Evaluation of Pierce County’s Sales and Use Tax for Behavioral Health and Therapeutic Courts

In 2020, the Pierce County Council passed Ordinance No. 2020-138s, levying a Sales and Use Tax for Behavioral Health and Therapeutic Courts. The tax provides funding for expanded access to behavioral health services for Pierce County residents. The ordinance requires that: "In calendar year 2026, the Performance Audit Committee shall conduct a comprehensive assessment of all services and programs receiving funding from this tax, which the Council may use in its evaluation of whether to extend the sunset date…" The ordinance established sections in County Code require the Human Services Department to develop a Behavioral Health Improvement Plan (BHIP) to guide effective use of County-directed behavioral health spending and a Behavioral Health Advisory Board to assist in the development of the plan, which was to reflect the Council's policy goals to: A. Reduce the number, time, and rate of avoidable behavioral health crises; B. Ensure broad access to treatment for Pierce County residents in both urban and rural communities, regardless of the type of health insurance coverage or lack thereof; C. Prioritize services to especially vulnerable populations, particularly youth and veterans; D. Divert adults and youth with behavioral health needs from costly interventions (e.g., emergency rooms, hospitals, jails, police, EMS, etc.) to more appropriate services; E. Reduce rates of substance use morbidity and mortality. F. Reduce rates of suicide and other self-harm; G. Link, leverage, and align behavioral health programs and services available in the community; and H. Provide trauma-informed, culturally competent services. The BHIP was also to include (a) a six-year plan that prioritized, based on cost-effectiveness, expenditure of County directed behavioral health resources, including any resources raised by the Behavioral Health and Therapeutic Courts Tax, with a focus on early intervention, crisis services, and services for justice-involved populations; and (b) relevant performance and outcome measures for identified objects of expenditure. The latest plan was released in 2024 and includes guidelines for a request for proposal process that targets specific funding priorities. It also states that "Applicants will be asked to propose innovative and efficient programs that meet the identified needs. This allows organizations with expertise to identify solutions rather than the funders prescribing a specific approach. For the2024-2025 biennium, there were 60 applications with over $69 million in requests for approximately $34 million in available funding. There was also over $10,000,000 in allocations made directly. Parts of the current evaluation required in the legislation are being conducted internally, as noted in the Scope of Work below. This request for proposals project seeks to address gaps in the analysis and provide an understanding of the effectiveness of the structure of the program.