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One-on-One with State Rep. Lauren Davis: Lynnwood’s Community Justice Center

LYNNWOOD, Wash, September 10, 2021 — Rep. Lauren Davis (Lynnwood) has worked tirelessly with the Recovery Center task force over the last five weeks. The task force, established by Lynnwood Mayor Nicola Smith, was charged with reexamining the Community Justice Center’s (CJC) programs and purpose. In collaboration with her fellow co-chair Lynnwood Police Chief Jim Nelson and other leaders on the task force, Davis helped bring forth the reconfiguring of the CJC. 

Central to the new layout is the inclusion of a Community Recovery Center (CRC); a space specifically dedicated to addressing the behavioral health needs of the community. The Lynnwood Times had the opportunity to ask Rep. Davis a few questions regarding the CJC and this new CRC development. 

Public Townhall for 6 p.m. September 10

The proposal for the updated configuration of the CJC was discussed during a Lynnwood City Council work session this last Tuesday, and evaluated by the Snohomish County Council the following day. As the proposal moves forward, Lynnwood will be holding a feedback session today at 6 pm for open public comments regarding the CJC.

To attend the virtual town hall, click here.

“The community understandably has a ton of questions,” Rep. Davis said, concluding her comments with the Lynnwood Times. “I think behavioral health in general is not very well understood and so the more we can help educate the public (the better). And when this facility, God willing, if the council approves and it comes online, we want people to use those resources. We want them to know that it’s there. We want them to know what types of situations would be appropriate, so the more information we can get out to the public the better.”

Q: How will funding and budgeting proceed for the new Community Recovery Center proposal?

Short Answer 

The budgeting will proceed in three phases. The first involves allocating Behavioral Health Grants, which was already accomplished in July. The second phase is applying for a RFP (Request for Approval). Finally, state representatives will write a supplemental capital budget. 

Rep. Davis’s Full Answer

It would come in three different phases, more than likely. I mentioned this in my comments on Monday night, but in 2018 we shifted the way we invested in health facilities away from these large state-run facilities and into what we call “community behavioral health” — so the smaller facilities that are actually in communities like Lynnwood. So we’ve (the state) put close to three hundred million dollars in the last three years toward those efforts. And this project is consistent with that same trajectory and in line with that trajectory. 

Every year in the capital budget there’s sort of two different types of projects. There’s direct appropriations, which is basically a line item that says, you know, “Lynnwood Recovery Center: x million,” and then there’s also competitive grants, and we had already allocated competitive behavioral health grants that went live July 1 of this year in the biannual budget that passed this year. And they’re in a bunch of different categories. There’s money for in-patient psychiatric facilities. There’s money for what’s called Enhanced Services Facilities that serve folks like your geriatric population who also have psychiatric challenges. 

And then there’s also money for crisis stabilization and that’s a two million dollar allocation currently and this project would be extremely competitive because projects that are competitive are projects that are shovel-ready — projects that have multiple funding partners and we already have a commitment from the county, and those are incredibly attractive. And again, the fact that the first floor of this is already going to be built and we’re adding kind of a second a third story — what happens and what has happened historically is state money goes towards projects, some of which never materialize maybe because of push-back from neighbors, maybe because the funding doesn’t come together, but again, this project would be extremely competitive because we have all our ducks in a row and we’ve got the money and we got the project, you know, there’s a lot of stakeholders involved.

So we would apply for that RFP (Request for Proposal) and if it’s competitive again, then I would argue we are very competitive with what we can put forward. And that money, the RFP goes out this fall. I’m not exactly sure when the check would be received to the kind of winning facility. 

And then in addition to that, we will write a supplemental capital budget. That money goes out in March of 2022. And it is the intention of our legislative delegation — so myself and Cindy and Jesse — to request funding in the supplemental capital budget. But just to give you a gauge, that capital budget, as a whole, is generally much smaller ’cause of the supplemental, right? Our capital budget we just passed for 2021 —  the whole capital budget was 6 billion. And the capital budget that will pass in 2022 is about 82 or 83 million, so significantly smaller. So the intention is that our delegation will make a request for funding in the supplemental, but it won’t be a huge check because it’s a smaller budget. And then we would ask for the difference — whatever is left, right? In the 2023 biannual budget because that’s when you get a large capital budget again somewhere in the 6 billion neighborhood or if not north of that — assuming the economy continues to clip along.

Q: How will the operational costs of the Community Recovery Center be covered?

Short Answer 

Operational costs are not a significant concern as the majority of services that will be offered at the CRC will be insurance billable. For the smaller portion of patients who don’t have insurance, the costs for their services will be paid for by the Behavioral Health Administrative Services Organization.

Rep. Davis’s Full Answer

That’s a great question. So we definitely need to have some additional stakeholder conversations to make sure that we have willing providers, which I don’t doubt that we would, and then kind of working on the math of the operational cost. But I’m not particularly worried about the operational cost and the reason is, what we’re proposing to put there are insurance billable services. And so the bulk of the operating cost would be paid for by whoever the payers are of the people who receive services in that facility. 

I would suspect that a substantial chunk of the individuals who receive services there would be medicaid patients so that is a state and federal match that pays for that. Also I suspect that we will see a number of individuals with private insurance, and so particularly at the behavioral health urgent care you’re going to see a lot of folks with commercial insurance. And so those costs are billed to the Premeras and the Regences and the Kaisers of the world. 

And then you’re going to have a smaller portion of folks who are uninsured and those costs are generally paid for by what’s called the BHASO (Behavioral Health Administrative Services Organization).

So it’s a blend, but for the most part the services are all billable and so they’re billed to the appropriate insurer. And it’s kind of like the well that never runs dry because it’s like any other healthcare facility. So the reason why some places struggle is because they’re providing services that are not insurance billable. And so if you’re providing housing services, for instance, you can’t bill insurance for that, and so then they really have to hustle to try to cobble together funding for ongoing operations. That’s not really the case where you’re talking about a behavioral health facility where you’re billing health insurers.

Q: Regarding the recently passed SB 5476 Bill, when it comes to operational costs, do you think that some of the bill’s provisions will go towards the center as well?

Short Answer

No. The services included in the bill are not insurance billable services. The provisions will direct patients to the Community Recovery Center, but the facility won’t be funded out of that bucket.

Rep. Davis’s Full Answer

That’s a great question. No, is the short answer. The services that are in that bill are largely not insurance billable services and they serve people who are not currently connected to care. So not all, but the bulk of the funding in that bill goes to what’s called a recovery navigator program. In the original bill it was called forensic navigator and then it got changed. And the recovery navigator program’s primary purpose is to connect with individuals who have untreated substance abuse disorders who are not connected to services. 

So people who might be experiencing homelessness, people who might be presenting to the emergency department, people who might be coming into contact with law enforcement because of their substance use disorder and actually providing intensive case management and bringing those folks into our existing array of services. 

We know that only about 11% of substance use disorders ever actually access services, and a lot of that is not because they’re not interested. It’s because there are so many barriers for folks to navigate and access the system and it’s very challenging to access even for people who are highly educated and highly motivated. Let alone people who have more barriers right? Whether it’s barriers because of poverty or english language proficiency or transportation issues or whatever. So the recovery navigator program would direct people to receive services at this facility, but the facility would not be funded out of that bucket. 

Q: As 36 beds were removed from the CJC’s initial design to make room for the Community Recovery Center, what will be the capacity for the new CRC?

Short Answer

It depends on how many floors will include rooms for beds and if those rooms will house one or two beds each. The current estimation is anywhere between eight and 16 beds. 

Rep. Davis’s Full Answer

That’s a great question. It depends on the exact service array. The current intention would be crisis stabilization — at least one floor would be crisis stabilization, and if you put two people to a room, you could easily do sixteen beds on a floor out of 5000 sq feet. If you made two floors into beds you could do 32 if they were doubled rooms ,or sixteen total if they were single. 

But there’s a strong interest from community partners in this behavioral health urgent care modality, which is actually an outpatient modality. So people are not over-nighting and if we do one of the floors as a behavioral health urgent care, you’re going to have patient rooms right? Like you’d have at your typical med-urgent care. But you’re not going to have overnight beds. So if I had to guess right now with my crystal ball I would probably guess one floor is going to be an overnight in patient type for the crisis stabilization and that would be somewhere between 8 and 16 beds depending on how you configure it. And the other floor, in my dream world it would be a 24/7 urgent care, but people are not over-nighting there. So you’re really just having sort of patient rooms and things like that.

What services will be offered in the Crisis Center section of the CRC?

Short Answer

The Crisis Center will offer various types of services that cater to patients whose condition does not warrant a trip to the ER, but aren’t necessarily in a safe enough condition to go home either. These services include helping people suffering from mental health issues, such as suicidal thoughts or severe anxiety attacks; as well as people suffering from substance abuse issues.

Rep. Davis’s Full Answer

So it’s a little bit lower acuity than inpatient-psych. So people who would receive services at a crisis stabilization center are not so acute that they need to be in in-patient psychiatry, but they’re also not stable enough to go home. And so we have a lot of people that fall in between and two things happen to them. We either send them into in-patient, where they don’t really belong and it’s a poor use of resources, or we send them home and they’re not really safe to go home when there’s an emergency of some kind — the person is having a suicidal crisis or the family doesn’t know how to care for them or what have you. 

So crisis stabilization, it tends to be shorter than in-patient psychiatric stay, so we’re talking somewhere between like three and seven days. Oftentimes the people who will need these services are going through a sort of mental health crisis of some kind. So that could be significant depression; it could be someone who’s experiencing an anxiety attack. It could be someone who is having auditory hallucinations of some kind, or a suicidal crisis of some kind. So if somebody had attempted suicide, they’re going to need to go to the emergency department ‘cause there’s probably something medical that needs to happen, whether its lacerations or whether they’ve ingested something. But if they’re having suicidal ideation or suicidal thoughts but have not acted, they could certainly receive services at this facility. 

And then the third category would be some kind of substance abuse challenge for someone who is using opioids or methamphetamine or alcohol and is interested in stopping or reducing their use could receive services at this facility. Someone who is having some sort of behavioral symptoms that are associated with substance abuse could receive service at this facility.

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