Staff: Luke Wickham (786-7146).

Summary of Substitute Bill:

The Governor must maintain a Children and Youth Multisystem Care Coordinator (Care Coordinator) to serve as a state lead on addressing complex cases of children in crisis.  The Care Coordinator must direct:

• the appropriate use of state and other resources to a child in crisis, and that child's family, if appropriate; and
• the appropriate and timely action by state agencies to serve children in crisis.

 

Additionally, the Care Coordinator must:

• have access to flexible funds to support the safe discharge of children in crisis from hospitals and long-term, appropriate placement for children in crisis who are dependent; and
• coordinate with:
  • the rapid response team to make sure that resources are effectively identified and mobilized for people who meet the definition of child in crisis and a youth or young adult exiting a publicly funded system of care; and
  • youth behavioral health and inpatient navigator teams to efficiently and effectively mobilize services for a child in crisis.

 

The term "child in crisis" is defined to mean a person under age 18 who is:

• at risk of remaining in a hospital without medical necessity, without the ability to return to the care of a parent, and not dependent;
• staying in a hospital without medical necessity and who is unable to return to the care of a parent but is not dependent; or
• dependent, experiencing placement instability, and referred to the Rapid Care Team (Team) by the Department of Children, Youth, and Families (DCYF).

 

The Care Coordinator, in coordination with the DCYF, the Health Care Authority (HCA), the Office of Financial Management (OFM), and the Department of Social and Health Services (DSHS), shall develop and implement a Team for the purpose of supporting and identifying appropriate services and living arrangements for a child in crisis, and that child's family, if appropriate.  The Team must be implemented as soon as possible, but no later than January 1, 2024.

 

The Team's work is managed and directed by the Care Coordinator, working to quickly identify the appropriate services and living arrangements for a child in crisis.  A Team must include:

• one designee from the HCA;
• one designee from the DSHS;
• one designee from the OFM;
• one designee from the Developmental Disabilities Administration of the DSHS;
• one designee from the DCYF; and
• any other entities or individuals that the Care Coordinator deems appropriate to support a child in crisis.

 

In creating the Team, the Care Coordinator must develop and implement a system for:

• identifying children in crisis who should be served by the Team;
• initiating the Team in a timely manner that reduces the time a child in crisis spends in a hospital without a medical need;
• locating services and connecting youth and families with the appropriate services to allow the child in crisis to safely discharge from a hospital;
• screening referrals for a child in crisis;
• accepting referrals from the DCYF for a child in crisis; and
• determining when it would be appropriate for the DCYF to provide services to a child in crisis as the:
  • youth meets the definition of a "child who is a candidate for foster care;"
  • youth meets the definition of "dependent child" based on the child being abandoned; or
  • family should be offered a voluntary placement agreement.

 

The Team may provide assistance and support to a child in crisis, or the family of a child in crisis.

 

Individuals who may refer a child in crisis to the Team include:

• a child in crisis themselves;
• a family member of the child in crisis;
• an advocate for the child in crisis;
• an educator;
• a law enforcement officer;
• an employee of the DCYF;
• an employee of the DSHS;
• an employee of the HCA;
• a service provider contracting with the DCYF;
• a service provider contracting with the DSHS;
• a behavioral health service provider;
• a person providing health care services to the child in crisis
• a representative from a managed care organization;
• a representative from a youth behavioral health or inpatient navigator program; or
• a hospital employee.

 

By November 1, 2023, the Governor must provide an initial report to the Legislature describing the process of developing and implementing the Team created under this section, and must include a projection of when the Team process will be implemented.  By November 1, 2024, the Governor shall provide a final report to the Legislature, including data and recommendations related to the Team.

Appropriation: None.

Fiscal Note: Preliminary fiscal note available.

Effective Date of Substitute Bill: The bill contains an emergency clause and takes effect immediately.

Staff Summary of Public Testimony:

(In support) Hospitals are where people go when there is an emergency.  A child in crisis is also a family in crisis.  A trip to the emergency room often provides relief.  For some, that visit does not result in relief from a concrete medical issue.  Finding the right support for a child and family in crisis is very challenging and very complex.  Each child and family in this scenario has a unique story.

This bill is about helping to support families to allow children to safely discharge from hospitals.

 

There are about 15 to 200 children boarding in Washington hospitals.

 

This bill creates a multisystem response and a responsible entity for this issue.

A change in the interpretation of the abandonment statute, and not a change in the statute itself, has led to more children remaining in hospitals.  Typically these children are connected to several state agencies.

Children are stuck in adult hospitals as well as the three children's hospitals in the state.

 

Seattle Children's Hospital has repeatedly had children remain in the hospital for as long as a year or two following a psychiatric admission.  Prolonged stays in a hospital setting has a detrimental impact on a child's health. 

There is currently minimal accountability for state services responsible for providing support for these children.  The process created in this bill will allow agencies and providers to come together more effectively.  It is critical that there is a process that makes agencies and providers come together more effectively to create a plan of services for children who no longer need to be hospitalized and have nowhere else to go. 

 

Since 2021 Mary Bridge Hospital (Mary Bridge) has boarded over 23 children for over 600 days because their parents could not safely bring them home.  These children have complex developmental challenges that overwhelm their families.  In desperation, families bring their children to hospitals in hopes that their child will find an out-of-home placement to foster their child's recovery.  No one agency can provide all that is necessary for kids to be healthy and well.  The complexity of these cases led Mary Bridge to quickly understand that creating safe dispositions for kids stuck in hospitals requires a collective approach with funding from the Legislature for youth and inpatient navigators we developed regional multidisciplinary teams focused on complex and difficult to discharge patients.  The Pierce County multidisciplinary team helped find the 23 children at Mary Bridge a way to return to the community with the appropriate services. 

 

Some of these children spend their days in windowless hospital rooms for days on end.  Imagine being in an 8 by 8 foot room with no windows for over a year.  The only exercise the person gets is walking down the hallway.  The individual listens to the trauma coming in and out of the hospital all day and eat cold grilled cheese sandwiches. 

 

Some of the children who are boarding in hospitals require a higher level of care than can be provided at home, but that does not appear to exist in this state.  There needs to be better places for children and families.

 

There are children in virtually every hospital across the state spending days, weeks, and even years unnecessarily.
 
The emergency rooms in hospitals are already overrun.  These children do not have adequate therapy, especially when living in adult hospitals. 

 

The resources should be spent helping get these children back in the community. 

 

This bill is necessary for children and families across the state, particularly the children staying in nonpediatric hospitals that are not designed for their needs. 

 

Children across the state have severe mental health needs.  There is an increase in youth using fentanyl.  Finding inpatient treatment centers is difficult. 

 

One of the recommendations of the Developmental Disabilities Ombuds report is creating support navigating services.  This bill would help build cross-system partnerships.  This would be beneficial for building services to help support these children in crisis.

 

(Opposed) None.

Persons Testifying: Representative Lisa Callan, prime sponsor; Jamie Kautz, MultiCare Health System; Nina Martinez, Latino Civic Alliance; Greta Johnson; Cara Helmer, Washington State Hospital Association; Mike Barsotti, Providence Sacred Heart Children's Hospital; Noah Seidel, Office of Developmental Disabilities Ombuds; Kashi Arora and Sina Shah, Seattle Children's Hospital; Jessica Cook; Kristian Stone, EvergreenHealth; and Anna Morrow.

Persons Signed In To Testify But Not Testifying: Diana Stadden, The Arc of Washington State.