Service Area Strategic Plan
4/16/2014   1:06 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Community Substance Abuse Services (720 445 01)
Description

Community Substance Abuse Services funds public community substance abuse services provided by 39 community services boards and one behavioral health authority, hereafter referred to as CSBs, throughout the Commonwealth. CSBs function as the single points of entry into the publicly funded services system. Additionally, CSB offer prevention services that are aimed at substantially reducing the incidence of alcohol, tobacco, and other drug dependency and abuse. CSB responsibilities for services to consumers and for other administrative and operational requirements are identified in, reported on, and monitored through community services performance contracts negotiated annually by the Department with each CSB and associated contract reports. Community substance abuse services are integrated with other direct services and supports at the local level for individuals with special needs or those receiving services from multiple agencies, including adults and children or adolescents with co-occurring disorders such as mental illness and substance use disorders, and individuals who are hospitalized or involved in the criminal justice system.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Community substance abuse services align directly with the agency’s mission and are required to implement the Department's vision of a consumer-driven system of services and supports that promotes an individual's self-determination, empowerment, recovery, resilience, health, inclusion, and participation in all aspects of community life, including work, school, family, and other meaningful relationships. Community substance abuse services benefit society and promote the message that recovery from substance use disorders in all their forms is possible. These services focus on enhancing protective factors and reducing risk factors within the community, overcoming stigma, denial and other barriers to treatment associated with substance use disorders, and assisting individuals to lead healthy and productive lives in recovery.

    [Note: In this service area, substance use disorder names a condition (alcohol or other drug dependence or abuse) that a person has, while substance abuse names the services used to treat that disorder.]
  • Describe the Statutory Authority of this Service
    Chapter 5 of Title 37.2 of the Code of Virginia authorizes the establishment and operation of community services boards (CSBs) by local governments to provide community substance abuse services and authorizes the Department to fund CSBs.
    • § 37.2-500 authorizes the Department to provide funds to assist local governments in the provision of substance abuse services; it requires every city and county to establish or join a CSB; it specifies the core of services to be provided by CSBs; and it requires CSBs to function as the single points of entry into publicly funded substance abuse services.
    • § 37.2-508 requires the Department to negotiate the performance contracts through which it provides funds to CSBs to provide services pursuant to this chapter.
    • § 37.2-509 requires the Department to allocate available state-controlled funds to CSBs for disbursement in accordance with procedures established by the Department and performance contracts approved by the Department.

    Chapter 6 of Title 37.2 of the Code of Virginia authorizes the establishment and operation of a behavioral health authority (BHA) by a specified city or county to provide community substance abuse services and authorizes the Department to fund a BHA.
    • § 37.2-601 authorizes the Department to provide funds to assist certain cities or counties in the provision of substance abuse services; it specifies the core of services to be provided by a BHA; and it requires a BHA to function as the single point of entry into publicly funded substance abuse services.
    • § 37.2-608 requires the Department to negotiate the performance contract through which it provides funds to a BHA to provide services pursuant to this chapter.
    • § 37.2-611 requires the Department to allocate available state-controlled funds to a BHA for disbursement in accordance with procedures established by the Department and performance contracts approved by the Department.

    Sections 1921-1954 of the Public Health Services Act authorize the federal Substance Abuse Treatment and Prevention (SAPT) Block Grant, providing federal funds to the Department for community substance abuse treatment and prevention services.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals receiving CSB substance abuse services Individuals with substance use disorders served by or seeking services from CSBs 43,657 45,706
Participants in community prevention programs and coalitions Participants in community prevention programs and coalitions 660,522 660,552

Anticipated Changes To Agency Customer Base
o Virginia's population is increasing, becoming more culturally diverse, and growing older. The customer base for the Commonwealth's behavioral health and developmental services system will change to reflect these demographic trends.

o The continued significant growth in Northern Virginia, Central Virginia, and Eastern Virginia will significantly increase the consumer base for community substance abuse services.

o Increasing numbers of veterans are returning to Virginia from Iraq and Afghanistan and are experiencing behavioral health issues.

o Increasing numbers of individuals with co-occurring combinations of mental health or substance use disorders, developmental other related disabilities, chronic medical conditions, or behavioral challenges will demand specialized interventions and care.

o Individuals receiving behavioral health and development services have more complex medication regimes, or are experiencing serious medical conditions requiring specialized health services will require ongoing preventive care.

o Increasing numbers of adults and juveniles in the criminal justice system have identified behavioral health issues.

o Based on the 2007 National Household Survey on Drug Use and Health and 2008 Population by Age and Sex Estimates, the Department estimates that 180,453 Virginians ages 12 and older (1.97 percent) are dependent on or abuse illicit drugs and 476,215 (7.31 percent) are dependent on or abuse alcohol. Of these 128,337 (1.89 percent) met the criterion for drug dependence and 168,050 (3.17 percent) met the criterion for alcohol dependence. While not all of these individuals will seek services from the public sector, many of them will do so.

o Individual counts provided by CSBs for the 2010-2016 Comprehensive State Plan identify 2,049 individuals who are currently on waiting lists for community substance abuse services because they are not receiving needed services provided by or through CSBs. Virginia’s ongoing population growth will result in the need for additional community substance abuse services.

o Medicaid coverage for substance abuse treatment services for children and adults, which became effective July 1, 2007, will expand revenue available for emergency services; evaluation and assessment; outpatient services, including intensive outpatient services; targeted case management; and day treatment.
Partners
Partner Description
Community services boards and behavioral health authorities (CSBs): The Department provides state and federal funds to the 40 CSBs to support the provision of community SA services and supports. CSBs participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the public services system.
Federal agencies: The Substance Abuse and Mental Health Services Administration provides grants of federal funds to the Department that support community SA services, and it provides technical assistance to the Department and CSBs about requirements associated with the receipt of block grant funds that support the provision of community SA services.
Individuals receiving services and advocacy organizations: Individuals receiving services and substance use disorder advocacy organizations, such as the Substance Abuse and Addiction Recovery Alliance (SAARA), the Virginia Alliance of Methadone Advocates, and the Virginia Association of Alcohol and Drug Programs, provide important feedback to the Department and CSBs on service needs, services, and policy, planning, and regulatory development activity for the public services system. Some individuals and family members serve on CSB boards.
Local governments: Local governments establish CSBs and approve their CSBs’ performance contracts with the Department. They also provide financial resources to the CSBs to match state funds, and, in some instances, may provide administrative services that are essential to CSBs’ efficient operation.
Other state and local agencies: The Department works closely with many state agencies that provide or fund services and supports that respond to the needs of individuals with substance use disorders, including the Departments of Medical Assistance Services, Social Services, Corrections, Rehabilitative Services, and Housing and Community Development. Local and state agencies provide or fund many services or supports such as auxiliary grants for assisted living facilities, various social services, health care, and housing assistance that are critical to the success of individuals receiving community substance abuse services. Substance abuse services are provided to approximately 50 percent of the families involved with child welfare agencies that are affected by substance use disorders. Recently, DMAS has become a more active partner in funding community substance abuse services for individuals with co-occurring mental health and substance use disorders for Medicaid eligible youth through EPSDT.
Private providers (for profit and non-profit organizations): Private providers are critical components of the publicly funded substance abuse services. They deliver a significant portion of community substance abuse services across the state through contracts with CSBs.
Virginia institutions of higher education (universities, colleges, and community colleges): The Department partners with the federally-funded Mid-Atlantic Addiction Technology Transfer Center, located at Virginia Commonwealth University, which is responsible for assisting the four states within its region with workforce development.
Products and Services
  • Factors Impacting the Products and/or Services:
    o Demands for community substance abuse services are expected to increase as Virginia's population grows.

    o As Virginia's population becomes more diverse, providers of community substance abuse services must improve their responsiveness to the needs of culturally and linguistically diverse groups.

    o The addition of Medicaid coverage of substance use disorders and the expansion of treatment and support services for substance use disorders are important and significant improvements to the publicly funded substance use disorder service delivery system. However, a persistent lack of residential treatment services capacity adversely affects the services system’s ability to address unmet service needs.

    o The dramatic problems associated with underage drinking and substance abuse, significant problems associated with abuse of prescription and other substances, problems among the elderly, overwhelming demand for services plus the under funding of prevention services put enormous pressure on state behavioral health and other systems.

    o The patterns of drug use will reflect an increased prevalence of prescription drug abuse and dependence.

    o There will be an increased emphasis on prevention services and the importance of community prevention coalitions as federal regulations shift their emphasis from individual change to community SA policy and substance use change.

    o Decreasing availability of qualified professionals, particularly direct care staff, makes it more difficult for CSBs and private providers to maintain or expand existing services or develop new services to address unmet demands for services or adopt or develop new service modalities or approaches, such as evidenced-based practices.

    o Beginning in 2008, the Department conducted a workforce survey to build the capacity of the existing infrastructure by documenting the knowledge and skills of the current workforce. The Department also developed a workforce development plan and provided training delivered by nationally recognized experts on evidence-based and culturally competent treatment practices for individuals with co-occurring disorders.

    o Improved assessment and screening of adults and children with co-occurring disorders will increase demands for integrated services to treat these co-occurring conditions.

    o Increasingly complex federal requirements to report treatment and prevention outcome data decrease staff time available to provide direct clinical services. For example, the National Outcome Measures require CSBs to collect and report outcome measures in at least six domains: abstinence, employment or education, crime and criminal justice, stability in housing, access to services, and retention in services, with other measures in other domains now under development.
  • Anticipated Changes to the Products and/or Services
    o Ongoing collaborative efforts with CSBs and other stakeholders to transform the public behavioral health and developmental services system will increase the need and demand for existing and new types of community substance abuse services.

    o Implementation of specialized services and supports for older adults with substance use disorders and integration of behavioral healthcare into primary care and other generalist settings.

    o Adoption and expanded use of peer-provided and peer-run programs.

    o Implementation of practice changes and community-based approaches through the Commonwealth's Children's Services System Transformation Initiative that build local service capacity, restructure existing services, assure intensive care coordination, and support community-based alternatives to detention.

    o Increased emphasis on service quality through promoting technology transfer regarding evidence-based or consensus-determined best practices or standards of care. The identification and adoption of these types of practices will require additional resources to implement, monitor, and evaluate these practices and services in clinical treatment programs.

    o New SAPT block grant requirements and the National Outcome Measures will require that CSBs offer only evidence-based prevention programs and practices, input all service data into the KIT Prevention System on a regular basis, and evaluate all services as appropriate.
  • Listing of Products and/or Services
    • Emergency services, including crisis intervention
    • Local acute psychiatric inpatient services
    • Community-based substance abuse medical detoxification inpatient services
    • Outpatient services, including therapy, counseling, intensive outpatient, medication assisted treatment
    • Day treatment and partial hospitalization
    • Rehabilitation services, including psychosocial rehabilitation programs
    • Sheltered employment
    • Group supported employment
    • Individual supported employment
    • Highly intensive residential services, such as substance abuse social detoxification services
    • Intensive residential services, such as primary care, intermediate and long-term habilitation, group homes, and jail-based habilitation services
    • Supervised residential services, such as supervised apartments, domiciliary care, and sponsored placements
    • Supportive residential services, such as supported living arrangements
    • Prevention services, including community prevention coalitions
    • Early intervention services
    • Motivational treatment services
    • Consumer monitoring
    • Assessment and evaluation services
    • State and federal funds provided by the Department to CSBs support special projects, such as the Co-Occurring Services Integration Grant (COSIG) and Strengthening Families.
Finance
  • Financial Overview
    This area is funded with 54 percent general funds and 46 percent federal funds. The federal funds are from the Substance Abuse Prevention and Treatment (SAPT) Block Grant that is passed through to community programs. CSBs also receive funds from other sources such as local funds, Medicaid, other fees, and other revenues. These funds are not appropriated by the Commonwealth and are not included are not included in the following table.

    The information on these tables is presented at the service area level. However, funding by fund source is appropriated at a higher program level. This results in the allocation of the non-general fund amounts to the various service areas within the program level in accordance with reasonable allocation methodology. This methodology has been applied and is represented in these amounts.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $54,852,521 $41,019,447    $54,852,521 $41,019,447
    Change To Base -$7,275,861 $0    -$7,275,861 $0
               
    Service Area Total   $47,576,660  $41,019,447     $47,576,660  $41,019,447 
Service Area Objectives
 
  • Implement community SA services and supports that promote self-determination, resilience, recovery, and community participation and achieve the vision of a individual-driven system of services consistent with services system transformation.
    Objective Description
    The Department, its state facilities, CSBs, individuals receiving services and families, advocacy groups, and other stakeholders have been involved in a multi-year effort to restructure and transform the public substance abuse services system to fully implement the vision of an individual-driven system of services. These initiatives will increase individual and family member participation and involvement, the recovery orientation of providers, and the availability of services crucial to system transformation. System transformation initiatives emphasize the flexible use of resources by CSBs within regions in collaboration with their partners to develop and implement programs that meet their unique needs and circumstances within the larger framework and goals of the vision and the Integrated Strategic Plan. A key principle in any system transformation efforts is the retention within the system of any savings from cost avoidance or cost offsets to support those efforts and encourage additional transformation activities.
    Alignment to Agency Goals
    • Agency Goal: Fully implement self-determination, empowerment, recovery, resilience, and person-centered core values at all levels of the system through policy and practices that reflect the unique circumstances of individuals receiving behavioral health and developmental services.
    • Agency Goal: Align administrative and funding incentives and organizational processes to support and sustain quality individually-focused care, promote innovation, and assure efficiency and cost-effectiveness.
    • Agency Goal: Enhance service quality, appropriateness, effectiveness, and accountability through performance and outcomes measurement and service delivery and utilization review.
    Objective Strategies
    • Identify, and where appropriate, implement national and state service models that represent best practices across Virginia.
    • Develop, in collaboration with the Department of Veterans Services, a state level strategy and protocols for serving veterans with substance use disorders.
    • Strengthen the ability of CSBs to provide specifically designed services for adults and youth with co-occurring diagnoses of mental illnesses and substance use disorders.
    • Improve the level of consultation, collaboration, and integration among providers of mental health and substance abuse services around policy, funding, staffing, and programming issues.
    • Expand the capacity of communities to provide substance abuse services that minimize crises, reduce reliance on the most intensive levels of care, and promote independence and choice.
    • Provide training to increase the basic knowledge and competency of public and private substance abuse services providers in the use of evidence-based and best practices.
    • Continue to establish and expand peer specialists and other peer provided services across Virginia, including peer-run programs for persons with co-occurring mental health and substance use disorders.
    • Expand access to integrated assessment and treatment services for individuals with co-occurring mental illnesses and substance use (alcohol or other drug dependence or abuse) disorders.
    • Support statewide implementation of instruments that enable the CSBs to assess the degree to which their organizations support the Comprehensive, Continuous, Integrated System of Care model.
    • Identify core competencies required of professionals to meet the needs of individuals with co-occurring mental health and substance use disorders and provide training, technical assistance, and consultation to clinicians to increase their knowledge of and competencies in providing assessments, interventions, and integrated services to individuals with co-occurring mental health and substance use disorders.
    • Continue collaborative partnerships with primary health care providers to improve identification, screening and diagnosis, and treatment of individuals with substance use disorders.
    • Increase the capacity of the behavioral and developmental services system to provide culturally and linguistically appropriate services and supports to diverse populations across Virginia.
    • Continue and strengthen the ability of community-based prevention planning coalitions to engage in an on-going prevention planning process, address identified risk and protective factors and service needs, and implement evidence-based prevention services.
    • Promote continuous quality improvement for the Department and behavioral health and developmental services system providers.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Number of CSBs that provide integrated MH and SA assessment and services
      Measure Class:
      Other
      Measure Type:
      Output
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Frequency Comment: Fiscal year

      Measure Baseline Value:
      0
      Date:
      6/30/2005

      Measure Baseline Description: Number of CSBs providing integrated assessment and services

      Measure Target Value:
      30
      Date:
      6/30/2012

      Measure Target Description: Number of CSBs providing integrated assessment and services

      Data Source and Calculation: Source: Semi-annual CSB reports of the degree to which they are implementing the Comprehensive, Continuous and Integrated System of Care (CCISC) Model Calculation: Add the total number of CSBs implementing the CCISC Model.


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