Research and Data Analysis

The Impact of Forensic Projects for Assistance in Transition from Homelessness (FPATH) on Competency Services and Other Key Measures—An Outcome Evaluation

Forensic Projects for Assistance in Transition from Homelessness (FPATH) programs provide outreach and case management services to people involved in Washington State’s forensic mental health system who face substantial barriers to behavioral health care and community supports. This study evaluates the impact of FPATH programs in three Washington regions by comparing outcomes for Medicaid-enrolled FPATH participants with a statistically matched comparison group of people who did not participate in the program. Key outcomes examined included use of competency services, behavioral health treatment, homelessness, and criminal legal system involvement. Results demonstrated that FPATH participants used crisis services, outpatient emergency room services, inpatient substance use disorder treatment, and Foundational Community Supports more frequently and for longer periods than the comparison group. There were no meaningful differences between groups in competency orders, arrests or legal charges, inpatient or outpatient mental health services, or homelessness during the outcome period.

2025 Caregiver Survey Report

Every year, the Department of Children, Youth, and Families (DCYF) partners with the Research and Data Analysis (RDA) Division of the Department of Social and Health Services (DSHS) to gather feedback from kinship and foster caregivers in the State of Washington. Between October 2024 and June 2025, DSHS surveyed 666 kinship caregivers and 350 foster caregivers who had a child in care in the past 12 months. The response rate was 77%. Surveys were completed over the phone (63%) or online (37%). Satisfaction was high in 2025, with most caregivers giving positive responses to all structured questions. Both kinship and foster caregivers were more positive in 2025 than in 2024 on several questions. In addition, kinship caregivers were more positive than foster caregivers on most questions. In their open text comments, caregivers noted the hard work and support provided by DCYF staff and expressed appreciation for available resources. Caregivers who participated in trainings found them helpful. Caregiver comments also identify some areas that need work, including service coordination and timeliness. Many caregivers also commented that they thought DCYF needed additional staff.

Long-Term Services and Supports: 2025 Annual Report

This study is the first in a series of annual reports directed by House Bill 1694 assessing the workforce available to supply Long-Term Services and Supports (LTSS) and the projected demand for LTSS in Washington State. Data from the U.S. Census Bureau and Bureau of Labor Statistics, combined with Medicaid LTSS claims data, are used to describe current LTSS workforce and utilization patterns, and to generate forecasts to 2050 of Medicaid-paid LTSS utilization and the number of individuals providing paid direct care in LTSS settings. We found that demand for LTSS is projected to far outpace supply, based on current utilization and employment patterns. Analyses found that wages were low for the direct care workers supplying the majority of LTSS services compared to Washington’s median wage and wages of similar occupations. Potential strategies to address this gap include increasing wages and benefits for these workers from their historical lows and incentivizing new workers into the LTSS field with tax benefits, expanding training and career opportunities, enhancing public perceptions of the LTSS jobs.

Prenatal Substance Exposure in Washington State: Prevalence, Treatment, and Other Service Needs

Prenatal substance exposure, defined as the exposure of a fetus to alcohol or drugs during pregnancy, can impact a range of infant health outcomes and lead to long-term negative effects on child development. This report summarizes recent trends in prenatal substance exposure among infants in Washington’s Medicaid program (Apple Health); in maternal substance use during pregnancy; and in access to treatment during pregnancy and postpartum. Opportunities to supplement treatment with additional supports are also discussed.

Mental Health Assessments for Young Children: An Examination of Assessment Trends Following 2022 Policy Changes

This report examines trends in mental health assessments following Apple Health policy changes that went into effect January 2022, collectively referred to as Mental Health Assessment for Young Children (MHAYC). The MHAYC policy changes included reimbursement for multi-session assessments and for provider travel to home and community settings, as well as a requirement for providers to use the DC:0-5TM, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. This report presents an overview of trends in mental health assessment characteristics in the 3 years before and 2 years after MHAYC policy changes, covering calendar years (CY) 2019 to 2023.

TANF Caseload Changes: The Well-Being of Parents and Children Leaving WorkFirst in Washington State

The Temporary Assistance for Needy Families (TANF) program provides cash assistance to low-income families with children in Washington state. This report examines how COVID-19-related TANF program changes were associated with the well-being of parents and children leaving TANF by comparing families leaving TANF during state fiscal year (SFY) 2022 to families leaving TANF in SFY 2017.

Characteristics of People with Apple Health and Stimulant Use Disorder Diagnosis in Washington State: Prevalence, Geographic Distribution and Healthcare Service Utilization over Five Years (Fiscal Years 2018 to 2022)

This report examines people with Apple Health medical coverage who were diagnosed with a stimulant use disorder (StimUD) between State Fiscal Years (SFY) 2018 and 2022. To support the development of effective interventions and policies to mitigate the impacts of stimulant use, this report analyzes the demographic and geographic prevalence of StimUD, as well as behavioral health diagnoses and service utilization among this population. Special attention is given to priority populations including: American Indian or Alaska Natives (AIAN); pregnant and postpartum individuals; people experiencing homelessness; and those involved with the criminal legal system. Over the five-year study period, the average prevalence of StimUD among adults with Apple Health coverage was five percent. Higher prevalence rates were observed in high-density urban centers, and among the identified priority populations. People with StimUD also experienced higher rates of behavioral health diagnoses, increased healthcare utilization, and elevated mortality compared to those with any substance use disorder.

2025 Social and Health Services Client Survey

The biennial Client Survey shares the experiences of Washingtonians who use social and health services in the state. The results highlight where services are strong and where customer service can be improved. Between October 2024 and May 2025, the Research and Data Analysis Division of the Washington State Department of Social and Health Services (DSHS) conducted 1,167 telephone interviews with randomly selected clients who received services from at least one of ten programs between May 2023 and April 2024. The programs are in DSHS (Aging and Long-Term Support, Division of Child Support, Community Services Division, Developmental Disabilities, and Vocational Rehabilitation), Health Care Authority (Apple Health/Medicaid, Mental Health Services, Substance Use Disorder Treatment Services), and Department of Children, Youth, and Families (Child Welfare Services). Results show that clients continue to be satisfied with program services and to say that programs are helpful for them and their families. Compared to 2023, clients are significantly more satisfied with phone access to staff, even as this also remains an area for ongoing improvement. On all other questions, results were stable, and there were no significant declines in satisfaction. In their comments, clients express appreciation for compassionate staff and gratitude for the services they receive. They also mention that program resources don’t always keep up with growing needs and that navigating the system can be challenging.

Changing Support Needs Among Adults Experiencing Homelessness: Washington State Apple Health Clients, 2019-2023

This report describes the distribution of single adults experiencing homelessness across five categories of support needs—low service use, health care needs, criminal legal involvement, primary mental illness, and significant care needs—over time from 2019 to 2023. We find that the number of single adults experiencing homelessness has increased by 8 percent over this period. This increase was largely due to growth in the number of people experiencing homelessness in the low service use category, and declines in the number of people exiting homelessness from one year to the next. Individuals in the criminal legal involvement category of support needs were the least likely to exit homelessness from one year to the next compared to those in other categories. The findings highlight (a) the need for low-barrier housing to prevent new episodes of homelessness among those with relatively few other support needs and (b) supportive housing services for those exiting the criminal legal system.

A Descriptive Profile of Parents with Intellectual or Developmental Disabilities and Their Children

This report presents a descriptive portrait of parents who have IDD, their needs and access to services, as well as the characteristics and potential service needs of their children. We find that parents with IDD and their children tend to have more health conditions and risks, as well as a higher utilization of social and health services, when compared to other parents on Medicaid.

Housing Service Disparities Among Adults Experiencing Homelessness in Washington State

Adults experiencing homelessness face a lack of affordable housing and suitable economic opportunities. State and federally funded homelessness and housing services can help address these conditions. Using linked administrative data from Washington State to identify adults experiencing homelessness in State Fiscal Year 2023, this report estimates the percentage who accessed state or federally funded homelessness or housing services as recorded in the Department of Commerce’s Homeless Management Information System (HMIS). Of the estimated 186,469 adults experiencing homelessness in SFY 2023, 24 percent received housing services, but rates differed by county, race/ethnicity, and age, signaling potential disparities in housing services access.

Building Dementia Capable Communities: Program Implementation Evaluation

Dementia, including Alzheimer’s disease and related disorders, poses a growing public health challenge as the population ages. The Building Dementia Capable Communities (BDCC) program is a pilot initiative funded by the state legislature aimed at enhancing the support network for people living with dementia and their caregivers. Through the BDCC program, three Area Agencies on Aging (AAAs) hired dedicated staff members to expand the availability of dementia support services, develop professional training programs, create new community partnerships, and increase community awareness around dementia and resources. This report evaluates the program’s effectiveness, focusing on its implementation through a program inventory and surveys of caregivers, AAA staff, and community partners.