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King County's MIDD is a countywide 0.1% sales tax generating an about $136 million per two-year biennium, specifically for programs and services for people living with or at risk of behavioral health conditions. King County’s MIDD is managed and operated by the King County Department of Community and Human Services' Behavioral Health and Recovery Division.

What's New


MIDD 2018 Annual Report

MIDD 2018 Annual Report - Technical Supplement

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MIDD 2 Service Improvement Plan

The adopted MIDD Service Improvement Plan (SIP), which is the blueprint for MIDD 2, links to the MIDD 2 Implementation Plan and Evaluation Plan. Both the Implementation Plan and the Evaluation Plan were approved by the Council in early 2018. Together these three documents outline the mission of MIDD and address key aspects of MIDD, from funding, to services, to evaluation.

The MIDD 2 Service Improvement Plan (SIP) brought together extensive collaborative work by a diverse range of County and community stakeholders. Shaped by values and guiding principles and ongoing strategic feedback from the MIDD Oversight (now Advisory) Committee, a multistage community-driven process was undertaken to shape programming recommendations for MIDD 2. This process included:

  • Input from more than 1,000 King County residents
  • 141 programming ideas generated through an open call for concepts
  • 90 briefing papers analyzing potential new programming options
  • Diverse community review panels that sorted programming options for funding consideration

County staff then aligned recommendations and identified funding levels in light of amended policy goals for MIDD 2. Initial recommendations were released for public comment and stakeholder review in April 2016, with revised recommendations released and reviewed in May 2016. Final programmatic and funding recommendations were transmitted to the Council as part of the MIDD 2 SIP in August 2016, along with a range of other planned improvements to MIDD operations and evaluation.

The SIP was approved by King County Council via Ordinance 18406 in November 2016. Updates to the SIP as of mid-2017 are described in detail in the MIDD 2 Implementation and Evaluation Plans.

The MIDD 2 Implementation Plan provides a point-in-time status report on the implementation of new MIDD 2 initiatives and planned changes to initiatives continuing from MIDD 1. It is a summary of planning efforts completed to date and a preview of the continued work ahead to implement MIDD 2. Including the updated initiative descriptions contained within it, the Implementation Plan addresses the following elements called for by King County Council Ordinance 18407:

  • A schedule of implementation of initiatives, programs, and services outlined in the Service Improvement Plan
  • Discussion of needed resources including staffing and provider contracts
  • Outcomes and performance measures
  • Procurement and contracting information
  • Community engagement efforts
  • How MIDD’s initiatives advance the county’s behavioral health policy goals
  • Updated biennial spending plan and financial plans

An essential companion to the Service Improvement Plan (SIP) and the Implementation Plan is the MIDD 2 Evaluation Plan. The Evaluation Plan contains information about:

  • Process and outcome evaluation components
  • A proposed schedule for evaluations
  • Performance measurement information including targets
  • Data to be used for reporting
  • Overarching principles, framing questions, and approaches for the evaluation of MIDD 2

The development of the MIDD Evaluation Plan was significantly informed by the principles of the Results-Based Accountability (RBA) framework. RBA is a national model and provides a disciplined, data-driven, decision-making process to help communities and organizations take action to solve problems by starting with desired ends and working backward toward strategies to get there. 

MIDD 2’s evaluation approach begins by articulating the result desired from MIDD’s investments. Using an RBA performance measurement lens, the MIDD evaluation will seek to answer to what extent and in what ways MIDD helps to achieve the five adopted MIDD Policy Goals. 

The Evaluation Plan will help ensure MIDD is accountable for performance of MIDD initiatives. The impact of MIDD initiatives on individuals and families directly served by programs will be assessed using performance measures. The evaluation approach will also ensure that MIDD-funded activities connect to desired population-level changes and contribute to those outcomes. 

Additional Info

2005: The Washington State Legislature created an option for counties to support behavioral health services locally by increasing the local sales tax by 0.1 percent to augment state funding for behavioral health services and therapeutic courts. As required by state law (Revised Code of Washington 82.14.460), revenue raised under the MIDD must be used for new and expanded mental health and substance use disorder services, including King County’s therapeutic courts.

2006: The King County Council began exploring of the possibility of utilizing the tax option in response to shrinking state investment in community-based behavioral health services and corresponding escalation in the use of jails and hospitals for people living with behavioral health conditions.

2007: After significant work in partnership with communities and the Executive, the Council authorized the sales tax levy collection to begin in 2008 and extend through 2016. King County is one of 23 counties (along with one city) in Washington State that have authorized the tax revenue.

2016: King County Council voted unanimously to extend sales tax collection for MIDD through 2025. The nine-year extension of the tax is expected to generate an estimated $134 million per biennium (two-year budget cycle), and is known as MIDD 2. Also, the Service Improvement Plan for MIDD 2 was approved by King County Council, updating policy goals for MIDD 2.

2017: As called for by the Council, the MIDD 2 Implementation Plan and Evaluation Plan were transmitted, building upon and updating the Service Improvement Plan.

2018: Both MIDD 2 Plans were approved by the Council.

The plans are large files. Some browsers may have trouble displaying them. If this happens, try right-clicking and selecting “Save As”

King County's MIDD is guided by adopted policy goals (King County Ordinance 18407) and the Service Improvement Plan (Ordinance 18406). The forthcoming Implementation and Evaluation Plans, due to the Council in August 2017, will further detail operations and assessment components for MIDD initiatives. 

As required by the Council annual MIDD reports are provided to the Council. Find MIDD reports

The MIDD Advisory Committee is an advisory body to the County Executive and Council on matters related to King County's MIDD, as described in Ordinance 18452. The MIDD Advisory Committee is a unique partnership of representatives from the health and human services and criminal justice communities, including providers and other stakeholders. MIDD Advisory Committee meetings are open to the public and comments are welcome.

Find a schedule of meetings and meeting notes from past meetings on the MIDD Advisory Committee page.

As adopted by King County Council, MIDD’s five policy goals updated for MIDD 2 are as follows:

  • Divert individuals with behavioral health needs from costly interventions, such as jail, emergency rooms, and hospitals. 
  • Reduce the number, length, and frequency of behavioral health crisis events. 
  • Increase culturally appropriate, trauma-informed behavioral health services. 
  • Improve health and wellness of individuals living with behavioral health conditions. 
  • Explicit linkage with and furthering the work of King County and community initiatives.

The MIDD 2 Framework is an accountability structure driven by the results policymakers and stakeholders want to see in the community as the result of investment of MIDD funds; the indicators that the county will use to signal that it is headed down the right path to get there; and the actions the county and its partners will take to create the change stakeholders want to see. The MIDD 2 Framework organizes the work of MIDD.

The MIDD 2 Framework includes:

  • MIDD Result – the overarching purpose of MIDD 2
  • Adopted MIDD 2 Policy Goals – King County Council’s direction for MIDD 2 via Ordinance 18407:
    • Divert individuals with behavioral health needs from costly interventions, such as jail, emergency rooms, and hospitals.
    • Reduce the number, length, and frequency of behavioral health crisis events.
    • Increase culturally appropriate, trauma-informed behavioral health services. 
    • Improve health and wellness of individuals living with behavioral health conditions.
    • Explicit linkage with and furthering the work of, King County and community initiatives.
  • Theory of Change – what’s going to happen as a result of the application of MIDD 2 funds
  • Strategy Areas – five distinct areas that organize MIDD 2’s services and programs into a continuum of services
  • Sample Performance Measures*– examples of how service capacity, service quality, and individual outcomes will be measured for MIDD 2 programs.

* “Sample Performance Measures” are not intended to capture an exhaustive list of outcomes. They are a representative example of the types for the strategy areas. It is expected that outcomes will change over time, including during MIDD 2 implementation, based on community and stakeholder feedback.

The MIDD 2 Framework is a living document that will continue to be updated over the life of MIDD 2 to reflect specific programmatic and services or other drivers. The MIDD Advisory Committee reviews and discusses this framework at its meetings, providing input on any revisions.

The 2018 MIDD Annual Report was transmitted to King County Council in July 2019, summarizing key outcomes from MIDD-funded services in 2018, including continued significant long-term reductions in psychiatric hospitalizations, jail utilization, and emergency department admissions for MIDD service participants. It also describes implementation progress for MIDD's various initiatives in 2018.


 
The 2018 MIDD Annual Report is accompanied by a companion Technical Supplement that provides further discussion of detailed evaluation results.

Find all MIDD reports.

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