Over the past several years, Virginia has been making concentrated and meaningful efforts to reform its strained public mental health system. In an effort to improve the system, the Department of Behavioral Health and Developmental Services (DBHDS) worked with the McAuliffe Administration, the General Assembly, and stakeholders and drew from national best practices to design System Transformation Excellence and Performance (STEP-VA). STEP-VA requires all community services boards (CSBs) to provide the same services, such as same day access, primary care screening, outpatient services for mental health and addiction, targeted case management, crisis services, and other critical services. These essential services will be available consistently across all 40 CSBs. In addition, STEP-VA features a uniform set of required services, consistent quality measures, and improved oversight in all Virginia communities. Notably, STEPVA services are intended to foster wellness among children and adults with behavioral health disorders and prevent crises before they arise. STEP-VA is also intended to provide critical support for individuals at risk of incarceration, those in crisis and those in need of stable housing. The result should be fewer admissions to state and private hospitals, decreased emergency room visits, and reduced involvement of individuals with behavioral health disorders in the criminal justice system.

In 2017, the General Assembly provided funding for 18 CSBs to implement the first STEP-VA service, Same Day Access (Item 315 GG). It also required that the first two phases of STEP-VA, same day access and primary care screening, be implemented by July 1, 2019, and that the remaining STEP-VA services be implemented by July 1, 2021 (SB1005 and HB1549). In addition the 2018 General Assembly provided additional funding for the remaining 22 CSBs to implement Same Day Access, Primary Care Screening, Outpatient Services, and Substance Use Detoxification Services. These actions signaled intent to significantly reform Virginia’s behavioral health system and also expressed a commitment to a long-term infusion of funds to build these critical community services.

SB1005 and HB1549 were designed to support the development and implementation of a behavioral health system which will include a uniform, minimum set of services to be offered by community services boards (CSBs) across Virginia. A major goal for this new vision for behavioral health is to bring a level of consistency and performance expectation to services while taking into account unique local attributes that may be based on community population, rurality, or other existing innovations. DBHDS will be conducting a state wide behavioral health needs assessment beginning in early 2019 to inform decisions on how future services and funding will be allocated to support implementation of STEP-VA services across the commonwealth.

The first step taken for STEP-VA was the planning and implementation of the Same Day Access (SDA) model as described in SB1005 and HB1549. This report details the progress made to date on disbursement of funds, SDA planning and implementation among all 40 CSBs. It also reviews preliminary and future planning for Primary Care Screening, Mental Health and Substance Use Disorder Outpatient Services, and Substance Use Detoxification Services.