Supporting Youth & Young Adult Housing Stability Through Partnerships
A Two-Part Training Series with Rachel Baxter, Emerging Adult Behavioral Health Stable Housing Policy Lead, Health Care Authority (HCA)
The Bridge Coalition hosted a two-part training series with Rachel Baxter, Emerging Adult Behavioral Health Stable Housing Policy Lead at the Washington State Health Care Authority (HCA).
This comprehensive series provided a detailed overview of how Washington State’s behavioral health, Medicaid, discharge planning, and housing systems intersect to ensure that no young person exits a public system of care into homelessness.
Part One focused on behavioral health systems, care coordination structures, the Prenatal-to-25 (P-25) framework, and Medicaid discharge requirements.
Part Two focused specifically on housing stability, statewide resources, discharge accountability, prevention infrastructure, and community-based housing supports.
Download the full HCA Presentation (PDF): TO VIEW THE FULL PDF PLEASE CLICK HERE
Watch Training – Part 1: [VIDEO TRAINING PART ONE]
Watch Training – Part 2: [VIDEO TRAINING PART TWO]
PART ONE
Behavioral Health Systems, Care Coordination & the Prenatal-to-25 Framework
Presenter: Rachel Baxter, Emerging Adult Behavioral Health Stable Housing Policy Lead, Health Care Authority (HCA)
Youth and Young Adult (YYA) Homelessness
Rachel began by defining youth and young adult homelessness as a broad spectrum that includes:
- Literal homelessness
- Couch surfing
- Doubling up with friends or relatives
- Other forms of unstable housing
She emphasized that most young people experiencing homelessness are exiting systems of care such as:
- DCYF: child welfare, juvenile rehabilitation, reunification services, and foster care
- HCA: behavioral health care systems and substance use treatment
- DSHS: developmental disabilities and other family services
- Criminal justice systems
Primary vulnerabilities contributing to youth instability include:
- Behavioral health needs
- Family conflict
- Poverty
- The current housing crisis
- Immigration status
Rachel noted that these vulnerabilities often overlap, compounding barriers during transitions to independence.
Behavioral Health: A Foundational Concept
Rachel reframed behavioral health as more than mental illness or substance use. It encompasses the Eight Dimensions of Wellness, each contributing to overall well-being and stability:
- Emotional – Coping effectively with life and creating satisfying relationships.
- Environmental – Occupying pleasant, stimulating environments that support well-being.
- Financial – Satisfaction with current and future financial situations.
- Intellectual – Recognizing creative abilities and expanding knowledge and skills.
- Occupational – Personal satisfaction and enrichment derived from work.
- Physical – Recognizing the need for physical activity, diet, sleep, and nutrition.
- Social – Developing connection, belonging, and a well-developed support system.
- Spiritual – Expanding sense of purpose and meaning in life.
She emphasized that certain patterns of thinking and emotional responses can fuel unhealthy behaviors. Recovery is a process of change through which individuals improve health and wellness, live self-directed lives, and strive to reach their full potential.
HCA’s work is rooted in behavioral health equity—ensuring services and supports are accessible across communities.
Core Principles of HCA’s Work
Rachel outlined foundational principles guiding HCA initiatives:
- Developmentally appropriate supports
- Diversity, equity, and inclusion
- Data-informed decision making
- Trauma-informed practices
- Lived experience driven systems
- Poverty impact mitigation and attention to social determinants of health
The Division of Behavioral Health and Recovery (DBHR) serves as the single state authority for mental health and substance use, managing federal behavioral health grants and statewide priorities.
Care Management Overview
Care Management is an umbrella term that includes both Care Coordination and Case Management.
Care Coordination (CC)
- Focuses on short-term or intermittent needs
- May be provided by unlicensed/nonclinical staff
- Addresses access to care and social supports
- Improves clinical outcomes
- Builds self-management skills
- Voluntary and member choice-based
Case Management (CM)
- Focuses on longer-term support (3–6 months engagement)
- Provided by licensed/clinical staff
- Assists members in managing complex healthcare needs
- Goal setting based on individual priorities
- Integrated care planning with member consent
- Voluntary and member choice-based
Medicaid Notification & HB 1860
Rachel discussed HB 1860, which requires:
- Identification when a member is experiencing homelessness or housing instability
- Notification to the Medicaid Managed Care Organization (MCO) at least 24 hours prior to discharge
- Collaboration between providers and MCOs
HCA encourages notification as early as possible—ideally at admission—to improve discharge outcomes.
The Prenatal-to-25 (P-25) Framework
Rachel introduced HCA’s P-25 developmental framework, which integrates behavioral health across the lifespan.
Early Childhood (Prenatal–5)
- Mental Health Assessment for Young Children
- Parent Child Assistance Program
- Pregnant and Parenting supports and services
- Prenatal substance exposure supports
School-Age Youth (5–18)
- Children’s Long-Term Inpatient Program (CLIP)
- Family Initiated Treatment
- System of Care and Healthy Transitions (SAMHSA grants)
- Wraparound with Intensive Services (WISe)
- Youth Network
Young Adults (16–25)
- Stable housing strategy and supports
- Collegiate recovery innovation and support
- New Journeys – First episode psychosis intervention
Across all age groups, HCA integrates:
- Trauma-informed care
- Early intervention through recovery supports
- Family Youth System Partner Round Tables (FYSPRT)
- Center of Parent Excellence (COPE)
- Peer development initiatives
- Kids’ Mental Health Washington
- Youth Mobile Response Stabilization services
Meeting People Where They Are
Rachel emphasized:
- Diversion conversations
- “Nothing about us without us”
- Acknowledging trauma and environmental factors
- Outreach and networking
- Cultural considerations
- Addressing stigma
- Finding the support
She concluded Part One by linking P-25 directly to housing, reinforcing that housing is a key determinant of behavioral health stability.
PART TWO
Housing Stability, Prevention, Discharge Coordination & Statewide Resources
Urgency of Safe Discharge
Rachel emphasized that effective transition planning is critical. Without coordinated treatment, stabilization, and safe housing, youth are at increased risk of:
- Secondary trauma
- Re-entry into emergency rooms
- Criminal justice involvement
- Disrupted brain development
- Long-term health impacts
Prevention & Early Supports
Statewide prevention resources include:
- Substance use prevention campaigns (college students, underage drinking, opioid prevention)
- Community Prevention & Wellness Initiatives (CPWIs)
- Community-based organizations (CBOs)
- School-based Student Assistance Professionals (SAPs)
Research Highlight: Youth Exiting Systems of Care
March 2024 DSHS Research & Data Analysis findings:
- 69% of youth who became homeless within 12 months had a prior history of homelessness
- 13% exited residential behavioral health facilities
Residential behavioral health settings include:
- Acute care hospitals and Evaluation & Treatment facilities
- Children’s Long-Term Inpatient Program (CLIP)
- Western and Eastern State Hospitals
- Long-Term Civil Commitment (LTCC) facilities
Early Insurance Reinstatement (Juvenile Justice)
HCA and DCYF implemented:
- Medicaid unsuspension 30 days prior to discharge
- Earlier identification of housing needs
- Ongoing discharge conversations
- DCYF discharge liaison for re-entry planning
HB 1860: Expanded Discharge Requirements
Providers must:
- Notify MCOs 24 hours prior to discharge
- Include housing instability risk
- Collaborate on discharge planning
MCO Responsibilities:
- Screen hospitalizations for housing risk
- Collaborate through utilization management
- Support housing applications and secure stable housing
Provider Responsibilities:
- Identify housing instability at admission
- Include housing status in continued stay requests
- Notify MCOs when additional support is needed
Performance Measures in MCO Contracts:
- Stable housing outcomes
- Reduced emergency and justice system involvement
- Improved health and wellness
- Increased participation in employment and education
- Reduced population-level disparities
Housing Program Landscape
Types of programs available statewide:
- Street outreach and drop-in services
- Emergency shelters and HOPE Centers
- Crisis Residential Centers (CRC)
- Transitional Living Programs (TLP)
- Independent Youth Housing Programs
- Rapid Rehousing (YHDP)
Flexible funding programs include:
HCA Housing & Transition Resources
Rachel highlighted the following statewide resources:
- DBHR Homeless Services Provider Map
- Pathways to Housing
- Discharge Planner’s Toolkit
- The Bridge Housing Program (Ages 18–24) – SHB 1929
- Friends of Youth
- Excelsior Wellness
- PATH (Projects for Assistance in Transition from Homelessness)
- Peer Pathfinder
- Forensic PATH
- HARPS
- Forensic HARPS
- Oxford Houses of Washington
- Recovery Residences
- Foundational Community Supports (FCS)
- FCS – Supportive Housing
- FCS – Supportive Employment
- Becoming a Wellpoint FCS Provider
- FCS Provider Map
- Apple Health & Homes (AHAH)
- Community Behavioral Health Rental Assistance Program (18+)
- Youth & Young Adult Housing Response Team (YYAHRT)
- YYAHRT Resources One-Pager
- YYAHRT Office Hours
- DCYF Community Housing Programs & Resources
- 1580 Children in Crisis FAQ
- Lake Burien Transitional Facility (DDCS)
- Lake Burien Transitional Facility – Referral
- Lake Burien Transitional Facility – Application
- Lake Burien Transitional Facility – Monthly Presentation Information
- Kids’ Mental Health Washington
- Youth Navigator Program
- YouthNet
- Mobile Response & Stabilization Services for Youth
- Family Reconciliation Services (DCYF)
- Office of Homeless Youth (OHY)
- OHY Provider List
- Homelessness Prevention & Diversion Fund (HPDF)
- Youth Diversion Infrastructure Project (YDIP)
- Coordinated Entry (CE) Sites
- Washington Housing Authorities
- Washington Homeless Shelter Directory
- Hutton Settlement (Spokane, WA)
- LifePoint Excelsior Wellness (Spokane, WA)
- Beth’s Place (Longview, WA)
- Level Up Seattle (Seattle, WA)
- Washington Youth Academy (Kitsap, WA)
In Closing
These presentations were among the most comprehensive overviews the Bridge Coalition has hosted, offering both a systems-level understanding and practical, actionable guidance for supporting youth and young adults transitioning from behavioral health care into stable housing. Rachel Baxter, Emerging Adult Behavioral Health Stable Housing Policy Lead at the Washington State Health Care Authority (HCA), provided a clear and integrated framework that connects policy, prevention, discharge coordination, and housing resources across Washington State. For the convenience of our partners and community members, referenced materials — including the full presentation PDF, the Discharge Planner’s Toolkit, and both training recordings — have been linked above to support continued learning and implementation.
For questions related to HCA policy, discharge coordination requirements, or housing stability initiatives, Rachel Baxter can be contacted directly at: rachel.baxter@hca.wa.gov
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