Frequently asked questions (FAQs)

Find answers to your questions about children's behavioral health services in Washington.

General questions 

For a life-threatening emergency, call 911.

  • 24-hour telephone crisis evaluation and triage
  • Mobile crisis
  • Referrals
  • Crisis plans

Community behavioral health agencies provide mental health and/or substance use services through contracts with Behavioral Health Organizations or Managed Care Organizations. Services could be provided at the agency, in your home, or elsewhere in the community. Treatment services should be individualized and tailored to meet the needs of your child and family.

Treatment may include:

  • Brief intervention or individual treatment: A solution focused, outcomes oriented, time limited intervention designed to achieve goals identified in the treatment plan.
  • Medication management: The prescribing and/or administering and reviewing of medications and their side effects.
  • Medication monitoring: Cueing, observing, and encouraging consumers to take their medication as prescribed and reporting back to persons licensed to perform medication management services.
  • Psychoeducation: A set of activities that teach and explore the provision of emotional support, education, reducing stressors, resources, and problem solving skills to consumers and their family members.
  • Group treatment: Face-to-face activities provided by one or more staff to two or more individuals under the supervision of a mental health professional.
  • Family support: Support groups and advocacy to families to which there is a seriously disturbed child or adolescent.
  • Other services and supports as defined in the treatment plan.
  • Children and adults qualify for medically-necessary mental health services if they are covered by Medicaid.
  • Behavioral Health Organizations (BHOs)  are managed care plans for behavioral health services. They coordinate  services in their  area through contracts with community behavioral health agencies.
  • Other people who do not qualify for Medicaid, but have a serious or long-term mental illness, can receive services as resources allow.
  • All citizens of the state qualify for crisis mental health services, disaster response services, and involuntary treatment services.

Families may be involved in more than one child-serving system (i.e. special education, child welfare, juvenile justice) and can benefit from a coordinated planning that is thorough and comprehensive and reduces overlapping or conflicting assessments, plans, time limits, and requirements. Such a coordinated plan enhances achievement of family self-sufficiency and stability and thus supports the best interests of the parents/guardian and child.

  • While the law states that a parent can authorize the bringing of his or her minor child to an evaluation and treatment facility, it does not establish specific procedures, responsibilities or funding for transporting minors to an evaluation and treatment facility for evaluation of medical necessity for admission. It does not require law enforcement to transport or apprehend minors in these circumstances.
  • When called upon to assess whether a minor needs involuntary treatment, a Designated Crisis Responder (DCR) may take the minor or cause the minor to be taken into custody and transported to an Evaluation and Treatment facility providing inpatient treatment. RCW 71.34.600-660.
  • If the minor is not taken into custody for evaluation and treatment, the parent can seek review of the decision made by the DCR in court. RCW 71.34.600-660.
  • WISe is NOT a program, a type of service, or family therapy. It is a package of services and process based on the idea that services should be tailored to meet the needs of children and their families and coordinated across systems. There is an underlying value and commitment to create services and supports that are individualized to meet the needs of youth and their families and to promote community-based options to support children and youths with complex needs and their families.
  • Often one or more agencies are involved with the family and work collaboratively with them and others who are close to the family. They function as a team to support the family and each other, working towards common goals.

Children's Long Term Inpatient Program (CLIP) 

  • Yes. The referral process, the prior authorization process, and the process of obtaining consent are the same regardless of who initiates the referral.
    • School district personnel who refer minors to an inpatient treatment program must notify the parents within forty-eight hours. RCW 71.34.500-530.
  • A child in the legal custody of the Department of Children Youth and Families (DCYF) may be referred by their DCYF social worker. A judge cannot order any child into inpatient treatment except in accordance with RCW 71.34.
  • Any minor thirteen years or older who was voluntarily admitted to a CLIP facility with the consent of his/her parents may give notice of intent to leave at any time.
    • The notice has to be written and intent discerned.
    • The professional person must discharge the minor from the facility by the second judicial day upon following receipt of the notice of intent to leave. RCW 71.34.500-530.
  • Any minor thirteen years or older who was voluntarily admitted to a CLIP facility without the consent of his/her parents may give notice of intent to leave at any time.
    • The notice has to be written and intent discerned.
    • Copies of the notice shall be sent to the minor's attorney if any, the DCR (formerly DMHP)  and the parent.
    • The professional person shall discharge the minor by the second judicial day following receipt of the minor's notice of intent to leave. RCW 71.34.500-530.
  • Under a “parent-initiated” admission:
    • A minor receiving inpatient treatment cannot be discharged from the facility based solely on his or her request. RCW 71.34.052.
    • The minor admitted under this section may, however petition the superior court for release from the facility. RCW 71.34.052 (6).
  • Minors involuntarily committed for 180 days of inpatient treatment cannot legally sign themselves out of treatment.

The boys are in Pods together, usually by age. The girls have their own Pods. Boys and girls do not share a Pod. The one exception is an area of Orcas Cottage called the Close Attention Program (CAP). There are 7 bedrooms. The building design is such that each bedroom door is visible from the day area. Both boys and girls may reside in the Close Attention Program. Boys and girls are allowed to mix in the day hall, the dining room, daily outings and school under direct supervision by CSTC staff. 

  • A minor thirteen years or older may admit himself or herself to an evaluation and treatment facility for inpatient mental health treatment without parental consent. RCW 71.34.500-530.
  • The professional person in charge of the facility must agree that inpatient treatment is necessary because of a mental disorder and that it is not feasible to treat the minor in any less restrictive setting or the minor's home. RCW 71.34.500-530.
  • Written renewal of voluntary consent must be obtained every twelve months and the need for continued inpatient treatment shall be reviewed and documented every one hundred and eighty days. RCW 71.34.500-530.

Note: Given the short stays in acute inpatient care, this rule only applies to minors being served in CLIP facilities.

The application process is a two-tiered process that begins with contacting your local BHO/MCO representative, which is determined on which county you reside in. The least restrictive options are considered first. If a local decision is made to proceed with a referral to CLIP, the BHO/MCO gathers all the application materials and contacts the CLIP Administration.

The CLIP Administration is the final authority for determining a child's eligibility for admission.

The CLIP Administration manages the referral list as well as assigns children to one of the three cottage programs based on what is age appropriate and best suits the needs of the patient.

  • File a grievance with the inpatient provider.
  • File a grievance with the mental health ombudsman service from his/her home region.
  • Apply for a fair hearing.
  • The adolescent may seek the assistance of his or her attorney.

Parents have the right to participate in hearings and be represented by counsel when decisions are made to involuntarily commit their minor. After the hearing, the final decision of the court is binding.

No, you are not financially liable if you have not given consent. Once you give consent, you may be financially liable unless your child or adolescent is eligible for Medicaid.

Both the public mental health and chemical dependency (youth substance abuse services) systems have specialists able to assess and diagnose a range of disorders. In the past few years, there has been an increase in the number of mental health providers that are also chemical dependency providers.

To be eligible for public funds to help pay for acute inpatient treatment, the family must qualify for public assistance through the local DSHS Community Service Office.

  • All minors certified for admission to publicly funded CLIP beds are eligible for Medicaid.

 

There are three cottages, which are single story with a basement (storage only) and have basically the same layout.  An obvious exception is Orcas Cottage. It has an attached and enclosed basketball court where the others have access to a basketball court on the campus but not attached to their building. Orcas Cottage serves older kids, some of whom were referred by the juvenile justice system to CSTC. CSTC is the only state children’s long-term psychiatric hospital.

The items in common for all three cottages include a large main entry / meeting room (also referred to as the day hall), two TV / meeting rooms, a resource room, a large dining room and kitchen area, offices for the doctors and social worker, a nurse’s station, staff paperwork area and a quiet room (QR). It is also referred to as the “seclusion” room. Some cottages also have a calming room (CR). There are four Pods. The Pods contain 4 individual bedrooms and a common bathroom, shower and storage area. The kids in each Pod have a staff person who they go to for direction and help. This person is referred to as their "Primary."

All three cottages are locked from the outside and on the inside going outside. Access to every interior room is locked however access to the core of the structure is not. Staff have keys to all the rooms. There is a fire protection sprinkler system. The alarm system has sound and strobe lights. The floor is reinforced concrete with tile cover in the bedrooms, dining room, laundry room, bathrooms and part of the halls in the Pod areas. The Day Room, parts of the Pod halls and the office area have carpeting.

The state of Washington defines medical necessity for inpatient care as "a requested service which is reasonably calculated to diagnose, correct, cure or alleviate a mental disorder or prevent the worsening of a mental condition that endanger life or cause suffering and pain or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction and there is no adequate less restrictive alternative available." RCW 71.34.020 (12).

  • For publicly funded admissions, the DCR determines medical necessity for acute psychiatric care.
  • The CLIP Administration  makes determination of medical necessity for voluntary long-term inpatient care regardless of whether the child has public or private insurance.
  • For both levels of care, adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet medical necessity through the detention and commitment process as defined in RCW 71.34.750.
  • Federal requirements apply to all inpatient services provided to Medicaid clients.
  • The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.500-530
  • Admission to any inpatient setting requires a determination of medical necessity, financial eligibility, and willingness of the program to admit the youth.
  • The following are referred to as voluntary admissions:
    • For all minors under 13 years of age, a parent must give consent.
    • A minor 13-18 years of age and their parents may jointly give consent.
    • A minor 13-18 years of age may give consent for admission without parental agreement.
  • The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.044.
  • Involuntary admission:
    • In the event of any minor 13 years of age or older (and/or his/her parent) refuses admission, the minor may be evaluated and detained involuntarily by a DCR in accordance with RCW 71.34.
  • If the DCR makes a decision that the minor does not require inpatient treatment, the parent can seek review of that decision made by the DCR in court. RCW 71.34.
  • Parent initiated admission:
    (an option created in 1995 through legislation known as the At Risk Youth or "Becca Bill"):
    •  A parent may give consent for admission of their minor child. The consent of the minor is not required. RCW 71.34.
    • A parent may give consent for continued in patient care in the event his/her previously unwilling minor child requests discharge during an inpatient stay. RCW 71.34.
    • Providers are not obligated to provide treatment to a minor under the provisions of this section. RCW 71.34 (4).
    • ​This is NOT considered an “involuntary admission” in spite of the fact it is against the minor's will.