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Research Review

Systemic Overhaul of Medicaid for Youths With Mental Illness

"Like an apple seed, a kid can grow if he doesn't get put in a box," says Phillip Smith, one of the 10 youths who filed T.R. et al. v. Quigley et al., a class action lawsuit calling for reform of Washington's mental health system for children.

Earlier today, Smith and other youths attended a Fairness Hearing where U.S. District Court Judge Thomas Zilly approved an agreement obligating Washington's Department of Social and Health Services and Health Care Authority to develop and provide intensive, individualized mental health services to Medicaid-eligible young people in their homes or communities.

"Treating children at home whenever possible," says Patrick Gardner, an attorney with Young Minds Advocacy Project, "is more humane, less costly, and more effective than institutionalization." Under the agreement, the state will establish a new program and approach for delivering mental health services called Wraparound with Intensive Services or WISe.

The program will help prevent adverse outcomes for youths with serious mental illness such as hospitalization, long­term institutionalization in psychiatric facilities, and placements in the foster care and juvenile justice systems.

These are all experiences Smith has known personally and doesn't want repeated for other kids. "This case," says Smith, "was about doing something to make a difference so kids with illnesses like mine won't have to go through the things I did."

Leecia Welch, senior attorney at the National Center for Youth Law, agrees. "Approval of this settlement has set the stage for increasing access to appropriate mental health services for Washington's most vulnerable youths. Better access to care means better outcomes for kids like Phillip."

To Smith, "change is the key word" to describe the settlement. The changes to Washington's public mental health system will include providing class members with access to intensive care coordination, intensive home and community based services, and mobile crisis intervention and stabilization.

"These services will be coordinated using child and family teams," says Kimberly Lewis, managing attorney of Los Angeles at the National Health Law Program. "Using a collaborative teaming approach has been demonstrated to improve outcomes for children and families."

Now that the agreement has been approved, the State must work to increase its statewide capacity to deliver intensive, individualized services. Washington expects to serve as many as 6,000 young people each year once the settlement is fully implemented. Due to the size and scope of the system reform, it will take as long as five years to complete implementation.

"Once fully implemented, the scope and reach of this program will fundamentally transform Washington's public mental health system and the way it helps thousands of children," says David Carlson, director of legal advocacy at Disability Rights Washington.

— Source: National Health Law Program