BHA General FAQ

• 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.

• 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.

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. 

• 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.

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.

• 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

• Western State Hospital -- Established 1871

• 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.

• For a life-threatening emergency, call 911
• For Suicide Prevention: 1-800-273-8255 (TTY Users 1-800-799-4TTY) (4889)
• For 24-hour crisis counseling and referrals: Washington Recovery Help Line or the Crisis Line in your area: