While school facilities are closed because of COVID-19, families impacted by disability face complex challenges. For some, children’s difficult behaviors are a regular concern. According to the Centers for Disease Control and Prevention (CDC), stress and anxiety in children and youth may show up through unexpected or maladaptive behaviors. Those behaviors might get worse because of fear, isolation, and disrupted lives.
Meanwhile, some of the help that used to be there is gone. At school, students may have gotten 1:1 support or direct instruction to encourage behavioral skill-building. Those aspects of a special education program might be difficult or impossible to provide during social distancing.
While students are learning from home, parents can request individualized support from the school to support behavioral expectations, if behaviors have educational impact. Parent training can be a related service in a student’s Individualized Education Program (IEP). As always, family caregivers can request an IEP meeting to discuss options to support academic and behavioral goals and expectations.
To generally support caregivers in their various roles during COVID-19, Washington’s Office of Superintendent of Public Instruction (OSPI) offers a three-part webinar designed for families to help with behavior in continuous learning environments. The webinar has been recorded and uploaded to YouTube in sections, so families can access the content at their own pace.
The webinars are moderated by Lee Collyer, OSPI’s program supervisor for special education and student support. Collyer, a parent, describes his own challenges during the pandemic alongside ideas from research-based sources. Families are invited to send questions and comments to firstname.lastname@example.org.
In various forums, Collyer has described his investment in fostering positive behavioral supports for students in order to reduce disciplinary actions. In a May 13, 2020, OSPI webinar about Mental Health and Safety, Collyer said, “My fear is that we’re going to try to discipline our way out of trauma.”
Following is a brief description of each segment of the three-part webinar series, with a link to each specific webinar. If you start with the first one, you will have the option to stay connected and flow through all three. Each segment is 20-25 minutes long, and the first one includes some background information about OSPI and Collyer’s role.
Collyer begins the series by sharing OSPI’s official statements related to mission, vision and equity. He offers reassurance to parents that everyone is learning something brand new together, without time for proper training, and that “We should not let pressure from schools, teachers or school communities dictate what works for our family and what kind of learning we are prioritizing during this time.”
Collyer talks about the value of learning that is imbedded in everyday activities and part of family routines. He shares insights from psychiatrist Bruce Perry and psychologist Ross Greene, both widely regarded authors who apply their research to inform parents. Their names are linked here to practical articles about supporting positive behavior, and both are easily searchable to find additional materials.
The OSPI webinar includes signs of stress and anxiety to consider. Collyer recommends behavior solutions based on skill building: If children do not know how to do something (like behave), the answer is to teach, he points out, not punish. The segment ends by explaining how behavior serves a function and understanding that function is key to reducing escalations.
The second segment begins where the first leaves off, by discussing the functions of behavior and how to identify them and intervene early. Pre-teaching skills and reinforcing positive behaviors over negative ones in a 5:1 ratio is encouraged: For the best outcome, catch a child doing what is expected and provide encouragement five times more often than calling out an unexpected behavior.
The second segment also provides some specific strategies for home/school communications. Collyer describes the difference between a consequence and problem-solving and offers specific strategies for parent/child problem-solving.
The third segment begins with information about how a crisis might escalate and how reason and logic are compromised when fear and frustration highjack a person’s response system. Adults may need to consider their own escalation cycles and develop a personal plan for self-control to support children, Collyer says.
He describes how children might be uneven in their development of cognitive versus social-emotional skills and how that might create confusion about the best parenting strategy. How to set limits with considerations for trauma and ways to shift from negative to positive interventions are additional strategies provided in the final segment of this webinar series.
The Adolescent Behavioral Health Care Access Act, passed into law by the Washington Legislature in 2019, gives parents and providers more leverage in treating a young person who won’t or can’t independently seek medical help for mental illness and/or substance use disorder.
The Washington State Health Care Authority (HCA) in March 2020 launched several website links with information about the new law, which includes an option for Family Initiated Treatment (FIT).
The Washington State Hospital Association on July 9, 2019, provided a slide presentation describing the law’s history and its primary features.
A place to connect with other families concerned about adolescent mental healthcare access in Washington State is a group called Youth Behavioral Healthcare Advocates (YBHA-WA) on Facebook. Included on the page are handouts that summarize key aspects of the new law.
mental health help for a youth in crisis can be complicated, frustrating and frightening.
Mental Health America ranks states based on the incidence of mental
illness and access to services. The agency’s 2020 rankings list Washington in
the 43rd position, based on various measures that indicate a higher prevalence of
mental illness and lower rates of access to care.
barrier to treatment is the youth, who may not be able to see a problem or want
to get professional help. Parents often struggle to navigate systems that must
balance a young person’s autonomy with concern that they may not be able to
make good decisions because of their development, specific illness
circumstances or symptoms that impact the brain.
Washington State, the age of medical consent is 13. That means that a person
13-17 years old can independently seek medical treatment, without the consent
or knowledge of parents.
Age of consent laws also have meant that Washington
youth could say no to mental health or substance use treatment, regardless of
whether parents and providers agreed that such treatment was necessary to
protect the safety and well-being of the adolescent.
A law passed
by the Washington legislature in 2019 gives parents and providers more leverage
when a young person is struggling with a mental illness or substance use
disorder and won’t independently engage with treatment. The law does not limit
an adolescent’s ability to initiate treatment on their own.
A January 8, 2020, article in Crosscut profiles several families impacted
by the new law. “Until the new law,” the article states, “parents often were
shut out of their teenager’s care and treatment plans and couldn’t push a teen
toward necessary outpatient or inpatient care without their consent.”
Adolescent Behavioral Health Care Access Act enables parents/caregivers to bring
a child for inpatient or outpatient treatment without requiring consent from
the child, ages 13-17. The law includes elements introduced by the state Senate
and House of Representatives, which originally titled the bill as HB 1874.
the law was a win for the Children’s Mental Health Work Group, which studied and reviewed
recommendations from a stakeholder advisory group authorized by the 2018
legislature. The final version of the law included input from family members,
youth, clinicians, hospital staff and many others who met dozens of times. A June
13, 2019, slide presentation available online provides additional history and detail
about the work group and its recommendations: Family Initiated Treatment and
Engaging Families in Treatment of Youth. The webinar with sound is available on YouTube.
legislature is considering amendments to the law, and the Children’s Mental
Health Work Group continues to meet to consider proposals to clarify provisions
that relate to residential treatment and referrals for Wraparound with
Intensive Services (WISe).
The 2019 law
expands the definition of parent to include a wide range of family caregivers,
guardians and others who have authority to initiate treatment. The Revised Code
of Washington (RCW 9A.72.085) provides standards for “subscribing
to an unsworn statement” that can apply to a caregiver initiating
parents retain the right to make medical decisions for children younger than
13, and adults 18 and older are responsible for medical decision-making if
there is no guardianship.
substantive change with the 2019 law is that providers may share mental health
information with parents without an adolescent’s consent, if the provider
determines that information sharing with family is in the best interests of the
adolescent patient. A list of information-sharing guidelines is included below.
If a parent/caregiver
believes that an adolescent requires mental health or substance use disorder treatment,
the adult can escort the young person to an inpatient or outpatient treatment facility
even if the adolescent doesn’t readily agree to go.
will assess the adolescent and consider information from the family to
determine whether treatment is medically necessary. An adolescent’s refusal to
engage with the provider cannot be the sole basis for refusing to treat.
facility can detain the adolescent under Family-Initiated Treatment (FIT) if
medically necessary. Note: another option could be detention under the Involuntary Treatment Act (ITA), if the adolescent is
determined to be gravely disabled or at imminent risk of self-harm or harm to
necessity is found by an outpatient provider, a counselor is limited to 12
sessions over 3 months to attempt to work with the adolescent. If the young
person still refuses to engage with treatment, then the period of
Family-Initiated Treatment with that provider ends.
continue to encourage autonomy for young people, but family engagement is encouraged.
According to the Revised Code of Washington (RCW 71.34.010):
“Mental health and chemical dependency
professionals shall guard against needless hospitalization and deprivations of
liberty, enable treatment decisions to be made in response to clinical needs in
accordance with sound professional judgment, and encourage the use of voluntary
services. Mental health and chemical dependency professionals shall, whenever
clinically appropriate, offer less restrictive alternatives to inpatient
treatment. Additionally, all mental health care and treatment providers shall
assure that minors’ parents are given an opportunity to participate in the
treatment decisions for their minor children.”
for Information Sharing
law, 42 CFR Part 2,
restricts information sharing related to substance use, and clinicians cannot
share that information without a patient’s written consent, regardless of
whether the substance use co-occurs with mental illness.
have discretion in determining what information about mental health diagnoses
and treatment is clinically appropriate to share with parents of an adolescent
13-17. A provider retains discretion in withholding information from
family/caregivers to protect an adolescent’s well-being. In general, the Adolescent
Behavioral Healthcare Access Act encourages sharing information to support collaboration
between the clinical setting and home. Specifically, providers and families are
encouraged to discuss:
including risks, benefits, side effects, typical efficacy, dosages and schedule
the child’s mental health condition
parenting or behavioral management strategies
planning and safety planning
about state laws related to Behavioral Health Services for Minors is available
through the Washington State Legislature website under RCW 71.34.
about child and youth behavioral health services in Washington State is
available from the Health Care Authority (HCA).
FYSPRT (pronounced fiss-burt) is a hard acronym to learn, but it’s worth the effort for families and young people who want to talk about improving mental healthcare systems.
Here’s what FYSPRT means: Family members, Youth and System Partners (professionals) get together at a “Round Table” (meaning everyone has an equal voice) to talk about issues related to emotional distress, mental illness and/or substance-use disorder. All participants share ideas about what helps and what could make things better.
FYSPRT began after a class-action lawsuit against the state, TR v Dreyfus. The litigation resulted in development of the state’s out-patient mental-health services program for youth—Wraparound with Intensive Services (WISe).
FYSPRT is a place where families provide feedback about WISe, but all community members are welcome—regardless of age or agency affiliation.
Some regional FYSPRTs sponsor separate meetings and social events for youth.
Parents and young people who struggle with emotional distress, mental illness and/or substance-use disorder can feel powerless to affect change in a complicated medical system. 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. The groups also provide informal networking and can provide ways for families to meet up and support one another under challenging circumstances.
The state sponsors 10 FYSPRT groups to serve every county: A list of the groups and which counties they serve is included at the end of this article. Each group reports to a statewide FYSPRT, which provides information to state government to influence policy. The Washington State Health Care Authority (HCA) provides a map of the FYSPRT regions and includes contact information for local leaders and a schedule of where/when meetings are held.
FYSPRT began as part of a class-action lawsuit against the state, referred to as TR v Dreyfus. The litigation began in 2009, and settlements were mediated in 2012-13. The federal court found that Washington wasn’t providing adequate mental-health services to youth and required that the state start delivering intensive community-based mental-health treatment. The state responded by developing the Wraparound with Intensive Services (WISe) program for youth under 21 who are eligible for Medicaid. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital, which costs more and can be traumatizing.
Young people under 18 who need residential care are referred to the Children’s Long-Term Inpatient program: PAVE’s website provides an article about CLIP.
To provide accountability for the delivery of WISe services, the state created FYSPRT as a forum for families to provide feedback about how the program is working. The mission is to provide an equal platform for everyone within the community to strengthen resources and create new approaches to address behavioral needs of children and youth.
FYSPRT provides a space where youth impacted by behavioral health issues and their family members can share ideas about what works well and what would work better. The FYSPRT model is based on the belief that everyone’s unique perspective is equally important, and everyone is invited. For many parents and youth, FYSPRT becomes a place to bond and connect to support one another. Some regional FYSPRTs include separate meetings for youth, and those groups can become a key social outlet.
FYSPRT meetings are open to all interested community members. Each community has unique participants depending on what agencies work in the cities and towns within the region.
Staff who serve families through WISe are key participants. Other attendees are case managers from the state’s Medicaid-provider agencies, behavioral health counselors, foster-care workers, staff of homeless programs and staff and volunteers from affiliates of the National Alliance on Mental Illness (NAMI). Other participants are leaders of support groups for youth in recovery or working with issues related to gender identity or sexuality. PAVE staff are regular attendees in many regions, and PAVE manages the Salish FYSPRT program.
Every area of the state of Washington has its own FYSPRT, overseen by the Health Care Authority. Each of the ten FYSPRT regions is comprised of a single county or up to eight adjoining counties. In order to create greater participation from the general public, transportation and childcare stipends are available for families and youth in most areas. Some groups provide free meals for everyone and/or gift card incentives for the families and young people who attend.
Here are links to each regional FYSPRT’s website and a list of the counties each represents:
Two Washington students die from suicide each week. In a typical high-school classroom of about 30 students, chances are high that 2-3 students have attempted suicide in the past year. Read on for more detail from the 2018 statewide Healthy Youth Survey.
Approximately one in five youth experience a mental illness before age 25. About half of those with diagnosed conditions drop out of school.
These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for ideas about how to seek help.
Seattle Children’s Hospital has a new referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide.
A mom in Graham, WA, launched a program to improve education about mental health after her son died by suicide in 2010. The Jordan Binion Project has trained about 500 Washington teachers with an evidence-based curriculum from Teen Mental Health.
Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. To qualify, a disabling condition must significantly impact access to learning. An educational evaluation also must show a need for specialized instruction.
Parents can share these resources with school staff, who may be seeking more information about how to help youth struggling to maintain their mental health.
Help is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK.
Another crisis option is to text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
For youth who need support related to LGBTQ issues, the Trevor Project provides targeted resources and a helpline: 866-488-7386.
The thousands of young people who send thank-you letters to Deb Binion didn’t always believe their lives were going to work out. One writer had attempted suicide and been hospitalized many times because of her bipolar disorder. Two years after finishing high school, she reported she was doing well and offered thanks for a course in mental health that helped her understand her illness, its impacts on her brain, and how to participate in her treatment. “It made a total difference in my life,” she said in her thank-you letter.
“Until she got the educational piece and understood her illness, nothing was helping,” Binion says. “No one had ever explained to her why she had this illness and what was occurring.”
The program, which Binion started after her son Jordan’s suicide in 2010, has trained about 500 school staff throughout Washington State to help young people understand mental illness and what to do to support themselves and others. Although the numbers are difficult to track, Binion estimates that about 100,000 Washington students receive education through the curriculum each year.
“My mission is to get this information to the kids,” says Binion, who runs the non-profit Jordan Binion Project from her home in Graham, WA. She says a short-term, limited pilot project with the Office of Superintendent of Public Instruction (OSPI) showed promising results, with 60 teachers throughout Washington informally reporting that about 85 percent of students showed improvement in their “mental health literacy,” a key feature of the program.
Teachers are specially trained to provide the Mental Health Curriculum
The curriculum, available through TeenMentalHealth.org, was developed by a world-renowned adolescent psychiatrist and researcher, Stan Kutcher. He observed that classrooms often struggle to provide an emotionally safe learning environment for students with psychiatric conditions. Some attempts to provide education about mental health have created confusing and triggering circumstances for students impacted by illness and/or trauma, he found.
Kutcher, professor of psychiatry at Dalhousie University in Nova Scotia, Canada, responded with a model for training school staff in how to teach sensitive topics of mental illness:
attention deficit hyperactivity disorder (ADHD)
obsessive-compulsive disorder (OCD)
post-traumatic stress disorder (PTSD)
Deb Binion says the program was designed for students in grades 9-10, but middle-school and older students are also learning from it. She says the program takes about 8-12 hours to teach and that teachers in regular health classes, psychology classes, family and consumer science classes and others have taught the lessons.
Binion suggest that staff receive in-person training to understand how to create a safe learning environment for students. For example, teachers learn to provide individualized help without disclosing a student’s disability or medical condition to the class.
The topics can be confusing or triggering to some learners. Some of the videos might be difficult to watch because they include personal stories of self-harm, hospitalization and people suffering from emotional stress. The program may need individualized modifications for students in special education programs because of intellectual or developmental disabilities.
For information about how to bring a training to your area, individuals can contact Deb Binion through the Jordan Binion Project website or directly through her email: email@example.com.
Washington State recognizes a need for more education and direct support
OSPI, which oversees all school districts in Washington, provides an overview of Kutcher’s work and its connection to the Jordan Binion Project as part of the Mental Health & High School Curriculum Guide. Content in the guide was a collaboration between Kutcher and the Canadian Mental Health Association. At Dalhousie University in Nova Scotia, Kutcher serves as Sun Life Financial Chair in Adolescent Mental Health and Director of the World Health Organization Collaborating Center in Mental Health Training and Policy Development.
Washington State is aware that a lack of mental health services is impacting students. In 2018, OSPI released data that two children enrolled in Washington schools die by suicide weekly.
According to the 2018 Washington Healthy Youth Survey, at least one in three youth in all grades report feeling sad or hopeless for enough time to impact their activities. In ten years, those numbers increased by 10-20 percent across all grades. More than 900 schools administered the survey, representing all 39 Washington counties and 228 school districts.
About one in three 10th and 12th graders report feeling nervous, anxious or on edge, with an inability to stop worrying. From 2016 to 2018, the percentage experiencing these feelings increased for all grades. Rates of reported suicide have remained alarmingly high, with about 10 percent of students reporting that they have attempted suicide recently.
This means that in a typical high-school classroom of about 30 students, chances are high that two or three students have attempted suicide in the past year.
Female students and students who identify as lesbian, gay, or bisexual report higher rates of considering, planning, and attempting suicide. For youth who need support related to LGBTQ issues, the Trevor Project provides targeted resources and a helpline: 866-488-7386.
High rates of suicide attempts also are reported among students who identify as American Indian or Alaskan Native (18 percent) and students who identify as Hispanic (13 percent). Help for all is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK. Another crisis option is to text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
Despite the alarming data and evidence that adult support can impact outcomes, only half of students say they have access to direct adult support when they feel extremely sad or suicidal.
The 2018 Healthy Youth Survey introduced a modified Children’s Hope Scale, which measures students’ ability to initiate and sustain action towards goals. Across grades, only about half of students feel hopeful for their futures. Students who identify as lesbian, gay or bisexual and students of color were less likely to report adult support and were less likely to be highly hopeful for their futures.
State, local, community and school efforts are crucial for supporting youth mental health. With the release of the survey in Spring, 2019, the state issued a guide to information and resources to provide more detail about the survey and to direct families and school staff toward sources for support.
An OSPI survey in 2018 found that the number one concern statewide is that students don’t receive enough direct support in mental health, counseling and advising at school. The Washington School-Based Health Alliance (WASBHA) is working with some districts who have varied grants throughout the state to build on-campus health clinics to address a range of student health-care needs, including mental health. The Alliance sponsored an all-day summit May 3, 2019, at the Seattle Flight Museum that was attended by several hundred professionals invested in building collaborations between public health agencies and schools. Throughout the day, professionals discussed how students are much more likely to seek a counselor at school than in the community and that outcomes improve when providers and school staff collaborate and provide individualized help focused on relationship-building.
New state law expands parent involvement in mental-health treatment
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 may teens who don’t fully grasp their mental condition or how to recover.
In response, lawmakers wrote and passed the Adolescent Behavioral Health Care Access Act (HB 1874), signed into law by Gov. Jay Inslee May 13, 2019. The new law allows behavioral health professionals to provide parents or guardians with certain treatment information if they determine the release of that information is appropriate and not harmful to the adolescent. The bill also permits parents and guardians to request outpatient treatment for their adolescent, expanding the current parent-initiated treatment process so that adolescents can get treatment before they reach the point of hospitalization.
“Parents across the state are desperate to be allowed to help their children struggling with mental health issues or a substance use disorder,” says Rep. Noel Frame from the Seattle area. “At the same time, we need to protect the rights and privacy of these youth. This bill strikes a balance by ensuring adolescents can continue to access treatment on their own, while giving concerned parents an avenue to help their children and be involved with their treatment.”
Parents also have a new option for helping their children and youth by contacting Seattle Children’s Hospital, which in 2019 launched a new 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 will be positioned to identify gaps in the system through its engagement with families.
One in five youth are at risk
The Teen Mental Health website cites an international statistic that 1 in 5 youth experience a mental illness before age 25. Many of those illnesses lead to life challenges that require help, the agency concludes, and this makes adolescence a critical time for mental health promotion, prevention, early identification, and intervention. The agency provides a School-Based Pathway Through Care that promotes linkages between schools and healthcare agencies, parent involvement and strong educational programs that reduce stigma through knowledge and timely treatment access.
One way that Washington State has responded to the crisis is through promotion of trainings in Youth Mental Health First Aid. Through Project AWARE (Advancing Wellness and Resilience in Education) and other initiatives, Washington has grown a network of about 100 trainers for Youth Mental Health First Aid and about 4,000 first aid providers. These trained individuals can listen actively in order to offer immediate caring and can also refer youth to providers. OSPI reports that Project AWARE has led to 3,964 referrals for youth to connect with community- or school-based mental health services.
Washington has a program for treatment response for youth experiencing psychosis. The New Journeys Program is designed for youth 15-25 who are early in their diagnoses, but there is some flexibility in who might be eligible to participate. Families can contact the program for additional information about how to apply.
Information about psychosis, early warning signs and places to seek help are available through the website of the Washington Health Care Authority (HCA). The website contains a link to information about the Wraparound with Intensive Services program (WISe), which provides community case management for children and youth experiencing a high-level of impact from a mental illness.
Special Education is one pathway toward more help
Students access some aspects of mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). In Washington State, the category is referred to as Emotional Behavior Disability (EBD). The IEP might list any set of these words or the initials EBD or ED.
A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. A comprehensive educational evaluation can determine whether a student’s mental condition causes a significant disruption to the student’s ability to access school and learning and whether the student needs specialized instruction. Generally, that specialized instruction is provided through a category of education known as Social Emotional Learning (SEL). SEL can be provided in multiple tiers that might include schoolwide education, small group training and individualized programming. OSPI provides recommendations from a 2016 Social Emotional Learning Benchmarks Workgroup.
A student with a mental health condition also might qualify for an IEP under the category of Other Health Impairment (OHI), which can capture needs related to anxiety, ADHD, Tourette’s Syndrome or another specific diagnosis. Students with a mental health condition that co-occurs with another disability might qualify under another category, and Social Emotional Learning might be an aspect of a more comprehensive program. PAVE’s articles about the IDEA and the IEP provide further information about IEP process, the 14 categories of qualifying disabilities and access to special education services. A student with a mental health condition who doesn’t qualify for an IEP might qualify for a Section 504 plan.
If a student, because of a disability, is not accessing school and learning, then the school district holds the responsibility for appropriately evaluating that student and determining the level of support needed to provide access to a Free Appropriate Public Education (FAPE). Questions about FAPE might arise if a student with a mental health condition is not accessing school because of “school refusal,” which sometimes leads to truancy, or because a student is being disciplined a lot. Students with identified disabilities have protections in the disciplinary process; PAVE provides an article about school discipline.
Help NOW can mean a lifetime of better opportunities
The Center for Parent Information and Resources (ParentCenterHub.org) has a variety of resources related to mental health awareness, including a link to a video that details results from a national study. The study showed that students who qualified for special education programming because of Emotional Disturbance experienced the highest drop-out rates when they went into higher education, work and vocational programs. Meaningful relationships with adults who cared about them in school provided a significant protective factor. Students were more likely to succeed in life-after-high-school plans if specific caring adults provided a soft hand-off into whatever came next after graduation.
A federal agency called the Child Mind Institute provides parents with guidance about getting good mental-health care for their children and has articles on specific diagnoses and what parents and schools might do.
CLIP serves children ages 5-18 by providing residential mental-health treatment for a long-term stay that usually lasts 6-12 months. Read on for more information about CLIP eligibility and how to initiate a referral.
Governor Jay Inslee in December recommended $675 million in new funding for behavioral health improvements statewide, and policymakers are working on a variety of bills during the 2019 legislative session. Families can contact lawmakers to participate in advocacy.
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 to offer true stability that allows a child to return to school and life with successful outcomes.
One choice is to apply for the Children’s Long-Term Inpatient Program (CLIP), a state program that manages 89 beds in five locations throughout Washington. Most CLIP referrals are for children with Medicaid—public health insurance. 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 possessing a risk to themselves or others
Youth who warrant care under the supervision of a psychiatrist because of grave disability due to psychiatric illness
Youth who are not successfully treated through community-based mental health resources
CLIP serves children ages 5-18 by providing residential mental-health treatment for a long-term stay that usually lasts 6-12 months. Please note that eligibility for CLIP ends on the child’s 18th birthday.
Parents/legal guardians engage with the treatment team while the child is at the CLIP facility. The goal is to help the child stabilize and provide the family with the tools needed for a successful return to the home, school and community. Children attend school while at CLIP, and teachers manage any Individualized Education Program (IEP) or Section 504 plan that travels with the student from the local district.
Parents and legal guardians can refer children to CLIP by applying through one of the regional committees positioned throughout the state. Contact information for regional committee leadership is available through the CLIP website. The regional committee meets with the family to discuss the case and determine whether to refer the case to the CLIP Administration for review. The state committee then determines whether to approve the case for CLIP. Sometimes a child is put on a waiting list for an available bed.
Please note that 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.
The largest CLIP facility is the Child Study and Treatment Center (CSTC) in Lakewood, adjacent to Western State Hospital. CSTC provides 47 beds in cottages that house children in groups by age. Additional options include:
Burien, Sunstone Youth Treatment Center: 10 beds
Tacoma, The Pearl Street Center: 12 beds
Spokane, the Tamarack Center: 16 beds
Yakima, Two Rivers Landing: 4 CLIP beds in a facility with 16 total youth beds
Parents can initiate a referral, but children over Washington’s Age of Consent (13) must volunteer to go to a CLIP facility unless a county Designated Crisis Responder (DCR) determines the child meets the state’s criteria for a 180-day commitment under the Involuntary Treatment Act (ITA). Any persons over the age of 13 in Washington must be imminently threatening to harm themselves or others or be severely gravely disabled, in a state of extreme psychiatric deterioration, to receive an ITA admission to any inpatient facility.
Wording from Washington’s gravely disabled statute is as follows: “Manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety.”
State lawmakers are engaged in work to consider changes to the ITA law, and families are invited to contact policymakers if they have thoughts or concerns to share about this initiative or other activities related to treatment access, Age of Consent laws or Parent-Initiated Treatment. Governor Jay Inslee in December recommended $675 million in new funding for behavioral health improvements statewide.
CLIP is funded with state and federal dollars. A child’s Medicaid case manager through a Managed Care Organization (Molina, Community Health Plan of Washington, Coordinated Care, Amerigroup or United Healthcare) can provide guidance about CLIP applications. Families also can request further information from a care management team through the Wraparound with Intensive Services (WISe) program, which provides outpatient care coordination for children with intensive psychiatric needs in various Washington communities. A CLIP referral often happens because WISe was unable to help the child stabilize in the home.
WISe is managed through the state’s Health Care Authority, and HCA is another source for information about various options for mental healthcare for Medicaid-eligible children, youth and families. Families can reach out to the HCA for further information.
Songs in the store tell us this is the “hap/happiest” time of the year, but for people who have experienced trauma this season can trigger difficult emotions. For children with disabilities, those emotions can be particularly complex and confusing. Unexpected behaviors might show up at home or at school, especially when routines are disrupted.
Helping children understand their emotional responses to difficult circumstances is part of education, and schools are adopting new strategies around Social Emotional Learning (SEL). Social and emotional skills can be analyzed through educational evaluations, and the Individualized Education Program (IEP) establishes specific programming and goals around SEL for children with deficits in those areas.
A Functional Behavior Analysis (FBA) is another tool for determining what supports a child needs to behave in ways that are “expected” for success at school. The FBA leads to design of a Behavior Intervention Plan (BIP), which provides specific guidance to school staff for positively reinforcing expected behavior.
When designing behavior plans, parents and school staff may need to discuss whether unexpected behaviors are the result of trauma and/or overwhelm. Strategies for helping may need to consider whether rewards and punishments will work if behaviors are related to emotional dysregulation and fight/flight/freeze responses to internalized and persistent anxiety. Formed Families Forward, a community and family-focused resource center in Virginia, provides a video series to help families and professionals better understand trauma and how to respond. The agency’s website also provides a resource collection related to trauma-informed approaches in multiple environments.
The Office of Superintendent of Public Instruction (OSPI), which oversees Washington school districts, has developed curricula to help school staff teach children how to understand their emotions and become more skillful in social communication. PAVE’s website includes a three-part series of articles about the state’s initiatives and research related to SEL. Those articles include practical tips and a variety of additional links to further information.
Everyone can help create a calm environment. Best practice is to exhale long and slow, triggering the body’s relaxation response. Your feeling of calm can help someone else relax. Try it! Take 5 breaths, focusing on a long, slow exhale through your nose. Notice how you feel. If you feel calm, consider sharing that feeling with someone else through a loving smile, soft eyes or even a hug! Even if this is not the hap/happiest time of your year, give yourself permission to relish a simple moment of contentment or curiosity when you pause to breathe.