BHA General FAQ

A less restrictive alternative (LRA) is outpatient treatment provided to an individual who meets criteria for commitment but is not residing in a facility providing inpatient treatment. If the court finds that the individual meets the criteria for commitment, the court can either authorize commitment of the individual for inpatient treatment or for a less restrictive alternative treatment. Release under a less restrictive alternative is subject to conditions set by the court.

If the professional in charge of the outpatient treatment program or a DMHP determines that an individual is failing to adhere to the conditions of the court for a less restrictive alternative treatment or conditions for the release or if there is deterioration in functioning, the individual can be taken into custody and transported to an inpatient evaluation and treatment facility. The DMHP must then file a petition with the court for revocation of less restrictive alternative treatment. RCW 71.34.740 (5), RCW 71.34.740 (10).

  • An assessment is a process performed by a clinician to determine if treatment is necessary, functioning level, the diagnosis and if your child meets the Access to Care Standards. Additional information will be gathered to determine medical necessity, the length and level of care. This is done through an interview with the youth and could include parents and other family members. The clinician will also ask for historical and family information. In this process, it is important to remember that this is about exploring solutions and not about blaming.
  • Information and records with the consent of the parent, legal guardian or youth if appropriate might be gathered from other sources. These could be medical, mental health, school, juvenile justice and other types of records.
  • The assessment also includes the child and family's strengths, needs and situation. The clinician might also perform diagnostic tests.
  • Based on the assessment, a determination of whether the individual meets all the following requirements to be considered for a level of care assignment:
    • The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the list of Covered Childhood Disorders.
    • The individual's impairment(s) and corresponding need(s) must be the result of a mental illness.
    • The intervention is deemed to be reasonably calculated to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness.
    • The individual is expected to benefit from the intervention.
    • The individual's unmet need would not be more appropriately met by any other formal or informal system or support
  • If a level of care is assigned, a decision on the appropriate course of treatment will be made by the parents or legal guardian, the child or adolescent if appropriate, and the clinician.

The Patient Advocate’s office provides services to patients at Eastern State Hospital to help them resolve conflict and complaints. The Patient Advocate can be reached at (509) 565-4520.

  • Acute psychiatric inpatient treatment is provided in a community hospital or a certified freestanding Evaluation and Treatment facility (E&T).
  • For publicly funded services, a medical necessity determination is made by the RSN/PIHP or Designated Mental Health Professional (DMHP).  For privately funded services, the individual's insurance company makes that determination. The length of stay in the hospital is variable, depending upon the individual's needs.

Family-centered care and supports are developed with the philosophy that recognizes the pivotal role of the family in the lives of children. This approach ensures that families are supported in the natural care giving and decision-making roles for their children by building on their unique strengths as people.

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 has 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. 

Information coming soon...

  • Community mental health agencies provide mental health services through contracts with the Behavioral Health Organizations.  Services could be provided at the mental health 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 modalities could be:
    • 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.

In Washington, peer counseling is an approved Medicaid service. In order to bill Medicaid, contracted agencies must have peer counselors who have met the state requirements, taken the approved class, and passed the state test.

Peer counseling duties can vary widely, but they are all based on the effectiveness of assistance and support from people with shared life experience who are living in recovery. Peer counselors use their own stories in helping others develop hope and improve their lives.  Adults, youth, parents or legal guardians can provide support to their families.

Peer support can be provided in many other settings as well, such as consumer-run organizations and housing programs. The Division of Behavioral Health and Recovery (DBHR) peer support program, however, is specifically designed to prepare individuals to work in a Medicaid-funded setting.

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 RSN or the DMHP  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.

Once your child has been referred to the CLIP Administration by the Behavioral Health Organization (BHO), he or she is placed on a waiting list for placement in one of the CLIP programs.  If your child has program specific needs (for example specifically being referred to Camano Cottage at CSTC) because of age or specific issues needing to be addressed, your child will be waiting in line for the next available spot on that cottage.  There is a high demand so the list may be long.   

There are many factors that impact the time element. 

  • Youths age 13 and older can request outpatient services without the consent of the minor's parent. RCW 71.34.500
  • Parental authorization is required for outpatient treatment of a minor under the age of thirteen. RCW 71.34.500
  • Psychiatrist: A person having a license to practice as a physician and surgeon in this state and in addition has completed three years of graduate training in
    psychiatry in a program approved by the American Medical Association or the American Osteopathic Association and is certified or eligible to be certified by the American Board of Psychiatry and Neurology. RCW 71.34.020
  • Psychologist: A person licensed by a state examining board. This person must pass an oral or written exam or both as prescribed by the examining board. In addition, this person must have a doctoral degree from a regionally accredited institution obtained from an integrated program of graduate study in psychology. This person must also have had at least two years of supervised experience of which at least was one must have been after the doctoral degree was granted. RCW 18.83.070
  • MSW: A person with a masters or further advanced degree from a school of social work or a degree deemed equivalent under rules adopted by the Secretary of DSHS. RCW 71.34.020

Western State Hospital (WSH) is one of two Washington State operated psychiatric hospitals.  WSH is the regional state psychiatric hospital for 20 Western Washington counties.   Hospital treatment teams create and provide individualized intensive inpatient treatment for individuals with severe mental illness. 

Patients are admitted to WSH as a result of having received an involuntary commitment order by the court, either through a civil commitment proceeding under RCW 71.05, or a criminal justice proceeding under RCW 10.77.  There are over 500 civilly committed patients and over 200 criminally committed patients that are receiving inpatient treatment at WSH. 

  • Wraparound or ITC is NOT a program, a type of service, or family therapy. It is a process based on the idea that services should be tailored to meet the needs of children and their families. There is an underlying value and commitment to create services and supports "one kid at a time" 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.

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



Hospital and outpatient mental health services are available to you and your family if they are needed. Some of services include:

  • Crisis services;
  • Individual therapy;
  • Group therapy; and
  • Medication evaluation, prescription and management.

You may also receive employment support services, case management and other services through your BHO.

For more detailed information, please call the BHO for your community listed on the BHO pages or call the Division of Behavioral Health and Recovery at 1-888-713-6010.

Interpreter services are available upon request. Most written materials are translated into languages other than English based upon the service area population.

Some community mental health agencies have staff who speak other languages besides English. There is more information on the page for your BHO. If you or someone you know wants services in another language, your BHO must provide language assistance at no cost to you. Assistance can be provided both orally and in writing.

If you need mental health services, an individual service plan will be developed with you. Your plan will consider your age and your culture. You may receive one or more of the services listed above. The plan will be fit to you, according to your strengths and needs. Your mental health care provider will decide with you which services you will be provided and for how long.

Your mental health care provider may also ask permission to work with people who provide you other services such as housing, healthcare, and employment.

Other Medicaid benefits may be available to you. Here are some reference numbers:
Physical health: Contact information on back of your card
Substance Abuse: 1-877-301-4557
Transportation Broker: 1-800-562-3022/911 for crisis

  • DBHR-funded assessments, inpatient, and outpatient treatment services from a DBHR contractor or county subcontractor.
  • In-house Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings while in residential treatment if the meetings are required by the patient's treatment plan.

The Division of Behavioral Health and Recovery (DBHR) pays for interpreter services for patients participating in DBHR-funded treatment services provided on-site at a certified treatment facility.  DBHR also pays for interpreter services for people who attend DBHR-funded or sponsored events, such as major statewide conferences and public meetings.

For questions about interpreter services, email Ronnie San Nicolas or call (360) 725-1280.