2017-19 Biennium Budget Decision Package

Agency: 357 Department of Early Learning Decision Package Code/Title: PL-A7 – Safeguard Services to Vulnerable Children Budget Period: 2017-19 Budget Level: Performance Level Agency Recommendation Summary Text:

The Department of Early Learning (DEL) requests $2.2 million in General Fund - State (GFS) funding for fiscal year 2018 and $2.2 million for fiscal year 2019 to replace previously disallowed federal funds used to fund the Early Childhood Intervention and Prevention Services (ECLIPSE) program in past years. These funds will maintain existing services for 315 very severely abused children and families currently enrolled in the program.

Fiscal Summary

Operating Expenditures FY 2018 FY 2019 FY 2020 FY 2021

001-1 General Fund-State $2,152,000 $2,152,000 $2,152,000 $2,152,000

Total Cost $2,152,000 $2,152,000 $2,152,000 $2,152,000

Staffing FY 2018 FY 2019 FY 2020 FY 2021

FTEs 0 0 0 0

Object of Expenditure FY 2018 FY 2019 FY 2020 FY 2021

Obj. N – Grants & Benefits $2,152,000 $2,152,000 $2,152,000 $2,152,000 Package Description Previously enacted budgets provided $4.3 million GFS for ECLIPSE, backfilling disallowed federal funds. Because the funding was included on a one-time basis, DEL is requesting $4.3 million in permanent funding to maintain current service levels. Continued full funding of the program will ensure stable services for DEL’s most vulnerable clients.

ECLIPSE is a center-based intervention and preventative service program serving children from birth to five years of age. Children enrolled in ECLIPSE have experienced biological, familial, and environmental risk factors, such as fetal exposure to alcohol and/or drugs or other types of abuse and neglect, and require family centered, child focused mental health services. Children who display extreme behaviors because of exposure to risk factors are often expelled from their local child care setting and referred to ECLIPSE due to their behaviors. ECLIPSE provides mental health and behavior screening, clinical assessment, treatment plan development, individual treatment services, rehabilitative case management, discharge planning, family treatment, and daily transportation services to enrolled

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children and their families. The ECLIPSE program staff are professionally licensed child mental health experts trained to address any and all behaviors that children demonstrate given the traumatic stress experienced in their young lives. Licensed staff who are employed by program contractors work with the children and their families/caregivers to promote and develop social emotional competence, safety, security, and belonging so children can be successful in social settings and in life.

Base Budget: Currently, the Legislature funds ECLIPSE at a baseline level of $2.5 million plus annual one-time investments of $2.2 million, for a total of $4.7 million per state fiscal year.

Decision Package expenditure, FTE and revenue assumptions, calculations and details: The yearly budget for ECLIPSE is $4.7 million. There is currently one full-time ECLIPSE Administrator at DEL who manages the program and oversees contracts with two providers and one full-time child psychiatrist who provides clinical and program consultation for ECLIPSE services. Childhaven in King County is funded to provide services for 250 children birth to five years old, and Catholic Family and Child Services in Yakima County is funded to provide services for 65 children, for a total of 315 funded slots between the two providers.

Decision Package Justification and Impacts What specific performance outcomes does the agency expect?

ECLIPSE is an essential service for some of Washington State’s most vulnerable children. The children enrolled in ECLIPSE are from families struggling with substance abuse issues, histories of mental illness, domestic violence, homelessness, and chronic poverty.

With stable state funding, DEL will continue to expect the following outcomes:

Performance Measure detail: • A 5 percent reduction in the number of children who later become enrolled in special education

in public schools. • A 5 percent increase in family involvement in ECLIPSE, through parent support activities that

include monthly individual parent training and psychoeducational support groups. • A 5 percent reduction in the time children and families are enrolled in the ECLIPSE program

(average enrollment is currently 18 months).

Fully describe and quantify expected impacts on state residents and specific populations served.

In Washington State, there are several thousand children who are born drug-affected or are experiencing toxic stress, demonstrating challenging behavior and living in at-risk situations who need mental health treatment in a therapeutic environment focusing on family-centered services. While it might be difficult to measure the actual number of children affected by complex trauma, as a proxy, we can use the number of children who are in state dependency in this age group.

In January 2016, the number of children aged 0-5 statewide in non-relative or relative placement with the DSHS Children’s Administration was 5,504. This number represents an “outside” estimate of the

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number of children per year who might be in need of ECLIPSE services statewide. In general, these children do not meet the “access to care standards” developed by the Department of Behavioral Health and Recovery (DBHR) and most of them are not eligible for social/emotional adaptive services under the Early Support for Infants and Toddlers (ESIT) program; therefore, they are not being served by other programs. These children and their families need services to address their exposure to complex trauma.

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What are other important connections or impacts related to this proposal?

Impact(s) To: Identify / Explanation

Regional/County impacts? No Identify:

Other local gov’t impacts? No

Identify:

Tribal gov’t impacts? No

Identify:

Other state agency impacts? No

Identify:

Responds to specific task force, report, mandate or exec order?

No

Identify:

Does request contain a compensation change?

No

Identify:

Does request require a change to a collective bargaining agreement?

No

Identify:

Facility/workplace needs or impacts?

No

Identify:

Capital Budget Impacts? No

Identify:

Is change required to existing statutes, rules or contracts?

No

Identify:

Is the request related to or a result of litigation?

No

Identify lawsuit (please consult with Attorney General’s Office):

Is the request related to Puget Sound recovery?

No

If yes, see budget instructions Section 14.4 for additional instructions

Identify other important connections

None

Please provide a detailed discussion of connections/impacts identified above. There are no impacts identified above.

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What alternatives were explored by the agency and why was this option chosen?

The options that DEL has explored include:

• DEL and HCA are in negotiations with the Centers for Medicare and Medicaid services (CMS) to expand the ECLIPSE program services statewide – pending Legislative approval – and are preparing estimates of cost savings and increases based on a program evaluation expected from the Department of Health and Social Services (DSHS) Research and Data Analysis Division (RDA) in the fall.

• DEL will continue to request continued state funding to replace the lost federal share in the amount of $2.2 million per state fiscal year to ensure ongoing service for children and families enrolled in the program in King and Yakima counties.

What are the consequences of not funding this request?

A consequence of not funding ECLIPSE would result in the end of these comprehensive services for approximately 315 children and their families in King and Yakima counties. Without these funds, almost half of the available slots would be eliminated, and programs may need to close. Children experiencing toxic stress would lose much needed and valuable services that include: clinical assessment, treatment plan development, discharge planning, direct care, family therapy, case management, and transportation. This would directly work against DEL meeting its statewide kindergarten readiness goal.

How has or can the agency address the issue or need in its current appropriation level?

There are no other funds within DEL that meet the needs of replacing the federal share of funding to sustain the current program.

Other supporting materials:

A concept paper explaining the alternative State Plan Amendment for CMS is attached with proposed rate sheets.

Information technology:

☒ No

☐ Yes

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Attachment A – State Plan Amendment Proposal

Early Childhood Intervention and Prevention Services (ECLIPSE)

Pending legislative approval, the Department of Early Learning (DEL) and the Health Care Authority would implement a new statewide, evidence-based early intervention and prevention program that delivers comprehensive and coordinated care to children ages birth through 20 who have been exposed to complex trauma. Complex trauma impacts a child’s ability to form secure attachments, regulate emotions, and relate well to others. It is often associated with multiple or prolonged traumatic events that are invasive and interpersonal in nature, involve psychological maltreatment and neglect, or result from exposure to violence, including physical, sexual or emotional abuse. These “adverse experiences” often lead to behavioral, emotional, and cognitive impairments; and research has indicated they are predictive of long-term negative consequences in adulthood including increased risk of disease, addiction, physical and mental disability, behavioral problems, and premature mortality.

Program Objective

Early Childhood Intervention and Prevention Services (ECLIPSE) would be delivered in an agency designated Center of Excellence (COE) facility to minimize and remediate the adverse effects of exposure to complex trauma, and will help children develop positive behavioral-emotional functioning, restore appropriate developmental functioning, and reestablish healthy relationships.

The COE must deliver age-appropriate child- and family-focused evidence-based interventions that support and reinforce positive behavior and interactions, and help in building nurturing and responsive relationships.

Eligibility

Children potentially eligible for this program must be identified and referred through an Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) assessment or inter-periodic screening conducted by a Primary Care Physician or Advanced Registered Nurse Practitioner. Once referred to the program, the child is screened, assessed and diagnosed by a Licensed Mental Health Professional (LMHP) to determine whether or not the child meets eligibility criteria. After the LMHP clinical review and assessment, a psychiatrist then reviews the LMHP’s assessment and confirms medical necessity.

Program Description

Early detection and treatment through screening, assessment and evidence-based practices will assure children receive access to high quality care aimed at improving their behavioral, emotional and cognitive development and promoting healthy relationships.

ECLIPSE will be offered daily in a therapeutic setting with each child receiving the following direct care services:

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• Individual Treatment Services- Age appropriate treatment services as prescribed in the child’s treatment plan to support and reinforce positive behavior and interactions and improve communication and social skills. Treatment services include psychotherapy, behavior modification, therapeutic interventions and individual counseling.

• Rehabilitative Case Management Services - Case Management services include mental health assessment, treatment plan development, coordination of services with collateral service providers and referral, completing and reviewing case notes, and discharge planning.

• Clinical Screening- Psychiatrist reviews the screening and assessment completed by the LMHP and determines medical necessity for program services at minimum.

• Family Treatment-Psychological counseling provided with family members. Family-centered interventions are culturally appropriate and address family dynamics, build competencies to strengthen family functioning, and reduce family crisis. The treatment will provide family-centered interventions to identify and address family dynamics and build competencies to strengthen family functioning in relationship to the consumer. Family treatment may take place without the child present but services must be for the benefit of attaining the goals identified in the child’s treatment plan. This service is provided by or under the supervision of a mental health professional.

• Group Treatment-Facilitated group provided by or under the supervision of a mental health professional to two or more consumers at the same time. Group treatment may take place without the child present but services must be for the benefit of attaining the goals identified in the child’s treatment plan. Goals of group treatment include lessening the results of traumatic experiences, learning from the perspective and experiences of others, counseling/psychotherapy to establish and/or maintain individual and family functioning and strengthen parenting skills.

Center of Excellence Qualifications

These services would be only available at an agency-designated Center of Excellence facility. The qualifications to be an agency designated Center of Excellence are:

• Licensed as a mental health agency and follows the Washington State Division of Behavioral Health and Recovery rules and regulations;

• All mental health services are provided by, or under the supervision of, a Department of Health licensed mental health professional who meets all professional standards, clinical supervision requirements and licensure and/or credentialing requirements per Chapter 18.225 RCW, Chapter 246-809 WAC, Chapter 18.19 RCW, and Chapter 246-810 WAC;

• Appropriate evidenced based practice training for licensed mental health professionals and certified agency affiliated counselors;

• Adheres to evidence based practice standards for group services to ensure each family is given the support needed to fully participate;

• Deliver intensive rehabilitative evidence based services that provide a range of integrated and varied life skills training;

• Direct services are developmentally appropriate and are designed to assist an individual in the acquisition of skills, retention of current functioning, or improvement in the current level of functioning, appropriate socialization, and adaptive coping skills;

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• Staff has access to consultation with a psychiatrist or a physician who has at least one year’s experience in the direct treatment of individuals who have a mental or emotional disorder.

If legislative approval is granted to fund a shift of the ECLIPSE program to a Medicaid-eligible program, HCA intends to continue its partnership with DEL by entering into an Interagency Agreement (IA). The IA will detail DEL’s responsibilities in assisting HCA in providing proper oversight of this Medicaid program by ensuring qualified COE’s provide medically necessary, age appropriate services by qualified staff to children exposed to complex trauma.

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Attachment B

Rate Sheet for Early Childhood Intervention and Prevention Services (ECLIPSE)

Authority • Federal: Rehabilitation: 42 CFR 440.130(d) • State Plan: Rehabilitative Mental health Services - 3.1-A & B (13)(d)(7)

Staff Qualifications

• Licensed Mental Health Professional (LMHP) • Agency Affiliated Counselor under the supervision of the LMHP

Setting

• COE Facility • Child’s home

Services

• Day program Code: H2020 | $79.03 per diem

ECLIPSE is approximately a 4 hour a day program provided to children birth to 21 who have been exposed to or are at risk of complex trauma. Complex trauma impacts a child’s ability to form secure attachments, regulate emotions, and relate well to others. Services are provided by or under the supervision of a mental health professional. Services provided directly to the child during the day include:

o Individual Treatment Services - Age appropriate treatment services as prescribed in the child’s treatment plan to support and reinforce positive behavior and interactions and improve communication and social skills. Reimbursable treatment services include psychotherapy, behavior modification, therapeutic interventions and individual counseling.

o Rehabilitative Case Management Services - Case Management services include mental health assessment, development and update of treatment plan, coordination of services with collateral service providers, complete and review case notes, align child with other programs and services for identified needs that cannot be met in this program, discharge planning.

• Clinical Screening by Psychiatrist

Code: T1023 | $108.14 per assessment every 6 months Screening by a psychiatrist to determine if the child meets medical necessity for this program.

• Family Treatment Code: S5111 | $50.00 limit of 11 sessions per 6 months

Psychological counseling provided with family members. Family-centered interventions are culturally appropriate and address family dynamics, build competencies to strengthen family

March 2016

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functioning, and reduce family crisis. The treatment will provide family-centered interventions to identify and address family dynamics and build competencies to strengthen family functioning in relationship to the consumer. Family treatment may take place without the child present but services must be for the benefit of attaining the goals identified in the child’s treatment plan. This service is provided by or under the supervision of a mental health professional.

• Group Treatment Code S9446 | $ Varies by group size, twice a week maximum

Facilitated group provided by or under the supervision of a mental health professional to two or more participants at the same time. Group treatment may take place without the child present but services must be for the benefit of attaining the goals identified in the child’s treatment plan. Goals of group treatment include lessening the results of traumatic experiences, learning from the perspective and experiences of others, counseling/psychotherapy to establish and/or maintain individual and family functioning and strengthen parenting skills.

o UN Parent Training-2 families $55.00 o UP Parent Training-3 families $50.60 o UQ Parent Training-4 families $46.55 o UR Parent Training-5 families $42.83 o US Parent Training-6+families $39.40

March 2016

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Attachment C

Taxonomy for Early Childhood Intervention and Prevention Services (ECLIPSE)

Benefit/Code Rate Frequency Average cost per month*

Average cost per year per child per 12 months

Day Program Code-H2020

$79.03 Daily (Monday-Friday)

$1659.63 $19,915.56

Family Treatment Code-S5111 $50.00 11 sessions per 6 months (twice per month)

$100.00 $1200.00

Group Parenting Training Code-S9446 UN Parent Training-2 families $55.00 per fam UP Parent Training-3 families $50.60 UQ Parent Training-4 families $46.55 UR Parent Training-5 families $42.83 US Parent Training-6+families $39.40

Rates Vary by group size

Up to twice a week

Estimate $440.00 for 2 families attending per month-$315.20 for 6+ families

Estimate $5280.00 per year if 2 families attend group $3782.40 per year for 6+ families attend group

Total Estimated Cost per year $24,897.96 to $26,395.56 *Rate based on 21 service days a month

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