RD101 - An Integrated Policy and Plan to Provide and Improve Access to Mental Health, Mental Retardation and Substance Abuse Services for Children, Adolescents and Their Familes (Budget Item 330-F, 2004 Appropriations Act) July 1, 2005 - June 30, 2006


Executive Summary:
In 2003 and 2004, the General Assembly issued Budget Items 329-G and 330-F respectively. These budget items directed the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to continue the committee with the same budget language related to improving access to services for children and their families across disabilities and requires DMHMRSAS to report the plan to the Chairmen of the Senate Finance and House Appropriations Committees by June 30th of each year. In September 2005, the Department of Mental Health, Mental Retardation and Substance Abuse Services submitted a third report, 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 330-F and the report delineated the recommendations to improve access to mental health, mental retardation and substance abuse services for children and their families. The report included 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 needs in rural communities.

The current budget language of the 2005 Appropriations Act, Budget Item 330 F:

“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, Court Service Units, 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 cost and source of funding for the services, the strengths and weaknesses of the current service delivery system and administrative structure, and recommendations for improvement. The plan shall also examine funding restrictions of the Comprehensive Services Act which impede rural localities from developing local programs for children who are often referred to private day 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 cost 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.”

Several studies have been completed in the last five years demonstrating that there is much interest in, and awareness of, the significant problems in the children’s behavioral health services system in Virginia. Children make up 24% of the population in Virginia, but receive only 10% of state behavioral health funds; an inequity that undermines the development of needed services for children. When one examines Virginia’s behavioral health care system several themes emerge:

[Chart can be viewed in full report.]

Children's Services ...10%
Adult Services...........90%

• Lack of service capacity;

• Poor access to care;

• A shortage of child and adolescent psychiatrists and psychologists;

• Fragmentation of services;

• Lack of knowledge about what services are available;

• Lack of family involvement; and

• Other systems are left to provide care.

As noted in the 2005 report:

“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.”

General Assembly Support

Many people have been concerned about the very large sums that the Commonwealth has spent in recent years on residential treatment services. It is a problem that referral sources are accustomed to placing children in residential care. However, the main reason that children are placed in residential treatment is that the community-based services that children need to stay out of residential treatment do not exist, leaving families and communities with no other option but to place their children in residential care. The Virginia General Assembly has responded by providing funding for children’s services as part of a broader transformation initiative for community services for children’s behavioral health care.

Report Linkages with DMHMRSAS

DMHMRSAS is engaged in a major transformation of its mental health system that is 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. The system of care concept of serving children and their families is an approach that effectively supports this vision. DMHMRSAS worked in collaboration with the Office of Comprehensive Services (OCS) in developing this guidance, a reflection of the shared commitment to gaining the greatest impact from this funding initiative. The DMHMRSAS will fund two projects that create a capacity to serve youth in the most natural setting possible and that demonstrate local or regional intent to maximize all available funding streams in support of developing systems of care. Funded projects shall also demonstrate a commitment to provide services in a manner that utilizes evidence-based practices for serving youth with behavioral health needs.

This report builds on the 2005 report by outlining a ten-year plan for developing children’s behavioral health services in Virginia organized around three goals with strategies, activities, and measures. The goals are:

• Healthy, strong, resilient, stable families as evidenced by children who live in a safe home, attend school, make educational progress and are involved in positive peer activities and have their needs for healthy development met in their homes and communities.

• Equitable access to services without regard to racial/ethnic status, socioeconomic status, and geographic location as evidenced by all children having health insurance, mental health and substance abuse services that are covered under private insurance, and children and families who have access to behavioral health services and supports when they need them.

• Children are provided with humane, least-restrictive and effective services that support healthy child development, as evidenced by children’s needs that are accurately assessed, children’s needs a that matched to appropriate treatment interventions and levels of care, and family and child preferences and strengths that are driving forces in treatment planning. Additionally, clinicians and treatment programs utilize evidence-based, promising and best practices. (See Appendix B)

Priority Funding Recommendations for FY 2008

1. Increase Service Capacity:

• Provide mental health services in all eight remaining juvenile detention centers without them @ $1.2 million

• Provide school-based mental health clinicians in 20 middle schools in five regions @ $1.8 million

• Fund four new pilot projects @ $2 million

• Fund a web-based acute psychiatric bed reporting system @ $75,000

2. Increase the Size of the Workforce:

• Fund four child psychiatry fellowship and four child psychology internship slots @ $493,000 with payback provisions to work in underserved areas in Virginia

3. Enhance Workforce Capacity:

• Establish a university-based teaching center to organize, coordinate and lead the training of clinicians in evidence-based, promising and best practices for children’s behavioral health treatment across the Commonwealth @ $300,000

• Fund trainings – including regional, web-based, telemedicine and other forms of education – in evidence-based children’s behavioral health services for behavioral health clinicians @ $200,000

• Fund trainings – including regional, web-based, telemedicine and other forms of education – in children’s behavioral health services for pediatricians and family practitioners @ $200,000

4. Provide Families with Information and Support:

• Expand funding for a statewide family education, information and support network @ $150,000 to provide families with information about services available to their children, link families with support systems, and educate the public about the needs of children with behavioral health problems

Total Cost of Recommendations: $6,418,000

[Additional Chart can be viewed in full report.]