DBHDS Virginia Department of Behavioral Health and Developmental

DBHDS Virginia Department of Behavioral Health and Developmental Services A Plan for Community-Based Children’s Behavioral Health Services in Virginia Item 304. M. – Final Report John J. Pezzoli, Assistant Commissioner Virginia Department of Behavioral Health and Developmental Services

DBHDS Virginia Department of Behavioral Health and Developmental Services Background • The 2010 General Assembly required DBHDS to develop a comprehensive plan for children’s behavioral health services, both inpatient and community-based, as close to children’s homes as possible. • Interim report was due and submitted October 1, 2010. • Final report was due and submitted on November 1, 2011 • This is the first comprehensive plan for children’s behavioral health services and will provide guidance for both the General Assembly and DBHDS. Page 2

DBHDS Virginia Department of Behavioral Health and Developmental Services Intent The GA’s intent for the plan included: • identify the mental health and substance abuse services needed to help families keep children at home and functioning in the community • define the role of the Commonwealth Center for Children and Adolescents • make and prioritize recommendations with associated cost estimates • include input from stakeholders including CSBs, state and private inpatient facilities, state child-serving agencies, parents and advocates and others to assure full consideration of the issues. Page 3

DBHDS Virginia Department of Behavioral Health and Developmental Services Process For input, DBHDS convened 3 expert panels: • State Agencies – DSS, CSA, DJJS, DOE, DMAS, DBHDS, and the BHDS OIG. • Service Providers – Community services boards, private providers of community services and supports, and public and private inpatient service providers. • Family Members and Advocates – Parents and family members of children receiving services, representatives of family and advocacy organizations, and the Campaign for Children’s Mental Health, which includes over 50 supporting organizations. Page 4

DBHDS Virginia Department of Behavioral Health and Developmental Services Process • The panels met in small groups and together and reviewed the issues and explored questions such as: – What services are needed? – Funding issues – Prioritization of recommendations • Review and analysis of prior plans and reports on children’s behavioral health helped to build the foundation for this report. • Panel members provided expertise and information to support the process. • DBHDS summarized input from the panels, prepared the interim and final reports, seeking expert panel input as drafts were developed. Page 5

DBHDS Virginia Department of Behavioral Health and Developmental Services Target Population • The target population defined by the budget language is children through age 17 who: – Have a mental health problem; and – May have co-occurring mental health and substance abuse problems; – May be in contact with the juvenile justice or courts systems; – May require emergency services; or – May require long term community mental health and other supports. • The plan focuses on services supported with public funding, including state General Fund, federal block grants, local government funding, and Medicaid or CSA. Page 6

DBHDS Virginia Department of Behavioral Health and Developmental Services Challenges The plan describes current system challenges, including: • All communities have an incomplete array of services. • There is inadequate capacity resulting in waits for services. • Families are faced with inconsistency across the state in the array and capacity of services. • Because of the above, many children do not receive services early enough, risking worsened conditions and the need for more restrictive and more costly services. • Many other children who are ineligible for Medicaid or CSA cannot find access to services to meet their needs. • Workforce development is needed to assure professionals to provide the services. • There is inadequate oversight and quality assurance for existing services. Page 7

DBHDS Virginia Department of Behavioral Health and Developmental Services Final Report Estimates Service Gaps and Costs • Through a survey conducted in early 2011, DBHDS gathered information about the current status of the comprehensive service array, capacity and consistency in all communities. • Based on this data, DBHDS has identified the gaps and capacity issues in the comprehensive service array. • Further information and data about the base services has been used to develop cost estimates for reaching full availability of the base services statewide. Page 8

DBHDS Virginia Department of Behavioral Health and Developmental Services Report Findings and Data • There are large gaps in the service array throughout the Commonwealth, leaving few alternatives to meet the needs of children and families. • Having an array of services allows for targeting the best package of services for the child and family. • In addition to CSB services, the available array of services across the state includes significant services provided by private agencies. Page 9

DBHDS Virginia Department of Behavioral Health and Developmental Services Number of Service Types Provided by CSBs Page 10

DBHDS Virginia Department of Behavioral Health and Developmental Services Number of CSBs with Private Providers in Catchment Area Page 11

DBHDS Virginia Department of Behavioral Health and Developmental Services Inadequate Capacity or Limitations on Access • Inconsistency exists not only in the availability of services in different parts of the state, but in the funding sources that are available to families. • Even when services are present, in most communities there is not sufficient capacity for all the children that need them. Page 12

DBHDS Virginia Department of Behavioral Health and Developmental Services Inconsistency in the Availability and Capacity of “Base Services” • The CSB survey data show the expected wide variability in availability and capacity of CSB services, especially the base services. • Crisis Response category has the most significant gaps and the largest number of CSBs that do not provide these services at all. Page 13

DBHDS Virginia Department of Behavioral Health and Developmental Services Availability of Base Services by Number of CSBs Page 14

DBHDS Virginia Department of Behavioral Health and Developmental Services Availability of Base Services by Number of CSBs Page 15

DBHDS Virginia Department of Behavioral Health and Developmental Services Capacity of Base Services in CSBs Base Service Adequate Capacity Inadequate Capacity Services Not Provided Crisis Stabilization Unit for Children 5% 3% 93% Emergency Respite Care 5% 0% 95% 10% 75% 8% 10% 83% Psychiatric Services 20% 78% 3% Case Management 50% 0% Intensive Care Coordination 45% 35% 20% Intensive In-Home Services 23% 40% 38% In Home Crisis Stabilization Mobile Child Crisis Response Page 16

DBHDS Virginia Department of Behavioral Health and Developmental Services CCCA • At the present time the role of CCCA is to provide high quality inpatient services for the most challenged and traumatized children in Virginia • And to work with communities to return them to their homes in the shortest clinically feasible time. • For the Final Report, the following summary data are presented: Page 17

DBHDS Virginia Department of Behavioral Health and Developmental Services CCCA Admissions: FY 2008 FY 2011 YTD (July 1, 2010 -April 2011) FY 2008 Admissions 605 FY 2009 Admissions 605 FY 2010 Admissions 564* FY 2011 Admissions (YTD) 646 *Notes: During FY 10, CCCA was evacuated to WSH for 5 months and only had 24 operational beds during this times. SWVMHI was closed effective 6/30/10. Page 18

DBHDS Virginia Department of Behavioral Health and Developmental Services Recommendations The report contains the following recommendations the GA may consider for future decisions: 1. Define and promote through DBHDS the full comprehensive service array as the goal and standard for children’s behavioral health services in every community. 2. Expand the array and capacity of services to assure a consistent base level of services for children and families statewide. 3. Establish a children’s behavioral health workforce development initiative to be organized by DBHDS. 4. Continue the current role of CCCA (to provide high quality acute inpatient services for the most challenged children) for the foreseeable future until more adequate community-based services are in place. 5. Establish quality management mechanisms to improve access and quality in behavioral health services for children and families. Page 19

DBHDS Virginia Department of Behavioral Health and Developmental Services Priorities for Development • The priority recommendation is Recommendation #2: Expand the array and capacity of services to assure a consistent base level of services for children and families statewide. The four base services are: – – Crisis response services Case management and intensive care coordination Psychiatric services In-home services • The consistent availability of the base services will have the greatest potential to reduce unnecessary reliance on more intensive and costly services. Page 20

DBHDS Virginia Department of Behavioral Health and Developmental Services Funding Priorities • The priority recommendation is Recommendation #2: Expand the array and capacity of services to assure a consistent base level of services for children and families statewide. The four base services are: – – Crisis response services Case management and intensive care coordination Psychiatric services In-home services • The consistent availability of the base services will have the greatest potential to reduce unnecessary reliance on more intensive and costly services. Page 21

DBHDS Virginia Department of Behavioral Health and Developmental Services Base Service Capacity & Cost Estimates for Statewide Availability of Bed Services # of CSBs with Adequate Capacity # of CSBs with Inadequate Capacity # of CSBs that do not Provide Service Estimated Cost Stabilization 2 1 37 $6. 326 million Mobile 3 4 34 $10 million Psychiatric 8 31 1 $1. 4 million Case Management 20 20 0 $1. 6 million ICC 18 14 8 N/A Intensive In. Home 9 16 15 N/A Crisis Response Total $19. 326 million Page 22