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 a more robust community services system, which in turn will result in 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.

Based on the results of the Comprehensive Needs Assessment, a more systemic approach was adopted for the implementation of STEP-VA in FY 2021, in addition to the design and implementation of each specific STEP. Systemic achievements during FY 2021 include the design of a core performance dashboard shared between DBHDS and the CSBs (three metrics adopted and benchmarked at the end of FY 2021); a performance contract supplement for metric review and accountability which became active July 1, 2021; the authorization of a large scale project to transform the data exchange between DBHDS and CSBs; and the completion of a workgroup regarding the use of the Behavioral Health Equity Index and CSB Funding more broadly.

Despite the continuation of the COVID-19 pandemic, STEP-VA implementation and planning have continued. Primary care screening, metabolic screenings, same day access (SDA), and outpatient services were delivered across 40 CSBs, with CSBs providing telehealth and telephonic services as needed per public health guidance. During FY 2021, 44,305 SDA assessments were completed across the system. Regarding primary care screenings, a total of 54,674 primary care screenings were conducted for 29,957 individuals. Across FY 2021, a total of 57,640 metabolic screens were conducted, which is a 67 percent increase from FY 2020. These screens were conducted across 22,276 individuals (which is a 30 percent increase from FY 2020). Thus, on average, individuals were receiving 2.6 screenings per year (up from 2.0 in FY 2020).

Outpatient services and crisis services have both reached initial implementation, with significant ongoing training in evidence based practices, as well as increases in utilization for children’s residential crisis stabilization units. Also, 80 percent of the workforce achieved eight hours of trauma-focused training, 43 percent achieved 40 hours, and each region planned and implemented additional/specific training priorities. Additional data and analysis regarding the implementation of crisis services will be available following the launch of the initial (off the shelf) modules of Comprehensive Crisis System Data Platform in December 2021. Additional outpatient and crisis funding, as well as initial funding for two additional STEPs (SMVF and Peer and Family Supports) was appropriated for FY 2022 and has been disbursed to the CSBs and regions at the time of this report. There are three STEPs that have not yet been funded, which will be the focus of planning activities during FY 2022.