ENGROSSED SECOND SUBSTITUTE HOUSE BILL 2245
State of Washington 68th Legislature 2024 Regular Session
By House Appropriations (originally sponsored by Representatives
Bronoske, Eslick, Ramel, Senn, Reed, Macri, Leavitt, and Davis)
READ FIRST TIME 02/05/24.
1 AN ACT Relating to establishing co-response services and training
2 as an essential component of the crisis care continuum; amending RCW
3 71.24.905; reenacting RCW 71.24.025; adding new sections to chapter
4 71.24 RCW; and creating new sections.
5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
6 NEW SECTION. Sec. 1. The goals of co-response are to de-
7 escalate situations, divert people from criminal justice and
8 emergency medical systems, and bring medical and behavioral health
9 care into the field to serve vulnerable populations.
10 During the 2022 legislative session, the legislature passed
11 Substitute Senate Bill No. 5644 which, among other tasks, required a
12 behavioral health landscape analysis. The analysis showed that over
13 60 co-response teams are currently operating across the state with
14 gaps in funding and services among various regions as well as siloed
15 systems of crisis response between 911 and 988.
16 The legislature recognizes that there is a need for high acuity
17 first response services for people experiencing behavioral health
18 emergencies as the 988 hotline and behavioral health crisis response
19 systems develop. To help address this need, 911 and 988 personnel
20 must work together to create a seamless crisis care delivery system
21 for individuals in crisis. The 911 co-response teams respond to
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 1 behavioral health emergencies and other complex needs at the nexus of
2 health and behavioral health. First responders are critical to the
3 provision of medical care in the field and ongoing case management
4 and follow-up services, and they fill gaps in care when there are no
5 mobile crisis teams available.
6 The legislature recognizes the need for high quality training and
7 certification, workforce development, and peer support to enhance
8 regional collaboration. High quality training and regional
9 collaboration are essential for co-response service delivery to be
10 optimized due to discrepancies in current program efficacy and
11 outcomes. Behavioral health workforce shortages impact co-response,
12 and the nature of the work is challenging as critical incidents
13 happen regularly.
14 NEW SECTION. Sec. 2. A new section is added to chapter 71.24
15 RCW to read as follows:
16 (1) The University of Washington school of social work, in
17 consultation with the authority, shall establish a pilot program to
18 administer a co-response education training academy resulting in a
19 certification in co-response best practices in three behavioral
20 health administrative service organizations with a significant co-
21 response footprint. The co-response education training academy shall
22 be expanded to all 10 behavioral health administrative service
23 organizations by 2026. The certification shall be optional and may
24 not serve as an additional requirement for licensure for first
25 responders or licensed human services professionals.
26 (2) The University of Washington school of social work shall
27 explore, in collaboration with the department and the authority, the
28 development of a credential for licensure for behavioral health co-
29 responders.
30 (3) The University of Washington school of social work may
31 provide grants to small and rural co-response programs for staff to
32 attend the training to offset increased costs associated with sending
33 staff to training.
34 NEW SECTION. Sec. 3. A new section is added to chapter 71.24
35 RCW to read as follows:
36 The University of Washington school of social work, in
37 consultation with the authority, shall explore the feasibility of
38 collaborations across the state's institutions of higher education to
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1 develop a crisis training certificate for associate, bachelor, and
2 master's degree candidates who want to become crisis responders.
3 NEW SECTION. Sec. 4. A new section is added to chapter 71.24
4 RCW to read as follows:
5 The University of Washington school of social work shall
6 collaborate with a statewide organization focused on co-response
7 outreach to develop and pilot a statewide internal peer support
8 program designed to assist co-response professionals who have faced
9 life-threatening or traumatic incidents that occur while on the job.
10 Sec. 5. RCW 71.24.025 and 2023 c 454 s 1 and 2023 c 433 s 1 are
11 each reenacted and amended to read as follows:
12 Unless the context clearly requires otherwise, the definitions in
13 this section apply throughout this chapter.
14 (1) "23-hour crisis relief center" means a community-based
15 facility or portion of a facility serving adults, which is licensed
16 or certified by the department of health and open 24 hours a day,
17 seven days a week, offering access to mental health and substance use
18 care for no more than 23 hours and 59 minutes at a time per patient,
19 and which accepts all behavioral health crisis walk-ins drop-offs
20 from first responders, and individuals referred through the 988
21 system regardless of behavioral health acuity, and meets the
22 requirements under RCW 71.24.916.
23 (2) "988 crisis hotline" means the universal telephone number
24 within the United States designated for the purpose of the national
25 suicide prevention and mental health crisis hotline system operating
26 through the national suicide prevention lifeline.
27 (3) "Acutely mentally ill" means a condition which is limited to
28 a short-term severe crisis episode of:
29 (a) A mental disorder as defined in RCW 71.05.020 or, in the case
30 of a child, as defined in RCW 71.34.020;
31 (b) Being gravely disabled as defined in RCW 71.05.020 or, in the
32 case of a child, a gravely disabled minor as defined in RCW
33 71.34.020; or
34 (c) Presenting a likelihood of serious harm as defined in RCW
35 71.05.020 or, in the case of a child, as defined in RCW 71.34.020.
36 (4) "Alcoholism" means a disease, characterized by a dependency
37 on alcoholic beverages, loss of control over the amount and
38 circumstances of use, symptoms of tolerance, physiological or
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 1 psychological withdrawal, or both, if use is reduced or discontinued,
2 and impairment of health or disruption of social or economic
3 functioning.
4 (5) "Approved substance use disorder treatment program" means a
5 program for persons with a substance use disorder provided by a
6 treatment program licensed or certified by the department as meeting
7 standards adopted under this chapter.
8 (6) "Authority" means the Washington state health care authority.
9 (7) "Available resources" means funds appropriated for the
10 purpose of providing community behavioral health programs, federal
11 funds, except those provided according to Title XIX of the Social
12 Security Act, and state funds appropriated under this chapter or
13 chapter 71.05 RCW by the legislature during any biennium for the
14 purpose of providing residential services, resource management
15 services, community support services, and other behavioral health
16 services. This does not include funds appropriated for the purpose of
17 operating and administering the state psychiatric hospitals.
18 (8) "Behavioral health administrative services organization"
19 means an entity contracted with the authority to administer
20 behavioral health services and programs under RCW 71.24.381,
21 including crisis services and administration of chapter 71.05 RCW,
22 the involuntary treatment act, for all individuals in a defined
23 regional service area.
24 (9) "Behavioral health aide" means a counselor, health educator,
25 and advocate who helps address individual and community-based
26 behavioral health needs, including those related to alcohol, drug,
27 and tobacco abuse as well as mental health problems such as grief,
28 depression, suicide, and related issues and is certified by a
29 community health aide program of the Indian health service or one or
30 more tribes or tribal organizations consistent with the provisions of
31 25 U.S.C. Sec. 1616l and RCW 43.71B.010 (7) and (8).
32 (10) "Behavioral health provider" means a person licensed under
33 chapter 18.57, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79 RCW, as
34 it applies to registered nurses and advanced registered nurse
35 practitioners.
36 (11) "Behavioral health services" means mental health services,
37 substance use disorder treatment services, and co-occurring disorder
38 treatment services as described in this chapter and chapter 71.36 RCW
39 that, depending on the type of service, are provided by licensed or
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 1 certified behavioral health agencies, behavioral health providers, or
2 integrated into other health care providers.
3 (12) "Child" means a person under the age of eighteen years.
4 (13) "Chronically mentally ill adult" or "adult who is
5 chronically mentally ill" means an adult who has a mental disorder
6 and meets at least one of the following criteria:
7 (a) Has undergone two or more episodes of hospital care for a
8 mental disorder within the preceding two years; or
9 (b) Has experienced a continuous psychiatric hospitalization or
10 residential treatment exceeding six months' duration within the
11 preceding year; or
12 (c) Has been unable to engage in any substantial gainful activity
13 by reason of any mental disorder which has lasted for a continuous
14 period of not less than twelve months. "Substantial gainful activity"
15 shall be defined by the authority by rule consistent with Public Law
16 92-603, as amended.
17 (14) "Clubhouse" means a community-based program that provides
18 rehabilitation services and is licensed or certified by the
19 department.
20 (15) "Community behavioral health program" means all
21 expenditures, services, activities, or programs, including reasonable
22 administration and overhead, designed and conducted to prevent or
23 treat substance use disorder, mental illness, or both in the
24 community behavioral health system.
25 (16) "Community behavioral health service delivery system" means
26 public, private, or tribal agencies that provide services
27 specifically to persons with mental disorders, substance use
28 disorders, or both, as defined under RCW 71.05.020 and receive
29 funding from public sources.
30 (17) "Community support services" means services authorized,
31 planned, and coordinated through resource management services
32 including, at a minimum, assessment, diagnosis, emergency crisis
33 intervention available twenty-four hours, seven days a week,
34 prescreening determinations for persons who are mentally ill being
35 considered for placement in nursing homes as required by federal law,
36 screening for patients being considered for admission to residential
37 services, diagnosis and treatment for children who are acutely
38 mentally ill or severely emotionally or behaviorally disturbed
39 discovered under screening through the federal Title XIX early and
40 periodic screening, diagnosis, and treatment program, investigation,
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 1 legal, and other nonresidential services under chapter 71.05 RCW,
2 case management services, psychiatric treatment including medication
3 supervision, counseling, psychotherapy, assuring transfer of relevant
4 patient information between service providers, recovery services, and
5 other services determined by behavioral health administrative
6 services organizations.
7 (18) "Community-based crisis team" means a team that is part of
8 an emergency medical services agency, a fire service agency, a public
9 health agency, a medical facility, a nonprofit crisis response
10 provider, or a city or county government entity, other than a law
11 enforcement agency, that provides the on-site community-based
12 interventions of a mobile rapid response crisis team for individuals
13 who are experiencing a behavioral health crisis.
14 (19) "Consensus-based" means a program or practice that has
15 general support among treatment providers and experts, based on
16 experience or professional literature, and may have anecdotal or case
17 study support, or that is agreed but not possible to perform studies
18 with random assignment and controlled groups.
19 (20) "County authority" means the board of county commissioners,
20 county council, or county executive having authority to establish a
21 behavioral health administrative services organization, or two or
22 more of the county authorities specified in this subsection which
23 have entered into an agreement to establish a behavioral health
24 administrative services organization.
25 (21) "Crisis stabilization services" means services such as 23-
26 hour crisis relief centers, crisis stabilization units, short-term
27 respite facilities, peer-run respite services, and same-day walk-in
28 behavioral health services, including within the overall crisis
29 system components that operate like hospital emergency departments
30 that accept all walk-ins, and ambulance, fire, and police drop-offs,
31 or determine the need for involuntary hospitalization of an
32 individual.
33 (22) "Crisis stabilization unit" has the same meaning as under
34 RCW 71.05.020.
35 (23) "Department" means the department of health.
36 (24) "Designated 988 contact hub" means a state-designated
37 contact center that streamlines clinical interventions and access to
38 resources for people experiencing a behavioral health crisis and
39 participates in the national suicide prevention lifeline network to
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 1 respond to statewide or regional 988 contacts that meets the
2 requirements of RCW 71.24.890.
3 (25) "Designated crisis responder" has the same meaning as in RCW
4 71.05.020.
5 (26) "Director" means the director of the authority.
6 (27) "Drug addiction" means a disease characterized by a
7 dependency on psychoactive chemicals, loss of control over the amount
8 and circumstances of use, symptoms of tolerance, physiological or
9 psychological withdrawal, or both, if use is reduced or discontinued,
10 and impairment of health or disruption of social or economic
11 functioning.
12 (28) "Early adopter" means a regional service area for which all
13 of the county authorities have requested that the authority purchase
14 medical and behavioral health services through a managed care health
15 system as defined under RCW 71.24.380(7).
16 (29) "Emerging best practice" or "promising practice" means a
17 program or practice that, based on statistical analyses or a well
18 established theory of change, shows potential for meeting the
19 evidence-based or research-based criteria, which may include the use
20 of a program that is evidence-based for outcomes other than those
21 listed in subsection (30) of this section.
22 (30) "Evidence-based" means a program or practice that has been
23 tested in heterogeneous or intended populations with multiple
24 randomized, or statistically controlled evaluations, or both; or one
25 large multiple site randomized, or statistically controlled
26 evaluation, or both, where the weight of the evidence from a systemic
27 review demonstrates sustained improvements in at least one outcome.
28 "Evidence-based" also means a program or practice that can be
29 implemented with a set of procedures to allow successful replication
30 in Washington and, when possible, is determined to be cost-
31 beneficial.
32 (31) "First responders" includes ambulance, fire, mobile rapid
33 response crisis team, coresponder team, designated crisis responder,
34 fire department mobile integrated health team, community assistance
35 referral and education services program under RCW 35.21.930, and law
36 enforcement personnel.
37 (32) "Indian health care provider" means a health care program
38 operated by the Indian health service or by a tribe, tribal
39 organization, or urban Indian organization as those terms are defined
40 in the Indian health care improvement act (25 U.S.C. Sec. 1603).
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 1 (33) "Intensive behavioral health treatment facility" means a
2 community-based specialized residential treatment facility for
3 individuals with behavioral health conditions, including individuals
4 discharging from or being diverted from state and local hospitals,
5 whose impairment or behaviors do not meet, or no longer meet,
6 criteria for involuntary inpatient commitment under chapter 71.05
7 RCW, but whose care needs cannot be met in other community-based
8 placement settings.
9 (34) "Licensed or certified behavioral health agency" means:
10 (a) An entity licensed or certified according to this chapter or
11 chapter 71.05 RCW;
12 (b) An entity deemed to meet state minimum standards as a result
13 of accreditation by a recognized behavioral health accrediting body