|Agency Customer Group
||Customers served annually
||Potential annual customers
|Individuals receiving CSB mental health services
||Individuals with receiving CSB mental health services
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 mental health services.
o Additional individuals will need services from peer-run initiatives and additional peers and family members will need education and training programs to achieve the Department’s vision for the services system.
o Growing numbers of older adults will require community services to enable them to reside in their homes or other community placements. According to Mental Health: A Report of the Surgeon General (1999), almost 20 percent of the population 55 and older, or an estimated 337,345 Virginians (2005 Population Estimates), experience specific mental disorders that are not part of “normal” aging.
o Increasing numbers of veterans are returning to Virginia from Iraq and Afghanistan and are experiencing behavioral health issues. Based on current rates of diagnosis reported by the VA for recently discharged veterans seeking care at VA facilities, if historic trends in the veteran portion of Virginia’s population continue, Virginia could face as much as a 15 to 20 percent surge in the number of behavioral health consumers over current levels.
o With the implementation of changes to Virginia’s involuntary treatment laws which changed the "imminent danger" and "inability to care for self" criteria (widely believed to be too restrictive and vague) to broader and clearer standards based on "substantial likelihood" of causing or suffering harm and included new mandatory outpatient treatment procedures, the numbers of individuals receiving court-ordered outpatient services will likely increase.
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. Fifty to 75 percent of all youth in detention centers have at least one diagnosable behavioral health disorder. To address this issue, CSBs are providing services to children who have been identified as needing behavioral health services while they are in juvenile detention centers and linking them to ongoing services after they leave.
o Based on national epidemiological studies and 2008 Population by Age and Sex Estimates, the Department estimates that 327,474 Virginians adults have had a serious mental illness during the past year and between 87,529 and 106,980 children and adolescents have a serious emotional disturbance, with between 46,627 and 68,078 exhibiting extreme impairment. 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 6,072 individuals who are currently on waiting lists for community mental health 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 Virginia Department of Education counts made on December 1,2008, identified 10,629 students age six to 22+ with a primary disability (as defined by special education law) of emotional disturbance who are receiving special education services.
o A January 2008 statewide one-day point-in-time count and found 8,610 homeless persons, of whom 1,635 individuals (19 percent of all persons who were homeless) had been homeless for a year or longer or had been homeless at least three times in the previous four years and also had a disabling condition (i.e., meeting the HUD definition of chronic homelessness).
Factors Impacting the Products and/or Services:
o Demands for community behavioral health and developmental services are expected to increase as Virginia's population grows.
o As Virginia's population becomes more diverse, providers of community mental health services must improve their responsiveness to the needs of culturally and linguistically diverse groups.
o Implementation of the Virginia Supreme Court’s Commission on Mental Health Law Reform’s changes made to the criteria and procedures for emergency custody orders, temporary detention orders, involuntary commitment proceedings and other important measures will be promoted by the Department and disseminated to the field through training and technical assistance and may increase demand for inpatient and community-based services.
o Implementation of the Virginia Tech panel recommendations to expand the capacity of Virginia’s public behavioral health services system to provide secure crisis stabilization programs, outpatient treatment services, and case management services will continue.
o Potential reductions in reimbursement rates for Medicaid mental health services would make it increasingly difficult to sustain essential core services offered by CSBs and private providers.
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 the need to adopt or develop new service modalities or approaches, such as evidenced-based practices.
o An increasing focus at federal and state levels on improving assessment, screening, and services for adults and adolescents with co-occurring substance use disorders and mental illnesses or serious emotional disturbances will increase the need and demand for integrated substance abuse and mental health services to treat these co-occurring disorders.
o The decreasing availability of adequate health insurance coverage for the treatment of mental illnesses and the increasing numbers of individuals without health insurance who do not qualify for Medicaid will increase the demand for services provided by CSBs that are supported with only state, local matching, or federal funds.
o A persistent lack of residential treatment services capacity adversely affects the services system’s ability to address unmet service needs.
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 mental health services and supports.
o Adoption and expanded use of pre-and post trial alternatives and community treatment services such as crisis intervention teams and crisis stabilization services to prevent behavioral health situations from requiring a criminal justice response.
o Adoption and expanded use of peer-provided and peer-run behavioral health direct services and supports.
o Implementation of trauma-informed emergency services.
o Continued development of strategies that implement person-centered practices.
o Implementation of new types of community outreach and services, and clinical practices that meet the needs of more culturally and linguistically diverse populations.
o Implementation of specialized services and supports for older adults with mental health disorders and integration of behavioral healthcare into primary care and other generalist settings.
o Implementation of new CSB responsibilities for CSB participation in the involuntary process and in coordination of care.
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 Continued emphasis on building and maintaining the requisite capacity to manage their utilization of state facility and community inpatient psychiatric beds. This will require increased staff and infrastructure to conduct extensive and complex utilization management and review activities, but this activity will result in much more effective and efficient use of expensive and scarce state and local hospital beds.
o The identification and adoption of evidence-based or consensus-determined best practices, such as assertive community treatment, supported employment, illness management and recovery services, peer-specialist staff, multi-systemic therapy, functional family therapy, therapeutic foster care, and systems of care for children and adolescents with serious emotional disturbances.
Listing of Products and/or Services
- Emergency services, including crisis intervention and preadmission screening
- Local acute psychiatric inpatient services
- Outpatient services, including therapy and counseling, medication services, and intensive in-home services
- Assertive community treatment (PACT teams and ICT programs)
- Case management services
- Day treatment and partial hospitalization, including therapeutic day treatment for children and adolescents
- Rehabilitation services, including psychosocial rehabilitation programs
- Sheltered employment
- Group supported employment
- Individual supported employment
- Highly intensive residential services, such as crisis stabilization programs and residential treatment centers
- Intensive residential services, such as group homes
- Supervised residential services, such as supervised apartments, domiciliary care, and sponsored placements
- Supportive residential services, such as supported living arrangements
- Prevention services
- Early intervention services
- Consumer-run services
- Consumer monitoring
- Assessment and evaluation services
- Motivational treatment services
- State or federal funds provided by the Department also support peer-provided services and consumer and family member education and training activities conducted by CSBs and consumer and advocacy groups.