Background:

Evidence-Based Practices.

Evidence-based practices are generally defined as those programs or policies that are supported by a rigorous outcome evaluation clearly demonstrating effectiveness. Since the mid-1990s, the Washington State Institute for Public Policy (WSIPP), the research arm of the Legislature, has undertaken comprehensive reviews of evidence-based programs. It has examined programs and policies in the juvenile and adult criminal justice arenas, as well as in other public policy areas, including early childhood education, child welfare, children's and adult mental health, and substance abuse. A "research-based" practice has some research demonstrating effectiveness, but it does not yet meet the standard of an evidence-based practice. A "promising practice" or "emerging best practice" does not meet evidence-based standards but presents potential for becoming a research-based practice.

In 2007 the Legislature established the University of Washington Evidence Based Practice Institute (EBPI) which collaborates with the WSIPP and other entities to improve the implementation of evidence-based and research-based practices by providing training and consultation to mental health providers and agencies that serve the needs of children. The EBPI also provides oversight of implementation of evidence-based practices to ensure fidelity to program models.

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Summary of Substitute Bill:

The Juvenile Rehabilitation Administration, the Children's Administration, and agencies that administer funds related to children's mental health services must expend state funds on programs and services that are evidence-based, as identified by the WSIPP and a university-based evidence-based entity in Washington. The Children's Administration may also expend funds on research-based practices. The requirements for these expenditures are imposed incrementally.

Under this act, an "evidence-based" program or practice is defined as one that is cost-effective and includes at least two randomized or statistically controlled evaluations that have demonstrated improved outcomes for the intended population.

"Preventive and Treatment Services" are defined as services and programs for children and youth and their families that are specifically directed to address behaviors and circumstances that have resulted or may result in truancy, abuse or neglect, out-of-home placements, chemical dependency, substance abuse, sexual aggressiveness, or mental or emotional disorders.

In consultation with the EBPI, the Juvenile Rehabilitation Administration and the agencies that provide children's health must initiate or continue their review of sound promising and research-based practices with the goal of identifying and expanding the number of evidence-based practices that are cost-beneficial and effective. The Children's Administration must initiate or continue their review of sound promising and research-based practices in consultation with a university-based evidence-based entity in Washington.

Use of Funds.

For the Juvenile Rehabilitation Administration and agencies that provide children's mental health services, the determination of the amount of funds expended on evidence-based programs includes program costs necessary to directly implement evidence-based programs, including discrete staffing and training costs which would not have been incurred but for the implementation of an evidence-based program. Funds expended for indirect administrative costs may not be included. The Children's Administration may include funds expended on both research-based and evidence-based practices in their determination of amounts expended.

In collaboration with the Evidence-Based Practice Council, the Department of Social and Health Services (DSHS) must redirect existing funding resources, as necessary, to coordinate the purchase of evidence-based services and the development of a workforce that is trained to implement those practices.

Juvenile Rehabilitation Administration.

The percentage of funds expended on evidence-based programs that reduce criminal recidivism of the participants must be:

no less than 60 percent in fiscal years 2014 and 2015;
no less than 65 percent in fiscal years 2016 and 2017; and
no less than 75 percent in fiscal years 2018 and 2019.

Children's Mental Health Services.

The percentage of funds expended on evidence-based programs that improve mental health outcomes for the participants must be:

no less than 50 percent in fiscal years 2014 and 2015;
no less than 65 percent in fiscal years 2016 and 2017; and
no less than 75 percent in fiscal years 2018 and 2019.

Children's Administration.

The percentage of funds expended for child welfare services that reduce abuse and neglect, safely reduce the rates of out-of-home placement, decrease the length of time required to provide permanency for children in out-of-home care, or improve child well-being for participants must be:

no less than 35 percent in fiscal years 2014 and 2015;
no less than 50 percent in fiscal years 2016 and 2017; and
no less than 75 percent in fiscal years 2018 and 2019.

Evidence-Based Practice Council.

The DSHS must establish an Evidence-Based Practice Council (Council) to develop a unified and accountable system of care for the coordination and the delivery of prevention and treatment services to children, youth, and their families. The Council must act as a central mechanism for implementing evidence-based prevention and treatment programs and providing wraparound care coordination and peer support. The members of the Council must include representatives from the following:

child advocacy organizations;
tribal authorities;
the Division of Behavior Health and Recovery Services;
the Children's Administration;
the Juvenile Rehabilitation Administration;
the Division of Developmental Disabilities;
the Health Care Authority;
the Office of the Superintendent of Public Instruction;
family and youth support organizations;
regional support networks;
state and local provider organizations;
the EBPI; and
the WSIPP.

Reports.

Department of Social and Health Services.

The DSHS must track and document its compliance with the requirements of this act. It must also report annually to the Legislature regarding its progress in the coordination of the purchase of evidence-based services and the development of a trained workforce to implement those services. A preliminary report is due by December 31, 2012. A subsequent report is due December 31, 2013, and reports are due annually, thereafter.

Other Entities.

The WSIPP, in consultation with a university-based evidence-based entity and with any necessary assistance from the DSHS, must report to the Legislature. The reports must include:

an assessment of the amount of funds expended on evidence-based services;
an assessment of program fidelity to evidence-based models;
an assessment of outcomes for children and youth who receive evidence-based services; and
a description of the method of the DSHS's documentation of its compliance with the requirements of the act.

The first report is due no later than July 1, 2013. A second report is due July 1, 2015, and a final report is due December 1, 2019.

Substitute Bill Compared to Original Bill:

The substitute bill includes a definition for "prevention and treatment services." The evidence-based practices for which funds are expended are those identified by the WSIPP, in consultation with a university-based evidence-based practice entity. The Children's Administration may also expend funds on research-based practices.

The Juvenile Rehabilitation Administration and agencies that provide children's mental health services must, in consultation with WSIPP and the EBTI, initiate or continue to review promising and research-based practices with the goal of expanding the number of evidence-based practices available. The Children's Administration must consult with the WSIPP and a university-based evidence-based practice entity to initiate or continue its review of promising and research-based practices.

The Juvenile Rehabilitation Administration has six years to reach the graduated requirements for expenditures for evidence-based practices. In fiscal years 2014 and 2015, no less than 60 percent of its expenditures for treatment must be for evidence-based programs; in 2016 and 2017, no less than 65 percent; and in 2018 and 2019, no less than 75 percent.

In determination of the amount of funds expended as required by this act, the Children's Administration may include funds expended on both evidence-based and research-based practices. Collaboration with the EBPI is not required by any of the agencies in implementing evidence-based practices.

The DSHS must establish an Evidence-Based Practice Council instead of a State Interagency System of Care Team. The Council is governed by an executive committee whose members shall be the Secretary of DSHS, the WSIPP, and the EBPI. The members of the Council are representatives from the same entities that would have comprised the State Interagency System of Care Team. With the Council, the DSHS must develop a unified and accountable system of care for the coordination and delivery of prevention and treatment services.

In addition, the Council must:

act as a central mechanism for implementing evidence-based prevention and treatment programs and providing wraparound support;
ensure that the services through evidence-based treatment programs are delivered with fidelity; and
acknowledge the system of quality control already in place for the juvenile justice system and work within that system to meet the graduated requirements of the act.

In collaboration with the Council, instead of with the WSIPP and the EBPI, the DSHS must redirect existing funding resources to coordinate the purchase of evidence-based practices and the development of a workforce trained to implement those practices.

The reports required by the WSIPP must be prepared in consultation with a university-based evidence-based practice entity, instead of the EBPI.

Staff Summary of Public Testimony:

(In support) This bill represents reform in the way that treatment services are provided to children through the Department of Social and Health Services. It is about accountability to the Legislature, tax payers, and the children who receive the services. Even though much is known about effective practices, little is done to implement those practices. In the last 15 to 20 years, it has been clear that some practices work better than others. There is an opportunity to maintain children in their homes and to train professionals. This will increase the opportunity for children to be successful, to provide accountability for the state, and to make a great leap forward. In the past four years, there has been a systematic effort to increase the opportunity to address the mental health needs of youth. One of the strategies that this bill utilizes is more coordination. Under the bill, the strategy is for the agencies to combine and increase their ability to purchase services. With the outcomes from the use of evidence-based practices, the result will be a significant benefit to the tax payer.

(In support with concerns) The training and fidelity requirements of the bill will require additional expenditures,

(Neutral) It is not clear which services are subject to the requirements of the bill. It is important to make sure that the requirements under this bill do not decrease the number of children and families served. The roles of the WSIPP and the EBPI need to be clarified. Definitions for research-based and promising practices should be added to the bill.

(With concerns) The current structure used by juvenile courts in Washington is nationally recognized, and it has a quality assurance component. Evidence-based practices do not stand alone. A risk assessment is done to determine whether a youth is eligible for services, and there must be qualified persons to deliver those services. Fewer than one-half of juveniles receive evidence-based services, and there are not enough evidence-based practices to cover all children. Many evidence-based practices are not covered by Medicaid. It is not clear how the required evidence-based practices will be funded.

(Opposed) None.