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Behavioral Health

Behavioral Health Early Intervention for Youth

Read our Report and Guidelines

(adopted January 2025)

In 2021, 35% of 8 graders in Washington reported depressive symptoms for 2 weeks straight within the past year, almost 16% had a plan to commit suicide and about 1 in 10 had previously attempted suicide.1 Instead of waiting for a crisis to arise and overwhelming the already limited psychiatric crisis support, Washington state youth require support and treatment in addressing a short-term behavioral health condition; however, support is difficult to find, receive, and afford. Youth need to receive high-quality timely interventions to promote their mental health and well-being, learn skills to build resiliency to manage mental health symptoms as they arise and health promotion interventions involving children, youth and families to support their growth into healthy adults.

Implementation Tools

Supporting Materials

 

Workgroup Members

Name Title Organization
Terry Lee, MD (Chair) Senior Behavioral Health Medical Director Community Health Plan of Washington
Linda Coombs, MSW, LCIS Behavioral Health Clinical Director United Health Community
Delaney Knottnerus, LICSW, MSW School-based SBIRT Manager King County
Brittany Weiner, MS, LMFT, CPPS Senior Behavioral Health Medical Director Community Health Plan of Washington
Libby Hein, LMHC Director of Behavioral Health Molina Healthcare
Santi Wibawantini, MA, LMFT, CMHS Child Therapist Kaiser Permanente
Sarah Rafton, MSW Executive Director Washington Chapter of American Academy of Pediatrics
Kevin Mangat, LMHC, MHA Manager, Child & Family Team Navos
Sally McDaniel, LMFT, LMHC, SUDP, CMHS Clinical Manager, Child and Family Services Greater Lakes Mental Healthcare
Thatcher Felt, DO Pediatrician Yakima Valley Farm Workers Clinic
Jeffery Greene, MD Pediatrician Seattle Children’s
Erin Wick, MBA, SUDP Executive Director, Integrated Student Supports Educational Service District 113
Katie Eilers, MPH, MSN, RN Director of Office of Family and Community Health Improvement Department of Health
McKenna Parnes, PhD Postdoctoral Research Fellow University of Washington CoLab
Diana Cockrell, MA, SUDP Section Manager Prenatal to 25 Lifespan; Mental Health and Substance Use Disorders Washington HCA

Addiction and Dependence

Award winners for Best Practices in Opioid Use Disorder Treatment:

Read our Reports and Recommendations

(Adopted January 2015)

Many of us struggle with alcohol and/or drug use. This workgroup met through 2014 to increase screening, brief intervention, brief treatment, and site-to-site referrals for evidence-informed treatment.

Implementation Tools

Addiction and Dependence Treatment Webinar

 

Motivational Interviewing in the SBIRT Model Webinar

 

 

Workgroup Members

Member Title Organization
Charissa Fotinos, MD Deputy Chief Medical Officer Health Care Authority
Tom Fritz (Chair) Chief Executive Officer Inland Northwest Health Services
Linda Grant Chief Executive Officer Evergreen Manor
Tim Holmes Vice President of Outreach Services and Behavioral Health Administration MultiCare Health System
Ray Hsiao, MD Co-Director, Adolescent Substance Abuse Program Seattle Children’s Hospital
Scott Munson Executive Director Sundown M Ranch
Rick Ries, MD Associate Director Addiction Psychiatry Residency Program, University of Washington
Terry Rogers, MD Chief Executive Officer Foundation for Health Care Quality
Ken Stark Director Snohomish County Human Services Department
Jim Walsh, MD Physician Swedish Medical Center

 

Integration into Primary Care

Award winners for Best Practices in Behavioral Health Integration into Primary Care:

Read our Guidelines

(Adopted March 2017)

Many of us experience depression, anxiety, or substance abuse; but few of us are screened and even fewer are able to access treatment. Integrating behavioral health services into primary care is centered on the patient, helps people get the treatment they need, and makes us all healthier. Our workgroup met from April 2016 to March 2017 to define integrated behavioral health care, create a common vocabulary, and developed eight common elements that outline a minimum standard of care.

Implementation Tools

Behavioral Health Integration Webinar

 

Supporting Materials

Letter from Health Care Authority Accepting Behavioral Health Integration Recommendations
Behavioral Health Charter and Roster
Behavioral Health Integration Core Process Measures
Behavioral Health Integration Guideline Checklist

Workgroup Members

Member Title Organization
Brad Berry Executive Director Consumer Voices Are Born
Regina Bonnevie, MD Medical Director Peninsula Community Health Services
Michelle Guerra, MD Senior Clinician Premera
Larry Marx, MD Medical Director, Behavioral Health Support Services Kaiser Permanente
Rose Ness, MA, LMHC, CDP Behavioral Health Expert Sound Integration for Behavioral Healthcare
Kim McDermott, MD Physician NeighborCare
Mary Kay O’Neill MD, MBA Partner Mercer
Joe Roszak  CEO Kitsap Mental Health Services
Anna Ratzliff, MD, PhD/
Anne Shields, MHA, RN		 Director of the UW Integrated Care Training Program, Associate Director for Education/Associate Director AIMS Center, University of Washington
Jeff Reiter,  PhD Lead Psychologist Swedish Medical Services
Julie Rickard, PhD Program Director of Integrated Behavioral Services Confluence Health
Brian Sandoval, PsyD Behavioral Health Manager, Oregon and Washington Services Yakima Valley Farmworkers Clinics
Lani Spencer, RN, MHA Vice President Health Care Management Services, Amerigroup –Washington
Emily Transue, MD, MHA  Senior Medical Director Coordinated Care
Melet Whinston, MD Medical Director United Health Care

Opioid Use Disorder

Award winners for Best Practices in Opioid Use Disorder Treatment:

Read our Guidelines (2024)

Opioid use disorder continues to be prevalent in Washington State, with a 10% increase from 2018 to 2019 and 35% for both 2020 and 2021 over the prior year. The Bree Collaborative developed guidelines in 2017, outlining full or partial opioid agonists for treatment (as opposed to treatment without medication). As the number of opioid overdose death rate has continued to climb, the Bree Collaborative members decided to revisit the previous guidelines and report. In the time since the last report, the X waiver requirement has been removed, and the increase in fentanyl in Washington’s drug supply has complicated opioid overdose response. A significant number of methamphetamine overdoses involve opioids, and most people who use drugs use multiple substances. According to the Washington DOH, the stimulant-related overdose death rate has increased 388%. As a result, the response to opioid use and overdose should address strategies that are associated with many drugs not just opioids. Fentanyl and analogues carry a higher overdose risk than other opioids; in 2022, a survey by the UW’s Addiction, Drug & Alcohol Institute (ADAI) found that 18% of respondents had used fentanyl within the past 3 months. There is a need for guidance for providers to improve confidence and competence and for payors on successful and safe initiation, stabilization, and titration of individuals on medication for opioid use disorder in the age of fentanyl with a focus on populations that are or have been underserved

Read our Guidelines (2017)

(Adopted November 2017)

Implementation Tools

Opioid Use Disorder

 

Workgroup Members (2024)

2024 Workgroup Members

Name Title Organization
Charissa Fotinos, MD (Chair) Deputy Chief Medical Officer Washington HealthCare Authority
Nikki Jones, LCISW, SUDP, CMHS, DDMHS, GMGS Behavioral Health Addictions Administrator United Health Community
Michael Sayre, MD Medical Director Medic One
Brad Finegood, MA, LMHC Strategic Advisor Opioids and Health King County
Everett Maroon, MPH Executive Director Blue Mountain Heart 2 Heart
Tina Seery, RN, MHA, CPHQ, CPPS, CLSSBB Senior Director, Quality and Rural Programs Washington State Hospital Association
Tawnya Christiansen, MD Behavioral Health Medical Director Community Health Plan of Washington
Sue Petersohn, EN, MBA, CARN Program Manager, Multicare SUD Task Force MultiCare
Mark Murphy, MD Medical Director Addiction Services MultiCare
Libby Hein, LMHC Director of Behavioral Health Molina Healthcare
Ryan Caldeiro, MD Chief Chemical Dependency Services
and Consultative Psychiatry		 Kaiser Permanente
Herbie Duber, MD Regional Medical Officer – Northwest WA Department of Health
Bob Lutz, MD, MPH   CHAS Health
Amanda McPeak, PharmD Pharmacist and Director of Long-term Care Kelley-Ross/Harborview
Jason Fodeman, MD Associate Medical Director of Innovation and Outreach L&I
Maureen Oscadal, RN, CARN Registered Nurse Harborview Medical Center/Addiction Drugs and Alcohol Institute
John Olson, MD, MHA Addiction Medicine Physician Sound Health
Daniel Floyd Care Coordination and Recovery Section Manager King County Behavioral Health and Recovery Division
Kelly Youngberg, MHA Assistant Director for Health Care Implementation and Strategy Addictions, Drug and Alcohol Institute
Cris DuVall, PharmD, SUDP, WSPA Clinical Pharmacist Counselor Compass Health, Island Drug
Tom Hutch, MD, FASAM Medical Director We Care Daily Clinic
Liz Wolkin, MSN, RN, NPD-BC CEN Emergency Department Support Program Administrator Washington HealthCare Authority
David Sapienza, MD Lead Physician Pathways, Public Health Seattle & King County – Community Health Services Division

Workgroup Members (2017)

Member Title Organization
Charissa Fotinos, MD (Co-Chair) Deputy Medical Officer Health Care Authority
Andrew Saxon, MD (Co-Chair) Director, Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Health Care System
Jane Ballantyne, MD, FRCA Professor, Department of Anesthesiology and Pain Medicine University of Washington School of Medicine
Caleb Banta-Green, PhD, MPH, MSW Senior Scientist Alcohol and Drug Abuse Institute, University of Washington
David Beck, MD Immediate Past President Washington Society of Addiction Medicine
Ryan Caldeiro, MD Chief Chemical Dependency Services and Consultative Psychiatry Kaiser Permanente
Mary Catlin, BSN, MPH Institutional Nurse Consultant Department of Health
Nancy Lawton, MN, ARNP, FNP President ARNPs United of Washington State
Darin Neven, MD, MS President and Founder Consistent Care
Richard Ries, MD Director, Addiction Psychiatry Residency Program University of Washington
John Robinson, MD, SM Chief Medical Officer First Choice Health
John Roll, PhD Professor & Vice Dean for Research, Elson S. Floyd College of Medicine Washington State University
Terry Rogers, MD Medical Director Lakeside Milam Recovery
Vania Rudolf, MD, MPH Addiction Recovery Services Swedish Medical Center
Mark Stephens President Change Management Consulting
Milena Stott, LICSW, CDP Chief Of Inpatient Services Valley Cities Counseling

Pediatric Psychotropic Prescribing

Award winners for Best Practices in Pediatric Psychotropics:

Read Our Guidelines

(Adopted November 2016)

Among psychotropic medications prescribed to children and adolescents, antipsychotics have great potential for overuse. These drugs are often prescribed for aggressive or impulsive behaviors rather than psychosis and are associated with patient harms in a developing brain. The workgroup met from January to November 2016 to recommends strategies to improve the appropriateness of antipsychotic drug prescribing to pediatric patients

Supporting Materials

Workgroup Members

Member Title Organization
Shelley Dooley Parent Advocate  
Nalini Gupta, MD Pediatrician Developmental and Behavioral Pediatrics
Providence Health and Services
Robert Hilt, MD Director, Community Leadership; Director of Partnership Access Line Seattle Children’s
Paula Lozano, MD, MPH (Chair) Medical Director, Research and Translation Group Health Cooperative
Liz Pechous, PhD Clinical Director ICARD, PLLC
Robert Penfold, PhD Co-investigator, Mental Health Research Network Group Health Research Institute
James Polo, MD, MBA Chief Medical Officer Western State Hospital
David Testerman, PharmD Pharmacy Director Amerigroup
Mark Stein, PhD, ABPP Director of ADHD and Related Disorders Seattle Children’s
Donna Sullivan, PharmD, MS Chief Pharmacy Officer Washington Health Care Authority

Risk of Violence to Others

Award winners for Best Practices in Risk of Violence Toward Others:

Read our Guidelines

(Adopted January 2020)

The 2016 Washington State Supreme Court decision Volk v. DeMeerleer expanded the health care provider’s duty to warn potential victims of a patient’s violence. This workgroup recommended clinical best practices for providers caring for patients who may exhibit homicidal ideation. The workgroup met from January 2019 to January 2020.

Previous Meeting Materials

Date Materials
January 6 Agenda January 6 2020
Minutes October 10
Minutes January 6 2020
Recommendations Risk of Violence to Others
October 10 Agenda October 10
Minutes September 12
Draft Recommendations Risk of Violence
September 12 Agenda September 12
Minutes July 11
Minutes August 1
August 1 Agenda August 1
Minutes July 11
Draft Recommendations Risk of Violence to Others
July 11 Agenda July 11
Minutes June 13
Draft Recommendations
June 13 Agenda June 13
Minutes May 23
Draft Recommendations Risk of Violence
May 23 Agenda May 23
Minutes April 25
Draft Recommendations Risk of Violence to Others
April 25 Agenda April 25
Minutes March 14
Risk of Violence Literature Review 2019
Involuntary Treatment Act Investigations
Suicide Care Recommendations Summary
March 14 Agenda March 14
Minutes February 21
Ohio Duty to Protect
Summary Suicide Care Recommendations
February 21 Agenda February 21
Minutes January 17
Draft Charter and Roster
Presentation Duty to Protect
Ohio Duty to Protect
January 17  Agenda January 17
Bree Presentation Slides
Charter and Roster
Conflict of Interest Form
OPMA Training Roster

Workgroup Members

Member Title Organization
 Kim Moore, MD (chair)  Associate Chief Medical Director CHI Franciscan
G. Andrew Benjamin, JD, PhD, ABPP  Clinical Psychologist, Affiliate Professor of Law University of Washington
Kate Comtois, PhD, MPH  Professor Department of Psychiatry and Behavioral Sciences Harborview Medical Center
Jaclyn Greenberg, JD, LLM  Policy Director, Legal Affairs Washington State Hospital Association
Laura Groshong, LICSW Private Practitioner Washington State Society for Clinical Social Work
Ian Harrel, MSW  Chief Operating Officer  Behavioral Health Resources
Marianne Marlow, MA, LMHC Member Washington Mental Health Counseling Association
Neetha Mony State Suicide Prevention Plan Program Manager, Injury & Violence Prevention, Prevention and Community Health  Washington State Department of Health
Kelli Nomura, MBA Behavioral Health Administrator King County
Mary Ellen O’Keefe, ARNP, MN, MBA Clinical Nurse Specialist – Adult Psychiatric/Mental Health Nursing; President Elect Association of Advanced Psychiatric Nurse Practitioners
Jennifer Piel, MD, JD Psychiatrist Department of Psychiatry, University of Washington
Jeffrey Sung, MD Member Washington State Psychiatric Association
Samantha Slaughter, PsyD Member WA State Psychological Association
 Adrian Tillery   Harborview Mental Health and Addiction Services
Amanda Ibaraki Stine, LMFTA Member Washington Association for Marriage and Family Therapists

Suicide Care

Award winners for Best Practices in Suicide Care:

Read our Guidelines

(Adopted September 2018)

Suicide is a leading cause of death in our state. Rates vary by race, ethnicity, age, whether someone is a veteran, and by a person’s sexual and gender minority status. This workgroup met from February to September 2018 to develop recommendations organized to increase identification, assessment, management, and treatment.

Implementation Tools

Suicide Care Webinar

 

Watch our Partnering with Schools in Youth Suicide Prevention Webinar

 

Supporting Materials

Letter from the HCA Accepting Suicide Care Recommendations
Suicide Care Charter and Roster

Previous Meeting Materials

Date Materials
February 8 Minutes February 8
Suicide Prevention Charter Draft
Bree Collaborative Process
March 8 Agenda March 8
Minutes February 8
Draft Suicide Prevention Charter
Draft Suicide Prevention Recommendations
April 12 Agenda April 12
Minutes March 8
Draft Suicide Prevention Report
May 10 Agenda May 10
Minutes April 12
National Action Alliance for Suicide Prevention Recommendations
Draft Suicide Prevention Recommendations
June 14 Agenda June 14
Meeting Minutes May 10
Draft Recommendations Suicide Care
September 13 Agenda September 13
Meeting Minutes June 14
Draft Suicide Care Recommendations
Public Comments

Workgroup Members

Member Title Organization
Kate Comtois, PhD, MSW Psychologist Harborview Medical Center
Karen Hye, PsyD Clinical Psychologist CHI Franciscan Health
Matthew Layton, MD, PhD, FACP, DFAPA Clinical Professor, Department of Medical Education and Clinical Sciences Elson S. Floyd College of Medicine, Washington State University
Neetha Mony, MSW Statewide Suicide Prevention Plan Program Manager Washington State Department of Health
Julie Rickard, PhD Physician & Healthcare Consultant Confluence Health
Julie Richards, MPH Research Associate Kaiser Permanente Washington Health Research Institute
Hugh Straley, MD (chair) Chair Bree Collaborative
Jennifer Stuber, PhD Associate Professor University of Washington School of Social Work
Jeffrey Sung, MD Member Washington State Psychiatric Association
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