2023 Legislative Priorities: Helping Kids “Stuck” in the Hospital

With the 2023 Washington state legislative session underway as of January 9, Seattle Children’s top priority for the session continues to be youth mental health. In particular, we are urging legislators to support a package of recommendations that will prevent children from being stuck in hospitals’ inpatient psychiatric units and emergency departments (EDs) and help them instead be supported at home, in the community or with residential services.

The issue of inadequate services/supports contributing to child abandonment in hospitals is longstanding and felt statewide. Exacerbating the problem has been a change in the legal interpretation of the term “abandoned” by the Washington State Department of Children, Youth and Families (DCYF) in April 2021 wherein state agencies no longer step in when children are abandoned in EDs. As a result of this gap in our system, and no state plan to fill it, we estimate that at least 15 patients at Seattle Children’s stayed longer than was medically necessary, resulting in more than 700 days hospitalized unnecessarily. At both Seattle Children’s and Mary Bridge Children’s Hospital, some patients in this circumstance were admitted unnecessarily for a year or longer.

We are advocating for the legislature to advance investments and policy improvements to achieve critically necessary immediate, short-term supports, even as we work toward long-term, innovative solutions. Our proposed changes were shaped by an eight-month collaborative process across multiple state agencies including DCYF, the governor’s office, pediatric hospitals and the Washington State Hospital Association. They include:

• Funding included in the governor’s 2023-2025 proposed budget to:
  • Expand the capacity of the Washington State Developmental and Disabilities Administration (DDA) in-home and out-of-home services.
  • Expand access to applied behavioral analysis (ABA) by paying providers more and training them to treat behaviorally complex youth.
• One funding request was partially included in the governor’s proposed budget:
  • Expand the capacity and capability of Wraparound with Intensive Services for youth (WISe) to support youth with high-acuity behaviors. The budget instead funds enhanced provider training.
• One funding request was not included in the governor’s proposed budget:
  • Exploring a therapeutic educational residential placement in Washington state through an evaluation/study.
• Legislation
  • Codify a new approach to creating a service and placement plan for children.

In addition to leading this work to reduce and ultimately eliminate child abandonment in hospitals, Seattle Children’s supports the priorities of the state’s Child and Youth Behavioral Health Work Group, which are here.

Seattle Children’s will continue working to advance youth mental and behavioral health, a strategic and community health priority since 2019 and the focus of our Generation REACH initiative.

Read recent media coverage

• WA Gov. Inslee, lawmakers push budget hikes, policy changes to curb youth psychiatric boarding (Seattle Times, 12/18/22)
• Caught in WA’s youth mental health ‘disaster,’ a teen with nowhere to go (Seattle Times 12/18/22)
• Institutionalizing her son was the only option, a mother thought. Now she’s fighting to bring him home (Seattle Times, 7/3/22)
• Kids are waiting months for psychiatric beds. Why it’s such a struggle to expand care in WA (Seattle Times 5/21/22)
• Abandoned in the ER: When kids are left at hospitals, the state is no longer taking charge of their care (Seattle Times, 2/21/22)