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As October comes to a close, we're reflecting on how understanding and early support can change the path for young people and families across Washington. This month's newsletter looks at the ways connection, compassion, and practical tools help build healthier futures.
We start with borderline personality disorder (BPD): how it can show up in young people, why stigma gets in the way of care, and why there's real hope in evidence-based treatment. With Red Ribbon Week underway and Halloween around the corner, we also share tips on youth drug prevention, safe storage of cannabis products, and starting honest conversations at home. Our third article shows how Family Initiated Treatment (FIT) works in real situations when families decide to take the next step.
You'll also find updates on the new home for the Mental Health Assessment for Young Children (MHAYC) Workforce Collaborative (WC), the latest BROADcast on early psychosis, and the call for abstracts for Fetal Alcohol Spectrum Disorders (FASD) 2027. Together, these stories reflect our shared commitment to person-centered care for every youth, young person, family, and caregiver.
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Borderline personality disorder (BPD) is a mental health condition that can affect how a person experiences emotions, relationships, and their sense of self. People living with BPD may have intense emotions, difficulty regulating those emotions, impulsivity, or strong sensitivity to rejection and real or imagined abandonment. BPD doesn't have a single known cause. Research suggests that biological vulnerability and life experiences can interact to contribute to its development. Trauma, invalidation, instability, or disrupted relationships may play a role for some people, but there's no single pathway to a diagnosis. BPD was once widely viewed as extremely difficult to treat. We now know that specialized psychotherapy works, and many people improve substantially over time with ongoing treatment.
BPD is highly stigmatized and frequently misunderstood. Labels and assumptions can create barriers to care, including the belief that people with BPD are "difficult," "manipulative," or unable to recover. The American Academy of Child and Adolescent Psychiatry (AACAP) notes that in young people, BPD may look like emotions that become intense very quickly, extreme sensitivity to rejection, difficulty trusting that relationships are secure, impulsive behavior, or relationships that shift rapidly. A young person may experience an unanswered text, a change in plans, a disagreement, or a perceived rejection more intensely than their peers. What looks like an "overreaction" from the outside may reflect real difficulty managing overwhelming emotions.
Effective treatments are available, but one size doesn't fit all. One of the best-known treatments for BPD is dialectical behavior therapy (DBT), an evidence-based therapy originally developed for people experiencing chronic emotional dysregulation and suicidal behaviors. DBT teaches practical skills like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Other evidence-based approaches can also help, and treatment should be tailored to each person's needs and goals.
For Health Care Authority (HCA) and Washington's behavioral health system, understanding BPD connects to a broader commitment to accessible, person-centered care. Access means more than having a service listed on a website. People need to be able to find the right care, get into it when they need it, stay connected to it, and receive treatment that is respectful and responsive to their needs.
We can all help by challenging stigma, using person-first language, and remembering three things: BPD is not a character flaw, BPD is treatable, and people living with BPD deserve compassionate, evidence-based care.
Looking for support?
Washington families don't have to find the right provider alone. Kids Mental Health Washington offers free help connecting school-aged youth to mental health services, regardless of insurance or current services.
Young people and families enrolled in Apple Health can also contact their managed care organization for help finding an in-network provider. Primary care providers can help with assessments and referrals too. Apple Health covers adolescent DBT for self-harming behaviors.
The University of Washington Marsha M. Linehan DBT Clinic has information on DBT groups, along with educational resources to help you and your loved ones understand BPD and treatment options.
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A new home for the MHAYC Workforce Collaborative (MHAYC-WC)
We are excited to share that the UW Barnard Center is the new home for the Mental Health Assessment for Young Children Workforce Collaborative (MHAYC-WC). We are so thankful to the Center for Early Relational Health and the foundation they set as the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC) and are looking forward to this new partnership with the UW Barnard Center.
A reminder about the Workforce Collaborative: this is a professional development component of a larger effort to support mental health assessment and diagnosis best practices for young children enrolled in Apple Health (Medicaid), including training in the DC:0-5, an internationally-accepted system for developmentally appropriate assessment and diagnosis of young children’s mental health.
The BROADcast: Early psychosis in Washington
The latest BROADcast is out, with stories from the New Journeys network. This issue spotlights Valley Cities Behavioral Health Care, which has served young people and their families since 2016. You'll find a psychosis fact sheet, CBTp and Psychosis REACH training info, research participation opportunities, and a full list of New Journeys locations. Anyone can make a referral to New Journeys through the New Journeys website or by email.
FASD 2027: Call for abstracts
The 20th Annual International Conference on Fetal Alcohol Spectrum Disorders will take place March 12 to 15, 2027, in Albuquerque, New Mexico. FASD United invites abstracts in research, policy, practice, and lived experience. Submissions are due November 24.
Parent Voices Matter: Cultivating Resilient Parent Advisory Committees
Parent advisory committees work best when parents feel heard, supported, and ready to lead. Join this two-day training on November 4 and 5 to learn practical strategies for building, strengthening, and sustaining parent advisory committees that center family voice and build lasting partnerships in your community.
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Each year from October 23-31st, the National Family Partnership organizes Red Ribbon Week to spread awareness on youth drug prevention. Communities can participate by decorating schools, businesses, and other spaces in red ribbons in an effort to begin a conversation on the importance of supporting young people to make substance-free choices. Families and young people also wear ribbons to show solidarity in this vision for a healthier future.
While families and young people focus on preventing drug use in their community, Halloween may offer opportunities for accidental ingestion of cannabis products. With the rise of retail sales, ‘edibles’ (the term used most often for food-based cannabis products) often mimic the look of common candy. Packaging can be bright, colorful, and attractive to youth and children. While candy begins to flow around Halloween, families and caregivers should consider safe-storage practices including lockboxes and keeping products in their original packaging to prevent underage use.
This is also an opportunity to talk to your young person about the use of cannabis or other substances. Creating an environment where they feel comfortable asking questions can make it more likely that they will share with you when faced with difficult choices. Partnership to End Addiction has resources on how to start a challenging conversation. Remember, ongoing discussion about substance use is always more effective than a one-time talk.
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Understanding FIT is easier when you can see how it works in real situations. Below are two examples illustrating how different families might use the FIT pathway. (Note: These are composite scenarios for educational purposes only.)
Scenario 1: A caregiver notices escalating behavior
A parent of a 15-year-old notices increasing withdrawal, declining school performance, and emotional outbursts over several months. The youth refuses to see a counselor. The parent contacts their health plan and asks about FIT. The health plan connects them with a behavioral health provider, behavioral health clinic, hospital, or community health organization to request a FIT assessment. They may also choose to request an assessment by a professional person at a qualifying evaluation and treatment facility, inpatient facility licensed under Washington State law RCW chapter’s (70.41, 71.12, or 72.23) , or approved substance use disorder treatment program under RCW 71.34.600.
The provider conducts an evaluation, determines medical necessity is met, determines the appropriate level of care needed, and begins outpatient treatment. The provider works to engage the youth voluntarily throughout the process. Please note provider responsibility under RCW 71.34.600 (4).
What to know: The parent did not need a diagnosis to initiate the process. The provider determined medical necessity and the appropriate level of care.
Scenario 2: A school counselor informs a family
A school counselor notices a 14-year-old exhibiting signs of substance use and shares concerns with the caregiver. The caregiver feels overwhelmed and unsure where to start. The counselor provides the FIT family webpage and encourages the caregiver to contact their health plan. The family reaches out, is connected to an approved substance use disorder treatment program and requests that a substance use disorder assessment be conducted by a professional person. (RCW 71.34.600)
The youth receives an evaluation for substance use disorder (SUD) services. A note on SUD records: Washington’s age of consent for behavioral health services (e.g. mental health, substance use) is 13 years old. If an adolescent is admitted for SUD evaluation and/or treatment, all protected health information (PHI) must be redacted, unless the adolescent provides written consent to the disclosure of the admission or SUD treatment information per federal law 42 CFR Part 2, or if and when federal law is changed. A professional person who is licensed solely to provide SUD treatment, or co-occurring SUD and mental health treatment under an SUD license, will only be able to provide an evaluation to determine appropriate level of care and medical necessity. Information cannot be shared unless the adolescent is willing to sign a release of information as required by federal law. The provider should continuously attempt to engage the adolescent throughout the process to voluntarily consent to treatment, at which time FIT is no longer necessary. Family Initiated Treatment (FIT) - Guide for families, participants, and providers ( Steps to access FIT )
A young person may choose to consent to treatment anytime under FIT. This is often the situation when a clinician builds trust and rapport with the youth.
What to know: The school did not initiate FIT. The counselor provided information, and the family took the next step.
Key reminders for providers:
- FIT does not guarantee automatic admission; medical necessity applies
- Providers work to engage youth voluntarily whenever possible
- A diagnosis is not required before a family reaches out
When in doubt, refer
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