RD174 - 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 (Budget Item 311-E, 2007 Appropriations Act) July 1, 2007 - June 30, 2008


Executive Summary:
Since 2003, the General Assembly has issued budget items 329-G, 330-F, 311-E and 315-E respectively, directing the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to convene stakeholders to study ways to improve access to services for children and their families across disabilities. Budget language also requires the DMHMRSAS to report the plan to the Chairmen of the Senate Finance and House Appropriations Committees by June 30th of each year. DMHMRSAS convenes the interagency Child and Family Behavioral Health Policy and Planning Committee (CFBHPPC) to study children’s services and advise them regarding necessary changes in services. In June 2007, the Department of Mental Health, Mental Retardation and Substance Abuse Services submitted a fifth 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 Governor, and the respective Chairmen of the Senate Finance and House of Appropriations Committees. This June 2007 report satisfied the legislative intent of the budget language contained in 311-E 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.

Below is the current budget language of the 2007 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.”

A variety of studies have been completed over the last six years demonstrating that there is much interest in, and awareness of, the problems in the children’s behavioral health services system in Virginia. When one examines Virginia’s behavioral health care system, several themes consistently 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. Since 2004, funding has been approved for a number of initiatives recommended in DMHMRSAS’s report on child and adolescent 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 DMHMRSAS’s vision for community based care. Nonetheless, 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.

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: developing healthy, strong, and stable families; ensuring equitable access to services without regard to racial/ethnic status, socioeconomic status and geographic location; and providing services that are least-restrictive and support healthy child development. Last year’s report included a request to fund Intermediate-Level Community-Based Services @ $20.0 million in FY 2009 and $40.0 million in FY 2010. Although the 2008 report is not requesting funding for these services in this upcoming budget, the committee wishes to emphasize that, if a goal is to keep children out of residential treatment, group homes and inpatient psychiatric units, intermediate level community based services needs to be provided. These services include crisis stabilization, day treatment, in-home family therapy, intensive outpatient treatment, mobile crisis teams, intensive case management, school-based mental health services, wraparound services, respite care, after school intervention programs, and drop-in centers for emotionally and behaviorally troubled teens. Not only do such services enable children to remain in their homes and communities, they are also cost effective and can result in savings by diverting youth from residential services and juvenile justice.