HD23 - Youth with Emotional Disturbance Requiring Out-of-Home Treatment
House Joint Resolution 119 directed the Commission on Youth to conduct a two-year study of children and youth with serious emotional disturbance requiring out-of-home placement (SED-OH). The resolution instructed the Commission to develop and implement a methodology for accurately determining the number of children who were determined to be SED-OH. The resolution outlined goals for both the first year and second year of the study.
First Year Study
During the first year, the Commission established a 19-member Advisory Group to provide oversight and direction. The Advisory Group, whose composition was defined in the HJR 119 resolution, identified both child and family characteristics which define the children and youth with serious emotional disturbance in need of out-at-home placement. To be included in the study, the child was required to meet certain personal characteristics, as well as to have resided with a caregiver that exhibited certain family characteristics.
A child met the criteria for SED-OH if s/he was found to:
• have a DSM·IV Diagnosis and/or have at least two functional child characteristics* which have lasted or are expected to last at least one year without treatment; and
• live with a caregiver that exhibited certain family characteristics*
*A complete listing of the child and family characteristics that were considered for the purposes of this study is provided in Section VI.
The Commission contracted with the Applied Social Psychology Research Institute in the Department of Psychology at the College of William and Mary to assist in the data collection effort. In the fall of 2000 and the spring of 2001, the principal investigator, John B. Nezlek, Ph.D., of the College of William and Mary, conducted surveys that were designed to provide the Commission with an estimate of the number of children in the Commonwealth who experienced severe emotional disturbance in need of out-of-home placement (SED-OH). The Advisory Group identified Virginia officials integrally involved with children with SED-OH who could provide this information for each region.
Surveys were sent to the following Virginia officials:
• Chair, Community Policy and Management Team (CPMT)
• Director, Department of Social Services (DSS)
• Director, Court Service Unit (CSU) ,
• Director. Community Services Board (CSB)
• Director Special Education Services (SpEd)
The survey asked respondents in 26 selected communities in five regions to describe the SED-OH cases with which they were familiar. The SED-OH rates then were obtained by comparing these reports to population estimates. At the Commission on Youth's December 19, 2000 meeting. the survey results were presented. At this meeting, recommendations were made to strengthen the data collected and provide a more accurate representation of the number of children with SED-OH. Three administrative recommendations for the second year study were developed at the direction of the Commission.
The Commission on Youth, in conjunction with the College of William and Mary, should examine the reports of local agencies in which no qualifying cases were reported in the initial survey results from local Departments of Social Services, Court Services Units, Community Services Boards, and Special Education Departments to determine their accuracy.
The Commission on Youth, in conjunction with the College of William and Mary, should consider investigating reports from individual agencies that constituted less than 5% of the total reports in their respective communities.
The Commission on Youth, in conjunction with the College of William and Mary, should organize the data by regions (not locality) as the unit of analysis.
The initial findings and recommendations were published as an interim report in House Document 49, 2001. Updated first year report data is provided as Section V in this report. No legislation for the study was introduced in the 2001 Session.
Second Year Study
The Advisory Group established in the first year was reconvened with the addition of a representative from the Virginia Department of Medical Assistance Services. Upon opening the discussion and establishing the work plan for the second year at the study, it became clear that any study of children and youth with SED-OH could not be limited to a child's needs while in an out-at-home placement. Since a child's need for residential placement is only a moment in time within the full continuum of the child's treatment needs, a thorough examination of the issue necessarily would include a review of the full continuum of services that has been shown to be effective in treating children and youth with serious emotional disturbance. An examination of the needs of these children revealed that there are opportunities to help the child and his/her family prior to a residential placement that may, in fact, prevent or reduce the likelihood that the child will need residential placement. Likewise, there are opportunities to help the child and his/her family after the child returns from a residential placement that may prevent reentry into a residential placement.
In conducting the second year study, Commission staff reviewed numerous national and state publications and reports, convened four meetings of its 20-member advisory group, called a fifth meeting of advisors having special knowledge of related budgets and expertise in ascertaining fiscal impact, conducted five regional focus group meetings, and reviewed data collected during the first year of the study and data regarding service capacities.
Based upon an analysis of the data collected, reviews of related reports and publications and the input and expertise of the advisory and focus groups, the following recommendations were offered:
Child and Adolescent Acute Psychiatric Beds
Direct the Department of Mental Health, Mental Retardation and Substance Abuse Services to identify and create opportunities for public-private partnerships and the incentives necessary to establish and maintain an adequate supply of acute care psychiatric beds for children and adolescents, while acknowledging the Commonwealth's responsibility to serve this population.
Direct Virginia Health Information to provide the number of licensed and staffed acute care psychiatric beds and residential treatment beds for children and adolescents in public and private facilities, as well as the actual demand for these beds, to the General Assembly by December 1, 2002.
Direct the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Juvenile Justice, where appropriate, to identify and create opportunities for public-private partnerships and the necessary incentives to establish and maintain an adequate supply of residential beds for the treatment of juveniles with mental health treatment needs, including those who are mentally retarded, aggressive, or sex offenders and those juveniles who need short-term crisis stabilization short of psychiatric hospitalization.
Community-based Treatment Services
Amend Virginia Code § 37.1-194 (Purpose; services to be provided), which specifies the CORE services and other services that may be available through a Community Services Board (CSS), to specify that the services available will be provided to adults, children and adolescents rather than to "persons" as it is currently written.
Support and endorse the concept of KOKAH (*1) or other similar models in which an array of community-based services is emphasized. Support the continuation of existing funding levels for the KOKAH model implemented by Blue Ridge Community Services.
Amend and continue in the current biennium budget and in the 2002-2004 budget the current biennium language (323 K) that requires "the Department of Mental Health, Mental Retardation and Substance Abuse Services, the Department of Juvenile Justice and the Department of Medical Assistance Services, in cooperation with the Office of Comprehensive Services, Community Services Boards, and Court Service Units" to "develop an integrated policy and plan, including the necessary legislation and budget amendments, to provide and improve access by children, including juvenile offenders (*3), to mental health, substance abuse and mental retardation services..." Require the Departments to report on the plan to the Senate Committee on Finance and House Committee on Appropriations by June 30, 2002.
MENTAL HEALTH PROFESSIONAL AND TEACHER SHORTAGE
Direct the Virginia Department of Health (VDH) to expand the Virginia Physicians Loan Repayment Program to include more psychiatrists, including child psychiatrists, and appropriate additional funds to support such an expansion, including support for VDH staff to administer the program.
Appropriate $50,000 for and direct the Virginia Department of Health (VDH) to pursue the expansion of the National Health Service Corp (NHSC) - Virginia Loan Repayment Program to include mental health professionals (as defined by the NHSC). Financial support should include support for VDH staff to administer the program.
Direct the Virginia Department of Health (VDH) to expand the Virginia Physicians Loan Repayment Program to include other types of mental health professionals beyond psychiatrists, including doctoral clinical psychologist, clinical social worker, or psychiatric nurse specialist. The Virginia Department of Health Professions should also ensure that $1 be set aside from the state license fees of each of the participants in order to provide continued financial support for the program. Financial support should include support for VDH staff to administer the program.
Request that the Virginia Department of Health explore the expanded use of telepsychiatry for underserved areas.
Continue the current funding level for recruitment and retention of psychiatrists under the Gilmore Fellows Program (2000 Budget Item 323G), in which psychiatry residents are paid a stipend to work in under served areas with a portion designated for the recruitment and retention of child psychiatrists.
Direct the Virginia Department of Education (DOE) to expand the Virginia Teaching Scholarship Loan Program to enable more teachers seeking an emotional disturbance endorsement to receive funding. Financial support should include support for DOE staff to administer the program.
COMPREHENSIVE SERVICES ACT
Service Fee Directory
Request the State Executive Council to improve the information available in and revise the system through which provider information is placed in the Directory, including the procedures by which the information is updated and verified, and make Information about this process available to the public by July 1,2002.
Mandated versus Non-mandated
Request that the Department of Juvenile Justice provide information to localities on opportunities for using Virginia Juvenile Community Crime Control Act (VJCCCA) funds that address mental health treatment services, including the provision of intensive individual and family treatment, and structured day treatment and structured residential programs as authorized in Virginia Code § 16.1-309.3.
Request that the Department of Juvenile Justice, the Department of Mental Health, Mental Retardation and Substance Abuse Services, and the Department of Criminal Justice Services examine opportunities to leverage non-general fund sources of funding to meet the need for mental health and substance abuse assessment and treatment services of juveniles, including those within local detention homes.
Direct the Joint Legislative Audit and Review Commission (JLARC) to conduct a study that identifies viable incentives that encourage localities to enhance or maintain levels of funding for non-mandated children.
Support the current level of funding that was appropriated for non-mandated children and adolescents in the 2000-2002 biennium through. Budget Item 3258.
MEDICAID AND FAMIS (Family Access to Medical Insurance Security)
The Commission on Youth shall monitor the Joint Legislative Audit and Review Commission's study of the Department of Medical Assistance Services, and request that particular attention be given to Virginia's Medicaid provisions related to mental health services for children and adolescents.
Direct the Department of Medical Assistance Services to continue outreach efforts to enroll a greater number of children eligible for participation in Medicaid or FAMIS and report annually to the Commission on Youth by December 1.
Request that the Department of Medical Assistance Services continue their efforts to provide information to physicians and mental health providers about the comprehensive picture of services available through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT). The Department of Medical Assistance Services shall inform the Commission on Youth of its progress prior to the 2003 Session of the General Assembly.
Request the Department of Medical Assistance Services, together with the Virginia Department of Education, to provide information and training, including information on available services, to school nurses, school counselors and school social workers. The Department of Medical Assistance Services shall inform the Commission on Youth of its progress prior to the 2003 Session of the General Assembly.
Request the Department of Medical Assistance Services to encourage physicians to make referrals to mental health providers, when appropriate, so that a full assessment of the child's mental health treatment needs can be made. The Department of Medical Assistance Services shall inform the Commission on Youth of its progress prior to the 2003 Session of the General Assembly.
DATA COLLECTION, EVALUATION AND INFORMATION SHARING
Direct the Virginia Commission on Youth to coordinate the collection and dissemination of empirically-based information that would identify the treatment modalities and practices recognized as effective for the treatment of children, including juvenile offenders, with mental health treatment needs, symptoms and disorders. An Advisory Committee comprised of state and local representatives from the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services, Virginia Department of Social Services, Virginia Department of Medical Assistance Services, Virginia Department of Juvenile Justice, Virginia Department of Education, Virginia Department of Health, Virginia Office of Comprehensive Services, private providers and parent representatives should assist in and guide this effort.
Upon completion, client specific information on the types of services utilized for certain conditions and behaviors in Virginia should be collected. This information should be shared with entities involved in efforts to develop a policy and plan for children's improved access to mental health services as required under current biennium language (Item 323 K).
The results of the study shall be used to plan future services and resources within the Commonwealth for children with serious emotional disturbance or at risk of serious emotional disturbance; to identify effective models that could be replicated; and to identify effective means to transfer technology regarding effective programs, such as education, training and program development to public and private providers.
(*1) The Keep Our Kids At Home (KOKAH) project demonstrated success in reducing state inpatient hospitalization; the project also recognized a need for a broader array of community-based diversion and step-down services.
(*2) Amendment proposed by the Commission on Youth
(*3) Amendment proposed by the Commission on Youth