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2024 Crisis Care Centers Annual Report
Key accomplishments and progress of King County's first year implementing the Crisis Care Centers Levy.
In 2024, King County made meaningful early progress toward the purposes of the Crisis Care Centers (CCC) Levy to help meet the urgent needs of people experiencing a behavioral health crisis. Accomplishments for each Levy strategy, and how they advance Levy purposes, are described further in this 2024 annual report.
Executive Summary
In 2024, King County made meaningful early progress toward meeting the priorities of the Crisis Care Centers (CCC) Levy. Passed by voters in 2023, the goal of the CCC Initiative is to make crisis services easy for everyone to access, enabling the County to help get more people into recovery sooner, before their crisis escalates. By creating a network of five Crisis Care Centers, restoring residential treatment capacity, and strengthening King County’s community behavioral health workforce, the CCC Levy investments work to provide everyone in a crisis with someone to call, someone to respond, somewhere to go, and someone to follow up afterward.
As the CCC Levy Implementation Plan was adopted by King County Council midway through the year on June 18, 2024, CCC Levy spending in 2024 occurred in the last six months of the year. In 2024, the Department of Community and Human Services’ (DCHS) Behavioral Health and Recovery Division (BHRD) moved with urgency to open more doors to behavioral health care, expanding and launching programs across several Levy strategies.
In total, DCHS invested about $15 million in 2024 across Levy strategies and committed an additional $7.9 million in awards through 2024 procurements. DCHS made it possible to allocate this funding within a short timeframe by hiring the internal staff necessary to manage each Levy program as soon as the CCC Levy Implementation Plan was adopted. Once CCC Levy-related staff were hired, the Department focused on initial program implementation.
Key 2024 accomplishments across strategies include:
- Strategy 1: Launched the process to site and open Crisis Care Centers
- Released the first round of the CCC Request for Proposals (RFP) to select Behavioral Health Agencies (BHAs) for up to three of the five planned Crisis Care Centers.
- Engaged behavioral health service providers to inform the Post-Crisis Follow-Up (PCFU) program and future RFPs.
- Strategy 2: Preserved existing residential treatment facilities and beds
- Awarded $11.5 million for residential treatment facility capital improvements to three providers, across six projects.
- Strategy 3: Strengthened the existing behavioral health workforce
- Released the Career Pathways RFP and awarded contracts to 37 providers directing funds to expand community representation in the workforce.
- Expanded the Service Employees International Union (SEIU) Healthcare Training Fund’s apprenticeship program.
- Strategy 4: Boosted existing crisis services with early investments
- Increased the number of behavioral health counselors working with 911 call centers.
- Expanded Mobile Rapid Response Crisis Teams (MRRCTs), adding 10 new teams.
- Installed five naloxone vending machines and 17 naloxone distribution boxes at community organizations across King County.
- Strategy 5: Provided capacity building and technical assistance
- Procured capital consultants to provide capacity building and technical assistance to crisis care center and residential treatment facility RFP respondents.
The CCC Levy is already transforming how people experiencing mental health and substance use crises access specialized behavioral health care. As programs transition from planning to implementation, the County is positioned to significantly expand services in 2025. This includes awarding crisis care center operators, launching PCFU services, expanding workforce supports, and distributing funding to open more mental health residential treatment facilities.
Background
Introduction
The CCC Levy is a once-in-a-generation opportunity to transform and modernize how people experiencing mental health and substance use crises access specialized behavioral health care. This nine-year Levy is invested to create a countywide network of five Crisis Care Centers, restore residential treatment capacity, and strengthen King County’s community behavioral health workforce. The CCC Levy is authorized by Ordinance 19572.1
King County voters passed the CCC Levy in April 2023, and the CCC Levy Implementation Plan was adopted in June 2024 by Ordinance 19783.2 The CCC Levy Implementation Plan requires the Executive to make an online annual report available to the public and all interested parties, including the King County Council and Regional Policy Committee or its successor, beginning in August 2025.3 This CCC Levy online annual report details the previous calendar year’s results and describes King County’s actions to enhance behavioral health services and launch new facilities, consistent with the CCC Levy Implementation Plan.
Department Overview
DCHS’ mission is to provide equitable opportunities for King County residents to be healthy, happy, and connected to community. DCHS’ five divisions provide human services for adults; behavioral health care across the lifespan; services supporting children, youth, and young adults to thrive; services for people with developmental disabilities; and affordable housing and homelessness prevention. The Department invests approximately $1.5 billion annually in public funds to give King County residents access to a broad range of services. The Department, along with a network of community providers and partners, plays a leading role in creating and coordinating the region’s human services infrastructure. Approximately 400,000 people participated in services managed by DCHS in 2024. DCHS is responsible for oversight and management of five significant local human services plans and dedicated fund sources (identified below), in addition to other federal, state, and local funds:
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Best Starts for Kids (BSK);4
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Health Through Housing (HTH) initiative;5
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MIDD behavioral health sales tax fund;6
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Veterans, Seniors, and Human Services Levy (VSHSL);7 and
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The CCC Levy.8
BHRD is responsible for managing and funding behavioral health services and programs for King County residents enrolled in Medicaid, people with low incomes, all residents in need of behavioral health crisis services, and for implementing the CCC Levy.9 Approximately 70,000 residents annually receive services through BHRD-funded programs. BHRD primarily contracts with community behavioral health agencies to provide a full continuum of services.10 However, in some cases, like involuntary commitment services and behavioral health outreach teams, BHRD-employed staff provide services directly.11
Key Historical and Current Conditions
The impetus for the CCC Levy was a need for more behavioral health crisis care and supports in King County. For decades, federal and state investments in public behavioral health systems, including Medicaid reimbursements and funds distributed from Washington’s Health Care Authority (HCA) through the Behavioral Health Administrative Services Organization (BHASO), have been inadequate, leaving many communities behind and unable to receive the care they need.12 Consequently, as funding for behavioral health services has remained insufficient, the needs of people living with mental health and substance use conditions have persisted. Significantly:
- Between December 2023 and November 2024, the Harborview Medical Center’s Emergency Department received 4,052 Medicaid visits from King County residents, with behavioral health as a primary reason.13
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In 2024, 854 people were held in hospitals and emergency rooms for two days or longer because there were no beds for behavioral health treatment available.14
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In 2024, outreach to the 988 behavioral health crisis line increased overall, with over 9,000 phone calls, over 1,200 chats and nearly 3,000 texts coming in each month.15
- Nearly 1 in 4 Washington adults with a mental illness report an unmet need for treatment.16
Purposes of the CCC Levy
Providing Places to Go in a Crisis
The CCC Levy’s paramount purpose is establishing and operating five Crisis Care Centers across the county, with at least one in each of the four crisis response zones (CRZs) and one serving youth. The creation of specialized crisis facilities, like Crisis Care Centers, that are easily accessible, and a “no wrong door” model so that anyone can walk in, is frequently identified as a key strategy in the crisis service continuum.17 These facilities divert people from emergency department and carceral settings to higher-quality specialized settings that can provide care using trauma-informed, recovery-oriented, and cultural humility best practices.18, 19, 20
Addressing the Reduction in Residential Treatment Capacity
One of the supporting purposes funded by the CCC Levy is to expand the availability and sustainability of residential treatment and restore the number of mental health residential treatment beds in King County to 355, a 33 percent increase over the number of beds available at the time of the Levy’s passage.21 Residential treatment is a community-based behavioral health treatment option for people who need a higher level of care than outpatient behavioral health services can provide.22
Improving retention and recruitment in the Community Behavioral Health Workforce
The other supporting purpose funded by the CCC Levy is to increase the sustainability and representativeness of the behavioral health workforce in King County by expanding community behavioral health career pathways, sustaining and expanding labor-management workforce development partnerships, and supporting crisis workforce development. King County is experiencing a behavioral health workforce shortage that is impacting people’s ability to access behavioral health care when they need it.23 At a time when nearly one in five Americans lives with a mental health condition, and more people than ever are interested in seeking behavioral health support, the lack of access to diverse and qualified behavioral health professionals can serve as a barrier to accessing treatment for King County residents. CCC Levy-funded investments aim to sustain the existing workforce, create a pipeline to encourage others to join this workforce, and increase representation within the workforce which is reflective of the community the Levy serves.
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CCC Levy Strategies
King County advances the CCC Levy’s primary and supporting purposes through eight strategies, summarized in Figure 1.
Figure 1: Summary of the CCC Levy Strategies
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Summary of the CCC Levy Strategies |
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Strategy |
Summary Description |
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Strategy 1 Create and Operate Five Crisis Care Centers |
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Strategy 2 Restore, Expand, and Sustain Residential Treatment Capacity |
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Strategy 3 Strengthen the Community Behavioral Health Workforce |
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Strategy 4 Early Crisis Response Investments |
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Strategy 5 Capacity Building and Technical Assistance |
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Strategy 6 Evaluation and Performance Measurement |
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Strategy 7 CCC Levy Administration |
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Strategy 8 CCC Levy Reserves |
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Annual Reporting Requirements
The CCC Levy Ballot Measure Ordinance and the CCC Levy Implementation Plan establish requirements for annual reporting on the Levy’s progress towards accomplishing its purposes, as described above, and strategies, described in Figure 1. It also requires reporting on the Levy’s actual financial expenditures relative to the financial plan described in the CCC Levy Implementation Plan.27
Specifically, the CCC Levy Implementation Plan requires the Executive to provide an online annual report that includes:
- An overview of calendar year accomplishments, including changes to improve performance;
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An assessment of the financial plan for residential treatment;
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Fiscal and performance measurement;
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A geographic distribution map or summary;
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Geographic reporting by service category and ZIP code;
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Operator awards and progress on contracting;
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Facility utilization;
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Transportation data; and
- Historical and current data in a manner that can be used to analyze services and make year-over-year comparisons.28
The following sections respond to each of the above reporting requirements. The linked table shows how this report meets the requirements.
Overview of Accomplishments and Progress
In 2024, the County made meaningful progress across CCC Levy strategies, making important strides to meet the urgent needs of people experiencing a behavioral health crisis. Significantly, 2024 progress focused on building the foundation necessary to successfully implement the full suite of Levy programs in 2025 and beyond. Key accomplishments in 2024 included:
- Awarded funding for 50 contracts, including:
- $11.5 million to six existing behavioral health facilities for capital improvements;
- $12 million to 37 community behavioral health providers who applied to the Career Pathways RFP to boost supports for their workers;
- $491,000 to Seattle-King County Public Health for overdose prevention supplies, including three new naloxone vending machines;
- $1.5 million to launch 10 new MRRCTs in December 2024, expanding mobile crisis services; and
- $500,000 to capital facility development consultants for Behavioral Health Agencies (BHAs) applying for Levy capital funding opportunities.
- Released five procurements related to multiple CCC Levy strategies, including:
- RFP for Crisis Care Centers;
- RFP for Mobile Crisis Teams Expansion;
- Request for Applications (RFA) for Facility Capital Improvements;
- RFP for Career Pathways; and
- Request for Quotation for Capital Consultants to Provide Technical Assistance.
- Hired 30 full-time employees who now work to support one or multiple Levy strategies. In 2024, the County built the internal staff capacity necessary to carry out the work described in the CCC Levy Implementation Plan, including releasing procurements and awarding Levy funds to eligible activities. Investing in building internal staff capacity in 2024 allowed the County to quickly make meaningful progress toward Levy purposes, as described in this report.
2024 accomplishments, including by strategy, and how they advance Levy purposes, are described further below.
Community Engagement
The CCC Levy Implementation Plan prioritizes community engagement throughout the life of the Levy to inform implementation, to engage community around Crisis Care Center openings and new available services.29 In 2024, CCC Levy engagement included interactive sessions focused on Crisis Care Center education, awareness, destigmatization, and communities’ experiences with crisis services.
Through community engagement, DCHS heard clearly that successful crisis care requires a comprehensive, person-centered approach. Community members emphasized the importance of having trained professionals, such as doctors, nurses, and behavioral health technicians, readily accessible during a guest’s stay. They also highlighted the critical role of peers throughout the model, the need for warm and welcoming environments, access to medication for withdrawal management, and reliable transportation. These insights directly shaped the design of the CCC RFP released in 2024, ensuring these priorities were embedded in the model. The Post-Crisis Follow-Up RFP in 2025, to expand access to timely and coordinated follow-up services, is responding to the identified need for continued support after a guest’s stay.
In 2024, the County conducted 45 community partnership presentations and 16 additional individual community conversations to promote shared awareness of Levy activities. The County also conducted six presentations to agency providers on Culturally and Linguistically Appropriate Services (CLAS) for Post Crisis Follow Up (PCFU) to educate providers on PCFU overall, and to gain feedback and insight to help inform an upcoming RFP for PCFU CLAS providers.30 Lastly, the County conducted a community survey that was accessible to people in nine different languages and received responses from over 165 community members. As a result, DCHS was able to engage a wide range of King County communities in different formats, ensuring people had the support and resources necessary to meaningfully participate in learning more about crisis care and sharing their input on Levy implementation.
2024 CCC Levy Accomplishments by Strategy
This section provides additional information about 2024 CCC Levy accomplishments, organized according to the strategies described in Figure 1. Each strategy in the CCC Levy Implementation Plan includes a set of allowable activities, and this subsection describes the accomplishments achieved in 2024 for those allowable activities.31
In September 2024, just three months after Implementation Plan adoption, DCHS released the first round of the Crisis Care Centers RFP. This initial round was designed to select Behavioral Health Agencies (BHAs) to establish and operate up to three of the five planned Crisis Care Center facilities.
The Crisis Care Centers RFP included two categories:
- Launch Ready proposals demonstrated readiness to initiate an operational contract within 60 days of contract execution.32
- New Site proposals are not yet ready to begin operations. These proposals may involve sites that are still being identified, under review, awaiting purchase, already secured through ownership or long-term lease, or controlled through a facility purchased by the County.33
All interested BHAs were required to submit a Letter of Intent (LOI). However, submitting an LOI did not obligate the agency to submit a full proposal.
By October 25, 2024, the LOI deadline for Launch Ready proposals, DCHS received one LOI from a BHA in the North CRZ. By November 22, 2024, the deadline for New Site proposals, DCHS had received nine LOIs from five BHAs, covering all CRZs, including the Youth facility.
Operator Awards and Progress on Contracting
Operator selection for the Launch Ready site occurred in early 2025, with Connections Health Solutions awarded the North CRZ facility. New Site proposal awards are anticipated in summer 2025. Award announcements and updates on contracting status for both Launch Ready and New Site proposals will be included in the 2026 CCC Levy Annual Report.
Additionally, DCHS plans to release Round 2 of the Crisis Care Centers RFP in fall 2025. This round is expected to focus on selecting operators for the remaining Crisis Care Center facilities that remain after the Round 1 awards.
Post-Crisis Follow-Up (PCFU)
In 2024, DCHS conducted engagement and planning for the upcoming PCFU RFP scheduled to launch in 2025. DCHS focused on engaging with community providers that provide direct behavioral health services to help inform the upcoming RFP release. No funds from the PCFU component of strategy 1 were utilized in 2024 because the RFP was in development.
During these engagement sessions, providers discussed current gaps, barriers, and inequities their service populations experience that PCFU services could help address. Issues providers identified included: lack of care coordination between providers, engagement challenges due to logistical barriers (such as difficulties with transportation and difficulty accessing services), CLAS services accessible to diverse populations, and social determinants of health impacting behavioral health service utilization.34, 35
Providers identified needs and possible strategies to address the identified obstacles including workforce support for hiring and retention efforts, implementing multidisciplinary teams to promote whole-person care, community engagement to keep communities informed of services, and sufficient funding allowing programs to build further capacity and scope.
Facility Utilization
Facility utilization at Crisis Care Centers is expected to be closely monitored through performance measurement as a component of continuous quality improvement (CQI) efforts. DCHS intends to require and support Crisis Care Center operators to report data that allows DCHS to calculate key performance measures such as wait times, length of stay, occupancy rates, and throughput to assess how efficiently people move through the clinical components of each facility. Although operating at or near full capacity may indicate strong community need and program alignment, it is also critical that Crisis Care Centers maintain open capacity to ensure timely access for new individuals seeking care. DCHS expects to use this information to make data-driven adjustments that help ensure crisis services remain consistently accessible across facilities.
DCHS expects that Crisis Care Centers will require time to ramp up operations, and initial data may reflect lower utilization rates. This early phase may be influenced by factors such as the time needed to hire and train staff and to increase awareness and build trust with community members and referral partners.
To support operators during this start-up period, DCHS plans to make Strategy 5: Capacity Building and Technical Assistance funds available upon execution of Crisis Care Center contracts. These funds may be used for communication efforts, community engagement activities, translation and interpretation services, and efforts to reduce participation barriers–such as hosting accessible events or developing outreach materials.
If a facility continues to experience underutilization, DCHS intends to work closely with the provider to identify the root causes and implement targeted solutions to improve access and service uptake. This may include strategies such as outreach, partnership development, or expanded use of mobile crisis services to increase engagement and utilization.
CQI efforts will be highlighted in future CCC Levy annual reports, as more performance data becomes available and the system matures. These insights may inform ongoing efforts to strengthen crisis response infrastructure and ensure that all residents have equitable access to timely, high-quality behavioral health care.
Transportation and Insurance Data
The CCC Levy Implementation Plan calls for annual reports to include data on transportation to a Crisis Care Center, as well as data on insurance status for people arriving at a Crisis Care Center. As providers establish contracts to operate Crisis Care Centers starting in 2025, they will be required to collect both insurance status and mode of arrival data for the people they serve. DCHS expects to share information on insurance status and transportation in future annual reports, beginning with the 2025 report.
Capital Facility Improvements and Maintenance
In 2024, DCHS released a Request for Information and a rolling RFA for capital improvements and maintenance for existing MHR facilities. Through the rolling RFA, the department awarded $11.5 million of $15 million available for this purpose in contracts to three providers across six residential treatment projects: Transitional Resources, Sound, and Community House. Awardees proposed to use funds to renovate and modernize their facilities, by doing work such as replacing roofs and windows, installing HVAC systems, and making improvements in service and administrative spaces. Although none of the awarded funds were yet spent in 2024, funds were carried over into the 2025 budget for strategy 2 to support this needed investment to preserve existing MHR capacity. The remaining $3.5 million was awarded in January 2025 as part of the same rolling RFA, which remained open through December 2024.
Capital Facility Development
In 2024, DCHS worked to hire necessary staff and create solicitation materials for the Mental Health Residential (MHR) Capital Development RFP. Responding to community feedback to avoid overwhelming service providers with multiple large-scale procurements simultaneously, the release of this RFP was delayed until January 2025, as DCHS prioritized the CCC RFP first. As a result, $27 million in MHR capital development dollars were carried over into the 2025 budget for strategy 2 rather than being released in 2024. Accordingly, $59.2 million of capital development funds for new MHR facilities is available in 2025.
Career Pathways
In 2024, through a Request for Proposals funding opportunity, DCHS allocated CCC Levy funds to bolster the behavioral health workforce in community agencies. In total, Levy funding supported 37 contracts and awarded $12 million in funding for Career Pathways to strengthen, support the development, and increase the representativeness of King County’s community behavioral health workforce. The 37 contracts with behavioral health providers are supporting activities such as tuition assistance, paid internships, clinical supervision, professional licensure fees, staff well-being initiatives, and equity and clinical evidence-based training programs. DCHS also conducted a workforce survey across BHRD’s provider network to update existing data and assess changes since 2023. The survey highlighted staff vacancies and retention as continued challenges.
Labor-Management Workforce Development Partnerships
Work on Labor Management Workforce Development Partnerships in 2024 focused on planning for the Behavioral Health Education and Advancement Model (BEAM) contract with SEIU Healthcare 1199NW Multi-Employer Training and Education Fund ahead of its implementation in 2025. The investment aims to strengthen the behavioral health workforce by creating a dedicated training and education reimbursement fund for eligible KCICN and BH-ASO workers and by increasing the use of professional development resources, particularly among a racially diverse workforce.
Additionally, DCHS started development on a contract to strengthen the behavioral health workforce pipeline through registered apprenticeships and related training programs. In partnership with SEIU Healthcare 1199NW Multi-Employer Training and Education Fund, these apprenticeships will offer workers the opportunity to earn while they learn—combining paid, on-the-job training with the ability to earn college credit while maintaining full-time employment. The program will expand apprenticeship opportunities for three key roles: Behavioral Health Technician, Peer Counselor, and Substance Use Disorder Professional.
Crisis Workforce Development
In 2024, DCHS focused on planning for crisis specialty training resources to strengthen King County's community behavioral health crisis workforce. This included identifying specific training needs, as well as strategies to support recruitment and retention, clarify the role of mobile response teams, and enhance community representation within the workforce. In late 2024, DCHS initiated collaboration with training consultants to develop a framework that meets the needs of behavioral health professionals and inform the crisis specialty training RFP that is anticipated to be released in third quarter of 2025.
Training resources are intended to build and strengthen workers’ ability to assess and triage crises, and to provide effective behavioral health crisis stabilization and treatment services using evidence-based and promising practices, culturally and linguistically appropriate approaches, trauma-informed care, and care coordination best practices.
Embed Behavioral Health Counselors in 911 Call Centers
In 2024, DCHS led planning and development efforts to expand the integration of behavioral health counselors within 911 call centers, strengthening crisis response and reducing unnecessary involvement of first responders.
Building on a Washington State-funded pilot, Crisis Connections leveraged new funding through the CCC Levy to work with Valley Communications 911 Center in South King County, improving coordination between 911 call takers and crisis counselors, and supporting the transition to 24/7 operations. Specifically, Levy funds supported the co-location of trained behavioral health counselors in the Valley Communications Center, making it easier to redirect behavioral health crisis calls to staff with specialized behavioral health training. These behavioral health counselors are then able to support the caller over the phone, or dispatch a mobile crisis team to respond, reducing the need for first responder involvement.
Expand Mobile Rapid Response Crisis Teams (MRRCT)
Through the MRRCT program, trained mental health workers and peer specialists with lived experience of mental health or substance use challenges respond directly to individuals in crisis in the community to de-escalate, stabilize, and resolve crises onsite. They also facilitate connections to ongoing supportive services. These teams operate countywide.
In December 2024, BHRD expanded mobile crisis response for adults through the MRRCT, introducing 10 new teams and one new provider. This marked a 59 percent increase in adult mobile crisis teams in King County. Making crisis teams easily available to everyone in King County through the 988 Crisis Line, while increasing the number of available experts to respond in-person to a behavioral health crisis rapidly enhanced access to 24/7 crisis services. During its initial weeks of expanded operation in December 2024, CCC Levy-funded MRRCT served 131 King County residents experiencing a behavioral health crisis.
Building on existing mobile crisis services that have been in place since 2012, these teams serve as a resource for first responders, the King County Regional Crisis Line, and the 988 Suicide and Crisis Line. These mobile crisis response services reduce the cyclical involvement of people with behavioral health conditions in legal systems and emergency departments and connect people to services that address both immediate and ongoing needs.36
Reduce Fatal Opioid Overdoses by Expanding Access to Low Barrier Opioid Overdose Reversal Medication
In 2024, the CCC Levy funded the installation of five naloxone vending machines and 17 naloxone distribution boxes across seven agencies located throughout King County, allowing for low-barrier access to the life-saving medication. The vending machines and distribution boxes were placed in sites with high overdose rates including permanent supportive housing, low-income housing, emergency shelters, day centers, and food banks.37 Additionally, Public Health – Seattle & King County collaborated with over 100 community-based organizations, equipping them with naloxone to distribute to priority populations. These organizations have trained their staff to administer naloxone, resulting in successful overdose reversals and creating a more prepared and responsive network for overdose emergencies. The project is designed to address the urgent need for overdose prevention, particularly among individuals experiencing homelessness or who are unstably housed, who are disproportionately affected by high overdose rates.38 This initiative offers anonymous and accessible naloxone distribution points in these key community resource locations.
Mobile Response and Stabilization Services (MRSS) for Youth
In 2024, DCHS began planning for MRSS to strengthen and unify youth crisis response. A planning team conducted key analyses to ensure that service delivery aligns with best practices and state requirements. These efforts shaped service models and assessment of operational needs and laid the groundwork for implementation of expanded services.
DCHS also identified one-time startup needs such as vehicles and equipment to support program readiness. While no funding was spent under this strategy in 2024, the team made significant progress preparing for MRSS implementation. Program expansion is expected to begin in 2025.
Facility Operator Capital Development Assistance
In 2024, DCHS awarded capacity building and technical assistance contracts to three agencies: Advocates for Human Potential, Project Management Advisors, and OAC Services, and launched full implementation in early 2025. These technical assistance efforts support Mental Health Residential and Crisis Care Center facilities from planning through activation, setting the foundation for long-term success.
This section focuses on 2024 activities and investments in the five CCC Levy strategies that involve direct services and community-facing programs. The Levy’s three other strategies capture support processes such as performance measurement and evaluation, County administrative infrastructure, and financial reserves. In these areas, 2024 activities included hiring of the County’s Levy-funded staff and establishing the foundation for the CCC Levy’s performance measurement and evaluation. Results of these efforts appear throughout this report and DCHS expect to include further detail in future years’ reports.
The Crisis Care Centers initiative achieved significant progress in 2024, issuing five procurements and releasing 50 awards within a six-month period. In 2024, most CCC programs were in the early stages of development, including negotiating contracts and launching operations. As a result, no programmatic changes to improve performance have been identified at the time of this report. As these programs are implemented and more data becomes available, DCHS continues to assess performance and make necessary adjustments to ensure service quality and effectiveness.
The Fiscal and Performance Measurement section of this report addresses planned actions to implement levy programs expediently, including increasing the deployment of funds in 2025.
Fiscal and Performance Measurement
Actual Financial Expenditures
In 2024, DCHS focused on building the financial systems and internal capacity needed to implement the CCC Levy and meet long-term implementation goals. As shown in Figure 2, the CCC Levy Implementation Plan, approved in June 2024, projected $85.9 million in spending in 2024, while actual spending totaled $15 million.39 Funds originally projected to be spent in 2024 that remained at year-end, due to later plan adoption, hiring of new staff, and the phased approach to procurement, are expected to be expended in 2025 as more services start.
In 2024, DCHS prioritized issuing procurements, with a particular focus on the Crisis Care Centers RFP, the Levy’s most significant procurement and primary purpose. Given the size and complexity of the funding opportunities, DCHS intentionally staggered procurement timelines to avoid overwhelming providers, which in turn resulted in lower expenditures in 2024 than initially forecast. This approach responds directly to provider feedback, which highlighted the challenges of applying for multiple large procurements at once with limited staff capacity. Spacing out funding opportunities enables providers to better allocate their resources and submit stronger proposals for these essential service expansions.
Given the strong foundation built in 2024, DCHS anticipates expenditures to increase significantly across Levy purposes and strategy areas as implementation proceeds as programs are implemented and more procurements are completed.
An additional factor that affects the speed of the County’s implementation of crisis care centers is the prompt availability of Medicaid funding. While the CCC Levy funds capital, startup, and many operational costs, Medicaid is also expected to fund a significant proportion of ongoing service delivery, consistent with the CCC Levy Implementation Plan.40 As of the drafting of this report, Medicaid reimbursement does not begin until six to 12 months after services start, due to the slow process of rate-setting and actuarial review by the state Health Care Authority (HCA). State legislation from the 2025 session is expected to reduce these delays in future years.41 DCHS intends to continue urging the state to implement these improvements to Medicaid funding availability expediently, to support timely service capacity expansion when facilities are ready.
Figure 2: Financial Expenditures Table
Assessment of Residential Treatment Financial Plan
The CCC Levy maintains the financial capacity to restore, expand, and sustain mental health residential treatment to 355 beds countywide. The financial plan for the Levy’s strategy to restore, expand, and sustain residential treatment capacity did not substantively change in 2024, though the timing of some early expenditures has shifted slightly to reflect RFP timing.
In 2024, Strategy 2 under Supporting Purpose 1: Residential Treatment had $42 million available, of which $15 million was for capital improvements and maintenance, and $27 million was for capital development. As described further in the Overview of Accomplishments and Progress section under Strategy 2, DCHS awarded most capital improvements and maintenance funding in 2024 and included the remainder in a late 2024 procurement. Consistent with the CCC Levy’s phased procurement strategy, capital development funds were made available in 2025 instead of in 2024 as originally planned.
Performance Measurement
Since 2024 investments initiated Levy-funded activities, performance measurement efforts involved building the evaluation and performance measurement framework outlined in the CCC Levy Implementation Plan. The framework is intended to track meaningful data that enhances public accountability and transparency, informs continuous quality improvement, and generates insights that lead to tangible service improvements.
In 2024, DCHS began partnering with providers to establish data collection and performance measures for launched programs, such as MRRCT. This report does not include performance data for MRRCT because the program launched during the final two weeks of 2024. As a result, program data was limited to the initial days of MRRCT’s ramp-up phase, when service delivery had not yet reached full scale, and did not yet reflect steady-state operations. Performance data for a fully implemented MRRCT program is expected to be featured in annual reports beginning in 2025.
DCHS also started to plan measures for programs that would be contracted in 2025, including Crisis Care Centers. Notably, community input that helped shape the Implementation Plan also informed early Crisis Care Centers performance plans by identifying measures of success that are important to the community. As contract implementation advances in 2025, DCHS continues to work with providers and community partners to determine, expand, implement, and report performance measurement and evaluation data. Future reports are expected to highlight performance takeaways throughout the Levy’s programs.
Geographic Distribution
The CCC Levy Implementation Plan calls for each annual report to include a map or summary describing the Levy's geographic distribution. This section provides the available geographic information about investments in 2024.
Distribution of Expenditures by ZIP Code
2024 CCC Levy investments supported the entire county, with some programmatic investments connected to specific facilities or service areas. For example, investments in MRRCT were available to the entire county in 2024, and funding for overdose prevention programs supported naloxone vending machines and easy access Narcan supplies located in the North, South, and Central CRZs.42 For several additional programs, such as but not limited to residential treatment facilities, DCHS awarded CCC Levy funds to projects in various locations around the county, but these funds were not yet spent at the end of 2024. Related expenditures are expected to be included in the 2025 annual report.
A detailed table containing comprehensive geographic distribution data is also available at this link.
Figure 3: Expenditures Distribution Map
Distribution of Individuals Served by ZIP Code
Because CCC Levy funded programs were just starting up, programs in operation served a relatively low number of people. To avoid individually identifying service participants, data must be suppressed to protect privacy when numbers of individuals in a single geographic unit are low. Therefore, a geographic distribution of individuals served is unavailable for 2024.
The CCC Levy worked with contracted providers in 2024 to plan data collection and build technical infrastructure to collect ZIP code data and support robust geographic reporting starting in 2025. Future reports are expected to include a map and summary of the geographic distribution of people receiving Levy-funded services by ZIP code and CRZ of their residential address, as well as the location they received services, when available.
Conclusion
In its first year of implementation, the CCC Levy built a strong foundation for transforming King County’s behavioral health crisis response system by launching key procurements, awarding critical funding, building internal staffing capacity, and engaging an array of community partners. In addition, the levy launched a major expansion of mobile crisis response services in 2024.
Procurements, awards, and investments in 2024 reflect the paramount and supporting purposes of the CCC Levy: establishing a regional network of five crisis care centers, restoring and expanding residential treatment capacity, and growing the behavioral health workforce. The release of five major procurements, the establishment of 50 contracts across five Levy strategies, and early investments in needed services like mobile crisis response and naloxone distribution mark important steps toward delivering accessible, high-quality care across the County.
As programs transition from planning to implementation, and in some cases begin to scale up, the County is positioned to significantly expand services in 2025. As of the drafting of this report, anticipated 2025 actions included awarding crisis care center operators, launching PCFU services, expanding workforce supports, and distributing funding to expand residential treatment beds.
Next actions
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Additional Crisis Care Centers awards and contracts
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Supporting providers and jurisdictions through technical assistance and capacity building funding availability
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Award funding for post-crisis follow-up culturally and linguistically appropriate service providers
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Releasing procurement to build new residential treatment beds
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Launching youth mobile response and stabilization services (MRSS)
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Implementing career pathways and workforce development projects
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Building infrastructure for data reporting, including geography, insurance and transportation
Future annual reports are expected to include more detailed data and are expected to include a broader range of outcomes that reflect the impact of CCC Levy investments. Together with partners and community members, the County expects to build and operate a behavioral health crisis system that offers timely, compassionate, and effective care to all residents.
Footnotes
1. Ordinance 19572. [LINK]
2. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
3. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
4. Best Starts for Kids (BSK) website. [LINK]
5. Health through Housing (HTH) website. [LINK]
6. MIDD is referred to in King County Code and related legislation as the mental illness and drug dependency fund, tax, or levy. KCC 4A.500.300 and 4A.500.309. [LINK]. See also the MIDD Behavioral Health Sales Tax Fund website. [LINK]
7. Veterans, Seniors, and Human Services Levy (VSHSL) website. [LINK]
8. King County Ordinance 19572. [LINK]
9. King County BHRD Provider Manual. [LINK]. People with low incomes are defined as falling below an income benchmark of 220 percent of the federal poverty level for adults and 300 percent of the federal poverty level for children.
10. “Community behavioral health agencies” means agencies that meet the requirements defined in the Revised Code of Washington Chapter 71.24 Community Behavioral Health Services Act [LINK], are licensed by the Washington State Department of Health as a community behavioral health agency as defined in Chapter 246-341 Washington Administrative Code [LINK] and are contracted with the King County Behavioral Health Administrative Services Organization or King County Integrated Care Network. Community behavioral health agencies must serve people who are enrolled in Medicaid health insurance to be eligible for CCC Levy funding through Strategy 3.
11. RCW 71.05 [LINK] and 71.34 [LINK]. King County BHRD Crisis and Commitment Services website. [LINK]
12. Center for American Progress, The Behavioral Health Care Affordability Problem, May 26, 2022. [LINK]
13. Medicaid Claims.
14. BHRD Information System.
15. Reported by King5 in article titled: July recorded the highest number of calls to 988 in Washington since its launch [LINK]
16. Seattle Times “Here are the basic facts about mental health and treatment in Washington state” [LINK.]
17. Substance Abuse and Mental Health Services Administration. (2025). National Guidelines for Behavioral Health Crisis Care - Best Practice Toolkit. [LINK].
18. ME Balfour and ML Goldman, “Crisis and Emergency Services” in “Textbook of Community Psychiatry: American Association for Community Psychiatry, 2nd edition.” Wesley E. Sowers (Editor), Hunter L. McQuistion (Editor), Jules M. Ranz (Editor). Springer 2022, pp. 369-384.
19. ME Balfour and ML Goldman, “Collaborations Beyond the Emergency Department” in “Primer on Emergency Psychiatry” Tony Thrasher (Editor). Oxford University Press, 2023, pp. 463-478.
20. Cultural humility is an approach to providing healthcare services in a way that respects a person’s cultural identity. The use of this term is intended to align with the U.S. Department of Health and Human Services Office of Minority Health’s definition of cultural humility. [LINK]
21. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK] As of the drafting of this report, King County has 240 residential treatment beds for mental health conditions in seven facilities. Forthcoming CCC Levy investments are expected to begin to increase this number.
22. King County Ordinance 19572 defines residential treatment as “a licensed, community-based facility that provides twenty-four-hour on-site care for persons with mental health conditions, substance use disorders, or both, in a residential setting” [LINK].
23. King County Community Behavioral Health Provider Survey, 2023.
24. King County Crisis and Commitment Services offers evaluation of people with behavioral health disorders for involuntary detention in psychiatric and secure withdrawal facilities according to Washington law. The law for adults is RCW 71.05. [LINK] For youth 13 through 17 years of age the law is RCW 71.34. [LINK] Crisis and Commitment staff who perform these duties are referred to as Designated Crisis Responders (DCRs). [LINK]
25. Ordinance 19704 created the crisis care center fund to account for CCC Levy proceeds. [LINK]
26. This strategy creates a fund reserve equal to 60 days of budgeted expenditures, less capital expenses, consistent with King County Comprehensive Financial Management Policies (2016). [LINK]
27. King County Ordinance 19572 [LINK]; Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
28. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
29. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
30. Culturally and linguistically appropriate services (CLAS) are a way to improve the quality of services provided to all individuals, which will ultimately help reduce health disparities and promote health equity. CLAS are about respect and responsiveness: respect the whole individual and respond to the individual’s health needs and preferences. By tailoring services to an individual's culture and language preferences, including with use of interpretation and translation services, health professionals can help support positive health outcomes for diverse populations. National Culturally and Linguistically Appropriate Services (CLAS) Standards. Think Cultural Health, U.S. Department of Health & Human Services [LINK].
31. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
32. Launch Ready is the concept defined in the Crisis Care Centers Request for Proposals.
33. New Site is a concept defined in the Crisis Care Centers Request for Proposals.
34. The World Health Organization defines social determinants of health as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.“ [LINK]
35. The U.S. Department of Health and Human Services’ “Healthy People 2030” initiative identified five domains of social determinants of health: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. [LINK]
36. Substance Abuse and Mental Health Services Administration. (2025). National Guidelines for Behavioral Health Crisis Care - Best Practice Toolkit. [LINK].
37. King County Medical Examiner’s Office data, “Number of overdose deaths that occurred in King County in 2024”. [LINK]
38. King County Medical Examiner’s Office data, “Number of overdose deaths that occurred in King County in 2024”. [LINK]
39. To help meet the urgent need for crisis stabilization services, King County invested $6 million in other behavioral health funds to support a non-Medicaid funding gap for initial startup of a crisis stabilization facility in Kirkland. After the facility ended up being selected as a Crisis Care Center in early 2025 through an RFP, CCC Levy funds that had been designated for 2024 were transferred to provide for this previous startup need in order to alleviate distress on non-Medicaid funding in the behavioral health fund. The 2025 CCC Levy Annual Report will include additional detail about CCC Levy RFP awards and contracts, including the CCC Levy’s investment in this essential service.
40. Crisis Care Centers Levy Implementation Plan 2024-2032. [LINK]
41. Engrossed Second Substitute House Bill 1813 (2025). [LINK]
42. To help meet the urgent need for crisis stabilization services, King County invested $6 million in other behavioral health funds to support a non-Medicaid funding gap for initial startup of a crisis stabilization facility in Kirkland. After the facility ended up being selected as a Crisis Care Center in early 2025 through an RFP, CCC Levy funds that had been designated for 2024 were transferred to provide for this previous startup need in order to alleviate distress on non-Medicaid funding in the behavioral health fund. The 2025 CCC Levy Annual Report will include additional detail about CCC Levy RFP awards and contracts, including the CCC Levy’s investment in this essential service.