Service Area Strategic Plan
4/24/2014   6:58 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Community Mental Health Services (720 445 06)
Description

Community Mental Health Services funds public community mental health 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. CSBs also provide preadmission screening of all requests for involuntary inpatient treatment in state hospitals or other facilities. Finally, each CSB provides discharge planning for all individuals who reside or will reside in cities or counties served by the CSB before they are discharged from state hospitals. 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. Several consumer-run, non-profit organizations provide a few direct services under separate contracts with the Department. Community mental health 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 children or adolescents and their families, persons with co-occurring disorders such as mental illness and substance use (alcohol or other drug dependence or abuse) disorders, and adults or children who are hospitalized or involved in the criminal justice system.

This service area also funds CSBs to support the implementation of conditional release orders, pursuant to § 19.2-182.7 of the Code of Virginia, for individuals who have been acquitted by reason of insanity.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Community mental health services align directly with the agency’s mission and are required to implement the agency’s vision of a individual-driven system of services and supports that promotes individual self-determination, empowerment, recovery, resilience, health, inclusion, and participation in all aspects of community life, including work, school, family, and other meaningful relationships.
  • 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 mental health 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 mental health 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 mental health services.
    • § 37.2-505 requires CSBs to provide preadmission screening and discharge planning 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 mental health 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 mental health 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 mental health services.
    • § 37.2-606 requires a BHA to provide preadmission screening and discharge planning 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.

    Public Law 102-321 authorizes the federal Substance Abuse and Mental Health Services Administration to provide federal funds to the Department for community mental health services.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals receiving CSB mental health services Individuals with receiving CSB mental health services 101,796 107,868

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).
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 mental health 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 mental health 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 mental health services.
Individuals receiving services, family members, and advocacy organizations: Individuals receiving services, advocacy organizations, and peer and family groups 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 peers and family members serve on CSB boards. Peer providers and consumer-run organizations provide very valuable services and supports for individuals receiving mental health services, and some advocacy organizations provide training and education for individuals and family members.
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: Local and state agencies, such as the Departments of Medical Assistance Services, Social Services, Health, Rehabilitative Services, and Housing and Community Development, school systems, and Area Agencies On Aging, provide or fund many services or supports that are critical to the success of community mental health services. These include Medicaid mental health services, auxiliary grants for assisted living facilities, Medicaid eligibility determinations, various social services, guardianship programs, health care, vocational training, and housing assistance that respond to the needs of individuals with mental illnesses or serious emotional disturbances.
Private providers (non-profit and for profit organizations): Private providers are critical components of the publicly funded mental health services. Private providers deliver a significant portion of community mental health services across the state through contracts with CSBs.
Virginia institutions of higher education (universities, colleges, and community colleges): The academic medical centers, academic programs of other colleges and universities, and community college courses offer education or training for the CSB and private provider workforce that provides community mental health services. The Virginia Human Services Training Program, a collaborative effort of the Department, Region Ten CSB, the Department of Rehabilitation Services, and Piedmont Virginia Community College offers graduates a career studies certificate in human services. Graduates are employed by CSBs.
Products and Services
  • 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.
Finance
  • Financial Overview
    This area is funded with 94 percent general and 6 percent federal funds. The federal funds are from the Community Mental Health Services (CMHS) 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 in the Appropriation Act and, therefore, are not included in the following table.

    The information on the following 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 $160,446,270 $11,760,000    $160,446,270 $11,760,000
    Change To Base $9,819,665 $0    $9,819,665 $0
               
    Service Area Total   $170,265,935  $11,760,000     $170,265,935  $11,760,000 
Service Area Objectives
 
  • Implement community mental health 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 mental health 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: Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.
    • 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.
    Objective Strategies
    • Provide an array of community mental health services to individuals with serious mental illness or with or at risk of emotional disturbance.
    • Continue to implement the Governor’s transformation initiative statewide.
    • Increase the capacity of Virginia’s behavioral health services system to provide secure crisis stabilization programs, outpatient treatment services, and case management services as recommended in the OIG investigation of the Virginia Tech tragedy.
    • Identify, and where appropriate, implement national and state service models that represent best and most promising practices across Virginia.
    • 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.
    • Promote the development of a comprehensive array of specialized prevention and treatment services and supports for older adults with mental health and substance use disorders.
    • Improve the level of consultation, collaboration, and integration among providers of mental health services around policy, funding, staffing, and programming issues.
    • Provide training to increase the basic knowledge and competency of public and private mental health services providers in the use of evidence-based and best practices.
    • Support the expansion and establishment of peer-run programs, including programs that address recovery issues of older adolescents and persons with co-occurring mental health and substance use disorders.
    • Implement a variety of training opportunities designed to increase the knowledge and skills of staff at all levels of state facilities and community provider organizations in implementing recovery, resilience, and person-centered principles and practices.
    • Work with CSBs to implement the Recovery-Oriented System Indicators (ROSI) annually as part of an ongoing quality improvement process that assesses implementation of recovery and person-centered values and uses assessment results to track organizational culture change.
    • Partner with DMAS to align Medicaid mental health services with recovery and person-centered principles and practices and maximize opportunities within the State Medical Assistance Plan to incorporate recovery and person-centered practices into Medicaid service definitions and provider manuals.
    • Support efforts of the Children's Services System Transformation Initiative to enhance linkages with local schools to fill gaps and build community capacity and implement the continuum of services for children and adolescents.
    • Develop and implement community services for youth who are transitioning from children’s services to young adult (ages 17-21) services.
    • Work with CSBs, community providers of aging services, and community organizations to raise their awareness of the behavioral health service needs of older adults and develop a comprehensive, community-based continuum of specialized services for older adults in Virginia.
    • Provide jail diversion and jail and community-based treatment services that enhance Virginia’s capacity to effectively intervene and prevent or reduce the involvement of individuals with mental health and substance use disorders in the criminal justice system.
    • Work with the Consortium for Mental Health and Criminal Justice Transformation to support and enhance collaboration, education, and criminal justice-behavioral health partnerships at the state, regional, and local levels.
    • Provide cross training for state facility and community clinicians and direct care workers aimed at identifying and appropriately responding to the needs of individuals with co-occurring intellectual disability and mental health disorders, clarifying service responsibilities and reconciling differences in language, philosophy, and expected outcomes among services providers.
    • 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.
    • Partner with the Virginia Department of Veterans Services to assess existing and emerging service needs confronting veterans and their families, including PTSD and the behavioral health effects of traumatic injuries, provide specialized training to CSB clinicians on these challenges, and prepare for long term care requirements of veterans experiencing progressively adverse effects from traumatic injuries.
    • Initiate implementation of the Suicide Prevention Across the Lifespan Plan for the Commonwealth of Virginia through suicide prevention training and awareness activities targeted to youth and adults.
    • Collaborate with VHDA, DHCD, and other housing agencies in the design and implementation of affordable housing development plans for low-income and homeless Virginians with mental health or substance use disorders or intellectual disability.
    • Continue to collaborate with the Disability Commission, DRS, DSS, DMAS, constituency groups, and other state agencies to address inter-agency financial and organizational barriers to implementing evidence-based practices of supported employment and identify funding streams for employment-related services and supports.
    • Expand partnerships between providers of physical health and behavioral health and developmental services and support the development of formal agreements and cross-referral networks between CSBs and free clinics, federally funded health centers, and other providers of primary care services.
    • 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 to support services provided by the regional coordinators to provide accessible behavioral health or developmental services resources to persons who are deaf, hard of hearing, late deafened, or deafblind.
    • Support CSB efforts to acquire the staff expertise and infrastructure to conduct thorough utilization management and review of the psychiatric inpatient services that they use in state hospitals or purchase from local hospitals.
    • 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 individuals receiving crisis stabilization services
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      949
      Date:
      6/30/2007

      Measure Baseline Description: Number of consumers received Residential and Ambulatory Crisis Stablization Services

      Measure Target Value:
      1234
      Date:
      6/30/2010

      Measure Target Description: Number of consumers received Residential and Ambulatory Crisis Stablization Services

      Data Source and Calculation: Source: Community Consumer Submission (CCS) and CSB quarterly progress reports Calculation: Total the number of consumers receiving crisis stabilization services provided by projects funded by the system transformation initiative.


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