Lack of behavioral health care in WA forces families apart

Few in-state options means some parents must choose between the health of their kids and being with them.

A girl on a bike looks at her mom who stands holding a framed picture of a boy

Richelle Madigan's 9-year-old daughter, Ceryn, plays outside on their 5-acre property at their home near Moses Lake, Grant County, on May 28, 2020. Madigan holds a picture of her son, Christian, who has been in inpatient care for the past four years, first in Lakewood, and now in Spokane. The family traveled the three hours to Lakewood, then the hour and a half to Spokane, for biweekly visits, before COVID-19 stopped all in-person visitations. Now, they may have to fly to the East Coast to see him. (Emily McCarty/Crosscut)

Playing outside with her seven kids on her 5-acre property outside of Moses Lake, Richelle Madigan has her hands full. But she and her husband wish they had just one more reason to be busy.

Christian, their 12-year-old adopted son, is currently in inpatient treatment for children with behavioral issues at a facility in Spokane. One year ago, the facility issued him a 30-day notice, which has been extended to a year, for his increasingly difficult and violent behaviors, effectively giving the family a deadline. The family has been trying to find him an appropriate placement ever since.

But on June 12, that extension will end, and Christian will be discharged — and the Madigans have no one to turn to. He already spent two years in the state’s only public option for long-term mental health inpatient care for kids, called CLIP (Children’s Long-term Inpatient Program). Contrary to its name, CLIP typically houses children for fewer than 12 months, and Christian’s stay far surpassed that.

When parents with children like Christian run out of public options in Washington, they are forced to look out of state.

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Helen Caldart, a special education advocate at SEAL, the Special Education Advocates League, works with schools and parents to find those placements. She also sits on the CLIP committee for Pierce County. She was thrust into navigating the world of children’s behavioral health when she adopted a son born addicted to heroin.

School districts are required to provide "free appropriate public education" to students with disabilities ages 3 to 21. Behavioral healthcare often overlaps with a student's special education plan, called an IEP, and if those behavioral and educational needs can't be met within their public school, the state of Washington, through the school district, is responsible for paying for what's called a NonPublic Agency, of which 34 of the currently approved 64 are out of state. Those out-of-state facilities are of the type missing in Washington.

Washington’s largest hindrance to the lack of long-term facilities for youth is the age of consent in state law. At 13, teens can begin making their own behavioral health care decisions. This changed a small amount when House Bill 1874 passed in July 2019, where parents could legally become more involved in their children’s mental health care. But ultimately, teenagers have the most control about what care they receive.

Caldart said while CLIP serves a purpose, it isn’t meant for long-term care. And after youth leave this facility, there’s often nothing left.

“I don’t have one [kid] at this point that I’m aware of that’s been successful after they leave CLIP, because they just don’t have the skill set or time under their belt, yet, in order to function,” Caldart said. “We just don’t have the support services inside this state when they do leave.”

Richelle Madigan stands outside in her yard near Moses Lake on May 28, 2020, with two of her daughters, Ceryn, 9, and Aaralyn, 5. She balances a photo of Christian on top of one of the few possessions Christian came with from his last foster parent: a child's play car. Christian went through two foster homes before he came to the Madigans, but now, he's finally home: "We made a commitment to him that we would stay no matter what," Richelle said. (Emily McCarty/Crosscut)

In 2018, Christian was discharged after two years in CLIP, but was still deemed unsafe to be in the community even with significant support, so was sent to the residential group home in Spokane operated by Breakthough where he currently resides.

He needed inpatient care, locked doors and a high level of structure and safety, Madigan said. The problem was that Washington state doesn’t have that resource. Christian’s care team meets with his family every Friday, but their efforts to find a new solution have so far been unsuccessful. They’ve gone through a list of dozens of national placement options, Madigan said, and are trying to find somewhere that is a fit for Christian — as well as being a place that will accept him. 

Christian has a lot of needs. He had a rough start in life, born prematurely at about 32 weeks, suffering a brain injury from a lack of oxygen. He had other health issues at birth and in the months and years after. He was in intensive care for over a month and then Child Protective Services removed him from his biological mom because they found alcohol and barbiturates in his system. After two weeks in a foster home, he moved in with another foster mother, until she started to notice major behavioral issues and, because of her age, she worried she wouldn’t be able to take care of him.

Christian was then sent to the Madigans, who have taken care of him ever since with help from the state.

Multiple people have told Richelle Madigan that Christian is one of the most behaviorally challenged kids in the state, she said. 

Christian is autistic and has disruptive mood dysregulation disorder, ADHD and oppositional defiance disorder, among other behavioral diagnoses.

“He's kind of Dr. Jekyll/Mr. Hyde and the nature of his disability is such that when he's not dysregulated, he's delightful. He's kind, he's eager to please, he's wonderful,” Madigan said. “When he gets dysregulated … he will physically and sexually assault whoever is closest and also harms property and he self-injures.”

Although the Madigans feel like it’s the best option, sending him out of state will be hard on the family. They’re close with Christian, even with everything they’ve been through, Madigan said, and visiting him in another state will be logistically and financially difficult.

“It’s going to be incredibly traumatic for him and for our whole family if he goes someplace like Massachusetts, where we can’t bring our whole family to see him,” she said. “There isn’t anybody out advocating for these kids, kids who are disabled but whose disability makes them a chronic danger to themselves and others. They’re just not getting any support.”

Jason and Richelle Madigan sit on the porch of their home in Moses Lake on May 28, 2020, surrounded by their seven children, who range in age from 3 to 15. Their eighth child, 12-year-old Christian, smiles goofily inside the picture frame they brought outside to include him in the family photo because he currently is in an inpatient behavioral healthcare facility. (Emily McCarty/Crosscut)

SEAL’s Caldart wants to see these out-of-state models brought to Washington state to prevent this kind of family separation. She has placed five children in a facility in Kansas, where the state is paying a bill of $15,000 a month per child. The minimum cost she’s seen for facilities she’s worked with is $10,000 a month.

And rural families have it even harder, Caldart said. Larger school districts like Seattle don’t put up much of a fight to provide alternatives for special education students. But for smaller districts? “We almost always have to file a due process to even get the behavior support we need,” she said.

There’s also a lot of confusion for parents, who don’t know their options. That’s where SEAL steps in, compiling documents on its site, attending PTA meetings and providing one-on-one support for parents.

Banji Bottcher, a 46-year-old mother in Tacoma, met Caldart at a special needs PTA meeting. She was at wit’s end with her options for her 14-year-old son, Isaiah, who was discharged from CLIP on April 21. 

She didn’t want Isaiah discharged, especially in the midst of a pandemic. She’s had to use family leave to take time off work because he can’t be home alone. Isaiah has PTSD, ADHD and dysregulated mood disorder, along with learning disabilities. 

Bottcher is looking at two options for his next placement. While one is in Bellevue, she thinks the out-of-state option, at Logan River Academy in Utah, is far superior for Isaiah’s needs. 

Currently, Isaiah has access to WISe, or wraparound with intensive services, a program from the state Health Care Authority that is just what its name says — wraparound services for the family, with crisis care available 24 hours a day.

But that isn’t enough for a child with more specialized needs, especially one with physical aggression toward himself and others.

“He needs a structured environment in order to be successful, and a regular school or an EBD [emotional and behavior disorders] classroom that he can just walk in and out of is not enough structure for him,” Bottcher said. “I was kind of skeptical at first of sending him out of state, but I watched the video with Logan Academy and I talked to the director, and it just seemed like a really good fit.” 

But while she waits for another placement, Isaiah is at home, with WISe available only over the phone, as it isn't doing in-home visits during the COVID-19 pandemic.

Even if a CLIP bed were available, because Isaiah is over 12, he would have to agree to be admitted — and he doesn’t want to go back.

“It's really frustrating that [CLIP] wouldn't extend it longer just to kind of help get things set up somehow for him,” Bottcher said. “It's almost like they just kick them out the door and to the wolves, you know, sink or swim.”

Madigan feels similarly isolated with her options running out after CLIP.

“[It’s] Christian and I versus the world,” Madigan said. “It makes me cry. I lose sleep. It makes me mad. … It drives me to try and inflict change on our system.”

To meet some of these changes, Madigan joined the Behavioral Health Advisory Council for Washington state, where she sits on the executive committee, which helps guide parents through the confusing behavioral health inpatient system.

“There's a huge, huge need. There are a lot of people in the situation of making these traumatic decisions for their kids. … I really wish the state would take a look at the prevalence of … kids [who] have this need for residential treatment,” Madigan said. “Even if it was only one family, then we should come up with one resource to meet one family’s need. But it’s not one family, and it’s not one kid.”


This article was updated to reflect the correct spelling of Banji Bottcher's last name.

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About the Authors & Contributors

Emily McCarty

Emily McCarty

Emily McCarty is formerly a reporter for Crosscut, where she covered central Washington.