T.R. v. Quigley Final Settlement Agreement Summary Implementation of a new mental health program to help youth recover in their communities
� Why a Lawsuit? � What’s in the Agreement? � What is WISe? � How do kids access WISe?
Youth who use Medicaid insurance have legal rights to legal rights to legal rights to legal rights to get the treatment get the treatment get the treatment get the treatment they need they need they need they need for healthy minds and bodies.
E E E arly E P P P P eriodic S S S S creening D iagnostic & D D D T T T T reatment SERVICES SERVICES SERVICES SERVICES 42 U.S.C. § 1396a(a)(10)(A)
E E E arly E P P P P eriodic S S S S creening D iagnostic & D D D T T T T reatment SERVICES SERVICES SERVICES SERVICES 42 U.S.C. § 1396a(a)(10)(A)
Other EPSDT EPSDT EPSDT EPSDT Mental Health Litigation Other Other Other Mental Health Litigation Mental Health Litigation Mental Health Litigation � J.K. J.K. (Arizona) J.K. J.K. (Arizona) (Arizona) (Arizona) – Settled 2001 Settlement agreement committed Arizona to a redevelopment of children’s behavioral health system according to a set of principles that put child and family needs first. � Rosie D Rosie D . . (Massachusetts) (Massachusetts) – Won 2006 Rosie D Rosie D . . (Massachusetts) (Massachusetts) After trial, district court ordered Massachusetts to develop in-home services, including comprehensive assessments, case management, behavior supports and mobile crisis services. � Katie Katie A. Katie Katie A. A. (California A. (California (California (California) – Settled 2011 After 9 th Circuit affirmed California’s obligation to provide foster youth with effective mental health services, agreement reached for intensive care coordination and home-based services.
Commitments to develop develop develop develop Wraparound with Wraparound with Wraparound with Wraparound with Intensive Services (WISe) program Intensive Services (WISe) program between Intensive Services (WISe) program Intensive Services (WISe) program 2014 to 2018, which will include: Intensive Care Coordination � Direct Services � Mobile Crisis Intervention and stabilization �
For more detailed description of model, see WISe Manual available at: https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Mental%20He alth/WISe%20manual%20v%201.6-FINAL-effective%204.1.2016.pdf
Additional Counties Starting WISe: : : : � King � Grays Harbor � Lewis � Pacific � Wahkiakum � Chelan � Douglas � Asotin Complete referral contact list available at : https://www.dshs.wa.gov/sites/default/files/BHSIA � Garfield /dbh/Mental%20Health/WISe%20Referral%20Contac t%20List%20by%20County%20%284.16%29.pdf � Spokane
Thousands of kids are likely to be eligible for WISe. To be eligible, To be eligible, you must : To be eligible, To be eligible, � Be Medicaid Medicaid Medicaid Medicaid eligible � Be under the age of 21 under the age of 21 under the age of 21 under the age of 21 � Need intensive services Need intensive services Need intensive services Need intensive services to treat a mental illness or mental mental illness or mental mental illness or mental mental illness or mental health condition health condition health condition health condition that is interfering interfering interfering interfering with your school, family, or community life
� Youth with involvement in multiple child involvement in multiple child involvement in multiple child involvement in multiple child- - -serving - serving serving serving systems systems systems systems (e.g., child welfare, mental health, juvenile justice, developmental disabilities, special education, substance use disorder treatment). � Youth receiving or being considered for restrictive restrictive restrictive restrictive services services services services, such as psychiatric hospitalizations, residential/foster placement, � Youth at risk of school failure at risk of school failure and/or who have at risk of school failure at risk of school failure experienced significant and repeated disciplinary significant and repeated disciplinary significant and repeated disciplinary significant and repeated disciplinary issues issues issues issues at school
� Youth who have been significantly impacted by childhood or adolescent trauma trauma trauma trauma. � Youth prescribed multiple or high dosages of psychotropic psychotropic psychotropic psychotropic medications medications medications medications � Youth with a history of detentions detentions detentions detentions, arrests arrests, or other arrests arrests referrals to law law law law enforcement enforcement enforcement enforcement � Youth exhibiting risk factors such as suicidal suicidal suicidal suicidal ideation, danger danger danger to self or others. danger
Youth requesting or whose Youth requesting or whose Youth requesting or whose family Youth requesting or whose family family family is is is is requesting support requesting support requesting support requesting support in meeting the in meeting the in meeting the in meeting the mental/behavioral mental/behavioral health mental/behavioral mental/behavioral health health health challenges. challenges. challenges. challenges.
ANYONE ANYONE ANYONE ANYONE including youth and family.
� When a youth is referred to Children’s Long Children’s Long Children’s Long Children’s Long- - - - Term Inpatient Program (CLIP) Term Inpatient Program (CLIP) Term Inpatient Program (CLIP) Term Inpatient Program (CLIP) or Behavioral Behavioral Behavioral Behavioral Rehabilitation Services (BRS). Rehabilitation Services (BRS). Rehabilitation Services (BRS). Rehabilitation Services (BRS). � While a youth is enrolled in BRS or receiving CLIP services: no less frequently than every every every every six months, and during discharge planning six months, and during discharge planning six months, and during discharge planning six months, and during discharge planning.
� Prior to a youth discharging from a discharging from a discharging from a discharging from a psychiatric hospital. psychiatric hospital. psychiatric hospital. psychiatric hospital. � When a step step step step- -down request - - down request down request down request has been made from institutional or group care. � When a youth receives crisis intervention or crisis intervention or crisis intervention or crisis intervention or stabilization services, stabilization services, stabilization services, stabilization services, and there are past and/or current functional indicators of need for intensive mental health services
Youth will receive a WISe Screen WISe Screen that: WISe Screen WISe Screen � Must be offered within 10 working days of 10 working days of 10 working days of 10 working days of referral referral referral referral � Will gather information from referent and youth/family or others directly involved � Will complete a 26 question Child and Child and Child and Child and Adolescent Needs and Strengths (CANS) Adolescent Needs and Strengths (CANS) screen Adolescent Needs and Strengths (CANS) Adolescent Needs and Strengths (CANS)
Youth should be offered offered offered offered WISe if: � Enrolled or eligible to be enrolled* with a Behavioral Health Organization (BHO, formerly known as Regional Support Networks or RSNs); and � The CANS screen score meets the WISe Algorithm, or screening clinician determines WISe is medically necessary. *Youth who screen into WISe should generally be BHO eligible.
� Participation in WISe is voluntary voluntary voluntary voluntary for youth* and families and is NOT NOT NOT a prerequisite NOT a prerequisite a prerequisite a prerequisite for other medically necessary services. � Who decides whether dependent youth will participate in WISe? � Offering WISe does not eliminate obligation to Offering WISe does not eliminate obligation to Offering WISe does not eliminate obligation to Offering WISe does not eliminate obligation to provide other medically necessary services. provide other medically necessary services. provide other medically necessary services. provide other medically necessary services. *Age of consent is 14 and older.
These services generally cannot be delivered simultaneously with WISe: • Behavioral Rehabilitation Services (BRS)* • Children’s Long-Term Inpatient Program (CLIP) Admission* • State Hospital Admission (over 18 years old)* • Non-BHO mental health therapy covered by regular mental health Medicaid benefit ** *WISe is considered a less restrictive alternative to these services, but may be engaged during discharge planning and transition phases. ** Possible difference for beneficiaries in Clark/Skamania Counties
Youth may access WISe along with services from other child and family service systems, including but not limited to: Family Preservation services • Foster Care • Developmental Disabilities Administration (DDA) services, such • as respite, personal care, or case management Medical care • Specialized therapies • IEP or Section 504 Services • Probation services or other juvenile justice services • Evidence Based Practices • Services for Homeless Youth • Services from various community organizations serving youth • and families
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