Youth behavioral health

AN ACT Relating to supporting children and youth behavioral 1
health; amending RCW 74.09.4951 and 71.36.025; adding new sections to 2
chapter 43.06 RCW; and providing an expiration date.3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 74.09.4951 and 2024 c 372 s 1 are each amended to 5
read as follows: 6
(1) The children and youth behavioral health work group is 7
established to: 8
(a) Identify barriers to and opportunities for accessing 9
behavioral health services for children, youth, and young adults and 10
their families; 11
(b) Strengthen and build a coordinated systemic approach to 12
providing behavioral health care and supports that ensure that all 13
children, youth, young adults, and their families have timely access 14
to high quality, equitable, well-resourced behavioral health 15
education, care, and supports across the continuum when and where 16
they need it, including prenatal care; ((and))17
(c) Advise and provide recommendations to the children and youth 18
behavioral health leadership council established in section 5 of this 19
act regarding implementation of the Washington thriving strategic 20
S-4021.1
SENATE BILL 6224
State of Washington 69th Legislature 2026 Regular Session
By Senators C. Wilson, Warnick, Dhingra, Frame, Hasegawa, Lovick,
Nobles, Orwall, and Saldaña
Read first time 01/20/26. Referred to Committee on Human Services.
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plan developed under subsection (6) of this section and the system of 1
care that the strategic plan outlines; and 2
(d) Advise the legislature on statewide behavioral health 3
services for this population. 4
(2) The work group shall consist of members and alternates as 5
provided in this subsection. Members must represent the regional, 6
racial, and cultural diversity of all children and families in the 7
state. 8
(a) The president of the senate shall appoint one member and one 9
alternate from each of the two largest caucuses in the senate.10
(b) The speaker of the house of representatives shall appoint one 11
member and one alternate from each of the two largest caucuses in the 12
house of representatives. 13
(c) The governor shall appoint six members representing the 14
following state agencies and offices: The department of children, 15
youth, and families; the department of social and health services; 16
the health care authority; the department of health; the office of 17
homeless youth prevention and protection programs; and the office of 18
the governor. 19
(d) Subject to the requirements under (k) of this subsection, the 20
governor shall appoint the following members: 21
(i) One representative of behavioral health administrative 22
services organizations; 23
(ii) One representative of community mental health agencies;24
(iii) Two representatives of medicaid managed care organizations, 25
one of which must provide managed care to children and youth 26
receiving child welfare services; 27
(iv) One regional provider of co-occurring disorder services;28
(v) One pediatrician or primary care provider;29
(vi) One provider specializing in infant or early childhood 30
mental health; 31
(vii) One representative who advocates for behavioral health 32
issues on behalf of children and youth; 33
(viii) One representative of early learning and child care 34
providers; 35
(ix) One representative of the evidence-based practice institute;36
(x) Two parents or caregivers of children who have received 37
behavioral health services, one of which must have a child under the 38
age of six; 39
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(xi) One representative of an education or teaching institution 1
that provides training for mental health professionals;2
(xii) One foster parent; 3
(xiii) One representative of providers of culturally and 4
linguistically appropriate health services to traditionally 5
underserved communities; 6
(xiv) One pediatrician located east of the crest of the Cascade 7
mountains; 8
(xv) One child psychiatrist; 9
(xvi) One representative of an organization representing the 10
interests of individuals with developmental disabilities;11
(xvii) Three youth or young adult representatives who have 12
experience with behavioral health services; 13
(xviii) One representative of a private insurance organization;14
(xix) One representative from the statewide family youth system 15
partner roundtable established in the T.R. v. Strange and McDermott , 16
formerly the T.R. v. Dreyfus and Porter, settlement agreement;17
(xx) One representative from educational service districts 18
established under chapter 28A.310 RCW; and 19
(xxi) One substance use disorder professional.20
(e) The governor shall request participation by a representative 21
of tribal governments. 22
(f) The superintendent of public instruction shall appoint one 23
representative from the office of the superintendent of public 24
instruction. 25
(g) The insurance commissioner shall appoint one representative 26
from the office of the insurance commissioner. 27
(h) The work group shall choose one of the work group's cochairs 28
from among its legislative members and the other cochair must be the 29
representative from the health care authority. The representative 30
from the health care authority shall convene at least two meetings of 31
the work group each year. 32
(i) The cochairs may invite additional members of the house of 33
representatives and the senate to participate in work group 34
activities, including as leaders of advisory groups to the work 35
group. These legislators are not required to be formally appointed 36
members of the work group in order to participate in or lead advisory 37
groups. 38
(j) The cochairs may request that the governor appoint additional 39
members of the work group representing specific professions, 40
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organizations, or communities. The governor's office may consult with 1
the cochairs as needed on these discretionary appointments.2
(k) The terms for work group members appointed under (d) of this 3
subsection after June 6, 2024, may not exceed three years. Work group 4
members appointed under (d) of this subsection before June 6, 2024, 5
may remain in their positions until January 1, 2027, but their terms 6
may not go beyond that date. 7
(3) The work group shall: 8
(a) Monitor the implementation of enacted legislation, programs, 9
and policies related to children and youth behavioral health, 10
including provider payment for mood, anxiety, and substance use 11
disorder prevention, screening, diagnosis, and treatment for children 12
and young mothers; consultation services for child care providers 13
caring for children with symptoms of trauma; home visiting services; 14
and streamlining agency rules for providers of behavioral health 15
services; 16
(b) Consider system strategies to improve coordination and remove 17
barriers between the early learning, K-12 education, and health care 18
systems; 19
(c) Identify opportunities to remove barriers to treatment and 20
strengthen behavioral health service delivery for children and youth;21
(d) Determine the strategies and resources needed to:22
(i) Improve inpatient and outpatient access to behavioral health 23
services; 24
(ii) Support the unique needs of young children prenatally 25
through age five, including promoting health and social and emotional 26
development in the context of children's family, community, and 27
culture; 28
(iii) Develop and sustain system improvements to support the 29
behavioral health needs of children, youth, and young adults; and30
(iv) Achieve parity of private health insurance coverage for 31
behavioral health conditions with the coverage provided for other 32
health conditions; ((and))33
(e) Consider issues and recommendations put forward by the 34
statewide family youth system partner roundtable established in the 35
T.R. v. Strange and McDermott , formerly the T.R. v. Dreyfus and 36
Porter, settlement agreement; and37
(f) Use the Washington thriving strategic plan developed under 38
subsection (6) of this section to guide the priorities and efforts of 39
the work group. 40
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(4) At the direction of the cochairs, the work group may convene 1
advisory groups to evaluate specific issues and report related 2
findings and recommendations to the full work group.3
(5) The work group shall convene an advisory group focused on 4
school-based behavioral health and suicide prevention. The advisory 5
group shall advise the full work group on creating and maintaining an 6
integrated system of care through a tiered support framework for 7
preschool through twelfth grade school systems defined by the office 8
of the superintendent of public instruction and behavioral health 9
care systems that can rapidly identify students in need of care and 10
effectively link these students to appropriate services, provide age-11
appropriate education on behavioral health and other universal 12
supports for social-emotional wellness for all students, and improve 13
both education and behavioral health outcomes for students. The 14
school-based behavioral health and suicide prevention advisory group 15
shall consider the broader behavioral health issues impacting 16
children, youth, and families, while focusing on the issues that are 17
unique to children and families that interface with schools. The work 18
group cochairs may invite nonwork group members to participate as 19
advisory group members. 20
(6)(a) Subject to the availability of amounts appropriated for 21
this specific purpose, the work group shall convene an advisory group 22
for the purpose of developing a draft strategic plan that describes:23
(i) The current landscape of behavioral health services available 24
to families in the perinatal phase, children, youth transitioning 25
into adulthood, and the caregivers of those children and youth in 26
Washington state, including a description of: 27
(A) The gaps and barriers in receiving or accessing behavioral 28
health services, including services for co-occurring behavioral 29
health disorders or other conditions; 30
(B) Access to high quality, equitable care and supports in 31
behavioral health education and promotion, prevention, intervention, 32
treatment, recovery, and ongoing well-being supports;33
(C) The current supports and services that address emerging 34
behavioral health issues before a diagnosis and more intensive 35
services or clinical treatment is needed; and 36
(D) The current behavioral health care oversight and management 37
of services and systems; 38
(ii) The vision for the behavioral health service delivery system 39
for families in the perinatal phase, children, youth transitioning 40
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into adulthood, and the caregivers of those children and youth, 1
including: 2
(A) A complete continuum of services from education, promotion, 3
prevention, early intervention through crisis response, intensive 4
treatment, postintervention, and recovery, as well as supports that 5
sustain wellness in the behavioral health spectrum;6
(B) How access can be provided to high quality, equitable care 7
and supports in behavioral health education, promotion, prevention, 8
intervention, recovery, and ongoing well-being when and where needed;9
(C) How the children and youth behavioral health system must 10
successfully pair with the 988 behavioral health crisis response 11
described under chapter 82.86 RCW; 12
(D) The incremental steps needed to achieve the vision for the 13
behavioral health service delivery system based on the current gaps 14
and barriers for accessing behavioral health services, with estimated 15
dates for these steps; and 16
(E) The oversight and management needed to ensure effective 17
behavioral health care; and 18
(iii) A comparison of the current behavioral health system for 19
families in the perinatal phase, children, youth transitioning into 20
adulthood, and the caregivers of those children and youth that is 21
primarily based on crisis response and inadequate capacity with the 22
behavioral health system vision created by the strategic planning 23
process through a cost-benefit analysis. 24
(b) The work group cochairs shall appoint a chair for the 25
strategic plan advisory group and may invite nonwork group members to 26
participate as advisory group members, but the strategic plan 27
advisory group shall include, at a minimum: 28
(i) Community members with lived experience including those with 29
cultural, linguistic, and ethnic diversity, as well as those having 30
diverse experience with behavioral health care invited by the work 31
group cochairs; 32
(ii) A representative from the department of children, youth, and 33
families; 34
(iii) A representative from the department; 35
(iv) A representative from the authority; 36
(v) A representative from the department of health;37
(vi) A representative from the office of homeless youth 38
prevention and protection programs; 39
(vii) A representative from the office of the governor;40
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(viii) A representative from the developmental disability 1
administration of the department of social and health services;2
(ix) A representative from the office of the superintendent of 3
public instruction; 4
(x) A representative from the office of the insurance 5
commissioner; 6
(xi) A tribal representative; 7
(xii) Two legislative members or alternates from the work group; 8
and 9
(xiii) Individuals invited by the work group cochairs with 10
relevant subject matter expertise. 11
(c) The health care authority shall conduct competitive 12
procurements as necessary in accordance with chapter 39.26 RCW to 13
select a third-party facilitator to facilitate the strategic plan 14
advisory group. 15
(d) To assist the strategic plan advisory group in its work, the 16
authority, in consultation with the cochairs of the work group, shall 17
select an entity to conduct the activities set forth in this 18
subsection. The health care authority may contract directly with a 19
public agency as defined under RCW 39.34.020 through an interagency 20
agreement. If the health care authority determines, in consultation 21
with the cochairs of the work group, that a public agency is not 22
appropriate for conducting these analyses, the health care authority 23
may select another entity through competitive procurements as 24
necessary in accordance with chapter 39.26 RCW. The activities that 25
entities selected under this subsection must complete include:26
(i) Following a statewide stakeholder engagement process, a 27
behavioral health landscape analysis for families in the perinatal 28
phase, children, youth transitioning into adulthood, and the 29
caregivers of those children and youth outlining: 30
(A) The current service continuum including the cost of care, 31
delivery service models, and state oversight for behavioral health 32
services covered by medicaid and private insurance;33
(B) Current gaps in the service continuum, areas without access 34
to services, workforce demand, and capacity shortages;35
(C) Barriers to accessing preventative services and necessary 36
care including inequities in service access, affordability, cultural 37
responsiveness, linguistic responsiveness, gender responsiveness, and 38
developmentally appropriate service availability; and39
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(D) Incorporated information provided by the 988 crisis hotline 1
crisis response improvement strategy committee; 2
(ii) A gap analysis estimating the prevalence of needs for 3
Washington state behavioral health services for families in the 4
perinatal phase, children, youth transitioning into adulthood, and 5
the caregivers of those children and youth served by medicaid or 6
private insurance, including: 7
(A) The estimated number of families in the perinatal phase, 8
children, youth transitioning into adulthood, and the caregivers of 9
those children and youth who need clinical behavioral health services 10
or could benefit from preventive or early intervention services on an 11
annual basis; 12
(B) The estimated number of expectant parents and caregivers in 13
need of behavioral health services; 14
(C) A collection and analysis of disaggregated data to better 15
understand regional, economic, linguistic, gender, and racial gaps in 16
access to behavioral health services; 17
(D) The estimated costs of providing services that include a 18
range of behavioral health supports that will meet the projected 19
needs of the population; and 20
(E) Recommendations on the distribution of resources to deliver 21
needed services to families in the perinatal phase, children, youth 22
transitioning into adulthood, and the caregivers of those children 23
and youth across multiple settings; and 24
(iii) An analysis of peer-reviewed publications, evidence-based 25
practices, and other existing practices and guidelines with preferred 26
outcomes regarding the delivery of behavioral health services to 27
families in the perinatal phase, children, youth transitioning into 28
adulthood, and the caregivers of those children and youth across 29
multiple settings including: 30
(A) Approaches to increasing access and quality of care for 31
underserved populations; 32
(B) Approaches to providing developmentally appropriate care;33
(C) The integration of culturally responsive care with effective 34
clinical care practices and guidelines; 35
(D) Strategies to maximize federal reinvestment and resources 36
from any alternative funding sources; and 37
(E) Workforce development strategies that ensure a sustained, 38
representative, and diverse workforce. 39
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(e) The strategic plan advisory group shall prioritize its work 1
as follows: 2
(i) Hold its first meeting by September 1, 2022;3
(ii) Provide a progress report on the development of the 4
strategic plan, including a timeline of future strategic plan 5
development steps, to be included in the work group's 2022 annual 6
report required under subsection (10) of this section;7
(iii) Provide a progress report on the development of the 8
strategic plan, including discussion of the work group 9
recommendations that align with the strategic plan development thus 10
far, to be included in the work group's 2024 annual report required 11
under subsection (10) of this section; 12
(iv) Provide a draft strategic plan, along with any materials 13
produced by entities selected under (d) of this subsection, to the 14
work group by August 1, 2025. The draft strategic plan must be 15
developed in coordination with the joint legislative and executive 16
committee on behavioral health established in section 135 (15), 17
chapter 475, Laws of 2023, the department of health, and the health 18
care authority related to the implementation of the 988 crisis 19
hotline. 20
(f) The work group shall discuss the draft strategic plan and 21
adopt a final strategic plan that must be submitted to the governor 22
and the appropriate committees of the legislature at the same time as 23
the work group's 2025 annual report required under subsection (10) of 24
this section. 25
(7)(a) Staff support for the work group, including administration 26
of work group meetings and preparation of full work group 27
recommendations and reports required under this section, must be 28
provided by the health care authority. 29
(b) Additional staff support for legislative members of the work 30
group may be provided by senate committee services and the house of 31
representatives office of program research. 32
(c) Subject to the availability of amounts appropriated for this 33
specific purpose, the office of the superintendent of public 34
instruction must provide staff support to the school-based behavioral 35
health and suicide prevention advisory group, including 36
administration of advisory group meetings and the preparation and 37
delivery of advisory group recommendations to the full work group.38
(8)(a) Legislative members of the work group are reimbursed for 39
travel expenses in accordance with RCW 44.04.120. Nonlegislative 40
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members are not entitled to be reimbursed for travel expenses if they 1
are elected officials or are participating on behalf of an employer, 2
governmental entity, or other organization. Except as provided under 3
(b) of this subsection, any reimbursement for other nonlegislative 4
members is subject to chapter 43.03 RCW. 5
(b) Members of the children and youth behavioral health work 6
group or an advisory group established under this section with lived 7
experience may receive a stipend of up to $200 per day if:8
(i) The member participates in the meeting virtually or in 9
person, even if only participating for one meeting and not on an 10
ongoing basis; and 11
(ii) The member does not receive compensation, including paid 12
leave, from the member's employer or contractor for participation in 13
the meeting. 14
(9) The following definitions apply to this section:15
(a) "A member with lived experience" means an individual who has 16
received behavioral health services or whose family member has 17
received behavioral health services; and 18
(b) "Families in the perinatal phase" means families during the 19
time from pregnancy through one year after birth. 20
(10) Beginning November 1, 2020, and annually thereafter, the 21
work group shall provide recommendations in alignment with subsection 22
(3) of this section to the governor and the legislature. Beginning 23
November 1, 2026, the work group shall include in its annual report a 24
discussion of how the work group's recommendations align with the 25
final strategic plan described under subsection (6) of this section.26
(11) This section expires December 30, ((2029)) 2031.27
NEW SECTION. Sec. 2. A new section is added to chapter 43.06 28
RCW to read as follows: 29
(1) The governor shall, to the extent possible with existing 30
resources, support and facilitate coordination between various state 31
agencies to follow the framework of the strategic plan developed 32
under RCW 74.09.4951(6). 33
(2) The governor may use private funding sources to support the 34
strategic plan developed under RCW 74.09.4951(6), including the 35
support and facilitation of coordination between state agencies 36
described under subsection (1) of this section. 37
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NEW SECTION. Sec. 3. A new section is added to chapter 43.06 1
RCW to read as follows: 2
The governor shall maintain an executive coordination officer for 3
the children and youth system of care for the purposes of:4
(1) Coordinating and monitoring the state government 5
implementation of the Washington thriving strategic plan developed 6
under RCW 74.09.4951(6) across various state agencies;7
(2) Building the infrastructure described in the Washington 8
thriving strategic plan developed under RCW 74.09.4951(6);9
(3) Coordinating private funding used to support the Washington 10
thriving strategic plan developed under RCW 74.09.4951(6); and11
(4) Monitoring, in coordination with the Washington state office 12
of equity, the equity impacts of implementation of the Washington 13
thriving strategic plan developed under RCW 74.09.4951(6).14
Sec. 4. RCW 71.36.025 and 2019 c 325 s 2011 are each amended to 15
read as follows: 16
(1) It is the goal of the legislature that the children's mental 17
health system in Washington state align with the Washington thriving 18
strategic plan developed under RCW 74.09.4951(6) and include the 19
following elements: 20
(a) A continuum of services from early identification, 21
intervention, and prevention through crisis intervention and 22
inpatient treatment, including peer support and parent mentoring 23
services; 24
(b) Equity in access to services for similarly situated children, 25
including children with co-occurring disorders; 26
(c) Developmentally appropriate, high quality, and culturally 27
competent services available statewide; 28
(d) Treatment of each child in the context of his or her family 29
and other persons that are a source of support and stability in his 30
or her life; 31
(e) A sufficient supply of qualified and culturally competent 32
children's mental health providers; 33
(f) Use of developmentally appropriate evidence-based and 34
research-based practices; 35
(g) Integrated and flexible services to meet the needs of 36
children who, due to mental illness or emotional or behavioral 37
disturbance, are at risk of out-of-home placement or involved with 38
multiple child-serving systems. 39
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(2) The effectiveness of the children's mental health system 1
shall be determined through the use of outcome-based performance 2
measures. The health care authority and the evidence-based practice 3
institute established in RCW 71.24.061, in consultation with parents, 4
caregivers, youth, behavioral health administrative services 5
organizations, managed care organizations contracted with the 6
authority under chapter 74.09 RCW, mental health services providers, 7
health plans, primary care providers, tribes, and others, shall 8
develop outcome-based performance measures such as:9
(a) Decreased emergency room utilization; 10
(b) Decreased psychiatric hospitalization; 11
(c) Lessening of symptoms, as measured by commonly used 12
assessment tools; 13
(d) Decreased out-of-home placement, including residential, 14
group, and foster care, and increased stability of such placements, 15
when necessary; 16
(e) Decreased runaways from home or residential placements;17
(f) Decreased rates of substance use disorder;18
(g) Decreased involvement with the juvenile justice system;19
(h) Improved school attendance and performance;20
(i) Reductions in school or child care suspensions or expulsions;21
(j) Reductions in use of prescribed medication where cognitive 22
behavioral therapies are indicated; 23
(k) Improved rates of high school graduation and employment; and24
(l) Decreased use of mental health services upon reaching 25
adulthood for mental disorders other than those that require ongoing 26
treatment to maintain stability. 27
(3) Performance measure reporting for children's mental health 28
services should be integrated into existing performance measurement 29
and reporting systems developed and implemented under chapter 71.24 30
RCW. 31
(4) Any agency shall ensure that children and youth behavioral 32
health activities and planning efforts align with the Washington 33
thriving strategic plan developed under RCW 74.09.4951(6) and are 34
implemented in an equitable manner.35
NEW SECTION. Sec. 5. A new section is added to chapter 43.06 36
RCW to read as follows: 37
(1) The governor shall establish a leadership council to address 38
children and youth health and wellness issues and coordinate efforts 39
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to implement the Washington thriving strategic plan developed under 1
RCW 74.09.4951(6) and appoint members as provided in subsection (2) 2
of this section. 3
(2) The children and youth behavioral health leadership council 4
established in this section shall, at a minimum, include 5
representation from: 6
(a) Representatives from state agencies involved in children and 7
youth behavioral health or wellness activities identified by the 8
governor; 9
(b) Individuals with lived experience caring for individuals with 10
behavioral health issues experienced as a child or youth; and11
(c) Individuals representing a federally recognized Indian tribe 12
or tribes whose traditional lands and territories included parts of 13
Washington. 14
(3) The children and youth behavioral health leadership council 15
established in this section shall: 16
(a) Report to the governor on state agency practices and provide 17
recommendations for changes in state policy or practices that will 18
help implement the Washington thriving strategic plan developed under 19
RCW 74.09.4951(6); 20
(b) Provide easily accessible and publicly available updates 21
regarding the actions, decisions, and recommendations of the 22
leadership council; and 23
(c) Notify the governor and the appropriate committees of the 24
legislature when it believes that the executive coordination officer 25
for the children and youth system of care established in section 3 of 26
this act has accomplished the goals of that position and is no longer 27
needed. 28
(4) The children and youth behavioral health leadership council 29
established in this section may seek advice from the children and 30
youth behavioral health work group established in RCW 74.09.4951.31
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