Brief Description: Establishing a program to screen and treat children with attachment disorders.

Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Zarelli, Prentice, Rasmussen and Roach).

Hearing Date: 2/21/08

Staff: Sydney Forrester (786-7120).

Background:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, defines reactive attachment disorder (RAD) by the following criteria: disturbed and developmentally inappropriate social relationships beginning before age 5; failure to respond to or initiate social interactions, or being inappropriately friendly and familiar with strangers; and a result of failure of early care to meet the baby's or child's emotional needs for comfort and affection, failure of early care to attend to the child's physical needs, or repeated changes in the primary caregiver.

A 2006 report from a task force convened by the American Professional Society on the Abuse of Children indicates that attachment therapy is a young and diverse fieldd and the benefits and risks for many attachment-related treatments remain scientifically undetermined. The task force cautioned that because the DSM has recognized only RAD, and not other attachment or relationship disorders, a child described as having RAD may actually fail to meet formal diagnostic criteria for the disorder, and consequently the label should be viewed cautiously. The task force concluded its report with a set of 22 detailed recommendations regarding RAD assessment, diagnosis, treatment, and interventions.

The Department of Social and Health Services (DSHS) Children's Administration (CA) does not routinely screen children for RAD, although some interventions and therapies provided to maltreated children are consistent with accepted and noncontroversial attachment interventions, including promoting and supporting caregiver qualities such as environmental stability, consistency and safety, parental sensitivity, and responsiveness to children's physical and emotional needs.

Summary of Bill:

The DSHS must implement a pilot program in Clark County by contracting with a provider to develop an intake tool for screening and assessing RAD in children served by the child welfare system. The DSHS and the provider must work with experts in the field of attachment disorder to develop the tool. The experts must include a representative of the University of Washington Attachment Disorder Clinic and a representative of the University of Washington Evidence Based Institute. The intake tool must be developed by September 1, 2008.

The provider must use the tool to screen all children under age 9 entering foster care in Clark County and expected to stay for more than 30 days. The DSHS and the provider must meet with experts in the assessment, diagnosis, and treatment of RAD in developing treatment options that are evidence-based and have been demonstrated to be effective in treating RAD. The provider must utilize integrated and evidence-based intervention services for children diagnosed with RAD and must train child welfare staff to effectively and properly use the intake tool and the intervention services.

The Joint Legislative Audit and Review Committee (JLARC) must conduct a study of the pilot program the purpose of which is to evaluate the effectiveness of the intake tool and treatment model provided in the pilot program. JLARC's report is due to the Legislature by December 1, 2010. The poilot program expires on June 30, 2010.

The DSHS must operate the pilot program within the amount of funds appropriated in the budget. If the cost of the pilot program exceeds the appropriation, the DSHS must adjust the age of the children screened for RAD and must promptly notify the fiscal committees of the Legislature.

Appropriation: None.

Fiscal Note: Requested on February 14, 2008.

Effective Date: The bill takes effect 90 days after adjournment of session in which bill is passed.