RD240 - Virginia Department of Behavioral Health and Developmental Services Item 304.M. – Interim Report: A Plan for Community-Based Children’s Behavioral Health Services in Virginia - October 1, 2010


Executive Summary:
Item 304.M. of the Appropriation Act directed the Department of Behavioral Health and Developmental Services (DBHDS), in conjunction with several other state agencies and stakeholders, to establish a planning process, develop recommendations, and report on specific steps to provide behavioral health services to children. The language states:

The Commissioner of the Department of Behavioral Health and Developmental Services (DBHDS) shall establish a planning process to identify concrete steps to provide children’s mental health services, both inpatient and community-based, as close to children’s homes as possible. The planning process will produce a comprehensive plan that ensures there are child-centered services, both inpatient and community-based, delivered at the community level in every Health Planning Region in the Commonwealth. The target populations to be addressed in this plan are children through age 17 who: (i) have a mental health problem, (ii) may have co-occurring mental health and substance abuse problems, (iii) may be in contact with the juvenile justice or courts systems, (iv) may require emergency services, or (v) may require long term community mental health and other supports. The planning process should identify the mental health and substance abuse services that are needed to help families keep their children at home and functioning in the community and should define the role that the Commonwealth Center for Children and Adolescents will play in this effort. The plan should establish and rank recommendations based on greatest priority and identify future funding associated with each recommendation. The planning process shall include input from community services boards, state and private inpatient facilities, The Department of Social Services, The Office of Comprehensive Services, The Department of Juvenile Justice, The Department of Education, The Department of Medical Assistance Services, parents of children with mental health and co-occurring substance abuse problems, advocates for child mental health and co-occurring services, and any other persons or entities the DBHDS deems necessary for full consideration of the issues and needed solutions. The commissioner shall report interim findings to the Chairmen of the House Appropriations and Senate Finance Committees by October 1, 2010 and a final report by November 1, 2011.

A review of prior reports and recommendations on children’s behavioral health helped to build the foundation for this report. Those reports represent input from parents and advocates, state agencies, and service providers. The consensus of all prior reports indicated that if children with behavioral health problems could be served earlier with high-quality treatment, the more intensive and expensive services, such as inpatient, could be used less often.

To receive input for this plan, DBHDS convened three Expert Input Panels:

• State Agencies – including each of the state child-serving agencies listed in the language above, and the Office of the Inspector General for the Department of Behavioral Health and Developmental Services (OIG).

• Service Providers – including community services boards (CSBs), private providers of community services and supports, and public and private inpatient service providers

• Family Members and Advocates – including parents and family members of children receiving services, representatives of family and advocacy organizations, and the Campaign for Children’s Mental Health, which includes over 50 supporting organizations.

Focus

This plan focuses on children’s behavioral health services that are funded with public dollars. Public dollars include funding from: the state General Fund, federal mental health block grants, local government, and Medicaid or CSA. The target population for this plan is identified in the budget language in Item 304.M. as children through age 17 who:

(i) Have a mental health problem; and

(ii) May have co-occurring mental health and substance abuse problems;

(iii) May be in contact with the juvenile justice or courts systems;

(iv) May require emergency services; or

(v) May require long term community mental health and other supports.

Challenges

The plan details the full comprehensive service array that is needed to support a child-centered, family-focused system of care. The plan also describes the current status of the system of care. Virginia’s behavioral health services system for children faces a number of challenges, the most significant of which include:

• All communities have an incomplete array of services.

• In many of the services that are available, there is inadequate capacity resulting in children and families waiting for services.

• Families are faced with inconsistency across the state in the array and the capacity of services.

• Because of the incomplete array, inadequate capacity, and inconsistency, many children do not receive services early enough, which may mean their conditions worsen and result in delayed, more restrictive, and more costly services. Many other children, who do not meet the eligibility or service definition of the predominant funding streams – Medicaid and CSA – simply cannot find access to services to meet their needs.

• Workforce development is needed to support a comprehensive system.

• There is inadequate oversight and quality assurance for the services that do exist.

The current and future role of the Commonwealth Center for Children and Adolescents (CCCA) within a comprehensive system is addressed by this plan. At the present time, the role of CCCA is to provide high quality inpatient services for the most challenged and traumatized children and to work with communities to return the children to their homes in the shortest clinically feasible time. This service can be expected to continue until more adequate community-based services are in place. If the comprehensive community service array can be expanded over the next four to eight years, the need for public inpatient services can be projected to decline. However, if there is no growth in community services, then the role of CCCA and the demand for its services will likely stay the same.

Recommendations

Based on the information gathered from previous reports, the current status of the system and the work of the expert panels, the following recommendations are made as strategic initiatives that the General Assembly may want to consider moving forward in the future. These initiatives could be implemented in a phased manner over a number of years, as the Virginia’s budget scenario improves:

1. Define and promote through DBHDS the full comprehensive service array as the goal and standard for children’s behavioral health services in every community.

2. Expand the array and capacity of services to assure a consistent base level of services for children and families statewide.

3. Establish a children’s behavioral health workforce development initiative to be organized by DBHDS.

4. Continue the current role of CCCA for the foreseeable future, and until more adequate community-based services are in place.

5. Establish quality management mechanisms and metrics to improve access and quality in behavioral health services for children and families.

Funding Priorities

The General Assembly might consider gradual funding of these recommendations over successive fiscal years, beginning with FY2013. The priority recommendation is Recommendation #2: Expand the array and capacity of services to assure a consistent base level of services for children and families statewide. The consistent availability of the base services would have the greatest potential to reduce unnecessary reliance on inpatient and residential care.

Final Report

DBHDS is gathering current, detailed information about the status of statewide service array, capacity and consistency in all communities. Based on this data DBHDS will identify, by CSB and community, the specific needs to reach both the base level of services and sufficient capacity in every community. Corresponding budget needs will be included for subsequent biennia. This final report will be presented in 2011.