Children's Long-term Inpatient Program (CLIP)

What is CLIP?

• CLIP is psychiatric treatment provided in a secure and highly structured setting designed to assess, treat and stabilize youth diagnosed with psychiatric and behavioral disorders. CLIP is the most intensive inpatient psychiatric treatment available to Washington state residents, ages 5-17 years of age.
• Four CLIP programs are located in secure settings across Washington state, designed to assess, treat, and stabilize youth with significant mental health and behavioral challenges.
• Youth receive personalized treatment through evidence-based practices designed to increase skills, improve functioning, and prepare them to return to their community as soon as possible.
• Family involvement is critical to treatment success.
• Average stay is 6 to 9 months. 

Where are CLIP facilities located?

There are four CLIP facilities in Washington state, with approximately 109 beds. Assignment to a CLIP facility is done by the CLIP Coordinator in collaboration with family and team when possible.

• Child Study and Treatment Center (CSTC) in Lakewood
• Pearl Youth Residence in Tacoma
• Tamarack Center in Spokane
• Two Rivers Landing in Yakima

How Does a Child Access CLIP?

There are two routes to CLIP: Involuntary Commitment and Voluntary Application.

Involuntary Commitment (ITA):

Adolescents aged 13-17 can be committed for up to 180 days of inpatient psychiatric treatment through a civil court order under RCW 71.34.700-71.34.796. Under Washington state's juvenile mental health services law, an adolescent who is committed under a 180-day restrictive order becomes eligible for admission to a CLIP program, and their name is placed on the statewide waiting list as of the date of the order. 

The CLIP Administration's Placement Team is legally authorized to assign committed adolescents to the CLIP Programs. The assignment is based on preferences expressed by family members, community team members and by professionals directly involved in the adolescent's care. The location of the adolescent's supports and the availability of beds within the CLIP Programs also influence the assignment. Once admitted to a CLIP Program, the adolescent may agree at any time to remain as a voluntary patient. 

This process involves:

• Admission to the hospital under a 120-hour involuntary order.
• If further care is needed, the hospital can request a 14-day order, and then a 180-day order.
• If the 180-day order is granted or a Less Restrictive Alternative (LRA) is revoked, the youth may be placed on the CLIP waitlist.
• Youth must remain in the hospital until a bed at a CLIP facility becomes available.
• For more information, visit: clipadministration.org/referral/#twopaths

Voluntary Application:

Screening can be completed for youth up to age 18 who are Washington state residents and meet the following criteria:

• They have severe psychiatric needs that require inpatient care.
• All less restrictive community-based treatment options have been tried.
• They have had a psychiatric evaluation completed by a child psychiatrist or psychiatric ARNP within the past six months that indicates a medical necessity for a higher level of mental health treatment.
• If the youth is 13 or older, they must agree to go to CLIP.
• There is no specific IQ criteria, but they must be able to benefit from cognitive therapies.

About the King County CLIP Voluntary Application and Review Process

Begin the voluntary CLIP application process by contacting your regional Behavioral Health Administrative Service Organization (BH-ASO) or Managed Care Organization (MCO) representative. Find your BH-ASO/MCO contacts here.

Each region has their own review process. For more information about your region's process, please contact your local ASO/MCO CLIP Liaison.

Initial process:

• Contact the CLIP Liaison: The family or one of their supports/providers can contact the Administrative Service Organization (ASO) or Managed Care Organization (MCO) CLIP Liaison to discuss CLIP, request screening materials, and review the application process.
• Submit the following to the MCO or ASO CLIP Liaison:
  • A completed consultation form
  • A copy of the child/youth's recent (within the last six months) psychiatric evaluation. This may include an evaluation from a psychiatric inpatient hospital admission.
• Once submitted, a consultation is scheduled with the Community Resource Team (CRT) within 30 days.

Consultation:

• What to expect: CLIP Consultations occur via Zoom and last about 45 minutes. They are presented to the CRT which includes representatives from various child serving systems. It is important to include the youth’s mental health provider and other relevant supports in the consultation.
• Preparation/Consultation: The family and team should be prepared to discuss how the youth will benefit from CLIP and share:
  
  • Youth/family strengths
  • Behaviors and concerns
  • Mental health summary
  • Past interventions/strategies
  • Other relevant domains
  • Plan for child/youth after CLIP
• Post-consultation: The family and team will be dismissed from the Zoom call, and CRT will discuss and make a recommendation. Families will receive CRT's decision in writing within two business days. 
  • If CLIP is not recommended: The ASO or MCO Liaison will provide information on the appeal process and any other recommended resources/strategies.
  • If CLIP is recommended: The ASO Liaison will send a recommendation letter, the second part of the CLIP application, and a list of required documents to the MCO CLIP Liaison and/or the family and team.

Application and Decision

• Submit application materials: All application materials must be submitted to the CLIP Administration by the ASO or MCO CLIP Liaison within 60 days of the CRT consultation. If not submitted within 60 days the application process will restart and a new consultation must be done.
• Review and decision: Once the application is submitted, the child/youth will be placed on the CLIP waitlist. The CLIP Certification Team then reviews the application to determine whether the applicant meets the medical necessity criteria for CLIP. *The CLIP Certification Team may request additional documentation as needed.
  • If approved: The child/youth’s name remains on the statewide wait list until a bed becomes available at the most appropriate CLIP facility.
  • If denied: The child/youth is removed from the waitlist. The CLIP Administration notifies the ASO or MCO CLIP Liaison and the family about the decision and the appeal process.