RD427 - Report Regarding Acute Psychiatric Services for Children and Adolescents (Item 315.BB.2.)


Executive Summary:
The Commissioner of the Department of Behavioral Health and Developmental Services (DBHDS), formerly the Department of Mental Health, Mental Retardation, and Substance Abuse Services (*1), was directed by the 2009 General Assembly to develop options for the future of the Commonwealth Center for Children and Adolescents (CCCA) and the adolescent unit at Southwestern Virginia Mental Health Institute (SWVMHI). These options were to be informed by the work of a State and Community Consensus Team that would examine the need for public acute psychiatric services for children in Virginia.

Background

Governor Kaine’s budget for FY 2010 proposed the closure of CCCA and the SWVMHI adolescent unit by June 30, 2009. These two state-operated facilities provide public acute inpatient mental health services to children from all regions of the Commonwealth. In response to public opposition, the 2009 General Assembly’s final budget did not close these two facilities. The General Assembly also required the Commissioner of DBHDS to establish a State and Community Consensus Team and report on the findings of this team and make recommendations for alternative approaches to provide care in these two facilities.

Options

Based on the deliberations of the State and Community Consensus Team, coupled with previous reports referenced and appended, this report outlines two options two options for the current and future role of CCCA and SWVMHI’s adolescent unit:

Option 1: Close CCCA and SWVMHI’s adolescent unit. Utilize state general funds currently used for operation of these facilities for the purchase of private mental health treatment for uninsured children in each region of the Commonwealth. The Commonwealth could provide state general funds for the purchase of private mental health treatment services in each region of the Commonwealth. Previous research indicates that there are mental health services available in the community for children. There are 15 acute inpatient psychiatric providers in the Commonwealth that provide acute inpatient mental health services to children, thirteen of these are private providers with 245 licensed psychiatric beds. (*2) In addition, there are over 1800 beds in 25 residential treatment facilities that provide intensive services for youth. (*3) The number of licensed residential beds continues to expand over time. For example, for the quarter ending June 30, 2009, there were 1696 licensed residential beds available to treat youth and there were 1860 such beds for the quarter ending September 30, 2009. (*4) It is anticipated that the number of acute private psychiatric beds for children will also expand with recent changes to the Code of Virginia which eases state approval for inpatient psychiatric beds. (*5)

Bed capacity to serve children in Virginia is sufficient, but a significant number of children and their families do not have adequate insurance coverage to pay for services in their community. Data indicates one quarter to one half of admissions at these facilities are related to inadequate health insurance coverage. Funds to pay for local purchase of services could prevent admissions to CCCA and SWVMHI’s adolescent simply because of the lack of insurance coverage.

Second, the Commonwealth could provide a small amount of start up funding to establish additional crisis stabilization and intensive support services for youth in each region of Virginia. Medicaid provides funding for child crisis stabilization and other intensive services and start up funds could help get these services up and running for Medicaid and privately insured children. This would prevent admissions to CCCA and SWVMHI adolescent unit for many children. A sample indicates that at least 10% admissions fall into this category. Finally, the DBHDS and the Department of Juvenile Justice could partner to establish a mental health unit to provider services to children who are incarcerated. These children represent between 5-8% of admissions to CCCA and SWVMHI adolescent unit.

Option 2: Continue to support publicly-funded acute inpatient psychiatric care through the operation of CCCA and SWVMHI’s adolescent unit. The Commonwealth should maintain a publicly-funded safety net that includes acute inpatient services. Funding should be aligned so services are delivered in children’s communities closer to home. Currently, every CSB utilizes services at CCCA and a significant number of CSBs in the western part of Virginia use SWVMHI’s adolescent unit. Children and their families must travel vast distances from Northern Virginia, Tidewater, and the Southside to receive intensive services provided at CCCA. Ideally, all children should receive services as close to their home community as possible. Funding to operate these two facilities could be used instead provide services in every region of Virginia. It is preferable to have services available in each locality.

Team Findings

The Team found that both CCCA and SWVMHI adolescent unit are an important part of the safety net the Commonwealth provides for youth who need psychiatric services. They found that public funds should continue to support this safety net at first through the two facilities and then as services become available in each community, through those communities and regions. The State and Community Consensus Team also recommended additional funding for community services, improved coordination and collaboration to enhance existing services and improving data collection between public and private providers.

Conclusion

The State and Community Consensus Team supports continued expansion of community-based intensive psychiatric services for youth in the Commonwealth as does DBHDS. Based on the findings of the Team, previous reports and date, DBHDS believes Option 1, if paired with state general funds, will spur the development of services in each locality of the Commonwealth and ensure that each child in each community receives appropriate intensive mental health services. Resources should be invested in a state and community consensus team to work with private providers, community service boards, the Office of Comprehensive Services, the Department of Medical Assistance Services and others to develop a comprehensive plan for cultivating services in each region of the Commonwealth that are of consistent availability and quality.
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(*1) The Department’s name was changed on July 1, 2009.
(*2) 37.2-308 Child and Adolescent Data, July 1 –September 30, 2009
(*3) 37.2-308 Child and Adolescent Data, July 1 –September 30, 2009
(*4) 37.2-308 Child and Adolescent Data, April 1 –June 30, 2009 compared to 37.2-308 Child and Adolescent Data, July 1 –September 30, 2009.
(*5) VDH issued a Request for Applications on November 13, 2009 for acute inpatient psychiatric beds. Previously Certificate of Public Need applications were required to increase the number of inpatient psychiatric beds.