RD994 - Report on STEP-VA Implementation and CSB Performance Relating to the DLA-20 Assessment – December 1, 2024
Executive Summary: 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 Substance Abuse and Mental Health Services Administration (SAMHSA) national best practice model of Certified Community Behavioral Health Clinics (CCBHCs) and include: • Same Day Access 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. In 2024, DBHDS completed STEP-VA site visits with 20 of the 40 CSBs and launched multiple collaborative workgroups, meetings, and listening sessions to ensure that the experience, feedback, and successful strategies from CSB partners are taken into consideration throughout the process of examining and re-aligning the initiative. In FY 2024: • Overall delivery – CSBs report ongoing barriers preventing full implementation of components of all nine required steps. Setting baselines was one of the primary focal points for this iteration of STEP-VA for improved compliance monitoring to ensure CSBs could demonstrate access to services and outcomes related to the continuum. • Same Day Access (SDA) – 43,278 SDA assessments were completed. • Primary Care Screenings – 40,304 metabolic screens were conducted for 14,792 individuals. • Outpatient Services – The Columbia suicide screening was implemented and 74.5 percent of children ages six to 17, and 73.9 percent of adults received a screening. Of the 2,147 eligible staff, 1,791 met the minimum eight-hour trauma training requirement (83 percent). Also, outpatient services demonstrated positive clinical outcomes as measured by the DLA-20, a functional impairment measure used at each CSB. • Service Member, Veteran or Family (SMVF) – Of applicable direct service staff, 97 percent were trained in Military Cultural Competency, up two percent from last year. • Peer and Family Support Services - STEP-VA funds 103 out of 476 Peer and Family Services Full Time Equivalents (FTE) throughout the 40 CSBs • Initial Funding Received – all nine steps have been funded by General Fund dollars since FY 2023, with increases seen to all steps over the FY 2025-2026 biennium. Total funding for STEP-VA in FY 2025 is set at $139.8 million to be distributed across the 40 CSBs to cover each of the nine steps. Over the past year, DBHDS has focused on examining each component of STEP-VA to ensure that the requirements are updated to align with national best practices, SAMHSA requirements, and the changing needs that have been identified across the Commonwealth over the past several years. In collaboration with the 40 CSBs, DBHDS has worked to identify ways to better define each step, refine the requirements outlined in the performance contracts, and improve methods for measuring success and service efficacy. In addition, DBHDS will be working to employ a funding formula method to the STEP-VA funding allocation to ensure that funds are fairly distributed across the 40 CSBs based on data informed determination of needs using the most up-to-date data. Table 1 (on page 2 of the report) shows total FY 2024 STEP-VA funding by category. |