RD190 - Annual Report on 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


Executive Summary:
Over the past several years, the General Assembly has become aware of significant problems in the child and adolescent mental health, mental retardation, and substance abuse services system in Virginia. As a result, in 2003, the General Assembly adopted Budget Item 329-G, followed by the 2004 adoption of Budget Item 330-F and now named by the workgroup as Child and Family Behavioral Health Policy and Planning Committee.

The current budget language states:

“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 (CSU’s) 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, mental retardation services and substance abuse 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”.

General Assembly Support

While progress has been made with the system of care initiatives in improving access to services, most notably, the Comprehensive Services Act, the children’s service system is still plagued by fragmentation and gaps in services. There is still an over-reliance on residential care, inadequate community services to help parents keep their children at home, and parents forced to move from agency to agency seeking the coordinated package of services their children need. With remarkable consistency, legislative, policy, advisory, and family support groups have called for significant change resulting in better outcomes for children and families. Stable and sufficient funding to implement the system of care concept and to increase community capacity to provide evidence-based practices is a need that has been cited by all stakeholders. The Virginia General Assembly has responded by providing $6.1 million to the Department to provide services to children with behavioral health needs who are considered non-mandated for funding under the Comprehensive Services Act and for Virginia’s very youngest population, funding in the amount of $3.125 million has been provided for early intervention services.

Report Linkage with DMHMRSAS Efforts

In harmony with the recommendations contained in this report, the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) has been engaged in a major restructuring and transformation of its mental health system focused on implementing a vision that includes consumer-and family-driven services that promote resilience in children and the highest possible level of participation in community life including school, work, family and other meaningful relationships. This transformation initiative builds upon the collaboration and coordination process among child serving agencies and expands the focus into a comprehensive, cross-agency effort that includes, Medicaid, juvenile justice, social services, education and the Office of Comprehensive Services. In addition to the transformation initiative, the Department is engaged in an Integrated Strategic Planning Process (ISP) that builds on the transformation of services and focusing on the system of care. Finally, the DMHMRSAS assumed the lead role in preparing Virginia’s Mental Health Transformation Grant, forwarded to the Substance Abuse and Mental Health Services Administration (SAMHSA) under Governor Warner’s signature in June of this year. Funding decisions are expected in mid-September. The Transformation Initiative, the Integrated Strategic Planning process, and the Transformation Grant share a focus on the system of care model of serving children and their families.

This report provides a framework that Virginia can follow to address its children’s behavioral health care crisis. It recommends that the state officially adopt as its goal local and regional development of the national systems of care model. This model proves a continuum of services, from prevention and early intervention services to wraparound services designed to keep children in communities to more intensive levels of behavioral health care. These services are child centered and family driven, and they incorporate evidence based or promising treatment practices

Priority Funding Recommendations for 2006-2007 Biennium

Since the biggest single cause of the children’s behavioral crisis is lack of capacity, the report makes many suggestions about needed services and funding. The report recognizes that it is not possible at present to fund all of the unmet behavioral health needs of the children and youth of the Commonwealth; instead, the report prioritizes three funding recommendations for the 2006-2007 biennium.

Recommendation 1: Family Support

Build a statewide family support coalition designed to link existing family support organizations and groups such as Association for Retarded Citizens (ARC), Family Voices, Parents and Children Coping Together (PACCT) and other organizations that provide services, supports and advocacy to families who have children with mental health mental retardation, substance abuse, chronic illness, disabilities and other special needs.

Recommendation 2: Training

Expand training and education opportunities for new clinicians where there is an undersupply of specialists (child psychiatrists, child psychologists, etc.) with payback provisions so they can practice in Virginia. Provide ongoing behavioral health care training for existing staff and health care professionals such as pediatricians, family practitioners and primary care physicians. Often primary care physicians are the first professionals to evaluate children with behavioral health disorders.

Recommendation 3: System of Care

Fund evidence based initiatives that will serve as the catalyst for the expansion of systems of care in selected localities. Implementing these specific projects will result in empirically based outcome data that will provide clear/compelling reasons to replicate/expand these initiatives throughout the State.

System Change Without Funding

Within the systems of care framework, the report makes numerous recommendations for change, many of which do not require funding. These include:

Adopting Children’s Behavioral Health Services as a Very High Priority. The DMHMRSAS needs to emphasize through policy that children’s behavioral health policies, plans, and services are of the highest priority.

Using CSA funding Flexibly and Creatively to Develop Additional Services. The State Executive Council should authorize and encourage communities to use CSA funds more flexible and creatively, including developing pilot projects to serve children with behavioral health needs more effectively at the same or lower cost.

Suspending Rather Than Ending Medicaid Benefits When Youth enter Juvenile Justice Facilities. DMAS should suspend rather than end Medicaid benefits when youth enter detention and prison facilities.

Developing Standards for Case Management: The DMHMRSAS should develop case management standards for Community Service Boards throughout the state.

Coordinating and Leading Children’s Behavioral Health Services Planning with other State Agencies. The DMHMRSAS is only one state agency among several including DMAS, DJJ, DSS, DOE, OCS, VDH, and DRS that play a role in the welfare of children in the Commonwealth. DMHMRSAS should coordinate and lead the planning for children with behavioral health needs; and

Providing Guidance to Local Offices to Maximize Children’s Behavioral Health Funding. The DMHMRSAS should develop guidance document to help local offices maximize third party funding for children’s behavioral health services.

Expanding the Membership on the Child and Family Services Behavioral Health Policy and Planning Committee: The State Legislature should add DSS, DOE, VDH, DRS, family organizations, organizations serving youth in the juvenile justice system, and other organizations involved in the provision of children’s behavioral health services to the list of agencies and entities comprising the membership of the Child and Family Behavioral Health Policy and Planning Committee in the FY 2007-2008 biennium budget language reauthorizing the Committee.

Making prevention activities a central focus: The Department should make prevention activities a centerpiece of its policies and plans regarding children’s behavioral health services. Evidence-based preventions services have been shown not only to reduce child and family suffering due to behavioral health problems, but also to save money. Funding prevention services when children are young will reduce the cost of services to the sate as they age.

Taking initial steps to change the term “case management” to care Coordination: Families of children with behavioral health problems often resent being thought of as “cases” that need “managing, which they experience as dehumanizing. They prefer to have their care coordinated so that all providers who work with them work in concert with each other towards a set of shared goals. Changing the official term to care coordination would recognize the central role families play in the care of their children.