RD632 - Report on Funding for Child Psychiatry and Children’s Crisis Response Services – October 1, 2019

Executive Summary:

In the 2011 report to the General Assembly, Item 304.M. “A Plan for Community-Based Children’s Behavioral Health Services in Virginia," the Department of Behavioral Health and Developmental Services (DBHDS) described the comprehensive service array needed to meet the needs of children with behavioral health problems. A survey of community services boards (CSBs) indicated that of all the services in the comprehensive service array, crisis response services, including mobile crisis services and crisis stabilization services, were the least available services in Virginia. These services are in short supply due at least in part to the expense of such service models that require highly trained clinicians 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 among the CSBs in a region. Child psychiatry is an integral part of all crisis response services, and it was also one of the highest-rated needed services in the survey for the 304.M: A Plan for Community-Based Children’s Behavioral Health Services in Virginia.

DBHDS awarded funding for regional crisis services through a request for proposals and application review process to each of the five regions. A map showing the primary DBHDS regional structure can be found in Appendix A. Each region has a lead CSB, which are:

• Region 1 - Horizon Behavioral Health

• Region 2 - Arlington County CSB

• Region 3 - Mount Rogers CSB

• Region 4 - Richmond Behavioral Health Authority

• Region 5 - Hampton-Newport News CSB

The regions have experienced growth in the number of children served through child psychiatry access from one or more of the following psychiatry services: face-to-face visits, tele-psychiatry, and consultation with pediatricians and primary care physicians. As the general fund allocation has increased from $1.5 million in FY 2013 to $8.4 million in FY 2017, there has been growth in the number of children who received mobile crisis and crisis stabilization services. Since FY 2016 there has been a 24% increase in the number of children that received a mobile (ambulatory) crisis service and since the first year of operation, crisis stabilization units have seen a 371% increase of the number of children seen. Funding for FY 2019 remains steady at $8.4 million. Budget language allocates funding to regions based on the availability of services with a report on the use and impact of funding due annually. Due to the flexible nature of the appropriations language, each region uses funds differently, leading to the variability in access and types of services across the Commonwealth.

In the first year of funding, five proposals were received, one from each region. Three proposals were selected: Region 1, Region 3, and Region 4. In FY 2014, Regions 2 and 5 were added. This report describes the services provided by all five regions from July 1, 2018 through June 30, 2019. Figure 1 (on page 3) illustrates the distribution of funding by each of the five regions in FY2019.