RD144 - 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, 2009- June 30, 2010


Executive Summary:
Since 2002, the General Assembly approved Appropriation Act language (Items 329-G, 330-F, 311-E, and 315-E respectively) directing the Department of Behavioral Health and Developmental Services (DBHDS) to convene stakeholders to study ways to improve access to services for children and their families across disabilities. The language also required DBHDS 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 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.”

To assist in this process, DBHDS convened an interagency workgroup to study children’s services and advise it regarding needed changes as well as strategies to implement these changes. The workgroup changed its name several times over the years and in December 2008, adopted the name, the Systems of Care Advisory Team (SOCAT).

Language for the DBHDS report was edited and updated during the 2010 General Assembly Session; consequently, this report to the 2011 General Assembly will be the last one submitted in response to the original budget language.

In June 2009, the Department submitted its seventh consecutive report, A Policy and Plan to Provide and Improve Access to Mental Health and Substance Abuse Services to Children, Adolescents and Their Families. That report delineated recommendations to improve access to services for children and their families as well as ways to address unmet service needs, funding, infrastructure, and system issues. This report to the 2011 General Assembly identifies many of the ongoing concerns and recommendations noted by the workgroup in previous reports.

There has been considerable interest in the children’s behavioral health services system over the past 20 years and numerous reports and studies have been generated. In addition to DBHDS, various state executive and legislative agencies generated reports 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), were also asked to study special areas of concern. These reports identified and reported similar findings and concerns regarding Virginia’s behavioral health care services for youth, 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 have laid a helpful foundation for ongoing change. Unfortunately, in this era of unprecedented budget concerns, it has been difficult to identify new funds to support service needs. Consequently, Virginia’s child-serving systems have become increasingly resourceful and creative in their efforts to address concerns. As Virginia continues its efforts to develop a broader range of services and supports for children and adolescents across the Commonwealth, stakeholders work collaboratively to address unmet needs and ensure that providers have the required skills and knowledge to provide better-coordinated services for children and their families.

DBHDS continues its Transformation Initiative to reform the community behavioral health system by implementing a vision that includes individual- 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.

Two state-directed initiatives, the Children’s Services System Transformation and Smart Beginnings, have emerged in recent years. Both are large, complex, interagency efforts aimed at changing how services are delivered to children and their families across the Commonwealth. Whereas the Children’s Services System Transformation has focused primarily on school age youth, Smart Beginnings has addressed the needs of early childhood.

This report includes a brief update on the current status of children’s behavioral health care in the Commonwealth, recommendations funded by the General Assembly in past years and examples of the creative ways in which Virginia’s child serving systems have sought to improve behavioral health care services for children.

Aware of the current budget dilemma, the workgroup identified those efforts most critical to transforming Virginia’s behavioral health care services for children with the hope that, once funds do become available, these recommendations will be funded. When funds are available, the workgroup recommends that the following areas be addressed:

1) Fund community systems of care and increased community service capacity. Virginia needs to provide a basic array of behavioral health care services for children and adolescents that are available uniformly across the Commonwealth from the least intensive to the most intensive.

2) Fund behavioral heath services in school settings. Children spend most of their day in school and can be most easily reached in the school setting. Behavioral health professionals need to be on site in schools so that children can continue to learn and are able to remain in their community.

3) Fund workforce development for child behavioral health professionals. A comprehensive workforce development program is recommended that would target training to professionals at all levels. This could be accomplished through a partnership between DBHDS and a state university.

4) Reinstate funding for fellowships to ensure Virginia is able to retain an adequate supply of children’s behavioral health care providers. To the extent possible, fellowships for professions such as psychiatry, psychology, social work and other behavioral disciplines should be made available. There should be an emphasis on fellowships for professionals who will make a commitment to work in rural and underserved areas.

This series of reports has been the first to focus on services for all youth – regardless of their disability, funding source or the system within which they received services – and has involved stakeholders from all of Virginia’s youth serving systems as well as, public and private providers and family members. Involving such an extensive cross section of participants enabled members to better understand these different systems and how they interact with another to shape Virginia’s services for children and their families. The workgroup strongly believes that interagency coordination has been strengthened through the collaboration of its membership and supports an interagency approach in every aspect of services to children.