The System Transformation Excellence and Performance (STEP-VA) initiative is Virginia’s concentrated effort to reform the public mental health system by improving access, quality, consistency, and accountability in public mental health services across the Commonwealth. It requires that all 40 community services boards (CSBs) implement nine essential services, referred to as steps, and requires consistent quality measures and oversight. After full implementation of STEP-VA, DBHDS anticipates 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 the past year, despite the COVID-19 pandemic, STEP-VA implementation and planning have continued. Key progress and learnings from FY20 include:

- Primary care screening and same day access continue to be provided across Virginia’s 40 CSBs, with CSBs providing telehealth or telephonic services as needed to prevent the spread of the virus.

- During FY20, over 55,000 individuals received same day assessments

- In FY20, a total of 34,534 metabolic screens were conducted for 17,113 individuals using the primary care screening process.

- Mobile crisis services and outpatient services have been partially implemented, though full funding of resources is necessary to complete implementation across Virginia.

- Planning is nearly complete for military and veteran’s services and peer and recovery services, and planning continues the final three steps: case management, care coordination, and psychiatric rehabilitation.

- There continues to be a critical need for Central Office staff to provide the centralized planning and coordination necessary for effective STEP-VA implementation that has been noted in the Joint Legislative Audit and Review Commission (JLARC) report from 2019 and the 2020 Comprehensive Needs Assessment.

- There continues to be a need for critical data infrastructure to ease the administrative reporting burden on CSBs and provide DBHDS with the timely metrics necessary to gauge quality of services and institute performance improvement goals.

DBHDS continues to work with DMAS partners to align STEP-VA with Behavioral Health Enhancement and works to implement the Behavioral Health Equity Index to identify a pathway to more equitable allocation of funding across CSBs. This report concludes with future directions and an overview of activities for SFY21.