RD160 - 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 I, 2008- June 30, 2009


Executive Summary:
Since 2002, the General Assembly has approved Appropriation Act language (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. The language also requires DMHMRSAS to report the plan to the Chairmen of the Senate Finance and House Appropriations Committees as follows:

''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/or 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."

DMHMRSAS convenes the interagency Systems of Care Advisory Team (SOCAT) previously known as the Child and Family Behavioral Health Policy and Planning Committee (CFBHPPC) - to study children's services and advise it and the General Assembly regarding necessary changes in services. In June 2008, DMHMRSAS submitted its sixth consecutive report, "A Policy and Plan to Provide and Improve Access to Mental Health and Substance Abuse Services to Children, Adolescents and Their Families." This report delineated recommendations to improve access to services for children and their families. The report included recommendations to address unmet service needs, funding, infrastructure, and system issues.

Over the past seven years there has been considerable interest in the children's behavioral health services system and numerous reports and studies have been generated. Besides DMHMRSAS, several state executive and legislative agencies have generated reports and recommendations related to mental and behavioral health services needed by youth. These include the Office of the Inspector General (OIG), the Virginia Commission on Youth (COY), the Joint Legislative Audit and Review Committee (JLARC), and the Virginia Commission on Mental Health Law Reform (CMHLR). Independent legislative committees, such as the Joint Subcommittee to Study Strategies and Models of Substance Abuse Treatment and Prevention (SJR 77), have also been asked to study special areas of concern. In total, at least 18 reports or studies have been issued in the past 2 years directly addressing or pertaining to Virginia's behavioral health care system for children.

These reports have identified similar findings, including:

• Lack of service capacity;
• Limited access to care;
• Lack of a full continuum of community-based care;
• Shortage of child and adolescent psychiatrists and psychologists;
• Fragmentation of services;
• Families unaware of available services;
• Lack of family and youth involvement;
• Lack of statewide evidence-based treatments; and
• Reliance on other systems to provide care.

The numerous reports, initiatives and activities described in this and previous reports have laid a helpful foundation for ongoing change. As Virginia continues its efforts to develop a broader range of services and supports for children and adolescents across the Commonwealth, stakeholders are working to address unmet needs and ensure that providers have the required skills and knowledge to provide better-coordinated services for children and their families.

In recent years multiple efforts to transform behavioral health care services for children, adolescents and adult services have been implemented. DMHMRSAS continues its Transformation Initiative to reform the community behavioral health system by implementing a vision that includes consumer- and family- driven services promoting resilience in children and the highest possible level of participation in community life including school, work, family and other meaningful relationships. Through an ongoing collaboration and coordination process across child-serving agencies, focus has expanded into a comprehensive, cross-agency effort that includes Medicaid, juvenile justice, social services, education and comprehensive services.

DMHMRSAS participated in two federal grants to effect system transformation - one to address services for adolescents with a substance use or co-occurring mental health disorder; the other to transform services for adolescents and adults who have co-occurring mental health and substance use disorders. Two other state-directed initiatives, the Children's Services System Transformation and Smart Beginnings, have emerged in Virginia. Both are large, complex, interagency efforts aimed at changing how services are delivered to children and their families across the Commonwealth; however, those initiatives focus on different populations.

The SOCAT offers recommendations in the following areas for FY 2010:

• Improving the Availability of Child and Adolescent Behavioral Health Services Available across Virginia's Communities
• Future Funding (as state budget conditions improve)

The recommendations are detailed on pages 22 through 25.