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Research Question #1

What does recovery mean to children, youth, and families, and what barriers exist to keep them from accessing needed services?


A total of 85 responses were gathered: 83 in English, and 2 in Spanish. 53 respondents filled out the full survey. 15 responded to the Recovery Questions portion only (including the 2 responses in Spanish); 5 responded to the Navigation, Access, Benefits and Types of Care portion only; and 12 responded to the Trust and the System of Care portion only. These results are not unduplicated, meaning the same individual could have filled out the full survey and/or a smaller survey more than once. Every version of the survey included a request for demographic information and 60 respondents filled out that section.

Demographic Information

The North Sound region in Washington State includes Snohomish, Whatcom, Skagit, Island, and San Juan counties:

Only 34 of the total 85 (40%) of respondents indicated where they live. 64.71% of those were from Whatcom County, while only 14.71% were from Snohomish, and 8.82% were from Skagit. The other respondents indicated they live in other parts of Washington state (specifically King and Spokane counties).

60 of 85 (70.59%) respondents indicated their role as a youth, family member, or community partner. Of those, 49% identified as family members, 37% as youth, and 14% as community partners, with a total representation of youth and families of 86%:


Many youth and family respondents identified as community partners with formal roles in the System of Care:

Respondents were permitted to select more than one answer regarding their racial and ethnic identities. As such, there were 78 total selections for 60 respondents.


By contrast, though the categories do not line up exactly and the methods for gathering data vary, the U.S. Census Bureau’s statistics demonstrate that historically excluded groups are overrepresented among YFC’s survey respondents, while those who identify as White or Caucasian were underrepresented.

58 respondents shared their sexual orientation.


All 60 respondents shared their gender identity.


Finally, when asked if they had ever sought behavioral health services, respondents answered as follows:

Recovery Questions

Using a weighted average to rank responses to the Recovery Questions (The Most Important = 5, Fairly Important = 4, Important = 3, Slightly Important = 2, Not Important at All = 1), respondents rated the following aspects in order of importance:

  1. A stable and safe place to live (57)

  2. Physical and emotional health (55.8)

  3. Hope – the belief that challenges and conditions can be overcome (54.8)

  4. Relationships with other people, animals, and nature (54.2)

  5. Having a sense of purpose, including meaningful activities, age-appropriate level of independence, income, and resources to participate in society (51.6)

  6. Safe spaces to freely talk with others (50.8)

  7. Support from older family members, including parents, stepparents, foster parents, grandparents, aunts, and uncles (49.2)

  8. Support from people around the same age, including friends and young family members (48.4)

  9. Culture, including traditional healing practices (47.4)

  10. Support from adults at school, including teachers, school counselors, office staff, bus drivers, food workers, etc. (47)

  11. Support from faith communities, including churches, study groups, prayer groups, meditation groups, etc. (46.2)


Respondents were also asked to add anything else that might be important to someone in recovery. Themes included family companionship and understanding, a positive attitude, peer support from others who have been there, and forgiveness from others. Here are a few select responses:

  1. Poder estar presente con ellos y no juzgar por los sentimientos que sienten. Recordarle que sus emociones son válidos. (Be able to be present with them and not judge by the feelings they feel. Remind him that his emotions are valid.) 

  2. Understanding that relapse is a common thing, don't hold it against the person trying to get better. Everyone stumbles when learning to walk, the same goes for an addict, they're learning how to be clean.

  3. having the motivation to do it themselves. not doing it because someone else wants them to. they need their own motivation to do it for themselves

  4. No time restraint or restrictions, truly a personal pace.

Navigation, Access, Benefits, and Types of Care

There were 57 total responses to this portion of the survey.

Trust and the System of Care

There were 41 total responses to this portion of the survey.

Respondents were asked what they think is working in the overall System of Care. Here are a few select responses:

  1. Many people care and want to help

  2. Matching people with professionals they’re comfortable with

  3. Some resources for very low, or very high income youth.

  4. In community based organizations, the people care.

  5. Community Partners are becoming less siloed and some are working together

  6. I think it is really great that we have systems starting to come together to help our POC, and LGBTQ+ youth but more diversity in the actual community members providing care could also use more diversity.

  7. Some individuals work very hard in their jobs and care deeply.


Respondents were also asked what they think is not working in the overall System of Care. Here are a few select responses:

  1. Many are not aware of resources and even if they are it is so difficult to actually get the care they need due to various issues.

  2. Insurance and the fact that you aren’t eligible for some services due to inability to access fairly priced health care

  3. Inexperienced practitioners slow down the health system

  4. Few services for middle income youth and adults.

  5. Discrimination, being judgemental and conviction of others.

  6. Lack of Medicaid BH providers and prescribers

  7. I dont think there is enough peer support in the underserved communities.  Youth in these at risk groups are less likely to complete a program because their support system is not as large.  There needs to be whole family support, not just for the youth but the parents, the aunts, uncles, and all those in the "village" that are helping to raise and influence these kids. Otherwise they will continue down to struggle.

  8. Because everyone is working so hard, there is little time to look up at the landscape of services.   I also notice there is a lot of Community design of services and this takes a very long time...    Could there be less (but still some) community design?

  9. CPS, this resource, I've heard, has been historically ineffective.

  10. Not enough providers. Some providers are under-trained, particularly about symptoms related to lack of insight and topics related to cultural relevance. Family engagement is almost never a priority for a provider's time. Systems don't work together very often. Families have to know jargon and code words to get a doorway open even just a crack. There really isn't a "system" at all. It's a disjointed set of puzzle pieces that don't fit together into any intelligent design.

Research Question #2

What do schools need to make efficient connections with behavioral health services?

Connections Between Schools and Behavioral Health Services

The YFC team took a broad view of available resources, structural issues, and relevant policies, including recommendations issued by state and national organizations (see Appendix).

The team reviewed agency access lists issued by the North Sound Behavioral Health Ombuds at Community Action of Skagit County (August and October 2021). At that time, providers working with children, youth, and families reported limited availability due to staffing issues. While a few providers reported that they had openings, the vast majority were either closed to new clients or they reported wait times of 1 week to 5 months. This was true for both routine outpatient services and WISe.

The situation had not changed in June of 2022 when the WISe programs presented data to YFC. It was clarified that WISe was not allowed to have a waitlist. Rather, all the WISe programs in the region have “interest lists.” Families are assessed in the order they were added to the list. According to the WISe Quality Management Plan, CANS 5= Quarterly Report for Quarter 2, 2022 North Sound (2022), schools have constituted between 7% and 15% of all WISe referrals over the past 3 years and were consistently in the top 5 referral sources for the program. Other top referral sources included: Self and Family, Mental Health Provider – Outpatient Tx, Child Welfare Services/Non-BRS, and Medical Provider.

According to the Office of the Washington State Auditor’s K-12 Student Behavioral Health in Washington report (2021) students have, “uneven access to behavioral health supports,” (p. 4). The authors attribute this to the insufficiency of state-level oversight and the need for school districts to develop behavioral health plans with limited support (p. 3-4). Further, when it comes to connecting students to community providers, schools must go through the students’ health insurance plans. The lack of available community resources for WA Apple Health enrollees was described above. For those who are privately insured or uninsured, the cost of accessing care can be prohibitive (p. 10). Finally, among the school districts audited for this report, 58% did not offer at least one service in the full continuum of supports identified as core elements of effective school-based behavioral health systems (p. 15-16). Notably, the greatest gaps were in the following activities (p. 17):

  • Prevention activities:

    • Behavioral health-related campaigns, initiatives or events (15% reported this activity)

  • Early intervention services:

    • Student mentoring programs (35% reported this activity)

  • Targeted intervention services:

    • Intensive individualized student interventions (47% reported this activity)

    • School-based health center (14% reported this activity)

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