an adolescent 13-18 may be committed for up to 180 days of involuntary inpatient psychiatric treatment if commitment criteria are met. Residential placement at CLIP is one way to carry out a commitment order, which may be based on a standard of imminent threat (to self or others) or grave disability/severe psychiatric deterioration. Seattle Children’s Hospital provides a Guide to the Involuntary Treatment Act (ITA).

To refer a child or youth to CLIP for voluntary admission, the parent, legal guardian, or youth may get help by following a CLIP administration menu that starts with the name of the child’s heath plan. A child’s mental health provider or social worker also can support a CLIP application.

The family can request a hearing with a regional committee, which may then refer the case to the CLIP Administration for final approval. Sometimes a child is put on a waiting list for an available bed.

CLIP is a step up from WISe

Young people placed in CLIP have a record of being unable to access an appropriate level of care within their community. That usually means failure to recover with services from our state’s most intensive outpatient option for children and youth, which is Wraparound with Intensive Services (WISe).

The WISe program was begun as part of the settlement of a class-action lawsuit, TR v Dreyfus, in which a federal court found that Washington wasn’t providing adequate mental-health services to youth. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital.

Families engaged in WISe and/or CLIP services are encouraged to participate in their regional Family, Youth, and System Partner Roundtable (FYSPRT), which provides a place to share resources, solidarity, and feedback about the behavioral health system. See PAVE’s article: Families and Youth Have a Voice on Mental Health Matters Through FYSPRT.

Organize and prepare for a CLIP application process

Families need an organized set of medical and school paperwork to complete CLIP applications. Refer to PAVE’s article about document management for guidance about how to create a care notebook or other filing system for this and other purposes.

The regional CLIP committee includes care providers from managed care organizations and other agencies that may provide additional support and resources to the family, regardless of whether a CLIP referral is recommended. Generally, the committee determines that all community-care options have been exhausted before recommending a more restrictive placement through CLIP. The team will also make a recommendation based on whether the child is likely to benefit from the therapeutic program, which is mental health based and may not be a good fit for an individual with a severe form of developmental or intellectual disability.

Where is CLIP located?

The largest CLIP facility is the Child Study and Treatment Center (CSTC) in Lakewood, adjacent to Western State Hospital. CSTC provides about 60 beds in cottages that house children in groups by age and other factors. Additional options with fewer beds include:

  • Tacoma, The Pearl Street Center
  • Spokane, the Tamarack Center
  • Yakima, Two Rivers Landing

Further Resources

Washington’s Health Care Authority (HCA) has additional information about WISe, CLIP, early signs of psychosis, and Family Initiated Treatment (FIT).  If a person 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys (website link includes access to a referral form).

Quick Start Your Advocacy in Two Steps

Asking for something you want or need for yourself or someone you love can take courage and inner strength. The ask is easier when you have basic advocacy tools. This short video provides a two-step process to help advocates step into their role with more confidence.

Here are the words that go with the video:

Being an advocate means speaking up to request something and pressing onward until the goal is met. The best advocates are really clear about two steps you cannot skip:

  1. Know what you want, and;
  2. Know who has the power to make that possible.  

This may sound obvious, but it’s not always easy. Let’s break it down with an example.

This is Julia—she’s a mom. Her 7-year-old son, Jose, isn’t learning to read like other kids his age. Julia wonders if Jose might have a learning disability. She mentions this to the attendance secretary one morning. Nobody contacts her. She assumes her worries are wrong or not important.

Hmmm, that doesn’t sound quite right, does it?

If she applies our two-step guide to advocacy, Julia can try again. She starts here:

  1. What does she want?
  2. Who has the power to make that happen?

First, she wants her son to get more reading help at school. Second, a classroom teacher or a special education teacher might help, but the attendance secretary is not the right person to ask.

It will take some work to press onward. Julia may need an appointment to formally talk with Jose’s teacher or a school administrator to get her advocacy project started. Here are some questions she might ask:

  • What do I do if I think my son might have a learning disability?
  • Is there a form for me to request a special education evaluation?
  • Who should I send my request to?
  • When will I get a response?
  • What’s the process for getting services to help my son?
  • What are my options if I disagree with the school’s decision?

Making a list of questions is an advocate’s homework. Taking careful notes helps with planning and often leads to faster results.

Remember, Julia wants her son to get more help learning to read. Her questions will help her figure out who to work with and what to do next.

Advocacy requires persistence. Don’t give up, and keep your eye on these two questions:

  1. What do I want?
  2. Who has the power to work with me and make that happen?

Stay Stubborn! One Girl’s Self-Determination while Navigating Healthcare

By Kyann Flint

Being stubborn is the right approach when it means self-determination. Having the drive to learn what you want and need and then speak up for yourself gives you control over your life. 

I learned that lesson young. By age 6, I was advocating in my own healthcare. My doctor wanted to stick a swab up my nose and down my throat at the same time. I told him, “No!” and asked, “What would that accomplish?” I was not sick. Why put me through that? I had been through enough tests. If this one was not going to improve my pain or give me a diagnosis, then it did not need to happen. Because I spoke up, it didn’t!

My parents supported my growing self-advocacy and also advocated for me. As my voice blossomed, so did my skills for self-determination. The self-determination skills I worked on throughout childhood have helped me gain independence and make some of the most important adult decisions of my life.

When I was 8, I was diagnosed with a type of genetic peripheral neuropathy called Charcot Marie Tooth (CMT). The coating around my nerves becomes scarred and cannot be repaired, making it hard for my brain to tell my legs, arms, feet, and hands what to do.

I continued to have symptoms that did not quite fit this diagnosis, so testing continued. By age 12, I started asking whether further diagnoses would improve my quality of life. The answer was no, so I chose to end the poking and prodding and deal with my symptoms as they came.

Right after I turned 21, I was in tremendous pain and needed more help. Three years later, I had a second diagnosis: Heredity Spastic Paraplegia. Four years after that, the cause of my pain was finally found. My bladder was failing, which made it difficult to go to the bathroom. I eventually lost the ability to go to the bathroom on my own. On September 30, 2020, I made one of the best decisions of my life and had the Mitrofanoff surgery that now allows me to go to the bathroom independently.

I needed a lot of self-determination to get to this point. Before the surgery, one doctor advised against it, explaining that I wasn’t a good candidate due to my progressive neuromuscular disorders. She predicted that I would be incapacitated one day, so “why bother?” I decided that even if she were right, I wanted the independence that the surgery could provide now. I found a new surgeon. I am so thankful that I did!

My surgeon related well with me and supported my belief that I was “worthy” of this procedure. He agreed that it was a good choice to enable me to live more independently right now. The choice to proceed wasn’t easy or pain-free. I needed many tests and procedures, including a colonoscopy without anesthesia. Delays in scheduling the surgery tested my self-determination, but I persevered.

My surgery included a week in the hospital and months of recovery, but my stubborn nature helped me get through it all, despite the frustration of having limited manual dexterity and being legally blind. But I figured out how to go to the bathroom independently!

It took a lot of self-determination to move forward with one of the best decisions of my life, but I am proud that I made this decision. If you have a decision to make in your life, I hope you will tap into your own stubborn self-determination. Figure out what you need and want and speak up for yourself. I’m so glad I did.

About the author: Kyann Flint, Director of Accessibility for Wandke Consulting, is a passionate advocate for the disability community. As a person with a disability, she strives to educate society on how social barriers, like ignorance and stereotypes, limit the disability community. Kyann loves coffee and traveling.

Telling Your Story with a Purpose: How to Inspire Action in Two Minutes

Every person’s story has the potential to impact how others think or act. Disability rights have been legislated because of individuals who spoke up and sparked change. This video introduces a strategy for telling a potent story in two or fewer minutes, using your own hand to guide the process. Think of this as a hand model for an inspirational elevator speech to improve or inspire:

  • Self-advocacy
  • Public comment
  • A meeting with public officials
  • Legislative forums or candidate meetings
  • Community education

 The Arc of Washington State provides pathways for people to participate in legislative advocacy. The Arc serves people with intellectual and developmental disabilities of all ages and their families. 

Some staff members at PAVE are certified to teach Telling your Story with a Purpose, a training created by the state’s Department of Health and Seattle Children’s Hospital. For support to create your story, fill out a PAVE Helpline request, and a trained staff member will contact you.

Questions to consider first:

  1. What is the challenge or problem that you, your child or your family faces? Think of a problem that also affects other people and families. Consider writing one sentence about people in general and one sentence about your own story, child, or family. 
  2. How does this challenge affect others?
  3. How might this challenge affect others if nothing changes?
  4. What needs to change?
  5. What can be done to improve the situation?
  6. Who has the power to make a change? 

Key information for your story:

  1. Who are you?  Be sure to say your name and the district, city, or town you live in.
  2. If you want to include information about other people be sure you have permission before sharing anything confidential, such as names, ages, or health information.
  3. Clearly and simply describe the problem or challenge.
  4. Explain why this is important.
  5. Include a short story (4-5 sentences) about how this issue has affected you and your family. If possible, use a positive example – a situation where things went well and why you want others to have a similar experience.
  6. What do you want your listener to do? State your request in one sentence with 30 or fewer words. Avoid a general request for “support.” Provide a clear action:
    • “I ask you to vote for…”
    • “I want you to change this policy in order to…”
    • “I want you to fund a program that…” 
  7. Stop and check: Consider if your comments might make the listener feel criticized or attacked. Focus on the solution. Make sure you’ve included statements about how others in the community can benefit.
  8. End by restating your request and saying thank you. When possible, thank the listener for something they have done in the past that you appreciate–voting for a bill, serving on a committee, funding a program.