A Brief Overview
- Alarming statistics indicate the pandemic has worsened behavioral health outcomes for young people. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.
- Students eligible for special education services through the federal category of Emotional Disturbance are more than twice as likely as other disabled peers to quit school before graduating.
- These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for further information and resources.
- Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.
- Help is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK.
- Text HEAL to 741741 to reach a trained Crisis Text Line counselor.
- For youth who need support related to LGBTQ issues, the Trevor Projectprovides targeted resources and a helpline: 866-488-7386.
- A place to connect with other families is a Facebook group called Healthy Minds Healthy Futures.
- Family caregivers can request support and training from A Common Voice, a statewide non-profit staffed with Parent Support Specialists who have lived experience parenting a child with behavioral health challenges. The program is part of the Center of Parent Excellence (COPE), managed by the state’s Health Care Authority, which provides contact information for regional lead parent support specialists.
Alarming statistics indicate the COVID-19 pandemic has worsened circumstances for young people who were already struggling to maintain mental health. Washington’s most recent Healthy Youth Survey, from 2018, revealed that 10 percent of high-school students had attempted suicide within the year. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.
The governor’s order requires schools to provide in-person learning options and directs the Health Care Authority and Department of Health to “immediately begin work on recommendations on how to support the behavioral health needs of our children and youth over the next 6 to 12 months and to address and triage the full spectrum of rising pediatric behavioral health needs.”
The Children and Youth Behavioral Health Work Group (CYBHWG) was created in 2016 by the Legislature (HB 2439) to promote system improvement. CYBHWG supports several advisory groups, including one for Student Behavioral Health and Suicide Prevention. The work groups include representatives from the Legislature, state agencies, health care providers, tribal governments, community health services, and other organizations, as well as parents of children and youth who have received services. Meetings include opportunities for public comment. Meeting schedules and reports are posted on the Health Care Authority (HCA) website.
A press for school-based services and mental health literacy
Advocacy for direct school-based mental health services and education about mental health topics comes from the University of Washington’s SMART Center. SMART stands for School Mental Health Assessment Research and Training. The SMART center in 2020 provided the legislative work group with a report: The Case for School Mental Health. The document includes state and national data that strongly indicate school-based behavioral health services are effective:
“Increased access to mental health services and supports in schools is vital to improving the physical and psychological safety of our students and schools, as well as academic performance and problem-solving skills. Availability of comprehensive school mental health promotes a school culture in which students feel safe to report safety concerns, which is proven to be among the most effective school safety strategies.”
The SMART Center in partnership with the non-profit Chad’s Legacy Project in 2021 established an online Student/Youth Mental Health Literacy Library. Intended for staff at middle and high schools, the library provides resources to help schools choose curricula for mental health education on topics that include Social Emotional Learning, Substance Use Disorder, and Suicide Prevention. Goals of mental health literacy are:
- Understanding how to foster and maintain good mental health
- Understanding mental disorders and their treatments
- Decreasing Stigma
- Understanding how to seek help effectively for self and others
TIP: Families can direct their schools to this resource to support development or growth of a mental health education program.
Mental Health support to students is a statewide priority
Top priority for the statewide Student Behavioral Health and Suicide Prevention advisory group is to increase school staff who directly support students, including licensed mental health professionals imbedded in schools, counselors, social workers, school nurses and other support staff. The larger Children and Youth Behavioral Health Work Group (CYBHWG) shares that priority as an aspect of assessing and rethinking behavioral health delivery systems throughout the state.
In its recommendations to the 2022 legislature, CYBHWG recommends that the state fund a facilitated process to develop a strategic plan “to ensure that all Washington children and youth ages 0-25 years and families have timely access to high-quality, equitable, well-resourced behavioral health education, care, and supports across the continuum and where they need it.” School-based mental health services are listed as an aspect of those recommendations.
As schools returned to in-person learning in 2021, the Office of Superintendent of Public Instruction (OSPI) created a guidance document that addresses student mental health needs as a top concern: Questions and Answers: Provision of Services to Students with Disabilities During COVID-19 in the 2021–22 School Year. Included is this statement:
“The work of Washington public schools is to prepare students for postsecondary pathways, careers, and civic engagement. Washington must create the conditions for each student to be educated in racially literate, culturally sustaining, positive, and predictable environments that intentionally prioritize the instruction and development of social-emotional skills and mental health in addition to our primary focus on academic content.”
TIP: Family caregivers can ask their school what staff are on site to support students with their mental health needs. Some school districts seek support from an Educational Service District (ESD) to meet student behavioral health needs, so families can also ask whether ESD supports are available. Note that some ESDs are licensed as behavioral health providers.
What is MTSS, and why learn this acronym to ask the school about it?
Another priority for agencies involved in the statewide work is widespread implementation of Multi-Tiered Systems of Support (MTSS). Through MTSS, schools support well-being for all students and offer higher levels of support based on student need. Social Emotional Learning (SEL) is key to an MTSS framework, which can create a structure for implementing positive behavioral supports and trauma-informed interventions.
OSPI, the guidance agency for Washington schools, prioritized 2021 budget requests to Empower all Schools to Support the Whole Child, including through MTSS. In January, 2021, OSPI was awarded a five-year, $5.3 million grant from the U.S. Department of Education to build regional coaching capacity to help districts implement MTSS. As a local control state, Washington districts determine their own specific policies and procedures.
TIP: Families can ask school and district staff to describe their MTSS framework and how students are receiving support through the various levels/tiers.
Special Education is one pathway for more help
Students may access mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). Appropriate support can be especially critical for these students: According to the U.S. Office of Special Education Programs (OSEP), students eligible for school-based services under the ED category are twice as likely to drop out of high school before graduating.
Note that a student with a mental health condition could qualify for an IEP under the category of Other Health Impairment (OHI), which captures needs related to various medical diagnoses.
In Washington State, the ED category is referred to as Emotional Behavioral Disability (EBD). If the student’s behavioral health is impaired to a degree that the student is struggling to access school, and the student needs specially designed interventions, then the student may be eligible for an Individualized Education Program (IEP). Keep in mind that academic subjects are only a part of learning in school: Social Emotional Learning (SEL) is part of the core curriculum.
An educational evaluation determines whether a student has a disability that significantly impacts access to school and whether specially designed instruction and/or related services are needed for the student to receive a Free Appropriate Public Education (FAPE). FAPE is the entitlement of a student eligible for special education services and an IEP team determines how FAPE/educational services are provided to an individual student.
Behavioral health counseling can be part of an IEP
Counseling can be written into an IEP as a related service. When included in a student’s IEP as educationally necessary for FAPE, a school district is responsible to provide and fund those services. School districts can receive reimbursement for 70 percent of the cost of behavioral health services for students who are covered by Medicaid and on an IEP.
A student with a mental health condition who doesn’t qualify for an IEP might be eligible for a Section 504 Plan. A disability that impairs a major life activity triggers Section 504 protections, which include the right to appropriate and individualized accommodations at school. Section 504 is an aspect of the Rehabilitation Act of 1973, a Civil Rights law that protects against disability discrimination. Students with IEPs and 504 plans are protected by Section 504 rights.
Behavioral Health encompasses a wide range of disability conditions, including those related to substance use disorder, that impact a person’s ability to manage behavior. Sometimes students with behavioral health disabilities bump into disciplinary issues at school. Students with identified disabilities have protections in the disciplinary process: PAVE provides a detailed article about student and family rights related to school discipline.
Placement options for students who struggle with behavior
IEP teams determine the program and placement for a student. In accordance with federal law (IDEA), students have a right to FAPE in the Least Restrictive Environment (LRE) to the maximum extent appropriate. That means educational services and supports are designed to help students access their general education classroom first. If they are unable to make meaningful progress there because of their individual circumstances and disability condition, then the IEP team considers more restrictive placement options. See PAVE’s article: Special Education is a Service, Not a Place.
Sometimes the IEP team, which includes family, will determine that in order to receive FAPE a student needs to be placed in a Day Treatment or Residential school. OSPI maintains a list of Non-Public Agencies that districts might pay to support the educational needs of a student.
A precedent-setting court ruling in 2017 was Edmonds v. A.T. The parents of a student with behavioral disabilities filed due process against the Edmonds School District for reimbursement of residential education. The administrative law judge ruled that the district must pay for the residential services because “students cannot be separated from their disabilities.”
Strategies and safety measures for families
With the release of the Healthy Youth Survey in Spring, 2019, the state issued a two-page Guide to Mental Health Information and Resources to provide more detail about the survey and to direct families and school staff toward resources for support.
Included is a list of factors that help youth remain resilient to mental health challenges:
- Support and encouragement from parents/guardians and other family members, friends, school professionals, and other caring adults
- Feeling that there are people who believe in them, care about them, and whom they can talk to about important matters
- Safe communities and learning environments
- Self-esteem, a sense of control and responsibility, and problem-solving and coping skills
- Having an outlet for self-expression and participation in various activities
The handout includes tips for parents and other adults supporting teens who feel anxious or depressed:
- Bond with them: Unconditional love includes clear statements that you value them, and your actions show you want to stay involved in their lives.
- Talk with teens about their feelings and show you care. Listen to their point of view. Suicidal thinking often comes from a wish to end psychological pain.
- Help teens learn effective coping strategies and resiliency skills to deal with stress, expectations of others, relationship problems, and challenging life events.
- Have an evening as a family where everyone creates their own mental health safety plan.
- Learn about warning signs and where to get help
- Ask: “Are you thinking about suicide?” Don’t be afraid that talking about it will give them the idea. If you’ve observed any warning signs, chances are they’re already thinking about it.
- If you own a firearm, keep it secured where a teen could not access it. Lock up medications they shouldn’t have access to.
State options for behavioral health services and support
For Washington children and youth with Medicaid insurance, the highest level of community-based care in behavioral health is provided through 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.
Young people under 18 who need residential care to meet medical needs may be referred to the Children’s Long-Term Inpatient program: PAVE’s website provides an article about CLIP.
If a person ages 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys. This website link includes access to a referral form.
The Family, Youth and System Partner Round Table (FYSPRT) provides a meeting space for family members and professionals to talk about what’s working and what isn’t working in mental healthcare. FYSPRT groups provide informal networking and can provide ways for families to meet up and support one another under challenging circumstances.
Federal parity laws require insurers to provide coverage for behavioral health services that are equitable to coverage for physical health conditions. The National Health Law Program (NHLP) provides information and advocacy related to behavioral healthcare access and offers handouts to help families know what to expect from their insurance coverage and what to do if they suspect a parity law violation:
- Handout about parity for people with private insurance
- Handout about parity for people with public insurance (Medicaid)
Family Initiated Treatment (FIT) is an option in Washington
Youth older than 13 have the right to consent or not consent to any medical treatment in Washington State. Parents and lawmakers throughout 2018-2019 engaged in conversations about how that creates barriers to care for some teens struggling with behavioral health conditions. The Adolescent Behavioral Health Care Access Act (HB 1874), became law in May 2019. PAVE provides an article about the law and its provision for Family Initiated Treatment.
Places to seek referrals and information
Seattle Children’s Hospital in 2019 launched a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide. In addition to helping to connect families with services, the hospital is gathering data to identify gaps in care.
PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.
For information, help during a crisis, emotional support, and referrals:
- Suicide Prevention Lifeline (1-800-273-TALK)
- Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor
- Trevor Project Lifeline (LGBTQ) (1-866-488-7386)
- The Washington Recovery Help Line (1-866-789-1511)
- TeenLink (1-866-833-6546; 6pm-10pm PST)
Further information on mental health and suicide:
- OSPI’s Youth Suicide Prevention, Intervention, and Postvention page
- Washington Department of Health Suicide Prevention page
- Forefront Suicide Prevention
- Child Mind Institute
- National Alliance on Mental Illness (NAMI) provides on-demand family training videos and information about how to access additional training opportunities, support groups, and advocacy through national, state, and local affiliates
- NAMI Washington provides a list of local affiliates and contact information