RD127 - 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 (July 1, 2006 through June 30, 2007)


Executive Summary:
General Assembly Guidance

In 2003 and subsequently, the General Assembly issued Budget Items 329-G, 330-F, and 311-E 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 June 2006, the Department of Mental Health, Mental Retardation and Substance Abuse Services submitted a fourth 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 delineated 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 for systems improvement to address unmet needs in rural communities.

The current budget language of the 2006 Appropriations Act, Budget Item 311-E:

“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. When one examines Virginia’s behavioral health care system, several themes emerge:

• Lack of service capacity;
• Limited access to care;
• Lack of a full continuum of community-based care;
• A shortage of child and adolescent psychiatrists and psychologists;
• Fragmentation of services;
• Lack of knowledge about what services are available;
• Lack of family and youth involvement;
• Lack of statewide evidence-based treatments; and
• Other systems are left to provide care.

DMHMRSAS continues its transformation initiative to reform the community behavioral health system by 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. Consistent with the budget language contained in the 2006 Appropriations Act, 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, the juvenile justice/mental health projects, and system enhancements to align the Part C early intervention system to ensure improved outcomes for children and families are all approaches that effectively support this vision.

Children make up 24% of the population in Virginia, but received only 10% of state behavioral health funds in the transformation initiative, an inequity that undermines the development of needed services for children.

As noted in the 2006 and previous reports:

“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.”

Many people have been concerned about the very large sums that the Commonwealth has spent under the Comprehensive Services Act (CCSA) in recent years on residential treatment services. One reason is 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 limited funding for children’s services as part of a broader transformation initiative for community services for behavioral health care.

In 2006, the Secretary of Health and Human Resources requested that the 330-F committee develop a 10 year strategic plan for children’s behavioral health. This report updates the 10 year plan and its goals of: healthy, strong, and stable families; equitable access to services without regard to racial/ethnic status, socioeconomic status and geographic location; and services that are least-restrictive and support healthy child development.

The following are the Child and Family Behavioral Health Policy and Planning Committee’s FY 2009 priority recommendations:

Priority Funding Recommendations for FY 2009

1. Increase Service Capacity:

• Fund Intermediate-Level Community-Based Services @ $20.0 million
• Fund 12 System of Care projects @ $3.6 million
• Fund MR Family Support @ $62,500 for each of 40 CSBs @ $2.5 million
• Fund MR waiver slots @ $6.0 million
• Fund Part C Early Intervention for an average increase of 6% per child for the per child annual rate @ $1,730,000
• Fund 3 additional Project LINK programs @ $375,000
• Fund outpatient Substance Abuse services @ $3.0 million
• Fund school-based mental health clinicians in 20 middle schools in five regions @ $1.8 million
• Fund infrastructure in the Department’s Office of Child and Family Services (OCFS) to support these initiatives to increase service capacity statewide @ $990,000

2. Increase the Size of the Workforce:

• Fund four new child psychiatry fellowship and two new child psychology internship slots @ $1,036,000 with payback provisions to work in underserved areas in Virginia

3. Enhance Workforce Capacity:

• Establish three Teaching Centers of Excellence 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 @ $700,000

4. Provide Families with Information and Support:

• Fund 1.5 FTE for a Resource/Service Coordinator and administrative support to assist families in accessing needed services for their children and adolescents, educate families about available services, link families with support systems, and educate the public about the needs of children with behavioral health issues @ $100,000

Total cost of funding recommendations: $41,831,000 for FY 2009