RD259 - Report on Funding for Child Psychiatry and Children’s Crisis Response Services (Item 315.W., 2013 Appropriation Act) - October 7, 2013

Executive Summary:
This report was developed in accordance with Item 315.W. of the 2013 Appropriation Act which addresses the management of the general fund appropriation for child psychiatry and children’s crisis response services for children with mental health and behavioral disorders. Specifically, the language states:

"W. Out of this appropriation, $1,500,000 the first year and $3,650,000 the second year from the general fund shall be used to provide child psychiatry and children’s crisis response services for children with mental health and behavioral disorders. These funds, divided among the health planning regions based on the current availability of the services, shall be used to hire or contract with child psychiatrists who can provide direct clinical services, including crisis response services, as well as training and consultation with other children’s health care providers in the health planning region such as general practitioners, pediatricians, nurse practitioners, and community service boards staff, to increase their expertise in the prevention, diagnosis, and treatment of children with mental health disorders. Funds may also be used to create new or enhance existing community-based crisis response services in a health planning region, including mobile crisis teams and crisis stabilization services, with the goal of diverting children from inpatient psychiatric hospitalization to less restrictive services in or near their communities. The Department of Behavioral Health and Developmental Services shall report on the use and impact of this funding to the Chairmen of the House Appropriations and Senate Finance Committees beginning on October 1, 2013 and each year thereafter."

This language was included in the current budget to address certain recommendations included in the 2011 report “A Plan for Community-Based Children’s Behavioral Health Services in Virginia,” (Report Document 267, Item 304.M.) by the Department of Behavioral Health and Developmental Services (DBHDS). That report described the comprehensive service array needed to meet the needs of children with behavioral health problems.

Included in that plan were the results of a survey of community services boards (CSBs) which indicated that, of all the services in the comprehensive service array, crisis response services including both mobile crisis and crisis stabilization were the least available services in the state. At least part of the reason crisis response services are in short supply is because of the expense of such service models, which require highly trained clinicians who are available on a 24/7 basis to respond to crisis situations. Rural CSBs are particularly challenged in supporting these service models. For these reasons, a regional approach was proposed to allow the services to be shared across a health planning region.

Through a competitive Request for Applications, three regional proposals were selected from those submitted from all five health planning regions:

Region I – Horizon Behavioral Health is the lead CSB for the region
Region III - Mount Rogers is the lead CSB for the region
Region IV - Richmond Behavioral Health Authority is the lead CSB for the region

This report covers the first 10 months of funding following the application process (September 1, 2012 through June 30, 2013) and the $1,500,000 million appropriated for FY2013.

Overall, the three regions achieved good outcomes in keeping children with their parents and attending school. They established child psychiatry access through face-to-face visits, tele-psychiatry and consultation to pediatricians and primary care practitioners and reduced their utilization of the DBHDS Commonwealth Center for Children and Adolescents (CCCA), the state’s only public inpatient facility for children. It is early in the life of these regional projects, but in all three funded regions admissions and bed days have been reduced. Though there were good outcomes in all three regions, start-up challenges in Region IV resulted in fewer families and children served.