The System Transformation Excellence and Performance (STEP-VA) initiative is Virginia’s 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. The nine services mirror the national best practice model of Certified Behavioral Health Clinics (CCBHCs) and include:

• Same Day Access
• Primary Care Screening
• Outpatient Services
• Crisis Services
• Peer and Family Support
• Psychiatric Rehabilitation
• Veterans Services
• Case Management
• Care Coordination

After full implementation of STEP-VA, DBHDS anticipates reaching important outcomes such as decreased emergency room visits, and reduced involvement of individuals with behavioral health disorders in the criminal justice system. STEP-VA implementation and planning have continued despite the continuation of the COVID-19 pandemic and the behavioral health workforce crisis. In FY 2022:

• Overall delivery – Primary care screening, metabolic screenings, same day access (SDA), and outpatient services were delivered across 40 CSBs, with CSBs providing in person, telehealth and telephonic services as needed per public health guidance.

• Same Day Access (SDA) – 47,259 SDA assessments were completed across the system.

• Primary Care Screenings – A total of 59,224 primary care screenings were conducted for 29,806 individuals. A total of 29,734 metabolic screens were conducted across 13,950 individuals in FY 2022.

• Outpatient Services – The Columbia suicide screening was implemented, and in year one, 65.3 percent of children ages 6 to 17 received a screening and 60.8 percent of adults received a screening. Also, of the 1,917 eligible staff, 1,513 met the minimum eight-hour trauma training requirement (79 percent), which is a significant increase from last year (70 percent). In addition, outpatient services demonstrated positive clinical outcomes as measured by the DLA-20, a functional impairment measure used at each CSB.

• Initial Funding Received – Peer and Family Support Services and Service Members, Veterans and Families (SMVF) Services received initial funding by the 2021 General Assembly, and initial allocations and metrics are included in this report. Finally, the last three STEPs (psychiatric rehabilitation, case management, and care coordination) were in the planning phase over the year covered by this report; and during 2022 Session, funding was allocated to begin July 2022.