Transforming the way Washington State cares for youth with serious mental health needs
T.R. v. Quigley is a federal class action lawsuit filed on behalf of all Medicaid-eligible youth in Washington State. Initially filed in November 2009, the lawsuit seeks to prevent unnecessary institutionalization of children who may benefit from intensive home and community-based mental health services. Armed with research demonstrating that treating children in their homes whenever possible is more humane, less costly, and more effective than institutionalization, Young Minds Advocacy and our co-counsel pressed the State of Washington to fundamentally transform the way it cares for youth with serious mental health needs. The State agreed and, in December 2013, a federal judge approved a settlement agreement obligating Washington to develop and provide intensive, individualized home and community-based mental health services to a class of children with serious mental health needs or at risk of out-of-home placement.
Approval of the TR settlement set the stage for dramatically improved access to appropriate mental health services across the state – and for better outcomes for vulnerable youth and their families. Called Wraparound with Intensive Services (WISe), the specific package of reforms required under the settlement includes access to care coordination, intensive home and community based services, and mobile crisis intervention and stabilization. Currently, Young Minds and its co-counsel are working closely with the State of Washington to build the framework necessary to ensure that class members statewide have access to these critical services.
Prior to the TR lawsuit, children with serious unmet mental health needs faced stark choices under Washington’s Medicaid system. Most children were able to access a limited range of office-based mental health services. However, if these services proved inadequate, it was often the case that the only intensive treatment option available was placement in a residential facility. Unfortunately, institutional care—when it is available—is often far from home, highly restrictive, and involves the additional trauma of separation from family and loved ones.
T.R.*, the named plaintiff in the case, was 10-years-old when the case was originally filed. He is from King County, Washington and experienced significant mental health needs. Although his treatment team noted that his condition would worsen in an institutional setting, he was unable to access in-home or community based treatment that would have allowed him to return home safely. Instead, he remained confined for over nine months at the state psychiatric hospital for children.
Many children with serious mental health needs, like T.R., can remain safely with their families if they have access to appropriate mental health services and supports. However, because intensive home and community-based services were generally not available under Washington’s Medicaid program, far too many children were unnecessarily sent to residential placements or simply went without appropriate therapeutic services.
Under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) provision of the Medicaid Act, federal law requires that states provide children and youth with a broad array of mental health services and supports, including intensive home and community-based services. Providing these services helps prevent costly – and frequently ineffective – residential placements.
T.R. v. Quigley (formally Dreyfus) was filed in November 2009 as a federal class action lawsuit on behalf of all Medicaid-eligible children and youth in the State of Washington. The suit sought declaratory and injunctive relief against the Washington Department of Social and Health Services (DSHS) based violations of federal law, including the Medicaid Act, the Americans with Disabilities Act, and the Rehabilitation Act.
In August 2013, the parties reached an agreement to implement reforms that will deliver intensive, individualized services to young people in their homes or in the most “home-like” setting possible. As part of the agreement, the state committed to provide: 1) Intensive Care Coordination, (2) Intensive Home and Community Based Services, and (3) Mobile Crisis Intervention and Stabilization Services. These three service categories are collectively referred to as Wraparound with Intensive Services (WISe).
In December 2013, federal U.S. District Court Judge Thomas Zilly approved the parties’ proposed settlement agreement. Young Minds is now working closely with our co-counsel and the State to implement the package of services required under the settlement agreement. Due to the size and scope of the proposed reforms, it will take an estimated five years to complete implementation statewide. When the settlement is fully implemented, Washington’s Medicaid program should have capacity to deliver these vital services and supports to as many as 6,000 young people each year. Improving access to intensive mental health treatment in the home, before behaviors escalate beyond the family’s ability to cope, will mean fewer out-of-home placements and more children living and thriving in their homes and communities.
*T.R. is not the plaintiff’s real name. The Courts use a pseudonym to protect the child’s true identity.
Our co-counsel include Disability Rights Washington, National Center for Youth Law, and National Health Law Program (NHELP).