Research and Data Analysis

2025 Social and Health Services Client Survey

The biennial Client Survey shares the experiences of Washingtonians who use social and health services in the state. The results highlight where services are strong and where customer service can be improved. Between October 2024 and May 2025, the Research and Data Analysis Division of the Washington State Department of Social and Health Services (DSHS) conducted 1,167 telephone interviews with randomly selected clients who received services from at least one of ten programs between May 2023 and April 2024. The programs are in DSHS (Aging and Long-Term Support, Division of Child Support, Community Services Division, Developmental Disabilities, and Vocational Rehabilitation), Health Care Authority (Apple Health/Medicaid, Mental Health Services, Substance Use Disorder Treatment Services), and Department of Children, Youth, and Families (Child Welfare Services). Results show that clients continue to be satisfied with program services and to say that programs are helpful for them and their families. Compared to 2023, clients are significantly more satisfied with phone access to staff, even as this also remains an area for ongoing improvement. On all other questions, results were stable, and there were no significant declines in satisfaction. In their comments, clients express appreciation for compassionate staff and gratitude for the services they receive. They also mention that program resources don’t always keep up with growing needs and that navigating the system can be challenging.

Changing Support Needs Among Adults Experiencing Homelessness: Washington State Apple Health Clients, 2019-2023

This report describes the distribution of single adults experiencing homelessness across five categories of support needs—low service use, health care needs, criminal legal involvement, primary mental illness, and significant care needs—over time from 2019 to 2023. We find that the number of single adults experiencing homelessness has increased by 8 percent over this period. This increase was largely due to growth in the number of people experiencing homelessness in the low service use category, and declines in the number of people exiting homelessness from one year to the next. Individuals in the criminal legal involvement category of support needs were the least likely to exit homelessness from one year to the next compared to those in other categories. The findings highlight (a) the need for low-barrier housing to prevent new episodes of homelessness among those with relatively few other support needs and (b) supportive housing services for those exiting the criminal legal system.

A Descriptive Profile of Parents with Intellectual Disabilities and Their Children

This report presents a descriptive portrait of parents who have IDD, their needs and access to services, as well as the characteristics and potential service needs of their children. We find that parents with IDD and their children tend to have more health conditions and risks, as well as a higher utilization of social and health services, when compared to other parents on Medicaid.

Housing Service Disparities Among Adults Experiencing Homelessness in Washington State

Adults experiencing homelessness face a lack of affordable housing and suitable economic opportunities. State and federally funded homelessness and housing services can help address these conditions. Using linked administrative data from Washington State to identify adults experiencing homelessness in State Fiscal Year 2023, this report estimates the percentage who accessed state or federally funded homelessness or housing services as recorded in the Department of Commerce’s Homeless Management Information System (HMIS). Of the estimated 186,469 adults experiencing homelessness in SFY 2023, 24 percent received housing services, but rates differed by county, race/ethnicity, and age, signaling potential disparities in housing services access.

Building Dementia Capable Communities: Program Implementation Evaluation

Dementia, including Alzheimer’s disease and related disorders, poses a growing public health challenge as the population ages. The Building Dementia Capable Communities (BDCC) program is a pilot initiative funded by the state legislature aimed at enhancing the support network for people living with dementia and their caregivers. Through the BDCC program, three Area Agencies on Aging (AAAs) hired dedicated staff members to expand the availability of dementia support services, develop professional training programs, create new community partnerships, and increase community awareness around dementia and resources. This report evaluates the program’s effectiveness, focusing on its implementation through a program inventory and surveys of caregivers, AAA staff, and community partners.

Children’s Long-Term Inpatient Program: Patient Characteristics and Outcomes

The Children’s Long-Term Inpatient Program (CLIP) is Washington State’s most intensive inpatient psychiatric treatment program for patients ages 5 through 17. This report describes the characteristics of children and youth discharged from CLIP in state fiscal years 2013 through 2018, compares these patients’ characteristics to those in the broader population of children and youth enrolled in Apple Health, and documents short- and long-term outcomes for CLIP patients. Results show that CLIP patients have extremely high needs at baseline, and that admission to CLIP appears to help stabilize this population during the episode of care. Nevertheless, most CLIP patients in the study population experienced an acute BH crisis event within the year following discharge and 5-year outcomes indicate substantial long-term challenges. Policy recommendations are discussed.

Health Service Utilization Among Apple Health Clients by Housing Status

Homelessness has a complex and reciprocal relationship with health. Poor health contributes to the risk of experiencing homelessness, and homelessness can contribute to the onset of new—or exacerbate existing—medical conditions, leading to high rates of emergency medical service use, hospitalizations, and mortality. In this report, we compare health service utilization patterns of Apple Health clients who became homeless in 2022 (“newly homeless”) to housed clients and individuals who experienced homelessness both before and during 2022 (“previously homeless”). Clients who experienced homelessness had higher rates of physical and behavioral health conditions and accessed health services more frequently than housed clients. Health service use for newly homeless clients increased around the time they became homeless before declining and stabilizing at higher levels than the 2 years before they became homeless.

First Episode Psychosis: Estimating Annual Incidence Using Administrative Data in SFY 2023

This report presents estimated incidence rates of first episode psychosis (FEP) among the Washington Medicaid population in state fiscal year (SFY) 2023. Using administrative data from 1997 forward, we identified 4,106 Medicaid enrollees in Washington State who received their first psychotic disorder diagnoses in SFY 2023. The overall incidence rate of FEP was estimated at 248 per 100,000 Medicaid enrollees. The demographic characteristics, type of psychotic disorder diagnosis, and geographic distribution of Medicaid enrollees experiencing FEP are presented in the report.

Washington State Behavioral Health Treatment Need and Service Utilization Update

In September 2019, the Centers for Medicare and Medicaid Services (CMS) awarded the Washington State Health Care Authority (HCA) a grant under the §1003 SUPPORT ACT. To support this effort, a current state assessment was conducted in state fiscal year (SFY) 2017–2019 to gain insight into the prevalence of substance use disorder (SUD) diagnoses, utilization of treatment services, and physical health and social outcomes among Medicaid beneficiaries with behavioral health diagnoses. However, the COVID-19 pandemic and subsequent public health emergency (PHE) may have impacted prevalence rates, treatment utilization, and use of acute SUD-related services. This set of four updated reports covers an updated time frame including the peak of the pandemic, SFY 2019–2022. Each report addresses a core question about behavioral health treatment and recovery support services in Washington and the potential impact of the COVID-19 PHE on those services.

2024 Caregiver Survey Report

Between September 2023 and September 2024, DSHS surveyed 1,342 caregivers (884 kinship and 458 foster) who had a child in care within six months of the sampling dates (August and November, 2023; February and May, 2024). These caregivers were asked about their satisfaction with the support and training provided by the Department of Children, Youth, and Families (DCYF) and private agencies contracted by DCYF. They were also invited to offer recommendations for change.