BOISE, Idaho —
This story originally appeared in the Idaho Press.
The pleas from Idaho families are heartbreaking, Dave Jeppesen says.
The state Department of Health and Welfare director regularly learns of families whose children are facing serious behavioral health issues for which there’s no suitable treatment facility available in Idaho, due to gaps in the state’s system of care. Those children, roughly 100 of them right now, have to be sent out of state, sometimes as far away as Georgia.
One young Idahoan was stuck in a hospital emergency department for weeks on end, awaiting a placement. “There was no medical reason for him to be there, but it was not safe for him to go home,” Jeppesen said. “We called 40 states, probably 100 facilities, looking for a place for him. It took us three months. Those are the heartbreaking stories.”
Idaho is about to change that. The governor and Legislature this year allocated $66 million over the next three years to implement a sweeping array of changes and improvements to Idaho’s behavioral health care system, recommended by a council that’s brought together all three branches of state government – the Legislature, the executive branch, and the judiciary.
Co-chaired by Jeppesen and Sara Omundson, administrative director of Idaho’s courts, the Idaho Behavioral Health Council, first formed in 2020, has an array of teams and working groups focusing on specific areas and is rolling out big changes including establishing a new youth Psychiatric Residential Treatment Facility, that specific high-level residential care now lacking in the state, in all three regions of the state; setting up eight Safe Teen Assessment Centers and new youth crisis centers; opening certified community behavioral health clinics across the state; developing a plan to address Idaho’s behavioral health worker shortage; new efforts to divert people with mental health or substance abuse issues from the criminal justice system; and vastly improving crisis response for both youth and adults.
“We’re really excited,” Holly Walund of the Idaho Department of Juvenile Correction told the council at its latest meeting on Friday. “We’re going to be filling a very critical gap in the youth services that are available.” New facilities will be opening up statewide over the next year and beyond.
“Wow, that is some amazing work,” Omundson responded, “and it is great news for our kids who might be having some struggles and need some support. Things that didn’t exist in Idaho a few years ago – now they’re funded and on the way.”
Jeppesen said, “In my mind, it’s transformational. We really are on the verge of having a true comprehensive crisis system across the state.”
Here are some highlights of the plans for the $66 million, which also will be supplemented by tens of millions more in opioid settlement funds and federal grants that are headed to the state:
YOUTH TREATMENT: The highest level of care for youth behavioral health treatment is acute hospitalization; Idaho has that, but it’s short-term. The level just below that, known by the acronym PRTF, is funded by Medicaid, but Idaho doesn’t have any. There was one at Eastern Idaho Medical Center’s Teton Peaks, but it’s now transitioning to the acute hospitalization level of care. Idaho does have Residential Treatment Centers, the next step down from a PRTF, and several other steps that follow below that.
The PRTF Expansion Plan will set up at least three of the psychiatric treatment facilities, which could be existing facilities that upgrade or new ones, with one in each of the state’s three regions: North Idaho, southwestern Idaho, and eastern Idaho. “That’s our goal, is to have PRTF’s in each of the three what we call ‘hubs’ of the state,” said Ross Edmunds, administrator of the Division of Behavioral Health for the Idaho Department of Health and Welfare. The Legislature allocated $15 million. Stakeholder engagement meetings are currently underway; all the facilities will be up and operating by June 30, 2024.
“It’ll make a pretty significant difference, to be able to get help within Idaho,” said Ruth York, executive director of Families and Youth in Idaho, a statewide advocacy group formerly known as the Idaho Federation of Families. “This money is super-important to address that gap.”
However, she warned, “If we don’t have as much focus going into the transition and step-down plans and services that people are going to need, then we’re just setting the PRTF’s up for failure.” She said, “I’ve had a child fail multiple times, coming home without a significant plan to support him. … That transition home is just fraught with peril.”
Jeppesen said that’s been particularly difficult for families whose kids are placed out of state. To have a safe return home, he said the care team must coordinate with the family at home. “It’s really hard to do that when your child is in Georgia,” he said.
Idaho also is in the process of setting up eight Safe Teen Assessment Centers around the state, including one in each of the state’s seven judicial districts and two in District 5, in south-central Idaho. Lawmakers approved a $6.5 million supplemental appropriation to the Department of Juvenile Correction for those in March. “Assessment centers provide a single point of contact and screening for youth,” Walund said. “They’re designed to really divert youth from entrance into the juvenile justice or child protection system.”
Idaho officials learned about the concept at a national conference and have toured successful centers in Nevada and Colorado. Walund said, “They serve as a safe place for law enforcement to bring youth to instead of detaining them for status offenses, things like that,” such as truancy or curfew violations. That way, she said, law enforcement officers can “go about their jobs,” and the teens can get connected to services. Eight grants already have been awarded and centers will open in every quarter of the fiscal year that started July 1.
“Idaho is the first state in the country that will have a statewide implementation of assessment centers, so we’re really excited about that,” she said.
The state also has allocated $4.4 million for youth crisis centers around the state, similar to the adult mental health crisis centers already established statewide. They provide a place for up to 24 hours for a person in crisis, who can’t safely remain at home; they can de-escalate, get connected to services, and avoid unnecessary hospitalization or incarceration. Grants for those are in the works and they should be up and running by June 30, 2023.
“There’s a fair amount of community buzz already about the youth crisis centers,” Walund said.
CALL 988 FOR CRISIS RESPONSE: On July 16, Idaho will go live with its new “988” service, which will incorporate the Idaho Suicide Prevention Hotline into a new emergency response line that also can take calls on other behavioral health matters. “Just like you would call 911 for fire or other emergency services, 988 is the number you would call either for suicide prevention or any other behavioral health crisis,” Jeppesen said.
This year’s Legislature approved $4.4 million in funding for the new line, a national effort that’s been long in the works.
“This is a big step forward in our crisis response system in the state,” Jeppesen said. “Just like you would expect any other first responder, you will have a first responder who responds to those behavioral health emergencies.”
Idaho’s 988 line will be answered by the Idaho Crisis and Suicide Hotline. Callers nationwide first will have three options: A Veterans’ Crisis Line, a line for non-English speaking individuals, or their state hotline. “Anybody that calls 988 will get answered by a live, trained behavioral health professional,” said Nicole Coleman of the Department of Health and Welfare.
The 988 line was created by Congress with three goals: Someone to call, someone to respond, and someplace to go. Coleman said Idaho, with its hotline and its network of crisis centers, will have all three. “But obviously, we’ll really find out next week,” she said.
COMMUNITY CLINICS: Lawmakers and the governor allocated $12 million to create a network of Certified Community Behavioral Health Clinics around the state, to be up and running by June 30, 2023. Edmunds said a stakeholder group including health districts, crisis centers, the Idaho Primary Care Association and more is working on plans for three grants to establish those and have them operating by this time next year, but at the same time, a second round of federal grants has come out for the same thing, and five Idaho entities have applied.
If all succeed – and Edmunds said that’s looking promising – Idaho could end up with a statewide network of eight of the community clinics, serving population centers and rural areas alike. “It has the potential to have a substantial impact,” he said.
Edmunds said part of the CCBHC model is development of crisis service including mobile crisis response teams. Between that, crisis centers, and the new 988 system, “Really all of the components, all the building blocks necessary to have a comprehensive crisis response system in Idaho is right in front of us,” he said. “We just have to organize it.”
WORKFORCE PLAN: All 44 of Idaho’s counties are classified as behavioral health worker shortage areas, Jeppesen said, and it’s a critical need. Adam Panitch, project manager with the Idaho Division of Behavioral Health, said, “No matter what ideas you come up with, you need a workforce to implement them.” Last fall, a work group of behavioral health providers, subject-matter experts and more convened and developed a comprehensive plan that’s now been finalized and published on the council’s website; it covers everything from credentialing, training, scholarships and provider rate reviews to “investing in a workforce with lived experience,” Panitch said, to bring in those who’ve experienced these issues in their own families to help others. Low- and no-cost continuing education also would be offered for providers.
York said this piece is key. “We’ve really got to pull some very new tricks out of the hat in order to create the workforce,” she said. “We’ve got to incent people into this workforce. I think if people understood the value of this work, and what a contribution it makes to our world, our country, that would help attract people. But you’ve got to pay people to do this kind of work. It’s grueling. It’s very wearing on a person to see people in distress all the time.”
“Unfortunately, right now so many providers feel so overloaded,” she said. “They know they’re not meeting the need, and that can’t feel good.”
There’s much more. Legislation passed both houses unanimously this year to update Idaho’s civil commitment process; other state laws also are being examined. Training is underway across the state on a “Sequential Intercept Model” to ensure Idahoans whose underlying issue is a behavioral health issue are intercepted from being routed into the criminal justice system. The Idaho Department of Correction has been allocated funds for pre-prosecution diversion grants and pilot programs on trauma treatment.
Rep. Brooke Green, D-Boise, one of four state legislators who serves on the council, said, “It’s incredible to see the progress moving forward. Kudos to all the teams and all the staff who have been working so hard on this.”
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