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Purposes of the Law

What are the overall purposes of the legislation? Prevention and intervention services delivered to children and juveniles in the areas of mental health, child welfare, and juvenile justice shall be primarily evidence-based and research-based, and it is anticipated that such services will be provided in a manner that is culturally competent.

What does it mean for services to be evidence-based and research-based?  What are promising practices? Evidence-based services are generally defined as those programs or policies that are supported by rigorous outcome evaluations clearly demonstrating effectiveness.  In the fields of mental health, child welfare, and juvenile justice, many organizations in the nation as well as Washington State have examined the research literature carefully to identify programs and policies that have been tested with a high degree of scientific rigor and found to result in significant improvements in outcomes for children and juveniles.  A second grouping of programs and policies have some research demonstrating effectiveness, but does not yet meet the standard of an evidence-based practice.  A third category of interventions fit into the category of “promising practices”  and these do not meet the above standards but show potential to do so in the future. (See section on Promising Practices (with hyperlink) for more detail on this category of services.)
What does it mean for services to be provided in a manner that is culturally competent? The legislation does not specifically define these words.
Which services is the law directed toward? The law is directed toward prevention and intervention services for children and youth and their families that address behaviors that have resulted from, or may result in truancy, abuse or neglect, out-of-home placements, chemical dependency, substance abuse, sexual aggressiveness, or mental or emotional disorders. 
What does the legislation anticipate in terms of existing or new resources?

The legislative intent is that increased use of evidence-based and research-based practices be accomplished to the extent possible within existing resources.  This goal is to be reached by coordinating the purchase of evidence-based services, the development of a trained workforce, and the development of unified and coordinated case plans to provide treatment in a coordinated and consistent manner. 
The legislation recognizes that to provide evidence-based and research-based services, contractors should have a workforce trained n the programs, and outcomes from the use of these practices should be monitored.

Milestones in the Law

What does the legislation direct as the first step? At present, we do not have baseline information in Washington State about the extent to which evidence-based and research-based practices are currently available and in use in the areas of children’s mental health, child welfare, and juvenile justice.  We also do not know the cost of those practices and the most effective strategies and appropriate time frames for expecting their broader use.  Thus, the law directs that baseline data be established regarding the use and availability of evidence-based and research-based practices.
What needs to happen before baseline information is available? The first step is to define evidence-based, research-based and promising practices in the areas of child welfare, juvenile rehabilitation, and children’s mental health services.  DSHS is directed to accomplish several tasks in consultation with several organizations:  the Washington State Institute for Public Policy, the Evidence-based Practice Institute at the University of Washington, Partners for our Children at the University of Washington, other national experts in the delivery of evidence-based services and organizations representing Washington practitioners
Who is directed to provide these definitions and what is their due date?

The Washington State Institute for Public Policy (WSIPP) and the University of Washington’s Evidence-based Practice Institute (EBPI) at the University of Washington are to provide descriptive definitions, in consultation with the Department of Social and Health Services.
WSIPP is a non-partisan research organization that receives its assignments from the legislature.  WSIPP has been in existence for 30 years and conducts research on a variety of topics.  For the last 10 years, WSIPP has published numerous reviews of evidence-based programs.  The most recent publication from WSIPP on this topic can be found at http://www.wsipp.wa.gov/pub.asp?docid=12-04-1201.

EBPI was created by the 2007 Legislature.  This organization provides training and consultation to mental health providers and agencies that serve the needs of children.  The EBPI also provides oversight of the implementation of evidence-based practices to ensure that the models are delivered as intended.  Their website is located here:  http://depts.washington.edu/ebpi/
The descriptive definitions are due by September 30, 2012.

What else were WSIPP and EBPI assigned to complete by September 30, 2012? The two organizations must prepare an inventory of evidence-based, research-based and promising practices for prevention and intervention services that will be used by state agencies to complete the baseline assessment.  This inventory will be periodically updated. 
In identifying evidence-based and research-based services, the two organizations must do the following:

  • Consider any available systemic evidence-based assessment of a program’s efficacy and cost-effectiveness;
  • Attempt to identify assessments that use valid and reliable evidence
For the inventory, what is expected for promising practices? The Department shall prioritize the assessment of promising practices identified in the inventory, with the goal of increasing the number of such practices that eventually meet the standards of evidence-based and research-based.  In accomplishing this directive, DSHS shall use state, federal, or private funds.
After the inventory, what happens next? DSHS and the Health Care Authority will use the inventory to determine the extent of evidence-based and research-based practices that exist in the areas of child welfare, juvenile rehabilitation, and children’s mental health.  This baseline assessment is to be completed by June 30, 2013.
What must the June 30, 2013 baseline assessment include? The assessment must include prevention and intervention services provided through Medicaid fee-for-service and Healthy Options managed care contracts.  The assessment shall include estimates of:

  • The number of children receiving such services;
  • For juvenile rehabilitation and child welfare services, the total amount of state and federal funds expended on the service;
  • For children’s mental health services, the number of percentage of encounters using these services that are provided to children serviced by regional support networks and children receiving mental health services through Medicaid fee-for-service or Healthy Options;
  • The relative availability of the service in the various regions of the state; and
  • To the extent possible, the unmet need for each service.
When do DSHS and the Health Care Authority report back to the legislature regarding this assessment?  What will their report cover? By December 30, 2013, the two state agencies will report to the governor and the fiscal and policy committees of the legislature on recommended strategies, timelines and costs for increasing the use of evidence-based and research-based practices.  The report must distinguish between a reallocation of existing funds to support the recommended strategies and new funding need to increase the use of the practices.
The report must include recommendations for the reallocation of resources for evidence-based and research-based practices and substantial increases above the baseline assessment for the use of these practices for the 2015-17 and 2017-19 biennia. 
Updated recommendations are required by December 30, 2014 and December 30, 2015.
What happens if DSHS or the Health Care Authority anticipates that it will not meet its recommended levels for upcoming biennia? Under these circumstances, the departments must report to the legislature by November 1st of the year preceding the biennium.  The report shall include:

  • The identified impediments to meeting the recommended levels
  • The current and anticipated performance level; and
  • Strategies that will be undertaken to improve performance.

Other Provisions in the Law

For the agencies’ recommendations, what are the expectations regarding programs for ethnically diverse clients and tribal members? The agencies’ recommendations must include strategies to identify programs that are effective with ethnically diverse clients.  They must consult with tribal governments, experts within ethnically diverse communities, and community organizations that serve diverse communities.

What direction does the legislation provide regarding case plans, quality control and monitoring, and data reporting systems? DSHS must accomplish the following:

  • Develop strategies to use unified and coordinated case plans for children, youth and their families who are or are likely to be involved in multiple systems within the department;
  • Use monitoring and quality control procedures designed to measure fidelity with evidence-based and research-based prevention and treatment programs; and
  • Use any existing data reporting and system of quality management processes at the state and local level for monitoring the quality control and fidelity of the implementation of evidence-based and research-based practices.

To complete this portion of its assignments, DSHS must consult with several entities: The UW EBPI,  the Washington partnership Council on Juvenile Justice, the Child Mental Health System of Care Planning Committee, the Children, Youth and Family Advisory Committee, the Washington State Racial Disproportionality Advisory Committee, Partners for our Children (UW), regional support networks, the Washington Association of Juvenile Court Administrators, and WSIPP.

What direction does the legislation provide regarding federal matching funds and other funding-related issues? DSHS and the Health Care Authority shall identify components of evidence-based practices for which federal matching funds might be claimed and seek such matching funds to support implementation of evidence-based practices.
DSHS shall efficiently use funds to coordinate training in evidence-based and research-based practices across juvenile justice, children’s mental health, and child welfare;
Nothing in the law requires DSHS or the Health Care Authority to take actions that would adversely impact tribal-state consultation protocols or contractual relations.
Other provisions clarify that the legislation will not affect the state’s Medicaid waiver, obligations pursuant to a court order or agreement, or substantially reduce federal Medicaid funding or impair access to appropriate and effective services for a substantial number of Medicaid clients.