Emerald City Enhanced Services
Enhanced Services Facilities (ESFs) in Washington State
An Enhanced Services Facility (ESF) is a specialized long-term residential care setting in Washington State for adults with severe mental health needs, cognitive conditions, or complex behavioral challenges who cannot safely live in traditional community housing.
ESFs provide 24/7 support, behavioral health services, medication management, and assistance with daily living in a secure, home-like environment. They are designed to help individuals stabilize, maintain safety, and regain structure after repeated hospitalizations, crisis episodes, or placement failures.
Who ESFs Are For
ESFs in Washington State serve adults who:
Have serious and persistent mental illness, neurocognitive disorders, or traumatic brain injuries.
Need continuous behavioral support or supervision that assisted living or adult family homes cannot provide.
Have a history of frequent psychiatric hospitalization, crisis calls, or destabilization in the community.
Require hands-on help with daily activities, medication administration, and behavioral interventions.
Qualify for Medicaid long-term care services or require a structured environment through guardianship or court orders.
These facilities are intentionally designed for people who often fall through systemic gaps and need a high-level, stable residential placement.
How Someone Moves Into an ESF
Individuals enter an ESF through coordinated referrals when lower-intensity services can’t meet their needs. Common pathways include:
1. Hospital Discharge Planning
State psychiatric hospitals and community inpatient units refer individuals who are stable enough to leave the hospital but unsafe to return to independent living.
2. Case Managers and Guardians
Social workers, care coordinators, and guardians identify ESFs as the appropriate long-term placement when other settings cannot meet the person’s medical or behavioral needs.
3. Assisted Living or Adult Family Homes
When residents’ needs exceed the capacity of traditional long-term care, they are referred to an ESF for higher support.
4. Less Restrictive Alternatives (LRAs)
Courts may order supervised residential care through an ESF as part of a mental health commitment plan.
Before admission, each individual receives a formal assessment to confirm they meet ESF criteria and that the facility can safely support them.
What Life in an ESF Looks Like
An ESF is not a hospital or locked psychiatric unit — it is a structured, supportive home environment. Residents receive:
24/7 staffing and supervision
Behavioral health support and crisis prevention
Medication administration
Assistance with hygiene, meals, and daily tasks
Care coordination with outpatient providers
Individualized behavior and safety plans
Opportunities for community integration when appropriate
The goal is long-term stability, safety, and quality of life.
Why ESFs Matter
Enhanced Services Facilities fill a critical gap in Washington’s behavioral health system. They prevent unnecessary hospital readmissions, reduce homelessness, and provide a safe, dignified home for individuals with complex needs.
