STEP-VA System Transformation for Mental Health Services

System Transformation Accountability and Performance (STEP-VA) Meredith Nusbaum Director, Adult Community Behavioral Health Services Department of Behavioral Health & Developmental Services 1

Purpose of STEP-VA To increase access, quality, consistency, and accountability in the public mental health system Services foster wellness in everyday life Prevent crises before they arise Reduce admissions to state and private hospitals Reduce ED visits and involvement with Criminal Justice System System Transformation Excellence and Performance (STEP-VA) 2 August 2024

System Transformation Excellence and Performance (STEP-VA) 3 August 2024

Code of Virginia Title 37.2-500 A. The Department, for the purposes of establishing, maintaining, and promoting the development of mental health, developmental, and substance abuse services in the Commonwealth, may provide funds to assist any city or county or any combinations of cities or counties or cities and counties in the provision of these services. Every city or county shall establish a community services board by itself or in any combination with other cities and counties, unless it establishes a behavioral health authority pursuant to Chapter 6 ( 37.2-600 et seq.). In order to provide comprehensive mental health, developmental, and substance abuse services within a continuum of care, the community services board shall function as the single point of entry into publicly funded mental health, developmental, and substance abuse services. B. The core of services provided by community services boards within the cities and counties that they serve shall include: 1. Emergency services; 2. Same-day mental health screening services; 3. Outpatient primary care screening and monitoring services for physical health indicators and health risks and follow-up services for individuals identified as being in need of assistance with overcoming barriers to accessing primary health services, including developing linkages to primary health care providers; and 4. Subject to the availability of funds appropriated for them, case management services. C. Subject to the availability of funds appropriated for them, the core of services may include a comprehensive system of inpatient, outpatient, day support, residential, prevention, early intervention, and other appropriate mental health, developmental, and substance abuse services necessary to provide individualized services and supports to persons with mental illness, developmental disabilities, or substance abuse. Community services boards may establish crisis stabilization units that provide residential crisis stabilization services. D. The purpose of behavioral health services provided by community services boards shall be to enable individuals who have a mental illness or substance use disorder that significantly impairs their functioning to access effective, timely, and cost-efficient services that help them (i) overcome or manage functional impairments caused by the mental illness or substance use disorder and (ii) remain in the community to the greatest extent possible, consistent with the individual's well-being and public safety. E. Every city or county or any combination of cities and counties that has established a community services board, in consultation with that board, shall designate it as an operating community services board, an administrative policy community services board, or a local government department with a policy-advisory community services board. The governing body of each city or county that established the community services board may change this designation at any time by ordinance. In the case of a community services board established by more than one city or county, the decision to change this designation shall be the unanimous decision of all governing bodies. F. A community services board may enter into contracts with private providers to ensure the delivery of services pursuant to this article. System Transformation Excellence and Performance (STEP-VA) 4 August 2024

Same Day Access Ensures that Virginians seeking mental health and substance use services at a CSB will be screened the day they contact the CSB and will have an appointment within 10 business days of that initial contact. Ensures that each person enrolled will begin clinical services within 30 calendar days of the initial contact. System Transformation Excellence and Performance (STEP-VA) 5 August 2024

Primary Care Screening All individuals with a Serious Mental Illness (SMI) or Serious Emotional Disturbance (Child) (SED) who receive ongoing (Targeted Case Management) services will be screened for physical health indicators, and receive appropriate referrals and follow-up as indicated. All individuals over age 3 who are prescribed an antipsychotic medication by a CSB prescriber will be screened for metabolic syndrome following the American Diabetes Association guidelines and will receive referral and follow-up as indicated. System Transformation Excellence and Performance (STEP-VA) 6 August 2024

Outpatient Treatment Services Outpatient services are considered to be foundational services for any behavioral health system, and may include diagnosis and evaluation, screening and intake, counseling, psychotherapy, behavior management, psychiatry, psychological testing and assessment, laboratory, and ancillary services. Ensures that each CSB provides access to high quality, evidence-based, trauma-informed, culturally competent, accessible outpatient psychotherapy services for eligible individuals. All behavioral healthcare providers should have a minimum of 40 hours of training in trauma- focused training (8 in year one, 4 each subsequent year). This STEP includes Outpatient therapy and Psychiatry for adults and youth. System Transformation Excellence and Performance (STEP-VA) 7 August 2024

Crisis Services Provide a comprehensive continuum of services that respond quickly to crisis needs and enable individuals in crisis to remain in the least restrictive environment, preferably at home or in the community. Core elements include: Crisis call centers, 24/7 mobile crisis, crisis stabilization programs, integrating essential principles and practices such as recovery orientation, trauma-informed care, use of peer staff, commitment to Zero Suicide. System Transformation Excellence and Performance (STEP-VA) 8 August 2024

Service Members, Veterans, and their Families Each CSB must provide specialized and culturally informed services for service members, veterans, and their family members. Core elements include: Regional SMVF Navigators, Lock and Talk, workforce training and capacity, enhance clinical services for SMVF Requires military cultural competence training for clinical staff. System Transformation Excellence and Performance (STEP-VA) 9 August 2024

Peer and Family Services Ensures high-quality, evidence-based, trauma informed, culturally competent, accessible recovery and resilience-oriented peer services that address a broad range of behavioral health and related issues. Delivered by Peer Specialists and Family Support Partners with lived experience with mental health and/or substance use disorders and recovery from these challenges. Peers can be integrated into a wide variety of services at any part of a person s treatment. System Transformation Excellence and Performance (STEP-VA) 10 August 2024

Case Management Case Management is a service to assist individuals who reside in a community setting in gaining access to needed services, improving the person s ability to maintain safety, stability, and integration within the community setting. Ensures behavioral health and physical health needs are routinely assessed to link appropriate services in a coordinated, effective, and efficient manner to support the needs of the individual and family and promote wellness and integration into all aspects of life. Each CSB in Virginia provides Targeted Case Management Services for eligible individuals with SMI, SUD, and/or co-occurring disorders, regardless of the person s ability to pay. System Transformation Excellence and Performance (STEP-VA) 11 August 2024

Psychiatric Rehabilitation Services Services that support individuals with SMI, SUD, and SED in developing skills and functioning to facilitate optimal independence in their community, such as: Addressing social determinants of health Finding and maintaining housing or employment Filling out paperwork, securing identification documents/cards Developing social networks Paying bills Interacting with others Includes services such as Mental Health Skill Building, Intensive In-Home Services, psychosocial rehab, ACT, Supported Employment, Permanent Supported Housing, and any other service that supports the development or improvement of independent living skills. System Transformation Excellence and Performance (STEP-VA) 12 August 2024

Care Coordination Deliberately organized activities that: Coordinate and share information among all participants in an individual s treatment team. Ensure that needs and preferences are known by all treatment providers. Ensures safer, more effective care and improved outcomes. Care Coordination is separate from Case Management in that it is provided to individuals regardless of what service they receive and should include coordination with outside providers. Care Coordination is a required activity, not a billable service. System Transformation Excellence and Performance (STEP-VA) 13 August 2024

Nine Steps System Transformation Excellence and Performance (STEP-VA) 14 August 2024

STEP 2023-2024 Updates Largely in-person CSB site visits; clear communication on expectations and Technical Assistance Weekly office hours available to every board for additional Technical Assistance Goals of System Transformation Advisory Council (bi-monthly) meetings: - Develop baselining across the state/discussion of change plans - Align as closely to SAMHSA s best practices as possible - Voting tasks inform changes to performance contracts, as well as developing and fine-tuning measurements System Transformation Excellence and Performance (STEP-VA) 15 August 2024

Annual STEP-VA Funding FY18-24 Total $97.1 Core services Same-day access Primary care BH crisis svcs. Outpatient BH svcs. Peer/family support Veterans' BH Psychiatric rehab. Care coordination Case management Cross-step admin IT infrastructure TOTAL FY18 $4.9 - - - - - - - - - - $4.9 FY19 $10.8 FY20 $10.8 FY21 $10.8 FY22 $10.8 FY23 $10.8 FY24 $12.0 FY25 $13.1 FY26 $13.1 3.7 7.4 9.8 15.0 7.4 9.8 15.0 7.4 31.2 21.9 5.3 3.8 - - - 4.9 - $85.4 7.4 38.4 21.9 5.3 3.8 2.2 6.5 3.2 11.9 2.6 8.2 39.1 24.3 5.3 3.8 3.8 6.5 4.1 10.9 5.2 9.1 48.5 27.9 5.8 4.2 4.0 6.8 4.3 11.0 5.2 9.1 49.1 27.9 5.8 4.2 4.0 6.8 4.3 11.0 5.2 59.6 225.9 153.8 27.5 19.9 13.9 26.7 15.8 49.6 18.2 $428.4 - - - - - - - - - - - - - - - - $43.0 - - - - - - - $43.0 $14.5 $114.1 $123.1 System Transformation Excellence and Performance (STEP-VA) 16 August 2024