At the Senate Behavioral Health Subcommittee to Health & Long Term Care meeting last week, lawmakers heard an update on partial hospitalization and intensive outpatient programs for adolescents in the state. Dr. Alysha Thompson, clinical director and psychologist of the Psychiatry and Behavioral Medicine Unit at Seattle Children’s Hospital, and Dr. Erik Loraas, program director of the Child and Adolescent Psychiatry Fellowship Spokane, both spoke on the issue.
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Over the previous two legislative sessions, the Washington State Legislature allocated funding at two sites – Seattle Children’s Hospital and Sacred Heart Children’s Hospital – for behavioral health services. The funding was specifically slated for Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP). The first round of pilot funding included $1.8 million for programs between Jan.1, 2021 and June 30, 2021, and the second round included an additional $8.5 million for programs between July 1, 2021 and June 30, 2023.
Loraas emphasized the incredibly high demand for behavioral health services like these among youth, which the pandemic has only exacerbated. According to the Washington COVID-19 Student Survey (CSS) administered to students during March 2021, nearly 13% of students in grades six through eight, and over 17% of students in grades nine through 12, had considered suicide in the past 12 months.
Additionally, of the 15.5% of students in grades six through eight who had sought mental health services in the past 12 months, 31.1% were unable to receive services. Likewise, of the 23.2% of students in grades nine through 12 who had sought mental health services in the past 12 months, 30.9% were unable to receive services.
In her presentation, Thompson explained that PHP and IOP are intensive levels of care programs involving daily group-based treatment, individual or family therapy several times a week, medication consultation and management, case management support, and parent change management and support. The PHPs treat each patient for a minimum of 20 hours per week, and the IOPs treat each patient for a minimum of nine hours per week.
Built into the schedule of these programs is time for the patient to go home and have dinner with their family. Thompson stated:
“The idea with these programs is that you can spend most of your day working on some really intensive therapy and work towards continued crisis stabilization, and then go home each night to be able to practice those skills that you’re learning with your family.”
There are several pilot programs that are currently up and running at Seattle Children’s. The Virtual Anxiety IOP is a new program which began in March 2021 and runs three hours a day, four days per week. The Virtual Dialectical Behavioral Therapy (DBT) IOP is a new program started in April 2021 that runs four hours per day, four days per week. The pilot funding from the legislature allowed these new programs to be established.
The Virtual OCD-IOP was an existing program running prior to Jan. 1, 2021, and is now accessible to youth with Medicaid due to the pilot funding. This program runs three hours per day, four days per week.
More pilot programs are currently in development, thanks to the funding. Thompson stated she is particularly excited about the Step-Down/Step-Up PHP being developed to serve youth who can participate in group programming environments, and whose needs may be too complex for a disorder specific program. Additionally, Seattle Children’s is in the process of establishing a Virtual Eating Disorder IOP and a Virtual Disruptive Behavior IOP that will exclusively serve Medicaid adolescents.
Through these programs, Thompson said Seattle Children’s is working to expand the geographic reach of its behavioral health services for adolescents, emphasizing that some programs plan to stay virtual even beyond COVID-19 in an effort to reach more people and make sure commuting is not a barrier.
“One of the nice things about COVID, if there are any, is that we have learned to be pretty flexible when it comes to delivering treatment. And that has meant that a lot of our programs have moved to be virtual. And that means also that we are able to include anybody from around the state who might have been impacted by a long commute to a program like this. They can now join virtually.”
Loraas highlighted the effective nature of these programs, with individualized and collaborative treatment approaches that involve peers, family, and school, as well as flexible time commitments for patients. He stated that these programs allow for immediate implementation and practice of skills learned, as patients are allowed to continue to engage in school and spend evenings at home.
In Spokane, the IOP and PHP programs include the Behavioral Emotional Skills Training (BEST) program, the Resources Insight Support Empowerment (RISE) Adolescent program, and the RISE Adult program. Loras stated:
“The structure is, in itself, really helpful for these kids. We’ve seen this a lot during COVID, with the lack of structure with being on virtual school, parents still being at work … These kids are really struggling in terms of creating structure to their own day, and so just by coming to our program, where they have this built-in structure. That alone can make huge difference just in a matter of a day or two.”
Loraas said COVID-19 has led to an unprecedented demand for acute psychiatric services for children and adolescents, with a waitlist that went up to 6 months at one point during the pandemic.