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 require consistent quality measures and oversight. The nine services mirror the 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
• Psychiatric Rehabilitation Services
• Services for Service Members, Veterans, and their Families
• Case Management
• Care Coordination

The focus of STEP-VA is to increase the availability and accessibility of behavioral health services across the state, ensuring that Virginians have access to the services they need within their communities to increase and maintain behavioral health stability, and 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.

Below are high-level updates for FY 2025:

The final three STEP-VA services: Care Coordination, Psychiatric Rehabilitation, and Targeted Case Management, are considered fully implemented as per the FY 2026 Performance Contract. This determination reflects the application of outcome measurements for each of these steps, ensuring not only that services are available statewide, but that they are measured consistently for quality and effectiveness.

DBHDS continued STEP-VA site visits across all 40 CSBs, including follow-up visits for higher-risk boards. Consistent with the work conducted in prior fiscal years, DBHDS maintained focus on updating service requirements to better align with nationally recognized best practices and the Substance Abuse and Mental Health Administration (SAMHSA) guidance. These updates included the addition of new outcome measurements designed to streamline services based on clinical need, strengthen program evaluation, and improve monitoring of wait time for services. DBHDS also launched multiple collaborative workgroups, meetings, and listening sessions to ensure that CSB experiences, feedback, and successful strategies were integrated throughout the ongoing review and realignment of the STEP-VA initiative.

DBHDS piloted the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a replacement for the Daily Living Activities-20 (DLA-20). The pilot demonstrated that WHODAS 2.0 is an evidence-based, efficient, and scalable tool that reduces administrative burden while producing meaningful outcome data. DBHDS will implement WHODAS 2.0 statewide beginning July 1, 2026, improving Virginia’s ability to measure consumer functioning and system-level outcomes.

Additional updates are as follows:

• Overall delivery – All 40 CSBs across Virginia are currently delivering all nine of the core services required by STEP-VA to varying degrees. While some CSBs continue to report ongoing barriers preventing full implementation of some components, the vast majority of CSBs are fully implementing all nine required steps.

• Same Day Access (SDA) – 31,212 SDA assessments were completed across the system in FY 2025(*1). (Superscripts noted throughout the report are defined on page 4.)

• Primary Care Screenings – A total of 62,942 primary care screenings was conducted for 27,146 individuals. A total of 29,386 metabolic screens were conducted across 11,483 individuals in FY 2025.(*1)

• Outpatient Services – The Columbia suicide screening continues to be utilized, and in year three of its utilization, 78.2 percent of children ages 6 to 17 received a screening and 77.0 percent of adults received a screening.(*1) Also, of the 3,239 eligible staff, 2,098 met the minimum eight-hour trauma training requirement.(*2) 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 – all nine steps have been funded by SGF 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 $145.7 million to be distributed across the 40 CSBs to cover each of the nine steps.
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(*1) Fiscal Year 2025 data reflect activity through April 2025; May and June data were not available for inclusion due to the transition to the new enterprise data warehouse (EDW). Starting FY 2026, all measures will be collected using standardized CPT/HCPCS Procedure Codes and ICD-1- Diagnostic Codes.
(*2) EBP survey data reflect preliminary submissions. At the time of reporting, verification from all CSBs had not yet been received.