The System of Care for Children and Youth

System Design | Access | Services | Cross-System Collaborations | Quality of Care

Values and Guiding Principles
The following values are the benchmarks of the mental health service delivery system:

• Family Centered: A family-centered service delivery system crosses disciplines and settings, views the family as the unit of attention, and organizes assistance in a collaborative fashion and in accordance with each individual family’s wishes, strengths, and needs.
• Least restrictive environments: Services are provided within the family’s own community whenever possible, and children are supported to remain with their families in their home community rather than being placed in institutional care.
• Individualized and tailored care: The plan for services is based on each child and family’s unique needs and characteristics, and are flexibly and creatively designed to respond to those needs.
• Strength-based: Strength-based services utilize a family’s existing competencies and abilities to shape and implement the individualized treatment plan. Strengths are maximized and generalized to areas where families want help to reach their goals.
• Culturally competent: Providers embody the capacity to accept, respect and give attention to cultural differences; to understand the knowledge, values, beliefs and customs belonging to particular cultural communities. Services are provided within the context of cultural competency.
• Eligibility: Eligibility criteria for the publicly funded systems are based on medical necessity and financial factors. Medical necessity criteria include a mental health diagnosis, symptoms related to that diagnosis, level of functioning across life domains, and conditions and circumstances that may contribute to the mental health of a person seeking services. In addition to determining eligibility, these features also determine the level of care needed at the time of service entry. Because MHCADSD is the publicly funded system, an additional criterion is income eligibility. All Medicaid funded children and families who meet the medical necessity criteria are eligible, and non-Medicaid funded children whose family income is no greater than 300% of the federal poverty level are also eligible.

Access:

Referrals for publicly funded mental health services can be made by directly contacting the mental health plan toll-free referral number at 1-800-790-8049. Parent or guardian consent is needed for children under 13 years of age, but youth aged 13 and over can seek (or refuse) treatment without parental consent. Referrals are also made through the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program, the federally mandated program for children under age 21 that directs that all children at or below the poverty level be screened for health problems (including mental health) and provided with appropriate services to treat any identified medical issues.

When a referral is made to a mental health provider, the first step is to do a screening that ascertains whether the person is in immediate need of a crisis intervention. If an immediate crisis intervention is not indicated and the person is seeking outpatient services, a limited set of questions are asked to determine whether the person meets medical necessity criteria and financial eligibility. If it appears the person may be eligible, a face-to-face intake appointment is set.

The intake initiates the enrollment process, and a mental health agency has 30 days to complete that process for any individual. During that time, assessments that will inform the individualized tailored care plan are completed and a benefit level is applied for. The types of assessment made will vary by child, but at a minimum must verify medical necessity criteria are met.

It is difficult for some families and youth to feel comfortable receiving mental health services due to stigma and other factors. Mental health providers can provide outreach and engagement services to families in their homes or communities at times and locations convenient to them. These activities not only foster a trusting relationship, but also help demystify mental health services.

Services:

The mental health system is designed to provide a continuum of care. That continuum includes crisis services (telephone, outreach, respite, next-day appointments), inpatient services (voluntary and involuntary under civil commitment criteria), and outpatient services. With the exception of involuntary commitment, all services are voluntary. As with referrals, services provided to children under the age of 13 must have parent or guardian consent, but services for youth aged 13 and older must be agreed to by that youth.

There is a set of core services that must be available in the system at all times. These include, but are not limited to: individual or group therapy; family counseling; case management; medication management/psychiatric services; emergency/crisis assistance; vocational/school-based services. Mental health agencies must either directly provide these services, or contract with other providers to assure availability.

Specialized services are another feature of the system, and were developed to address particular needs not specifically addressed under the Mental Health Plan. A sample of these services follows:

• Children’s Crisis Response Services: A specialized team that provides crisis outreach, stabilization and referral services 24 hours a day/7days a week to children and families in crisis.
• Seattle Public Schools Seriously Behaviorally Disturbed classrooms: Through a Memorandum of Understanding (MOU) with Seattle Public Schools, MHCADSD provides children's mental health specialist services in each of 36 Seriously Behaviorally Disturbed classrooms in the school district.
• Interagency Staffing Teams: Multi-system regional treatment teams designed to increase cross system understanding and coordination in order to reduce or eliminate barriers to service for the hardest to serve/multi-system involved children and families.
• At Risk Youth (ARY) and Children in Need of Services (CHINS): The Washington State Legislature developed legal processes through which parents/guardians seeking services on behalf of an eligible minor, or a minor seeking services on his/her own behalf could petition the court to receive those services. In King County, designated Interagency Staffing Teams provide wrap-around services for these youths and their families.
• Multi-Systemic Therapy (MST) and Functional Family Therapy (FFT): Through contracts with the juvenile justice system, mental health providers trained in these modalities provide services to adjudicated youth whose scores on a juvenile justice risk/needs assessment make them eligible.
• Blended Funding: A program designed to provide a broad range of community services tailored to the specific needs of the individual child or family, achieved through cooperative agreements and pooled resources from multiple service systems. Children enrolled in this program are the most in need, highest cost youth receiving services from multiple systems.

Cross-system Collaborations

MHCADSD recognizes that unmet service needs of youth and their families are not and must not be the sole responsibility of any one formal system. For youth to lead fully functional lives, they must be able to succeed at school, in their homes, at work, and in their communities. MHCADSD works to build and sustain cross-system collaborations and partnerships that foster cooperative approaches.

• Merger of mental health and the drug/alcohol treatment and rehabilitation services: Through a King County Ordinance, the mental health and drug/alcohol treatment and rehabilitation services were merged into a single division (MHCADSD) so that integrated service approaches can be developed for those who need them. A conservative estimate is that 50% of youth with mental illnesses/emotional disorders have co-occurring drug/alcohol treatment needs.
• Cross Agency System Trainings (CAST): MHCADSD has sponsored CAST trainings for nearly ten years. Trainings are structured to provide an overview of the child-serving system in King County, with an emphasis on publicly funded systems. These trainings are required orientation elements for Seattle Public Schools Family Support Workers, for Child Protective Service case managers, and for many other agencies across the County.
• Juvenile justice: In addition to the provision of Multi Systemic Therapy and Functional Family Therapy programs, MHCADSD partners with juvenile justice in a number of initiatives that seek to improve access to services for pre and post adjudicated youth.

Quality Inputs:

WAC 275-57 and MHCADSD oversee several quality inputs developed to assure certain minimum standards are met, and to improve the quality of care available to publicly funded service recipients.

• Licensing and Certification of providers: WAC 275-57 addresses licensing and certification standards community mental health agencies must meet in order to provide publicly funded services.
• Licensing and Certification of professionals: The State of Washington has licensing and certification standards for the various allied health service professionals.
• Mental Health Professionals: WAC 275-57 describes educational, supervision and work experience requirements in order to be deemed a Mental Health Professional.
• Mental Health Specialists: WAC 275-57 includes requirements for Mental Health Professional to obtain further certification as a Mental Health Specialist, meaning a person has additional education, supervision, and work experiences that deem him/or her a specialist in working with ethnic minority, deaf/hard-of hearing, children/youth, geriatric, or sexual minority populations.
• Provider Credentialing: In King County, mental health providers must be credentialed in addition to meeting the above requirements. Credentialling is done annually and is a detailed analysis of a provider's ability to meet pre-set standards for the Prepaid Health Plan.

Performance Measures
MHCADSD is committed to continuously measuring, evaluating, and improving the system of care, and developed measures that provide indicators of performance at the system level, and achievement of outcomes at the individual client level.

• System performance indicators: include the types of services provided, the duration and intensity of services, staffing patterns, and fiscal viability.
• Individual outcomes: Client outcomes are age group-specific. For children and youth, outcomes include: improvement/stabilization of psychiatric symptoms; improvement/stabilization of level of functions; prevention of psychiatric hospitalization; prevention of juvenile detention; prevention of homelessness; prevention of school suspension; prevention of out-of-home placement.