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 U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) national best practice model of Certified Community Behavioral Health Clinics (CCBHCs) and include:

• Same Day Access
• Primary Care Screening
• Outpatient Services
• Crisis Services
• Peer and Family Support Services
• Services for Service Members, Veterans, and their Families
• Psychiatric Rehabilitation Services
• Case Management
• Care Coordination

The focus of STEP-VA is to ensure Virginians have access to the services they need within their communities to increase and maintain behavioral health stability, and to decrease the need for crisis interventions. DBHDS anticipates that STEP-VA will assist the Commonwealth in reaching key outcomes including decreased emergency room visits for psychiatric crisis and reduced criminal justice system involvement for individuals with behavioral health disorders. STEP-VA planning and implementation was delayed by the COVID-19 pandemic and the behavioral health workforce crisis. However, in the past year, DBHDS has renewed focus on STEP-VA, with targeted work aimed at updating the service requirements to better align with current nationally recognized best practices and SAMHSA guidance, and to identify opportunities for improvement based on the data gathered in the initial stages of the project, including aligning measures with best practices.

DBHDS, in collaboration with the Virginia Association of Community Services Boards (VACSB), had previously established measures for the first six steps. As part of the refresh, DBHDS refocused efforts on measures that were more tied to individuals’ outcomes as opposed to the counting of events of occurrence. For example, DBHDS previously counted how many peer recovery specialists were trained while the new measure will now count how individuals benefit from peer recovery services. This refresh of measures outlined below aligns measures with best practices, focuses on individual outcomes and assures comparison of Virginia’s progress against other states.