What is the Most Urgent Need in Children’s Public Behavioral Health Right Now?
Mapping the origins of a community-centered design process to bring culturally responsive care to Washington State
CARE (Culturally Affirming & Responsive Mental Health) for Kids and Families, is a new, statewide initiative to promote culturally responsive behavioral healthcare while centering youth, caregivers, and community members with lived experience and expertise in the behavioral health system. In alignment with our project values of transparency and collective engagement, we want to share the story of how this initiative began, how it developed over time, and what led us to this moment in the process.
Project Origins: Addressing Systemic Challenges
The foundations of the CARE project were born out of a separate initiative focused on behavioral health care in Washington. In the spring of 2021, CoLab for Community & Behavioral Health Policy received funding from the Health Care Authority of Washington (HCA) to explore ways to strengthen the publicly funded children’s behavioral health workforce. At that time, there was significant concern around the shortage of child and family therapists in the Medicaid system, the high turnover rate in behavioral health agencies, and the broader context of navigating the cultural trauma of a global pandemic and its disproportionate impact on historically excluded communities. There was a feeling of urgency to address these challenges at both an individual and statewide level. The HCA funding was dedicated to thinking through scalable solutions to these issues.
As a first step, CoLab hosted three meetings in the summer of 2021. We brought together multi-sector partners involved in the public behavioral health system to discuss ways to improve services for kids and families in our state.
We wanted to know:
What are folks noticing in the behavioral health field right now?
What is working well and what are the challenges?
If we could write up a dream plan to improve services, what might that look like?
Who are the folks currently at the decision-making table, and whose experiences are not being centered?
A Collective Effort: Identifying Top Priorities
The meetings included folks from Accountable Communities of Health, managed care organizations, the Washington State Legislature, public health policy organizations, Health Care Authority, King County Behavioral Health, and others from across Washington state. Through a facilitated, participatory design process, the group named many priority areas for children’s behavioral health care, including health equity, trauma-informed care, person-centered approaches, best practices for brief interventions, integrated care, measurement-based care, clinical supervision, using data to improve outcomes, and focusing on effective evidenced-based components to better serve diverse populations.
Additionally, the group identified that one of the biggest challenges facing behavioral health agencies was workforce shortage and retention issues. It felt important that possible models or interventions developed through this group would alleviate, or would at least not exacerbate, the overwhelm many agencies were experiencing. Lastly, the group acknowledged that many organizations were already doing incredible work to improve children’s behavioral health services in Washington, and that it would be critical to partner, bridge, and defragment these efforts to ensure we don’t duplicate existing work. Collaboration and partnership around the work was identified as key to effecting meaningful community change.
“We asked: ‘What would you identify as the most urgent need that would improve the public children’s behavioral health system right now?’
They answered: ‘Expanding culturally responsive care that is evidence-informed.’”
Given the large number of priority areas identified by the group, we asked them the following question: if you could only pick one, what would you identify as the most urgent need that would improve the public children’s behavioral health system right now? They answered: Expanding culturally responsive care that is evidence-informed. Increasing the cultural responsivity of services for families on Medicaid felt critical for many reasons. First, we know that publicly funded behavioral health agencies provide some of the most important and life-saving services to children and families in Washington State. And, with the impact of the Covid-19 pandemic on mental health, there was (and is) growing concern that the current system could not adequately support community needs. Further, given the pandemic’s disproportionate impact on Black, Indigenous, Person of Color (BIPOC) communities and BIPOC communities’ disproportionately high enrollment levels in Medicaid services due to the economic impacts of systemic racism, there is an urgent need to ensure that public services are culturally affirming and responsive.
Turning Talk Into Action: Drafting a Funding Proposal
These conversations reflected the broader landscape of Washington’s behavioral health system and set the foundation for next steps in the CARE project development. Informed by feedback from the multi-sector group, behavioral health providers, health equity and organizational change management experts, a funding proposal was developed for the Washington State Legislature. This proposal outlined a plan that would strengthen public behavioral systems using a three-pronged strategy:
Provide organizational support to public behavioral health agency leaders;
Develop a training strategy to increase culturally relevant and evidence-informed treatment; and
Support an expansion of the workforce to include non-masters level providers with lived experience to deliver these treatments.
The proposal delineated a community-centered codesign approach to meet these three aims. This approach places individuals and communities who would be most impacted by these policies at the center of the design process, ensuring that it is directly informed by their lived expertise and experience. The project values, which were identified by all partners throughout the planning process, include transparency, co-creation, community ownership and centering community lived experience. The CARE initiative proposal was submitted to the Washington State Legislature in December 2021, and was officially passed in the 2022 Supplemental Operating budget under Engrossed Substitute Senate Bill 5693, Section 603 (74).
Where We Are Now
The funding officially began on July 1st, 2022, and since then the CoLab staff has worked to build partnerships, build out the design teams, and spread the word across Washington state to ensure that anyone who wants to be involved, can be.
Importantly, CoLab does not have ownership of the products developed through CARE. Rather, it is a collective, community-owned, iterative process. We are incredibly excited to have watched this initiative develop from an idea to a proposal and into a fully-fledged project—one that has the potential to effect critical positive change for Washington State families. The CARE project, in many ways, is just beginning. We continue to grapple with what it means to do community-centered work equitably and transparently, and how to operationalize our project values. Thank you for sharing this journey with us.
WRITTEN BY ANNA DUNCAN