T.R. v. Dreyfus and the Road to Reform

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T.R. v. Dreyfus and the Road to Reform

Improved Mental Health Services for Young People in Washington State – Part 3

This blog post is the third and final part of a three-part series highlighting mental health reform litigation that Young Minds’ has been working on with our co-counsel in Washington State.  Filed in 2009, T.R. v. Dreyfus is a federal class action lawsuit brought on behalf of Medicaid-eligible youth in Washington. The lawsuit seeks to improve children’s access to intensive home and community-based mental health services and supports.

Part 1: Intensive Home & Community Based Service – The Benefits of Individualized Services (Posted on 8/15/13)
Part 2:  The Challenges and Opportunities for Reform in Washington (Posted on 8/22/13)
Part 3: T.R. v. Dreyfus – A Statewide Partnership for Reform

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Part 3 – Settlement Filed in Washington State Should Lead to Improved Access to Mental Health Services for Thousands of Young People!

It has been four years in the making, but after a year of litigation and many more months of complex negotiations, the parties in T.R. v. Dreyfus reached an agreement that will result in improved access to intensive home and community-based mental health services for Medicaid-eligible young people. Yesterday, plaintiffs’ counsel filed the parties’ proposed settlement agreement with the Honorable Judge Thomas Zilly of the United States District Court for the Western District of Washington. A copy of the full agreement can be found here.

The Settlement Agreement 

The central purpose of the Agreement is to develop  “a sustainable service delivery system for intensive home and community based mental health services to Medicaid eligible children and youth.”  Due to the size and scope of the proposed system reform, it will take as long as five years to complete implementation.

As part of the Agreement, state defendants committed to include in Washington’s Medicaid plan: (1) Intensive Care Coordination, (2) Intensive Home and Community Based Services, and (3) Mobile Crisis Intervention and Stabilization Services.  These three services are collectively referred to as Wraparound with Intensive Services (WISe). A more detailed description of these services can be found here. All services will be individualized to meet each class member’s unique needs, and provided in conjunction with a Child and Family Team.

The State will begin transitioning existing intensive services to the WISe program in January 2014, and plans to further expand services in a phased approach over the next several years.  Once fully implemented, Washington’s WISe program will have statewide capacity to deliver medically necessary WISe services and supports to as many as 6,000 young people annually.  The parties anticipate completing implementation of the settlement agreement by June 2018. 

The proposed Agreement resulted, in part, from a strong positive working relationship between plaintiffs and defendants. The relationship is largely attributable to the state’s leadership on children’s mental health system reform that is intended to improve outcomes for young people and their families. 

“The plaintiffs and the State agreed that the needs of these most vulnerable children, youth and their families, would not be served by a long-drawn-out litigation,” observed Assistant Secretary Jane Beyer, DSHS Behavioral Health and Service Integration. “We determined that providing intensive services in their homes and communities is the best approach to improving the outcomes for children and youth with the greatest need.”  The parties are hopeful that this collaborative partnership will carry through the process of implementation.

Washington’s Commitment to Reform

The proposed settlement is structured to give Washington maximum flexibility in administering its programs, while at the same time, ensuring that critical milestones and key outcomes are met.  The milestones are described in the Commitments section (part V.) of the Agreement.  The outcomes are detailed as Exit Procedure and Criteria (part VI.).  The agreement addresses many aspects of service design and delivery, including:

  • Access & Service Delivery
    • Washington will provide training to health care providers and child-serving agencies on how to identify and refer youth for WISe screening.
    • Class members and their families may self-refer to WISe services, and accessible information will be provided about the WISe Program, including explanations of how to access services.
    • The Child Adolescent Needs and Strengths (CANS) assessment tool will be part of the WISe screening process, and used statewide to manage and communicate about performance and outcomes.
    • Services will be provided according to a consistent and transparent protocol, outlined here.
  • Due Process
    • Class members have a right to object to decisions about their treatment services.
    • Washington State will require Prepaid Health Plains (PIHPs)(also known as Regional Support Networks) to notify class members of their due process rights by issuing a Notice of Action. PIHPs will be required to monitor and report on service reductions, terminations and denials.
  • Governance & Collaboration:
    • Youth and family will have an increased role in WISe program policy development and decision-making through Family Youth and System Partner Roundtables (FYSPRT) at both the regional and statewide level.  FYSPRTs are integral operating bodies within the larger interagency Children’s Mental Health Governance Structure (Governance Structure), outlined here.
    • Department of Social and Health Services and the Health Care Authority agencies will establish cross-system agreements to coordinate service delivery to class members. These agreements are intended to better coordinate funding, training, and data-informed quality control.
  • Quality Management:
    • Washington will develop a Quality Assurance Plan (QAP) with input from stakeholders. The QAP will include quality assurance tools, activities, and resources necessary to track implementation of the settlement agreement and monitor individual client outcomes and system performance.  The QAP will include steps to integrate data across DHCS and HCA’s child-serving systems.
    • Data will be collected and disseminated on the number of youth identified, screened, and assessed for WISe services.
  • Implementation Plan
    • Washington will complete an implementation plan within six months, and submit it to the court for approval.
    • Starting November 2014, the State Defendants will provide the court, the plaintiffs, and the public with an annual implementation status report.

Preliminary Response is Positive 

Tina's-CommnetIn an article in The Seattle Times Mark Stroh executive director of Disability Rights Washington (DRW) said “With this settlement, Washington has committed to build a mental health system that will bring this law to life for all young Medicaid beneficiaries who need intensive mental health services in order to grow up healthy in their own homes, schools, and communities.”

 Washington State Medicaid Director MaryAnne Lindeblad similarly emphasized the State’s dedication to systemic reform: “While our plan is based on a realistic phased approach, it carries a new and profound commitment to these families and their future of their children and youth.”

“This settlement agreement is a significant accomplishment and puts Washington among the leaders in the country in reforming the mental health system and providing Medicaid services to children,” said Kimberly Lewis, Managing Attorney at the National Health Law Program.

Patrick Gardner, President of Young Minds Advocacy Project, is confident that the Court will approve this agreement, “because it commits the state to increase access to care to thousands of young people who need intensive services and supports to remain safely in their homes, succeed in school, and avoid getting into trouble.  Everyone supports the transformation of Washington’s mental health system for young people into a more individualized, family centered, and collaborative model.”

What’s Next? 

Federal law requires that the parties obtain court approval of the settlement.  The first step in the process is the Court’s preliminary approval of the proposed Settlement Agreement.   If the Court grants its approval, the parties will notify class members about the proposed settlement and inform them of their right to comment on the Agreement.   

The court will schedule a fairness hearing, during which the court will consider all the evidence received and make a final determination.  If the Judge finds the settlement fair, reasonable, and adequate, the Court will approve the Agreement.

Over the next several months, Young Minds will provide updates on the progress on Washington’s Road to Reform including making more resources available regarding the settlement and describing opportunities to get involved. If you haven’t already subscribed to our e-mail list, click HERE, so you don’t miss any updates.

Individuals who believe they may be affected by the settlement can get more information about WISe services and the agreement by contacting Disability Rights Washington at 1-800-562-2702.

Additional Resources:

  • Settlement Agreement
  • Plaintiff’s Press Release
  • To hear more from Tina, check out Disability Rights Washington’s video here or this news article on Q13Fox.com
  • Disability Rights Washington – Resource Page and Video Announcement: “A Strategy for Success”
  • Washington State Department of Social and Health Services – “Overview of Improvements”
  • Seattle Times – “State to Boost Care for Medicaid Youths”
By |2019-04-24T13:45:33-08:00August 30th, 2013|Featured Posts, Litigation, T.R.|0 Comments

About the Author:

Annabelle Gardner
Annabelle Gardner is the director of communications at Young Minds and editor in chief of our blog, Hear Me Out. She believes storytelling is a powerful tool for social change.