Bill would establish new model for behavior support services in Washington


Shane Ersland


Senators discussed a bill that would establish a new model for behavior support services to care for Washingtonians with intellectual and developmental disabilities on Wednesday.


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The Senate Ways and Means Committee discussed Substitute Senate Bill 5506 during a public hearing. SSB 5506 would establish the Enhanced Behavior Support Homes (EBSH) program in the Department of Social and Health Services’ (DSHS) Developmental Disability Administration (DDA). It would also establish an enhanced behavior support specialist certification to staff the program.

Maria Hovde, committee staff, said DDA clients receive varying levels of services based on their preferences, capabilities, and service needs. Some of those needs include habilitation support. 

“Although some DDA clients live in residential habilitation centers, which is an institutional setting, the majority reside in the community in a variety of different settings,” Hovde said. “This bill establishes the EBSH program to provide enhanced behavioral services and support to individuals residing in these particular community settings.”

Under SSB 5506, DSHS would create standards for licensure for enhanced behavior support homes, including rules that require 24-hour supervision of residents, and staffing requirements to provide appropriate responses to the acuity of residents. It would establish enhanced behavior support specialists to work in the homes. 

Certification for workers would require a minimum of 40 hours of emergency intervention training that includes collaborative problem-solving techniques that utilize trauma-informed practices and positive behavior supports, as well as a minimum of 10 hours per year of ongoing training. 

Diana Stadden, from the Arc of Washington State, discussed the workforce that would be featured in EBSH homes. 

“They can be staffed with these new behavioral support specialists in homes that have people that have high needs, [or are] getting out of the hospital,” Stadden said. “We’re creating a workforce to work in community homes that are already here.”

Beth Florea, the mother of a 12-year-old son with complex developmental disabilities and challenging behaviors, including aggression, testified in support of SSB 5506. She said her son was placed in an out-of-state facility in July 2022

“Despite having extensive behavior training as parents, we were not enough for our own son,” Florea said. “He is having behavioral success in his current environment. He has a behaviorally-trained team. He needs this level of expertise and experience. He hasn’t had any serious aggression since October.”

His experience is proof that a home with a behavior-based model works, Florea said. 

“We need other options than out-of-state placement,” she said. “Passing this bill would potentially allow our son to come back to Washington state and live in the community near people that love him.”

Washington Autism Alliance President and CEO Arzu Forough said the EBSH model would also help her 26-year-old son, who is diagnosed with autism, Tourette anxiety disorder, and an acute stress disorder similar to PTSD. She said her son has been hospitalized for long periods of time after suffering from intense cycles during which he can be a harm to himself and others. After a recent cycle, he has been sheltered in an emergency department for a week.

“He is not able to be discharged; there is no safety plan for him,” Forough said. “In one cycle of escalation, it took five people to keep him safe and keep him from injuring others. SSB 5506 is a thoughtful and elegant approach to provide 24-hour behavioral health staffed by behavior technicians.”

Hovde discussed some preliminary general fund cost estimates for the staffing and implementation of EBSH homes. 

“The estimated daily rate for this new facility type is $4,500 per client per day, and that includes the cost of staffing those homes,” Hovde said. “The actual cost of the service will depend on the number of homes that are established.”

Estimates for full implementation of the program show an annual cost would be approximately $1.6 million for each EBSH home, Hovde said.

“So to give you a range, if five homes were established, annual costs would be $8.2 million,” she said. “If 10 homes were established, annual costs would be $16.4 million. And federal funds are assumed to cover about half of the cost of those homes.”

No action was taken on the bill, but it is scheduled for an executive session on Friday.