RD269 - Report on Funding for Child Psychiatry and Children’s Crisis Response Services - October 1, 2015


Executive Summary:
This report was developed in accordance with Item 308.S. of the 2014 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:

"S. Out of this appropriation, $3,650,000 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 Virginia.

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 health planning regions.

Funding was awarded through a request for proposals and application review process to each of the five health planning regions. Each region has a lead CSB. The regional CSB leads are:

• Region I – Horizon Behavioral Health
• Region III - Mount Rogers
• Region IV - Richmond Behavioral Health Authority
• Region II- Arlington
• Region V- Hampton-Newport News

All regions have been operational for at least one fiscal year. Overall, the regions have achieved good outcomes in maintaining children in their homes, with their parents and attending school. They also increased child psychiatry access, serving more children than prior years through face-to-face visits, tele-psychiatry and consultation with pediatricians and primary care physicians.