RD111 - An Integrated Policy and Plan to Provide and Improve Access to Mental Health, Mental Retardation and Substance Abuse Services for Children, Adolescents and Their Families - July 1, 2003 -- June 30, 2004


Executive Summary:
Background

In June 2003, the Department of Mental Health, Mental Retardation and Substance Abuse Services submitted a report of "A Policy and Plan to Provide and Improve Access to Mental Health and Substance Abuse Services to Children, Adolescents and Their Families" to the Chairman of the Senate Finance and House of Appropriations Committees. This report satisfied the legislative intent of the budget language contained in 329-G and the report delineates the recommendations to improve access to mental health, mental retardation and substance abuse services for children and their families. The report includes eight recommendations to address unmet service needs, funding, infrastructure and system issues as well as recommendations for improvement including analysis of the Comprehensive Services Act (CSA) and recommendations related to systems improvement to address unmet need in rural communities.

This report identifies the status of the eight recommendations made in June 2003 and recommendations for next state fiscal year. The budget language for 2004 is included in budget item 330-F from the 2004 General Assembly Session. The current budget language:

“The Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS), the Department of Medical Assistance Services (DMAS), and the Department of Juvenile Justice Services (DJJ), in cooperation with the Office of Comprehensive Services (OCS), Community Services Boards (CSBs), Courts Service Units (CSUs) and representatives from community policy and management teams representing various regions of the Commonwealth, shall develop an integrated policy and plan, including the necessary legislation and budget amendments, to provide and improve access by children, including juvenile offenders, to mental health, substance abuse, and mental retardation services. The plan shall identify the services needed by children, the costs and sources of the funding for the services, the strengths and weaknesses of the current services delivery system and administrative structure, and recommendations for the improvement. The plan shall examine funding restrictions of the Comprehensive Services Act which impede rural localities from developing local programs for children who are often referred to private and residential treatment facilities for services and make recommendations regarding how rural localities can improve prevention, intervention, and treatment for high-risk children and families, with the goal of broadening treatment options and improving quality and costs effectiveness. The Department of Mental Health, Mental Retardation, and Substance Abuse Services shall report the plan to the Chairmen of the Senate Finance and House Appropriations Committees by June 30th of each year”.

Recognizing the current budgetary situation, the recommendations contained within this report are designed to lay the groundwork for future action and to promote awareness of the need for continued support of children’s issues by legislators and key policy and decision makers. This report details DMHMRSAS activities for 2003-2004 related to the 329-G recommendations to provide and improve access by children and their families to mental health, mental retardation and substance abuse services and includes recommendations and work plan activities for the 2004-2005 fiscal year.

Implementation Plan for the Recommendations

Workgroup members were committed to ensuring broad support for moving forward in the direction of improving access to services for children and their families across disabilities and approved activities for implementing the final recommendations contained in the 2003 report. The workgroup endorsed the goal of moving from a concept to actuality the service needs of children and adolescents with mental health, mental retardation and substance abuse issues and their families would be met.

The workgroup recommended appointing an advisory group to the Department’s Office of Child and Family Services and that the Office develop a work plan consistent with the recommendations of the 2003 report. They suggested the advisory group be in place no later than the first quarter of State Fiscal Year 2004 and implementation activities begin in the second quarter of State Fiscal Year 2004 and continue forward as appropriate.

For the development of the 2004 Report, the Department organized a steering committee comprised of existing 329-G work group members to review and develop plans for the 330-F budget item report. Membership of the 329-G work group included child-serving state agencies such as the DMHMRSAS, the Department of Juvenile Justice (DJJ), the Department of Social Services (DSS), the Department of Criminal Justice Services (DCJS), the Department of Education (DOE), the Commission on Youth (COY), and the Virginia Supreme Court. This group also included representation from Voices for Virginia’s Children, local community service boards, community policy and management teams, family assessment and planning teams, and a parent representative.

The steering committee held two meetings to address the recommendations for the 330-F, the Policy and Plan to Provide and Improve Services to Children with Mental Health, Mental Retardation and Substance Abuse Services. Two meetings were held in the fourth quarter of the 2003 fiscal year, May 25, 2005 and June 17, 2004, respectively to review the status of the actions of the Department since the last report and to suggest strategies for developing recommendations for the next plan.

A variety of strategic planning activities have been initiated by the Department to develop and recommend strategic directions for restructuring the system of care for redirecting existing system resources and aligning the system of care with the vision of a community based system of care. The Child and Adolescent Special Populations Workgroup of the Department’s Restructuring Advisory Committee convened by the Commissioner included a majority of the representatives of the former 329-G workgroup. This group met from August 2003 to August 2004. This group was asked to develop sets of short-term and long-term recommendations on how mental health, mental retardation and substance abuse services for your and their families might be strengthened. The Child and Adolescent Special Populations Workgroup recommendations include developing and promoting a vision of integrated child and family services statewide, integration of services across disciplines, development of new services, primary prevention and early intervention, statewide cross training across disciplines, etc. The Child and Adolescent Special Population Workgroup endorsed the work of the 329-G workgroup and the steering committee, in turn proposed including many of the recommendations of the Child and Adolescent Special Population Workgroup into planning and implementation activities in accordance with the 330-F budget item.

In addition, the Steering committee determined that the report for FY 2004 should include the actions related to the 2003 report and an update on the eight recommendations and where appropriate, continuation of essential recommendations from the report, a summary of child-related projects of the Department, and the identification of new initiatives and funding recommendations. For a complete listing of participants of the 329-G workgroup, steering committee and the Child and Adolescents Workgroup representatives, please see Appendix A.

Recommendations and Status of Recommendations
(For more detailed status information the full report).

Recommendation 1:

DMHMRSAS should initiate a budget request to fund an integrated continuum of mental health, mental retardation and substance abuse services for children, adolescents and their families. The budget initiative shall give consideration to the varying geographic needs in Virginia, filling identified gaps, addressing co-occurring disorders and the needs of special populations such as children with early development needs, juvenile offenders, and adolescents in need of transitional services into the adult services system.

Recommendation 2:

The DMHMRSAS should initiate a budget request to build an infrastructure of children and adolescents and their families at the community services boards with a determined number of dedicated integrated case managers and mental health clinicians for community service boards/behavioral health authorities.

Recommendation 4A:

The DMHMRSAS, in conjunction with Community Services Boards and Behavioral Health Authorities, should request a dedicated pool of flexible funds to be used specifically for program start-up and program development, allocated in a manner that maximizes flexibility in program design and promotes achieving specific outcomes for children, adolescents and their families with mental health, mental retardation and substance abuse needs.

Status of recommendation 1, 2 and 4A: Recommendations 1, 2, and 4A addressed budget requests to be submitted by the Department to the General Assembly for funding. These three recommendations are addressed together. The Department initially developed four budget proposals to increase capacity for children and adolescents in the community.

The intent of the budget request was to provide funding for specialized populations, case managers, and for acquiring and promoting training for child psychiatrists in the state.

The outcome of the Governor’s biennium proposed budget included $2,000,000, to provide mental health services to children and adolescents by addressing the services needs and building capacity in the community. These funds were ultimately approved by the 2004-2006 biennium budget passed by the 2004 General Assembly. The intent of this appropriation is to finance non-mandated Comprehensive Services Act services (CSA) to build community capacity for the behavioral health needs for children’s services. Funds will be allocated to local community services boards.

Recommendation 3:

The DMHMRSAS should continue to explore existing resources within state and federal funds to provide statewide training on mental health, mental retardation and substance abuse services and in integrated case management as related to the recommended continuum of mental health, mental retardation and substance abuse services for children, adolescents and their families. All agencies within the Secretariats of Education, Health and Human Resources and Public Safety shall cooperate in the planning and funding of the training.

Status of Recommendation 3: In October 20003, a work group of select state staff of the Department of Mental Health, Mental Department of Health, Department of Social Services and Department of Education, and the Virginia Institute of Social Services Training (VISSTA) at Virginia Commonwealth University were organized to review the Bright Futures materials and to develop a curriculum for the training and education of staff across agencies. Georgetown University, National Technical Assistance Center for Children Mental Health provided technical assistance staff to this work group to assist in developing a Virginia-specific curriculum. The curriculum will be adopted by the Department and used statewide for training case managers and other entry-level staff who work with children.

Recommendation 4B:

The DMHMRSAS, in conjunction with Community Service Boards and Behavioral Health Authorities, should establish a cooperative agreement with a state university to evaluate the efficiency of such programs based on terms established by the DMHMRSAS.

Status of Recommendation 4B: No action has been taken on this recommendation. In conjunction with Community Services Boards and Behavioral Health Authorities, meetings will be planned to implement this recommendation in 2005.

Recommendation 5:

DMHMRSAS should continue to support the integrated Office of Child and Family Services in the Division of Community Support Services. This Office shall provide leadership for child and family issues on a statewide basis through coordination of services delivery and integration of disability service systems, with the goal of improving access to mental health, mental retardation and substance abuse services for children, adolescents and families in Virginia.

Status of Recommendation 5: This was a significant recommendation of the 2003 report that the Department has successfully implemented. The Department’s Office of Child and Family Services was established April 2004. This office provides leadership and direction in developing a seamless system of care that integrates services across disciplines. This involves partnering with stakeholders working to improve services for children, developing policies that promote children and family services, addressing gaps in existing services, developing new services using evidence based practices and expanding existing evidenced based models, increasing family involvement on committees, councils, task forces, addressing children’s issues, and increasing family involvement on committees, council, task forces addressing children’s issues and increasing funding for children services increasing funding for children services.

Recommendation 6:

The Office of Child and Family Services, DMHMRSAS should organize and support a state advisory committee composed of families of children with mental health, mental retardation and substance abuse services, children’s services representatives of state agencies representing a system of care, representatives of services program organizations, private providers and advocacy organizations.

Status of recommendation 6: Currently, several groups are involved in children’s services including but not limited to the 330-F workgroup, the Child and Adolescent Special Populations Workgroup, the Child and Adolescent Task Force and other parents who may or may not have affiliation with any of these groups. Consistent with the recommendations of the 329-G workgroup to form a statewide advisory group and to involve and build links to parents, the Department will establish an advisory group that is responsible for promoting services for children and to support activities that improve services to children. Representatives from groups representative of children’s interests will be invited to participate on this advisory group.

Recommendation 7:

DMHMRSAS should seek ways to build and link the network of parents of children and adolescents with mental health, mental retardation and substance abuse service needs.

Status of Recommendation 7: No action was taken on this recommendation during fiscal year 2003. Currently the Department has several contracts with organizations to provide family support services to parents of children with mental health and mental retardation disabilities. During 2004, the Department plans to assess existing resources available to parent organizations to determine how best to build and link the network of families with children who require or receive mental health, mental retardation and substance abuse services.

Recommendation 8:

DMHMRSAS should create, publish and fund an interactive website to be used as a resource for children, adolescents and families to enable improved access to mental health, mental retardation and substance abuse services, providers, educational resources and supports.

Status of Recommendation 8: The Department expects to continue publishing relevant information about mental health, mental retardation and substance abuse services and links to educational resources and supports for families and providers on its web site. Additional activities planned for 2004-2005 include strengthening partnerships with universities to explore training for child and adolescent service providers, professional development for clinicians trained in child and adolescent mental health, and to explore developing interactive, web based curriculum to meet the training needs of diverse regions statewide.