Integrating health care systems to support and care for people with substance use disorders  

Substance use disorders (SUDs) are complex conditions that continue to impact people from all walks of life. Like many communities across the nation, King County residents are seeing a rise in substance use disorders and overdoses, particularly with the tragic impacts of the fentanyl epidemic being felt across our communities.   

This summer, DCHS published a blog series focused on what residents should know about King County’s SUD response. You can read more here:  

The latest blog in the series will cover the range of health care systems where people can and will access support.   

Crisis Care Centers 

In response to growing need to strengthen our community’s behavioral health system, King County proposed the Crisis Care Centers (CCC) levy, passed by voters in April to create places for people experiencing an urgent behavioral health need, including SUDs, to access immediate care, similar to what’s available for physical health care. Nothing like this currently exists in King County.  

The initiative is a generational opportunity to improve our behavioral health system and deliver care to King County residents. It will create a path to recovery and promote continuity of care by linking the new 988 crisis line, mobile crisis units, and first responders.  

The CCC initiative will create five crisis care centers. Distributed geographically across the county, the centers will provide walk-in behavioral health care access and the potential for short-term stays to help people stabilize, with one center specifically serving youth. The CCC initiative will also preserve and restore mental health residential treatment beds and invest in the behavioral health workforce. 

The team in DCHS is now working closely with local leaders and members of communities most affected to develop the CCC Implementation Plan, which will be submitted to the King County Council for their review by the end of this year (2023). The Implementation Plan will set the nine-year strategy, including requirements, siting process and centers, cost structures, measurement and evaluation, and operations to achieve the goals set out by the initiative and endorsed by the voters.  

Meet the CCC Initiative planning team in this blog post and learn more about the CCC Initiative at the DCHS website. At the website, you can help guide the CCC implementation by taking a survey, registering to join a community meeting or focus group, watching a recording of a previous community meeting, or reading more information about the CCC (available in English, Spanish, Somali, Vietnamese and Chinese).  

Investing in the Behavioral Health Workforce 

It takes people to care for people. In few arenas is that truer than behavioral health. But our behavioral health workforce is currently understaffed, underpaid, undervalued, and stretched thin.  

King County is working on a number of strategies to invest in and build up the behavioral health workforce that is sustainable, representative, and has a viable career path.  

In addition to creating the crisis care centers, the CCC initiative will invest in the behavioral health workforce. While the exact implementation plan is being formulated with input from communities, the CCC will invest in equitable wages for the workforce at the crisis care centers and will work to create career pathways through apprenticeship programming and access to higher education, credentialing, training, and wrap-around supports to help grow a sustainable workforce.  

The MIDD behavioral health fund is another major way that King County is investing in our behavioral health workforce.  

Since 2008, MIDD has been a local fund source that addresses behavioral health needs in King County that otherwise would go unmet by funding from state and federal sources. In 2022, MIDD distributed over $76 million to 157 community partners who served 19,281 people across King County through 52 initiatives.  

One notable area of MIDD funding is in system improvements to strengthen access to the behavioral health system and equip providers to be more effective. MIDD funds four separate initiatives that support workforce, improve the quality and availability of services, and support community-initiated projects. Additionally, last year, the MIDD funded community driven behavioral health grant program and rural behavioral health service grant program funded 29 small agencies across King County to address unique needs within their diverse communities.  

Learn more about the MIDD behavioral health fund here.  

King County Integrated Care Network: A first-of-its-kind partnership to improve access to behavioral health care 

Our community-based providers want to provide the best SUD care to help people in their recovery journeys. Sometimes those goals run into obstacles when providers have to navigate the realities of our nation’s for-profit insurance model used to administer Medicaid-funded services to people most in need.  

In 2019, King County became the only county in Washington state to join with local behavioral health partners to establish a behavioral health network, the King County Integrated Care Network (KCICN).  

The KCICN is a first-of-its-kind partnership between King County Behavioral Health and Recovery Division (BHRD) and community-based agencies that provide access to behavioral health services for King County residents who are eligible for Medicaid and have significant behavioral health conditions.  

Before the establishment of the KCICN, King County had a traditional payor-provider relationship with providers. Now, this partnership collaborates jointly on how to build capacity and improve outcomes and supports providers to increase the quality and accessibility of care for King County residents in need.  

The KCICN partnership benefits providers by significantly reducing administrative burdens, improving access for clients, and enabling King County a comprehensive understanding of funding opportunities and challenges to inform local investments and complement gaps in Medicaid eligible services and populations.  

BHRD contracts with over 90 community based behavioral health service providers, and nearly half of BHRD’s contracted providers participate in the unique, nation-leading partnership. 

Get into the weeds and learn more about the KCICN here.  

Health Through Housing Initiative: Permanent Supportive Housing Connections to Behavioral Health 

There is a strong connection between the root causes of SUD and housing instability—economic, social, educational, safety—that push people into homelessness and poor health, including substance use disorders. 

Health Through Housing and other supportive housing programs are designed to provide housing and supportive services on a long-term basis to chronically homeless people with disabilities, including behavioral health conditions. Supportive housing is proven to reduce substance use, reduce jail and hospital stays, and improve overall health.   

Launched in 2021, Health Through Housing seeks to create up to 1,600 units of emergency housing and permanent supportive housing for people experiencing or at risk of chronic homelessness around the King County.  

Health Through Housing is a proven method to help people stabilize with resources available to people living in HTH buildings. The buildings offer a nurse station, employment navigators, and connection to behavioral health care.   

  • As of March 2023, there are 15 buildings in the HTH portfolio. Learn more about HTH here.  

Proactive Outreach to Shelters and Encampments 

King County invests in outreach teams that go out to shelters and encampments to build relationships with people experiencing homelessness, who may have limited support systems and complex health needs, and who have difficulty engaging in care at traditional opioid treatment programs. These teams, including Public Health – Seattle & King County’s Mobile Street Medicine Team, the Hepatitis Education Project, and Ryther Child Center, share information with individuals about the medications used to treat opioid use disorder while connecting people to treatment. 

Jail Health Services 

King County has a unique role in providing healthcare services to one of the most underserved populations in our community—people in our jails.  Like any other medical condition, for people with substance use disorder, it’s critical to ensure continuation of medications and opportunities for people to begin treatments if they haven’t previously had access to do so. 

Jail Health Services (JHS), a division of Public Health – Seattle & King County, provides a range of services to address opioid use disorder.  

  • Continuation and starting treatment: All people are screened at booking to assess needs for continuation of medications (buprenorphine, methadone, and naltrexone) to treat substance use disorder. In addition to continuing needed treatment medications, JHS is also able to start people on buprenorphine to help address opioid use disorder.  
  • Transition into the community: JHS provides release planning to help people transition back into the community, including bridge medications upon discharge. The team connects people leaving the jail with community providers who offer medical and mental health services, substance-use disorder treatment, housing assistance, and other social services. 
     
  • Overdose prevention: A disruption in SUD treatment, which can happen when people leave jail, can put people at higher risk of overdose upon release. In preparation for release, in addition to connections with providers in the community, individuals receive overdose prevention education and naloxone.     
     
  • In DCHS, the Diversion and Reentry Services division works with system partners to increase access to services available in jails in King County and makes use of this opportunity to link people to community providers for behavioral and physical health care.

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