State psychiatric hospitals include Eastern and Western State and the Child Study and Treatment Center. Services include inpatient psychiatric services for acutely and chronically mentally ill persons, mentally ill legal offenders, geriatric patients and inpatient psychiatric services for severely mentally ill children and adolescents.

Program Support provides administrative and technical support for all programs within Mental Health including policy development, fiscal planning, information services, federal demonstration grants as well as legislative and regional coordination.

Employment and Day Services integrate clients with developmental disabilities into the community and prevent institutionalization. County contracted employment services help clients obtain and maintain employment in integrated settings. Day services for adults over age 62 or those who opt out of employment services enable clients to participate in the community. Both employment services and day services provide respite for family caregivers. Services are provided mainly under a Medicaid waiver requiring clients to be functionally and financially eligible for Medicaid. A small number of clients served are funded with state-only dollars. This activity also includes the county contracted Child Development Services (CDS) program which provides specialized therapeutic and educational services for children at risk of developmental delays to promote the child's attainment of age-related developmental milestones. CDS includes the required state portion of funding for birth to age three services associated with federal programs at the Department of Early Learning.

Individual and Family Services waiver, prevents more costly interventions by promoting the long-term health and well-being of people with developmental disabilities, and by providing supports to their family caregivers. Services include assistive technology, behavior supports, community engagement, environmental and vehicular adaptations, respite, person-centered planning, specialized equipment and supplies, skilled nursing, peer mentoring, specialized nutrition, supported parenting, specialized evaluations, specialized clothing, occupational, speech and physical therapy, consultation and training and transportation to a waiver service. Funding includes federal match, and the number of people qualifying for services is limited by the funding available. Eligibility criteria are established in statute.

Field Services staff provide case management for clients with developmental disabilities. This includes assisting in determining service needs, providing ongoing information and referral, completing assessments and service plans, locating providers, and authorize services. Staff also develop and monitor contracted community services, provide technical assistance to private contractors, and coordinate the planning and delivery of training services with county governments.

The Office of the Deaf and Hard of Hearing contracts with Regional Service Centers of the Deaf and Hard of Hearing to provide client services to the Deaf, Hard of Hearing, and Deaf-Blind individuals and their families. Client services include case management, education, training, outreach, information, and referral. A similar contract with Deaf-Blind Service Center provides an additional service; support services provider (SSP) for the Deaf-Blind to live independently.

Other Community Programs prevent the institutionalization of people with developmental disabilities by maintaining them safely in the community. Services include provider background checks, respite care for Medicaid waiver clients who live with their family, and support services paid under the federally required State Supplemental Payment program. It also includes crisis intervention diversion beds contracted with mental health Regional Support Networks (RSNs) to prevent state psychiatric hospitalization of clients with developmental disabilities.

Personal care services serve clients in a community setting instead of in institutions. Clients have a range of acuity and receive assistance with activities of daily living such as personal hygiene, toileting, bathing, dressing, cooking, assistance with medication, and eating. Clients receive assistance from the provider for completing household tasks which include shopping, laundry and housework, and transportation to medical appointments. The majority of clients live at home with their families and have contracted providers such as home care Agency Providers (APs) or Individual Providers (IPs). Some clients reside in Adult Family Homes or Boarding Homes. Clients meet the financial and functional eligibility criteria for either the Community First Choice (CFC) or Medicaid Personal Care (MPC) programs. This activity also includes statutorily required training for providers.

Professional Services are contracted professional services provided to clients with developmental disabilities. These Medicaid waiver clients receive services designed to maintain them in the community and prevent institutionalization. Services include medical and dental services, technical assistance, and therapeutic services like counseling/behavioral management, and speech, occupational, and physical therapy.

Program Support staff provide administrative and technical support for all activities within the Division of Developmental Disabilities. Included are policy and program development, legislative and regional coordination, and coordination with Management Services (Long-Term Care activity E051) for fiscal planning, budgeting, and information technology.

Residential Habilitation Centers (RHCs) are four, state-operated facilities that provide 24/7 care for clients with developmental disabilities who meet federal Medicaid criteria for institutional level of care. Services include assessment, treatment, training, habilitative programs, recreation, and nursing care. RHCs also provide limited services to community clients including diagnostic, evaluation, consultation, emergency, licensed professional services, and a limited amount of out-of-home respite care services. Beginning July 1, 2012, RHCs will no longer serve individuals under the age of 16.

The Residential Program integrates clients with developmental disabilities into the community. Contracted Residential Programs, such as supported living and group homes, are provided as alternatives to institutionalization for clients who meet federal criteria for institutional level of care but choose to waive those services in favor of community placement. Clients meet the financial and functional eligibility criteria for the Medicaid Core waiver. Residential services can range from a few hours a month to up to 24/7 care based on acuity of the client.

The State Operated Living Alternatives (SOLA) program is similar to the “Residential Program” activity, except staffing supports are provided by state employees. While Residential Program contractors may choose not to serve some clients, SOLA is a 'zero-reject' option for clients who are not able to be placed in the Residential Program and otherwise would be in an RHC.

The Community Crisis Stabilization Services (CCSS) is a state operated community behavioral health program that provides stabilization services that enable an individual to remain in the community through a crisis or, if necessary, provides short term (up to 180-days) facility based services to stabilize the individual and return them successfully to their home community. Services are provided by a mobile participant team that includes the client’s natural supports and community providers as well as a crisis stabilization facility located in Lakewood, Washington. The program focuses on behavior stabilization, skill development, and supported transition to the community placement. Services include: individualized assessments; service planning; specialty treatment; collaborative treatment planning; transition planning; and in-home supports.

Adult Day Health Community Services (ADH) is a supervised daytime program providing nursing and rehabilitative therapy services to adults with medical or disabling conditions.  Services are provided in centers and clients typically attend an average of  2 to 3 days per week. Clients attending ADH also receive other services such as home care or residential services. Clients must be functionally and financially eligible for Medicaid, be enrolled on the Community Options Program Entry System (COPES) waiver, and have a skilled nursing or rehabilitation need, as determined by a doctor.  Case managers review eligibility and ongoing need for services.  ADH services are provided under contract, and centers are monitored by the Area Agencies on Aging (AAAs).

Adult Family Homes (AFHs) are contracted, private homes that serve between two and six residents. Clients receive room, board, laundry, necessary supervision, and assistance with activities of daily living, personal care, and social services. Some AFHs specialize in serving individuals with dementia, developmental disabilities, or mental illnesses. AFHs whose provider is a professional nurse will frequently provide limited nursing care for individuals with more complex nursing and medical needs. Clients residing in adult family homes meet the financial and functional eligibility criteria for either the Medicaid Personal Care (MPC) program or the Community Options Program Entry System (COPES) Medicaid waiver, or are vulnerable adults under Chapter 74.34 RCW, receiving state-funded adult protective services.

Program Support for Aging and Long Term Care Support Adminstration (ALTSA) includes program support for ALTSA and management services support for both ALTSA and Developmental Disabilities. ALTSA program support staff ensure compliance with federal regulations, and develop specific services and agency policy for both Area Agencies on Aging (AAAs) and ALTSA field staff. Management services perform accounting and budget, contract management, forecasting caseloads and expenditures, data analysis, performance management, and information technology support for both ALTSA and Developmental Disabilities.

Eligibility/Case Management Services includes determining eligibility to receive Aging and Long Term Support Administration (ALTSA) services, information and referral, and case management services for clients, either via state staff or via contractor (Area Agencies on Aging for ongoing in-home clients only). Financial eligibility staff determine if clients qualify for ALTSA Medicaid or other services. Case management consists of assessing and reassessing functional eligibility (level of disability), updating and monitoring a plan of care, finding a placement or provider, coordinating non-department services in response to a client’s need, responding to emergencies and status changes, and providing any additional assistance a client may need to maintain their placement or in some cases move to a new setting.

Clients receiving in-home services have a range of acuity, and continue to live at home while receiving assistance with activities of daily living such as personal hygiene, toileting, bathing, dressing, cooking, assistance with medication, and eating. Clients may receive assistance with shopping, laundry, housework, or transportation to medical appointments. Contracted providers include home care agency providers (APs) or individual providers (IPs). Additional In-Home Services may include home-delivered meals, nutrition programs, adult day care, environmental modifications, special medical equipment, and skilled nursing care. Clients receiving In-Home Services meet the financial and functional eligibility criteria for either the Medicaid Personal Care (MPC) program or the Community Options Program Entry System (COPES) Medicaid waiver.