here - Virginia Association of Community Services Boards (VACSB)

2015 ANNUAL REPORT
VA C S B 2 0 1 5 A N N U A L R E P O R T
Table of Contents
A MESSAGE FROM THE VACSB BOARD CHAIR............................................................................................................. 3
CHILDREN & YOUTH
Infant & Toddler Program (Part C) .................................................................................................................................................... 4
Behavioral Health Services ................................................................................................................................................................. 6
Prevention Services .............................................................................................................................................................................. 8
BEHAVIORAL HEALTH - ADULTS
Consumer Message ............................................................................................................................................................................10
Access to Care .......................................................................................................................................................................................11
Programs of Assertive/Intensive Community Treatment (PACT/ICT) ...............................................................................12
Substance Use Disorders ..................................................................................................................................................................13
Crisis Response & Jail Diversion Systems.....................................................................................................................................15
Crisis Response—Crisis Intervention Teams (CIT) and CIT Assessment Centers...........................................................16
Jail Diversion and Therapeutic Court Dockets............................................................................................................................19
DEVELOPMENTAL SERVICES
Department of Justice (DOJ) Settlement....................................................................................................................................20
Support Programs ...............................................................................................................................................................................21
End the Wait ..........................................................................................................................................................................................22
SUPPORT SERVICES
Permanent Supportive Housing and Transportation .............................................................................................................23
INTEGRATED CARE
Primary & Behavioral Health ............................................................................................................................................................24
WORKFORCE DEVELOPMENT ..................................................................................................................................................26
REGIONAL PROGRAMS.....................................................................................................................................................................27
PEOPLE, SERVICES & FUNDING ...............................................................................................................................................28
VACSB POLICY & BUDGET PRIORITIES ...........................................................................................................................31
VACSB MEMBER DIRECTORY ...................................................................................................................................Back Cover
VACSB STAFF
Jennifer Faison
Executive Director
David L. Conley
Public Policy Manager
Kay Springfield
Administrative Manager
Jo Powell
Operations Specialist
Linda Ramsey
Administrative Assistant
Virginia Association of Community Services Boards
10128 West Broad Street, Suite B / Glen Allen, VA 23060 Phone: 804.330.3141 Fax: 804.330.3611 www.vacsb.org
Graphic design by Northview Media Group
A message from the
VACSB Board Chair
Al Collins
VACSB Board Chair
The Virginia Association of Community Services Boards (VACSB) is proud
to present its 2015 Annual Report. Virginia’s Community Services Boards
and Behavioral Health Authority (CSBs/BHA) have continued to work hard to
achieve outstanding results in concert with the individuals and families they
serve.
CSBs/BHA’s continued commitment to the system of care for individuals with behavioral health and
developmental disability needs has helped Virginia be better equipped to face one of the greatest challenges facing
all of us: health and health care. CSBs/BHA work at the very core of this issue for the most vulnerable among us
so that these individuals and their families can live longer, healthier lives in a community setting that meets their
personal needs, allows them to work towards their goals and embodies the concepts of recovery, resilience and
independence. As a result, in FY2015, 232,079 individuals were served in such settings.
Over this past year, CSBs/BHA provided critical support and expertise to a number of statewide initiatives
including the Governor’s Access Plan (GAP) and the Commonwealth Coordinated Care program (CCC). We are
honored that our state agency partners place their trust in our system as we work together on initiatives such as
these. In addition, CSBs/BHA have partnered with law enforcement officers and other first responders to crisis to
provide Crisis Intervention Team training and to build capacity in new and existing crisis assessment centers.
There are a number of exciting opportunities ahead as well. Virginia has been awarded a federal grant which
will help eight CSBs transition into Certified Community Behavioral Health Clinics (CCBHC). These clinics will reach
deep into their communities to forge partnerships with primary care and other organizations. This project will bring
much needed care coordination, quicker access to care and critical additional resources into the system. In addition,
Enhanced Care Coordination, a CSB-designed service developed for high-needs individuals in the CCC program, will
be expanded beyond CCC in some parts of the state.
I am incredibly proud of the publicly funded system of care for individuals with behavioral health and
developmental disability needs. I strongly believe that additional funding, investment in core services and workforce
development and continued quality improvement measures will ensure that the trust we have earned from the
individuals we serve and the many organizations, agencies and local entities with which we partner will remain
strong in 2015 and beyond.
VACSB OFFICERS
Al Collins, Chair
Rappahannock Area
Community Services Board
Karen Grizzard, Past Chair
formerly with Henrico Area
Mental Health & Developmental Services
Gibbons “Gib” Sloan, 1st Vice-Chair
Chesterfield Community Services Board
David Coe, 2nd Vice-Chair
Colonial Behavioral Health
Jim Bebeau, Treasurer
Danville-Pittsylvania Community Services Board
Linda Drage, Secretary
Piedmont Regional Community Services Board
2015 Annual Report
3
Children &
Youth
Behavioral
Health
Developmental
Services
Support
Services
Integrated
Care
Workforce
Development
Regional
Programs
People, Services
& Funding
4
CHILDREN & YOUTH
Infant & Toddler Program (Part C)
Defying the Odds:
Paetynn’s Story
Paetynn moves easily around her living room
at home, climbing on furniture and into her toy
box, smiling and interacting happily as an active
toddler.
Paetynn’s mother, Jessica, is happy to share information about her beautiful little girl, who continues to display the strength and independence
that may have been the key to her survival.
Born at 25 weeks gestation, weighing just 15.5
ounces and 10½ inches long (about the size of
an iPad), Paetynn was the smallest baby to have
survived at Mary Washington Hospital in Fredericksburg.
Paetynn’s mother knows just how far her daughter has come since birth. Describing Paetynn’s
birth as the scariest time in her life, Jessica recalls
being overwhelmed with fear. Immediately after
Paetynn was delivered, Jessica heard the nurses’
concerns about the newborn’s size - even smaller
than they had expected.
And then, amazingly, Paetynn actually took her
first breath on her own, an early indication of her
strength and independence. Still, Paetynn had a
long road ahead of her, since she was considered
small for her gestational age in addition to being
extremely premature. A “micro preemie,” Paetynn
was so small that the odds of survival were low.
Early challenges
Paetynn was so tiny at birth that putting in a
breathing tube was a real challenge for her medical team. Jessica added that the scariest part after
Paetynn’s birth was seeing her baby each day in
the Neonatal Intensive Care Unit (NICU) on a ventilator, connected to tubes and wires seemingly
Paetynn
in the NICU
Virginia Association of Community Services Boards
Paetynn
everywhere. The information Jessica was receiving from the medical team about the potential
problems that Paetynn could face as she got
older did little to ease the worried mother’s mind.
Despite the grim outlook, Jessica described her
newborn as perfect, looking “like a porcelain doll
with perfect little features.”
Paetynn spent more than three months in the
NICU, receiving care around the clock. She was referred to Middle-Peninsula-Northern Neck CSB’s
program for early intervention services as soon as
she was discharged, and she began receiving occupational therapy, developmental therapy, and
service coordination in her home.
Now at 18 months, Paetynn goes to work each
day with her mother since she continues to be at
higher risk for infection, which is common for babies born so prematurely.
Paetynn is currently still small for her age but
continues to make gains every day. She has defied
the odds and continues to thrive and to amaze as
a terrific toddler.
Children &
Youth
CHILDREN & YOUTH
Infant & Toddler Program (Part C)
Behavioral
Health
Developmental
Services
Support
Services
Babies like Paetynn (pictured here) are considered premature when they are born too early and too
small, before 37 weeks. Approximately 10-12% of babies born in Virginia each year are premature.
Even if a woman “does everything right” during pregnancy, she can still have a premature baby.
Robin
Crawley
People, Services
& Funding
Crawley readily admits she has enough work to do overseeing Alexandria’s program, but she recently agreed to
take on extra duties at the state level. She was selected to
head the steering committee of The Council Coordinators
Association (CoCoA). The Council serves the managers of
PIE programs across the state.
Regional
Programs
The Parent-Infant Education Program
(PIE) began in the 1980’s but has grown in
recent years due to an improved referral
process. When Robin Crawley, Coordinator
of PIE, started working with the program
at Alexandria Community Services Board
in 2003, there were 50 individuals being
served. Today, there are nearly 500.
The PIE program works with parents and
their infants and toddlers who:
• have slower physical or mental development than expected;
• are diagnosed with a condition likely to result in delay; or
• have a 25 percent delay in one or
more development areas.
In 2010, Virginia added
the automatic eligibility
of children who are born
prematurely which has
made “a huge difference
in reaching children much
earlier, ” Robin noted.
“Although not all children
born prematurely have
developmental delays,”
she explained, “seeing
those children early in
life can help assure that
they remain on target for
growth and development.”
Workforce
Development
There are 40 Parent-Infant Education
(PIE) programs in Virginia
(30 CSBs and 10 other programs
administered by local organizations).
A total of 17,022 individual families
were served in FY 2015.
Integrated
Care
Parent-Infant Education (PIE) program expanding
2015 Annual Report
5
Children &
Youth
Behavioral
Health
Developmental
Services
Support
Services
Integrated
Care
Workforce
Development
Regional
Programs
People, Services
& Funding
6
CHILDREN & YOUTH
Behavioral Health Services
National prevalence rates suggest that there
are between 85,000 and 104,000 children
and adolescents (ages 9-17) in Virginia who
have a serious emotional disturbance.
Between 47,000 and 66,000 of these children
and adolescents are extremely impaired.
Community Services Boards (CSBs) are now
the largest provider of children’s mental health
services. The growth in these services has been
almost completely supported by public funding
through Medicaid and the Comprehensive Services Act (CSA). However, where there is need, the
CSBs do continue to serve as the safety net.
Children, of course, experience mental health
problems, too.
Trauma Informed Care
Trauma, especially for children, can leave lifetime scars yet sneak into our innocence like a
thief. When 14 year-old Jess arrived at Horizon
Behavioral Health, she had been robbed of her
youth. Her mother suffered from mental health
and substance use issues and couldn’t keep a job.
At 11 years old, Jess was made to prostitute
herself to make money for the family. Three years
later, Jess was shipped to her father’s house after
her mother declared she “could not do anything
with her.” It was clear, Jess was a broken child.
At her father’s she got in trouble, continuing
to use sex for attention and sometimes money.
Soon she was referred to Horizon’s Trauma Informed Care, an evidence based model shown to
work on the national level.
Therapists use books, games, drawing and interactive play to allow children to work through
their traumatic experiences in a non-threatening,
safe way.
Through this, Jess is beginning to regain control of her life, her emotions and her behaviors.
Coping with the effects of being sexually and
emotionally abused and neglected will take time.
Through Trauma Informed Care Jess is learning
that in time she will be better.
She is not ruined and she will trust again.
Coordinated Specialty Care (CSC)
The majority of individuals with serious mental
illness experience the first signs of illness during
Virginia Association of Community Services Boards
adolescence or early adulthood, and long delays
often occur between symptom onset and consistent, effective treatment.
SAMHSA began requiring the states to “set
aside” five percent of their Community Mental
Health Services Block Grant (MHBG) funds to support the development of early psychosis treatment programs in 2014.
In Virginia, this totals approximately $580,000
per year based on Federal FY 2015 funding levels. In addition, the Commonwealth’s biennium
budget for State FY 15 and 16 includes $7.5 million to support behavioral health services for seriously affected transition-age youth.
Using this combination of state and federal
funds, in July 2014, DBHDS funded eight (8) CSBs
who will develop CSC programs: Alexandria*,
Fairfax-Falls Church, Henrico, Highlands, Loudoun, Prince William, Rappahannock Area and
Western Tidewater.
*TRAILS offers hope to Alexandria youth
A 22-year-old woman hears voices telling her to
set fires. A 16-year-old boy thinks he has special
powers and is on a mission. A 17-year-old girl believes other people can hear her thoughts.
Now, these and other Alexandria youth
and young adults
struggling with mental illness have an avenue towards recovery thanks to a new
program, TRansitioning Adults Into Living
Successfully (TRAILS).
TRAILS, designed to eliminate the gaps in behavioral health programs between child/adolescent and adult, has a broad outreach to identify
and support Alexandria youth ages 16-25 who
have experienced a first episode of psychosis
within the previous two years.
According to international research, early intervention in children leads to better outcomes,
including improving symptoms, functions and
recovery skills. TRAILS has already begun to show
promising outcomes.
Children &
Youth
CHILDREN & YOUTH
Behavioral Health Services
Developmental
Services
Support
Services
This program was considered a success by the
school board and all involved and will be continued for another school year. The school is hoping
to eventually expand the number of students eligible for “Another Chance”.
District Courts, District 19 CSB sign agreements to provide
mental health, substance abuse services to local youth
Source: SAMHSA, Center for Behavioral Health Statistics and Quality,
National Survey on Drug Use and Health, 2009 - 2013.
People, Services
& Funding
Each year between 2009 - 2013,
about 51,000 Virginia adolescents
(8.4% of all adolescents in Virginia)
reported using illicit drugs within the
month prior to being surveyed.
Regional
Programs
• individual counseling to 22 consumers
• SA assessments to 18 consumers
• MH/SA assessments to 7 consumers and
• case consults for 10 consumers.
D19 also developed a Memorandum of Agreement (MOA) with the 12th District Court Service
Unit and is utilizing an existing staff member
to provide services to their youth in Colonial
Heights, one day per week. The 12th District
CSU Clinician provides primarily individual therapy and MH/SA assessments.
Workforce
Development
Over the years, District 19 CSB has maintained
a strong professional relationship with the three
Court Service Units that exist in their catchment
area.
Due to the success of this relationship, one of
the Court Service Unit Directors contacted District 19 in July 2014, stating that the 6th District
Court Service Unit (CSU) would receive funding
from the Department of Juvenile Justice to implement mental health/substance abuse services for
their youth. The localities involved in this project are Emporia/Greensville, Hopewell, Prince
George, Surry, Sussex, and Brunswick.
Services include mental health/substance
abuse assessments, individual counseling, family
counseling, group counseling, case coordination,
education, and crisis intervention coordination.
The Court Service Unit Clinician began providing
services in March 2014. During FY15, this position
provided:
Integrated
Care
Dinwiddie County Public Schools’ Safe and
Drug Free Advisory Council, District 19 CSB’s
Comprehensive Services and the Court Appointed First-Time Offenders Program collaborated to
develop an innovative intervention called “Another Chance”. The program is an alternative to long
suspension or expulsion for first-time offenders of
drug/alcohol usage, weapons, and other behavioral infractions.
“Another Chance” is an opportunity for students
to complete assigned work, attend intervention/
prevention student and parent sessions for alcohol or drug usage, and return to school after the
ten days of suspension. This alternative helps to
increase Dinwiddie’s on-time graduation and reduce the dropout rate.
All seven of the participating students successfully completed the required sessions. The
students and parents were active participants in
the groups and the students were motivated to
return to school.
Behavioral
Health
Community collaboration leads to innovative alternative
for first-time offenders of behavioral infractions
2015 Annual Report
7
Children &
Youth
Behavioral
Health
Developmental
Services
Support
Services
Integrated
Care
Workforce
Development
Regional
Programs
People, Services
& Funding
8
CHILDREN & YOUTH
Prevention Services
Prevention Council
promoting mental health
awareness and suicide
prevention initiatives
The Virginia Association of Community Services
Board’s Prevention Council is fully engaged in
implementing a wide range of diverse evidencebased environmental strategies, programs and
services designed to promote mental health
awareness, reduce stigma associated with mental
illness and promote suicide prevention awareness throughout Virginia.
Virginia Prevention Services professionals extensively implemented Mental Health First Aid
(MHFA) trainings, Applied Suicide Intervention
Skills Trainings (ASIST), Signs of Suicide (SOS) and
SafeTalk trainings from October 1, 2014 through
September 30, 2015. Over 7,000 people completed these evidence-based trainings.
In addition to implementing evidence-based
initiatives, Prevention Services Professionals, in
collaboration with their local coalition partnerships, have established local and regional Suicide
Prevention Task Forces that are implementing
suicide prevention and awareness media campaigns, and a host of other mental health promotion initiatives throughout their communities.
All 39 of Virginia’s Community Services
Boards and one Behavioral Health Authority
utilize evidence-based prevention programs
that support children and families through
programs proven to enhance family health and
wellness, family relationships, increased family
management, children’s mental health and
reduce substance abuse.
DID YOU
KNOW?
• Between 117,500 and 143,700 Virginia
children & adolescents ages 9-17 may
have a serious emotional disturbance
• There were 104 juvenile arrests for
Driving Under the Influence in 2014*
• More than 116,000 Virginia teens
(ages 14 - 19) rode with an intoxicated
driver*
• 98,940 Virginia teens have illegally
used a prescription drug at least once
in their lifetime*
* 2014 data supplied by Community Health Solutions
Blue Ridge Behavioral Healthcare
prevention staff earns national award
On September 3, 2015, the National Liquor Law Enforcement Association (NLLEA) selected the Roanoke Prevention Alliance, Roanoke Area Youth Substance Abuse Coalition (RAYSAC), and the Prevention
Council of Roanoke County, to receive the 2015 National Liquor Law Enforcement Association John W.
Britt Community Service Award to acknowledge the work in supporting the Virginia Alcoholic Beverage
Control Bureau of Law Enforcement.
This award is in recognition of non-law-enforcement organizations that have made a significant contribution to the efforts of alcohol or tobacco law enforcement through innovative and effective programs or services. These coalitions are working to help disseminate positive messages about avoiding
over-service of alcohol, preventing underage drinking, and increasing compliance with Virginia alcohol
laws.
Virginia Association of Community Services Boards
Children &
Youth
CHILDREN & YOUTH
Prevention Services
Mountain Youth Drama
Behavioral
Health
Developmental
Services
Support
Services
Integrated
Care
Many come back to help with new drama groups
developing their shows, and most all of them continue to share their accomplishments with Lori
through visits, phone calls and e-mails. By using
the arts, the concepts of teamwork, acceptance,
tolerance, and the ability to build solid relationships in the teen years are ignited with lasting effects.
Regional
Programs
- Cary Steffey
(MYD alum, 1999)
Licensed Clinical
Social Worker
People, Services
& Funding
“The members of MYD
gain as much or more
as the audience about
belonging, feeling safe
in expressing one’s self,
understanding, and
encouragement for peers
and adults. MYD led me
to my career and for that
I am thankful.”
Workforce
Development
HOW ARE THE ARTS USED
TO PROMOTE PREVENTION?
One example of a successful program is the
drama theater created by Lori Gates-Addison, Licensed Clinical Therapist and Certified Prevention
Specialist at Cumberland Mountain CSB.
Mountain Youth Drama (MYD) was developed
17 years ago to provide substance abuse prevention through a theatrical production presented
to youth throughout Russell County. Topics have
included teen relationships both with peers and
adults, teen pregnancy, alcohol and drug use,
child abuse, peer pressure, suicide, and decision
making. The cast of MYD are high school students who sign a contract to remain drug-free
and maintain passing grades at school. Through
the use of song, dance and original drama, the
cast develops a show that reminds it’s audiences
of the common struggles that youth face and the
at-risk issues in our current society.
Eighty-five percent of students involved with
MYD over the years have gone on to college.
2015 Annual Report
9
Children &
Youth
Behavioral
Health
Developmental
Services
Support
Services
Integrated
Care
Workforce
Development
Regional
Programs
People, Services
& Funding
10
BEHAVIORAL HEALTH
Consumer Message
Kay’s (not her real name) long decline from clinical depression and prescription drug dependency ended in December 2014 when she graduated
from college with a degree in nursing and passed
the boards in January 2015. She is currently gainfully employed as a nurse on the medical/surgery
floor in a hospital. We asked Kay if she would
share her story with others.
“Where do I start? I remember always having
bouts of depression growing up, but was sixteen
when the first major depressive episode occurred.
Following six years of counseling and medication, I
was okay for short periods of time but I began to rely
more and more on the drugs I was taking for anxiety. I finally declined to the point where I couldn’t
do anything- couldn’t go to school, couldn’t hold a
job, could barely get out of bed. My relationship with
my family deteriorated and I felt like I was a burden
to everyone around me. After a counseling session
where all I could do was cry, the therapist asked if I
thought it was time I went to the hospital. I nodded
‘yes’ and spent the next 12 days trying to get stable
enough to go home.”
Following hospitalization, Kay moved back in
with her mom and continued counseling and taking her medication. Unfortunately, life continued
much as it had before her hospitalization and she
spent her time sleeping all day and staying up all
night watching TV. She was diligent with her therapy, but one of the medications she was taking
began to take over her life and progressed to a
full-blown addiction. Despite the challenges, Kay
never stopped fighting to get better.
“I had heard about shock therapy from one of the
patients when I was in the hospital and because
I felt I was all out of options, I needed to do something drastic. I had three treatments a week for three
weeks and it really did help. I went back to school
and started to get my life on track. Sadly, because
I still couldn’t get off the anti-anxiety medication I
was taking (about 14 times the normal prescribed
dose), my progress hit a wall and I spiraled back
down.”
“Luckily, the Community Services Board (CSB)
where I was being treated set me up and paid for
a detox and rehab program I never would have
been able to afford on my own. When I got out
I joined their intensive outpatient program (IOP)
and I learned how to handle life without drugs. I
truly believe the CSB saved my life. The staff was
Virginia Association of Community Services Boards
Kay
“My message to the readers is don’t ever give up
or think that your life can’t change.
Fight for yourself and give yourself a chance at a
better life. If I can do it you can, too.
Finally, always be gentle with yourself. We all
make mistakes - don’t punish yourself for them.
Everyone deserves to be happy and healthy.”
uplifting, and I felt so safe, secure, and supported.
My peers and therapists pushed me to enroll in nursing school again, and I got a job as a nurse aide. I
held that position for four years, the longest I had
ever had a job, and I stayed in IOP the whole time
because I never wanted to leave. Fortunately, I didn’t
have to, and they asked me to stay on and start a
peer mentor program. I continued as a volunteer
and finished school. The day my grandma, mom,
sister, and brother walked on stage and placed my
nursing pin on my dress was the happiest day of my
life. My mom once told me she often stood outside
my door just to make sure I was still breathing. I felt
like my recovery was a gift to her as much as it was
to me.”
“My goal is to eventually get a job working with
others who have a chemical dependency or substance abuse issue because I believe you can’t be
truly happy unless you are helping others. I know
I couldn’t have done any of this without the CSB’s
support and my Mom not giving up on me.”
Access to Care
2015 Annual Report
People, Services
& Funding
Discrimination against people
who have mental illnesses keeps
them from seeking help
Regional
Programs
Stigma leads to …
- Inadequate insurance coverage for
mental health services
- Fear, mistrust, and violence against
people living with mental illness and
their families
- Family and friends turning their backs
on people with mental illness
- Prejudice and discrimination
Workforce
Development
What does stigma have to do with
mental illness or access to care?
Integrated
Care
As another brutal snow and ice storm pelted the icecovered mountains of Southwest Virginia in late February,
Governor Terry McAuliffe deployed National Guard troops
to assist residents who had been battling snowfall from
Valentine’s Day through the first week of March.
Two weeks of impassable conditions, plus several weeks
of below zero temperatures, essentially paralyzed services
in the region.
That’s when Planning District One Behavioral Health
Services’ (PD1-BHS) nurses Rosa Smith and Steffany McElyea teamed up with sheriff’s deputies from both Lee and
Wise counties to ensure that services could be delivered.
Thanks to law enforcement’s help with transportation,
the nurses were able to provide medication injections
and deliver prescribed medications to several individuals with serious and persistent mental illnesses who had
run out of their prescribed medications.
“They [consumers] appreciated us coming all the way to
their homes to administer medication,” remarked Steffany.
Rosa added, “It was certainly a team effort and we’re glad
we were able to assist.”
Support
Services
Sheriff’s deputies help CSB
nurses travel snow-covered
roads to provide needed care
Developmental
Services
Rosa Smith (left)
and Steffany McElyea
Obtaining services at Chesterfield Community Services Board has historically
meant being placed on a waiting list - taking anywhere from two weeks to eight
weeks to get an initial appointment. For
those in desperate need, this wait can
seem like an eternity. Understandably, this
issue has been a constant source of complaints from consumers.
Working with a consultant (MTM Associates), a committee of direct care workers,
supervisors and senior management reviewed and reconstructed the intake and
assessment aspects of the service system.
Along with reconstructing the staffing of
this service at the “front end,” components
such as centralized scheduling, collaborative documentation and caseload prioritization were reviewed and revised to manage the “back end” of service delivery.
As a result, individuals seeking services
can now obtain an intake and assessment
the same day they call or come in. There
is no wait and clinical appointments are
scheduled within 10 days of the initial assessment. Both of these changes appear
to be positively influencing the no-show
rates for these appointments.
Behavioral
Health
Same Day Access (SDA):
One solution to improved
access to services
Children &
Youth
BEHAVIORAL HEALTH
11
PACT is a way to deliver a full range of services
to people who have been diagnosed with a serious mental illness. Often referred to as “a hospital
without walls,” the goal is to provide consumers
with adequate community support and to help
them have a life that isn’t dominated by their
mental illnesses. The ICT programs provide the
same services as PACT but to fewer people due to
fewer resources to serve them.
Five new programs were funded by the General Assembly in the 2015 session. CSBs granted
the new funding include: Prince William County
CSB, Northwestern Community Services, Rappahannock Area CSB, Piedmont Community Services
and Western Tidewater CSB.
PACT FACT:
1,713 individuals were served by
16 PACT Teams and 5 ICT Teams
in Fiscal Year 2015
Prince William County
Community Services
enhances ICT program
to create new PACT team
Prince William County Community Services has
offered an ICT program for individuals with serious mental illness since 2008. The program is currently funded to provide treatment and support
to 48 people. Another 26 individuals are currently
on the waiting list for services.
Through new funding from DBHDS, Prince William County Community Services will expand the
program to create a fully-staffed PACT team and
increase coverage to 80-100 individuals.
In addition to helping families and caregivers,
the team approach can help allay emergency care
for individuals with seroius mental illness.
“It helps our public safety personnel because
they’re often called to go out and respond and
must bring people through the emergency system, which can overload the hospitals and acute
care centers,” said Executive Director Alan Wooten.
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Behavioral
Health
Developmental
Services
Programs for Assertive/Intensive Community Treatment (PACT/ICT)
Support
Services
Children &
Youth
BEHAVIORAL HEALTH
12
The Virginia Beach Human Services’ PACT Team (pictured here), funded by DBHDS and a local fund match in
2014, opened its doors with a full staff on January 21, 2015. By the end of August, the team had added 25
individuals to its caseload. That number is expected to grow to a maximum capacity of
80 clients by January 2017.
Virginia Association of Community Services Boards
Children &
Youth
BEHAVIORAL HEALTH
Programs for Assertive Community Treatment (PACT)
DEMOGRAPHICS
FY 2015
48
% Male
59%
% Female
41%
% White
51%
% Black
43%
% Asian
2%
% Other
3%
100
COST OF
DIAGNOSES
STATE HOSPITAL BEDS SAVED
Schizophrenia
71%
Other Psychosis
3%
Bipolar Disorder
13%
Individuals Served
1,713
Affective Disorder
1%
Co-occurring Substance Abuse
31%
Stable Housing = zero to one move, no
homelessness, no jail as residence
89%
Co-occurring Medical Problem
16%
Lived in Stable Private Households
71%
Co-occurring Personality Disorder
7%
Only zero to one Hospital Admission
87%
Co-occurring Intellectual Disability
2%
Had no arrests
94%
Unknown
14%
Had some employment experience
9%
FY 2015 OUTCOMES
Integrated
Care
1,713
Support
Services
Individuals Served
Developmental
Services
Data for
Average Age
1,713
Behavioral
Health
PACT/
ICT
Individuals Served
Consumer Story
Workforce
Development
Regional
Programs
Jacob
2015 Annual Report
People, Services
& Funding
Jacob, 35, hasn’t seen the inside of a psychiatric hospital
since he was 21. His 14-year stretch of not being hospitalized is
a huge accomplishment for someone who spent the vast majority of his childhood in and out of hospitals while counselors,
doctors, and his own family struggled to help Jacob cope with
his mental health issues.
“I guess you could say I’m a big-time success story,” Jacob
says with a grin and shrug of his shoulders. “The doctors told
me [after being released from the hospital] that I would be
back in two or three days.”
Diagnosed with Autism Spectrum Disorder and a psychotic
disorder, Jacob now maintains his mental well-being in the
community.
Jacob lives with a host home provider, regularly sees his psychiatrist, visits three times a week with his peers and friends
at New River Valley Community Services’ (NRVCS) Community
Recovery Center and spends the other two days working at
Goodwill Industries. His weekends often include visits with his
parents and spending time with his girlfriend.
13
Substance Use Disorders
Tabitha
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Support
Services
Developmental
Services
Behavioral
Health
Children &
Youth
BEHAVIORAL HEALTH
14
Tabitha’s Story
Tabitha looks like any other expectant mother
at first glance. Her third child will arrive in December 2015. She also has a 10- and 6-year-old
at home.
The new baby will continue what she hopes is a
new chapter in her life - one without drugs.
Now 30, Tabitha has spent nearly half of her life
battling substance abuse. In fact, things got so
bad at one point that she did a three-year stint in
prison for charges related to meth. She lost custody of her children as a result.
“I started shooting up when I was sixteen,” recalled Tabitha. “I finally got clean in October 2014
and that’s the first time I’ve been sober since I
started doing drugs.”
Her recovery began with her participation in
Stepping Stones, an intensive outpatient program offered by New River Valley Community
Services (NRVCS) that serves adults living with
substance use disorders. Stepping Stones uses
a group therapy model that is offered on three
varying levels of intensity, depending on the individual’s specific needs.
Virginia Association of Community Services Boards
“When I first started, I really didn’t take it seriously because I thought it was punishment,”
Tabitha admitted. “Eventually, I decided to shut
up for once and I listened and finally realized that
I wasn’t always right. I really did need this program if I wanted to live.”
Tabitha, who is also receiving case management services through NRVCS’ Special Deliveries
program for expectant mothers, still struggles
with anxiety and depression and actually had a
relapse in March.
Despite these challenges, Tabitha is committed
to a drug-free future.
“I’m very happy these days,” she remarked. “I’ve
still got a long way to go, but I’m not going to
back down. I have a lot of opportunities now that
I’m clean and sober that I wouldn’t have even considered before.”
“At one time, I just thought I would always be
on drugs,” Tabitha said. “I had completely given up
- gave up on life...I had always picked drugs over
my kids, but now I realize how wrong that was. My
kids are everything to me.”
Crisis Response & Jail Diversion Systems
Integrated
Care
2014
6787
2013
6346
2012
6322
2011
6481
2010
4867
2009
4278
2008
4879
Workforce
Development
# of Inmates
Support
Services
Number of Jail Inmates in
Virginia with a Mental Illness
Year
Developmental
Services
Jail diversion efforts divert persons with serious mental illness and co-occurring substance
use disorders from jail and into treatment. Diversions occur at police encounters, jail bookings,
court appearances and/or specialty mental health
court participation. Evidence of these models
show:
• Fewer days of involvement in jails and
prisons.
• 68% of program participants reported
fewer mental health symptoms.
• Alcohol use declined with 35% not using at
all and 53% using less when they were first
enrolled.
• Illegal drug use declined: 40% were not
using at all and 53% were using less than
at baseline.
• Programs achieved a 57% reduction in arrests and a 38% reduction in jail days in the
12 months after enrollment compared
with the prior 12 months.
• Only half (51%) of the participants were
arrested at all during the 12 months following enrollment.
• Three out of four projects that were funded
by SAMHSA were sustained after the SAMHSA grant funding ended. This fact
speaks to the community support.
Behavioral
Health
There is evidence that comprehensive community-based crisis response systems can divert
individuals with serious mental illnesses from
unnecessary hospitalizations, emergency rooms
and criminal justice involvement and can reduce
costs for psychiatric hospitalization.
There is established empirical evidence on the
effectiveness of a crisis response system in addressing the needs of individuals with serious
mental disorders and their family members that
include a continuum of the following types of crisis services:
• 23-hour crisis stabilization/observation
beds
• Short-term crisis residential services and
crisis stabilization
• Mobile crisis services
• 24/7 crisis hotlines and warm lines
• Psychiatric advance directives
Children &
Youth
BEHAVIORAL HEALTH
Regional
Programs
Hours of Treatment Provided
Hours
CSB Staff
9553
Private Provider
5700
Jail MH Staff
1715
Psychiatrists
1125
M.D.
309
People, Services
& Funding
Provider
(2014 State Compensation Board Report,
pgs. 5 and 12)
2015 Annual Report
15
Children &
Youth
Behavioral
Health
Crisis Response Systems:
Crisis Intervention Teams (CIT) & CIT Assessment Centers (CITAC)
Virginia has made much progress in establishing Crisis Stabilization Units (CSUs), as well as CIT
assessment centers (CITAC), often referred to as
“drop-off” centers. The map below displays the locations of CITACs and CSUs located in CSB catchment areas.
CIT progams have expanded over their 25 years
of existence to include other first responders to
crises, including firemen, emergency room personnel and others. Virginia’s Community Services
Boards with established CIT programs often provide training to other CSBs getting started.
Communities large and small are seeking answers to managing crisis issues and crisis services.
When changes are mandated, community collaborations and partnerships are the key.
Advocates have long asserted that law enforcement personnel often do not receive adequate
mental health training, resulting in ineffective
and sometimes fatal encounters or outcomes.
In 1988, the City of Memphis (Tennessee) introduced the first Crisis Intervention Team (CIT) as a
vital component to the demand for safer first responder crisis services.
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Support
Services
Developmental
Services
BEHAVIORAL HEALTH
16
1
Alexandria Community Services Board
CITAC
22
Loudoun County Community Services Board
CITAC
3
Arlington County Community Services Board
CSU & CITAC
23
Middle Peninsula-Northern Neck CSB
CITAC
4
Blue Ridge Behavioral Healthcare
CSU & CITAC
24
Mount Rogers Community Services Board
CSU & CITAC
6
Chesapeake Community Services Board
CITAC
25
New River Valley Community Services
CSU & CITAC
7
Chesterfield Community Services Board
CITAC
26
Norfolk Community Services Board
CSU & CITAC
8
Colonial Behavioral Health
CITAC
28
Piedmont Community Services
CITAC
9
Crossroads Community Services Board
CITAC
30
Portsmouth Dept. of Behavioral Health Services (with #6)
CITAC
10
Cumberland Mountain Community Serrvices Board
CSU
31
Prince William County Community Services Board
CSU
11
Danville-Pittsylvania Community Services Board
CSU & CITAC
32
Rappahannock Area Community Services Board
CSU
13
District 19 Community Services Board
CITAC
34
Region Ten Community Services Board
CSU & CITAC
15
Fairfax-Falls Church Community Services Board
CSU
35
Richmond Behavioral Health Authority (shared w/ #7)
CSU & CITAC
17
Hampton-Newport News Community Services Board
CSU & CITAC
37
Southside Community Services Board
CITAC
18
Hanover County Community Services Board
CITAC
38
Valley Community Services Board
CITAC
19
Harrisonburg-Rockingham Community Services Board
CSU
39
Virginia Beach Department of Human Services
CSU & CITAC
20
Henrico Area MH & Developmental Services (with #35)
CSU & CITAC
40
Western Tidewater Community Services Board
CITAC
5
Horizon Behavioral Health
CSU & CITAC
As noted above, some of the CSBs share the Crisis Stabilization Units (CSU) and/or Crisis Intervention Team Assessments Centers (CITAC)
Virginia Association of Community Services Boards
Crisis Response Systems:
Crisis Intervention Teams (CIT) & CIT Assessment Centers (CITAC)
Children &
Youth
BEHAVIORAL HEALTH
Officer uses CIT training to prevent possible suicide
Behavioral
Health
Developmental
Services
Officer Andrew Gohn
Support
Services
The man was lying on the sidewalk when officers arrived, an
eight-inch butcher knife firmly pressed against his stomach. He was
crying. He said he didn’t deserve to live.
Body-mounted cameras on officers recorded as Newport News
police officer Andrew Gohn knelt to the ground. He asked the man
about his problems and encouraged him to talk about his kids. The
incident happened just a week after Gohn had completed an advanced crisis intervention training course.
“This was my first actual time to put what I learned into effect,”
Gohn told reporters at Newport News Police Department Headquarters. He said he remembers thinking, “I need to go back to my
training and say the right things”. “It all happened so fast, it was 10
minutes but felt like 30-45 seconds”. Gohn had no idea the incident
had been recorded until several days later.
Every Newport News police officer receives basic crisis training,
but just 72 of the department’s nearly 440 officers have completed the more advanced course, according to a police department
spokesman. (Excerpts from story by Sarah J. Ketchum, Daily Press)
Williamsburg opens CIT Assessment Center
Integrated
Care
Workforce
Development
Regional
Programs
Colonial Behavioral Health Executive Director David Coe and
Del. Brenda Pogge greet Williamsburg Chief of Police David Sloggle.
“Most importantly, those who suffer from mental illness have
been able to access emergency psychiatric care quickly in a
less restrictive therapeutic setting,” noted Will Armstrong, CBH
Emergency Services Coordinator.
Through additional funding from DBHDS, CITAC has extended its open hours to 12 hours per day.
2015 Annual Report
People, Services
& Funding
The Colonial Area Crisis Intervention Team (CIT) formed in 2012.
Since its opening, the CIT has
worked to bring a crisis assessment
center to the Williamsburg area.
In September 2014, CIT, Colonial
Behavioral Health (CBH), and Riverside Doctors’ Hospital Williamsburg
opened the Colonial Area Crisis Intervention Team Assessment Center (CITAC). In its first nine months,
the center served more than 350
individuals experiencing behavioral
health crises.
CITAC gives law enforcement officers who encounter a person in
crisis a safe place to bring the individual for assessment and linkage to appropriate care and offers
the officer the option to transfer
an individual out of their custody.
By doing so, the officers are able to
return to patrol, which conserves
invaluable staff resources. Between
September and June, officers were
relieved of more than 380 hours.
17
Children &
Youth
BEHAVIORAL HEALTH
Crisis Response Systems:
Crisis Intervention Teams (CIT) & CIT Assessment Centers (CITAC)
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Support
Services
Developmental
Services
Behavioral
Health
Collaboration leads to Lynchburg psychiatric emergency center
18
Thanks to a grant secured by Horizon Behavioral
Healthcare from DBHDS (funds approved by the
General Assembly for new crisis assessment centers), Horizon, in partnership with Centra Lynchburg General Hospital and local law enforcement
agencies, developed a psychiatric emergency
center (PEC).
This five-bed unit is located across the driveway from Lynchburg General’s Emergency Room.
The PEC serves as a crisis stabilization unit (CSU),
providing direct mental health care to non-hospitalized individuals experiencing an acute crisis, as
well as a 24-hour CIT Assessment Center (CITAC)
for police officers who will be able to drop off individuals in crisis.
As part of the regional CIT, Horizon clinicians
also provide training for local law enforcement officers to properly assist a person in mental health
crisis. This training reduces unnecessary arrests
as well as officer time in local emergency rooms.
The PEC will also be used for CIT training.
The CIT training and the new PEC also mean
better safety, a continuum of care for those in
need in the community, and a slow deterioration
of the wall that is mental health stigma.
To date, the CIT program has trained 171 officers and first responders, along with dozens of
professionals from college security, social services, regional dispatch, corrections, and the fire
department.
Peer Support Specialist paying it forward
by supporting fellow consumers in crisis
Peer support is an evidence-based, cost-effective practice with the capacity to enhance the
mental health workforce by providing the “quantity time” needed to promote recovery. Peer support specialists are trained and credentialed to
use the wisdom gained from personal experience
to help clients navigate the challenges of daily
life, link the person to appropriate services and
provide emotional support. Peer support specialists have been employed effectively to defuse
psychiatric crises, reach the hard to engage and
minimize the need for high cost emergency and
inpatient care.
Paula Brent, Peer Support Specialist at Horizon
Behavioral Healthcare, puts her lived experience
to work in Centra Hospital’s Emergency room in
Lynchburg.
Paula was a junior in college when the hallucinations started with people “following her
around.” Upset, distraught and suffering from
severe hallucinations, Paula was involuntarily admitted to a psychiatric hospital and diagnosed
with Schizoaffective Disorder.
Today, Paula’s mental illness doesn’t stop her
from helping others. She now has her Master’s Degree in Community Counseling from
Virginia Association of Community Services Boards
Paula Brent (left) with Debra Johnson
Lynchburg College and works as a Peer Support
Specialist in Centra’s Emergency Room. Paula is
one of 28 CIT Trained instructors that teach public
safety officers how to spot a mental health crisis.
“There is hope. A mental illness is part of you
and there is recovery.” Paula says these words to
comfort clients suffering a crisis, but it also helps
the police officers that bring them in.
“I see officers that come [to the training] and say
they are wasting their time but by the end they
are saying ‘wow, I’m glad I came here,” says Paula.
Jail Diversion & Therapeutic Court Dockets
Reported by WSLS-Channel 10, February 2015
Several bills regarding mental health were on the
docket during the 2015 General Assembly session
including SB 903, which would create “problemsolving courts” - a special court for those with mental health issues. However, the bill was eventually
tabled and left with the Courts of Justice.
2015 Annual Report
People, Services
& Funding
(Reprinted by permission of The Roanoke
Times, story by Cameron Austin, February 2015)
Regional
Programs
Pulaski
County’s
Assistant Commonwealth’s
Attorney,
Skip Schwab, offered
Robinson a way out
— Pulaski County was
starting a drug court
under the leadership
of Circuit Court Judge
Leroy Robinson
Marcus Long. They
wanted Robinson to
be the first participant. “This is a miraclemiracle what’s happened here,” Robinson said.
With the end of his drug use, Robinson says
those labels that have defined him in the past
are gone. Now, people describe the smiling
young man in the wheelchair as confident.
Considerate. A survivor. “I’m high on life.”
Workforce
Development
When people used to look at Leroy Robinson, they labeled him a loser. A criminal. A
felon. He had been dealing drugs since he
was 15 and was immersed in the lifestyle that
the drugs brought with it — “the glamour, the
glitter, the money … all of it,” he says. He says
he was never an addict though, just a dealer.
That all changed two days after Christmas
in 2012 when he was shot in the back during
a drug deal. His spinal cord was severed putting him in a wheelchair for the rest of his life.
The shooting was just the beginning of
Robinson’s struggle with drugs. He ended up
in physical therapy in Roanoke, and began
making meth in his basement, hating himself.
The drug was controlling his life in a way like
never before.
The intervention that started the change
in his life was a drug task force raid. He was
charged with manufacturing meth and two
related charges and found himself sitting in a
cell 23 hours a day.
Integrated
Care
A shot at sobriety
Support
Services
Mental Health Courts
With one successful long-established Mental
Health Court in Virginia, Judges are advocating
for more and more latitude for dockets based on
problem solving (for example, Veterans Courts).
In the eyes of the court everyone is treated
equal under the law. But one judge wants to see
that changed.
“I’ve had people in court where they have mental problems or mental issues and they keep getting in trouble,” said Judge Marcus Long Jr. from
the 27th Circuit Court.
It’s an issue he sees all too often in the courtroom. [Judge Long presides over the first Drug
Court in Pulaski County.]
In the past, Long has been forced to sentence
people with mental health problems to prison because there’s no other option.
“These people do not belong in prison, they
need help,” he said.
Developmental
Services
Virginia Judges continue to create therapeutic
court dockets. Localities are finding ways to fund
them, as it is difficult to get funding for Drug Courts
and Mental Health Courts. Benefits of these programs may include savings in reduced jail time, as
well as court time due to fewer repeat offenders on
the Judges’ dockets. There are 23 Adult Drug Treatment Courts
(Halifax County is applying for a Drug Court)
8 Juvenile Drug Treatment Courts
One federally funded Mental Health Court
Behavioral
Health
Therapeutic Dockets
on the rise in Virginia
Children &
Youth
BEHAVIORAL HEALTH
19
Training Center
residents making
the transition to
community-based care
Under the DOJ Settlement, the Virginia
Department of Behavioral Health and
Developmental Services and the CSBs/
BHA have worked diligently to provide
resources in the community to help transition individuals from training centers to
community-based treatment.
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Support
Services
Behavioral
Health
Department of Justice (DOJ) Settlement
Developmental
Services
Children &
Youth
DEVELOPMENTAL SERVICES
20
The table to the right shows the progress that’s being made in transitioning individuals into community-based care.
Training Center Census Decrease
Facility
NVTC
(Closure by
3/30/2016)
SWVTC
(Closure by
6/30/2018)
CVTC
(Closure by
6/30/2020)
SEVTC
Remains Open
Total
July
2012
Census
July
2013
Census
July
2014
Census
July
2015
Census
153
135
107
55
173
156
144
122
350
301
288
230
106
84
75
69
983
790
614
476
A mother’s dream
comes true
On November 22, 2015, our
eldest son will come home to
Arlington. David lived with us
for 26 years until life with our
severely disabled son spiraled
into crisis.
Through the past decade,
Arlington CSB made sure that,
even though David was housed
at Northern Virginia Training
Center (NVTC), he continued
at the Community Integration
Center in Arlington. With the
DOJ Settlement, we asked the
CSB to do what many declared
impossible, to create a place in
Arlington for our son.
Four years and so much work and so many obstacles later, our son and nine others are moving
home. Our son, Tim, is pictured visiting with his big brother shortly after we received the news that
David was accepted into the Good Neighbor home. The picture that happened to be behind them
says it all.
Virginia Association of Community Services Boards
Support Programs
Establishing housing, supportive services for individuals with I/DD
42
73
29
# of referrals
to be made
to VHDA for
voucher
set-aside
# of
individuals
with I/DD
living in their
own home
44
386
Day support program promotes “Healthy Living”
Additionally, the program has made several
day-trips over the course of the past year to cities
like Williamsburg, Charlottesville, Old Town Alexandria, and Washington, D.C.
These trips and actitivies are optional and open
to the entire program, but also geared to specific
interests of the individuals served by the program.
People, Services
& Funding
2015 Annual Report
Regional
Programs
“While these events tend to generate the most
attention, the program seems to have elevated
the quality of the issues supporting the resident,”
said Dan Bairly, Supervisor of Brittany Supervised
Apartment Program.
“That is, the issues addressed on a daily basis include sound monetary budgeting, appropriate
portion control and making good dietary choices
- the same issues that the staff, neighbors, and
colleagues are working on in their own lives,” concluded Bairly.
Workforce
Development
In 1976, Rappahannock Area Community Services Board (RACSB) began working with concerned citizens to form the private, non-profit
agency, Rappahannock Adult Activities, Inc.
(RAAI). RAAI is a community-based developmental day program that promotes dignity, independence, individualization, inclusion, and productivity of people with intellectual disability.
One of RAAI’s very successful programs is
“Healthy Living” in which the residents purchase
healthy food and create salads, entrees, snacks
and desserts which they all share.
Daily activities include going to the library, dining out and listening to music. In other words, socializing to promote integration into the community. These forays allowed the program to grow
and eventually staff began to take residents on
trips to amusement parks, sporting events, live
music and theatre performances, and more.
Integrated
Care
# of rental
# of rental
# of
subsidies
subsidies used
individuals
remaining to
by
with I/DD
be utilizied
individuals
looking for
by individuals
with I/DD
rental housing
with I/DD
Support
Services
115
DBHDS staff – in partnership with the Virginia
Housing Development Authority (VHDA), the
Fairfax-Falls Church CSB, and the Virginia Beach
CSB – have been working on various initiatives
(for example, Rental Choice VA, Housing Choice
Voucher set-aside, etc.) to increase housing options prior to the kick-off. Below is a brief summary of the group’s work thus far:
Developmental
Services
# of rental
subsidies
allocated/set
aside for
individuals
with I/DD
ing options for people with intellectual or developmental disabilities who desire to live in a home
of their own,” said Virginia Governor Terry McAuliffe. “The Commonwealth is making a purposeful
shift away from using institutional settings, and
helping individuals and their guardians choose
where to live, how to live and with whom to live.”
Behavioral
Health
As part of Virginia’s commitment to tenets of
the American with Disabilities Act (ADA) and the
Olmstead decision, multiple agencies are collaborating on the Housing and Supportive Services
(HSS) initiative. This effort is aimed at increasing
integrated, independent housing options for
people with intellectual and developmental disabilities (I/DD) in the Northern Virginia, Hampton
Roads, and Richmond regions over a 100-day period.
At the conclusion of this effort, all of the teams
will meet again to share their accomplishments
and plan next steps with state leaders and other
community teams to keep this initiative moving
forward.
“Virginia is committed to providing more hous-
Children &
Youth
DEVELOPMENTAL SERVICES
21
Children &
Youth
Behavioral
Health
End the Wait
ID Waiver
waiting list
DD Waiver
waiting list
AGE GROUPS
0-4 in
5-16 in
17-20 in
EDCD
EDCD
EDCD
Total on
waiting list
Total in
EDCD
8,193
2,844
184
1,491
404
765
35%
2%
18%
5%
9%
AGE GROUPS
0-4 in
5-16 in
17-20 in
EDCD
EDCD
EDCD
21 & over
in EDCD
Total on
waiting list
Total in
EDCD
2,049
735
0
545
92
98
36%
0%
27%
4%
5%
21 & over
in EDCD
Source: DMAS, September 2015
Support
Services
Developmental
Services
DEVELOPMENTAL SERVICES
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
End the Wait!
22
Hundreds of self-advocates, families, providers and concerned citizens united in Richmond on
September 29 for the “Walk and Roll to End the Wait.” The event began with a rally in Capitol Square,
where advocates spoke about the I/DD Waiver waiting list crisis and the lack of access to integrated
services.
Attendees then walked through the streets of Richmond, marching past the General Assembly
building, the Governor’s offices, the Governor’s Mansion and the Department of Behavioral Health
and Developmental Services (DBHDS), ending at the steps of the Capitol building.
With over 10,000 individuals with I/DD on waiting lists for services, the individuals and their families are calling on the Governor, General Assembly, and leaders of state agencies to take action in the
upcoming budget to bring Virginia out of near bottom rankings for I/DD services.
Virginia Association of Community Services Boards
Permanent Supportive Housing & Transportation
Supportive housing helps individuals live more stable, productive lives
Community Services Boards work with other service agencies and community partners
to provide housing and supervision for individuals with serious mental illness.
Norfolk CSB, Shelter Plus Care
43 single units
8 family units
Arlington County DHS/ASPAN
18 single units
Northwestern CSB
Scattered Site
23 single units
5 family units
Alexandria CSB/Notabene &
Family Condos
10 single units
3 family units
Piedmont CSB, CRP, Passages
16 single units
Fairfax Falls Church CSB
partners in FACETs
19 single units
Portsmouth DHS
56 single units
13 family units
Hampton-Newport News CSB Project Onward
14 single units
Region Ten CSB, Shelter + Care
and Dual Recovery Center
30 single units
Transportation: A vital support service
Workforce
Development
win to extra driving practice completed on his personal time, as well as practicing with drivers from
community partners.
2015 Annual Report
People, Services
& Funding
RACSB Van Driver Tim Alsfeld (right) is pictured with
Jim Gillespie, Director Community Support for RACSB.
Of his win, Tim said, “The individuals served are the
most important cargo. To be a successful van driver
you have to care — and be patient.”
Regional
Programs
The Rappahannock Area Community Services
Board (RACSB) Specialized Transportation Program was created in 1986 to make RACSB day
support programs more accessible to individuals
residing throughout the region. The RACSB fleet
of nearly 60 vehicles travel more than 600,000
miles annually.
With transportation vital to access to care, the
Van drivers are trained in strict safety methods
and driver interactions with passengers. The
Community Transportation Association of Virginia sponsors a “Roadeo” for van drivers, scoring
the drivers on safety procedures, interaction with
passengers.
Tim Alsfeld has been a Van Driver with RACSB
for 13 years. He transports individuals with intellectual disabilities and mental health challenges
from their homes to day support programs.
A previous participant in the state roadeo, Alsfelt won first place awards in two categories this
year in the Virginia State ROADEO and credits his
Integrated
Care
76 single units
8 family units
Support
Services
Arlington County DHS
Developmental
Services
Studies have shown that persons placed in supportive housing reduce shelter use, hospitalizations, length of stay per hospitalization, reduce
time incarcerated and are cost effective when
other societal costs of homelessness and mental
illnesses—such as emergency room visits, hospitalizations and incarcerations—are taken into account.
Behavioral
Health
Permanent supportive housing is intended to
stably house individuals with serious mental illness who have been unable to have access to and
maintain stable housing without some level of
support.
It is a successful, cost-effective combination of
affordable housing with services that help people
live more stable, productive lives.
Children &
Youth
SUPPORT SERVICES
23
Support
Services
Developmental
Services
Behavioral
Health
Children &
Youth
INTEGRATED CARE
Primary & Behavioral Health
Commonwealth Coordinated Care
Virginia’s Community Services Boards participated in the Commonwealth Coordinated Care
demonstration project in FY 2015 to provide case
management and access to primary care for individuals who were receiving both Medicaid and
Medicare Benefits.
Commonwealth Coordinated Care (CCC) is a
demonstration project with CMS partnering with
DMAS and Magellan which promises to enhance
integrated care for individuals who are eligible
for both Medicare and Medicaid. The project was
launched in 2014.
Enhanced Coordinated Care (ECC) is a brand
new CSB-developed service offered in 2014 with
CCC through DMAS. ECC provides support and
services to more than 60 of District 19 CSB’s consumers with a chronic medical condition. ECC has
impacted the lives of each of our consumers and
the following story is just one example of how
positive changes are being made.
An individual was referred to ECC by his case
manager in November. The individual had not
been keeping medical appointments or taking
prescribed medication. The ECC staff met with the
individual and his medical doctor to set up a series of visits, labs and tests and linked him to additional supportive services within the community.
As a result, the individual now has controlled
blood pressure and blood sugar within the normal range. This individual also regularly attends
medical appointments and fully participates in
a treatment regimen that was prescribed by the
team.
ECC has resulted in the development of a robust relationship with the medical providers in
the community, including medical physicians,
optometrists, dentists and other specialists. In
this regard, it makes it easier to contact the physician’s office to request medical appointments
and medical records in a timely manner. It helps
to give the ECC case manager an opportunity to
request certain tests be run on a consumer who
otherwise wouldn’t be able to ask for it.
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Integrated care program launched in Wise County
24
On July 1, 2015, Virginia Premier and Wise
County Behavioral Health Services launched the
pilot Wise County Integrated Care Program so
individuals can receive primary and behavioral
health care at the same location.
Wise County Integrated Care (operated by Planning District One Behavioral Health Service (PD1BHS) in partnership with Frontier Health) is providing a “holistic” approach to care and includes
care coordination, primary care and behavioral
health services for Virginia Premier members with
serious mental illness.
Virginia Premier reported that claims data indicated behavioral health consumers in far Southwest Virginia, in comparison to other portions of
the Commonwealth, had higher medical co-morbidities and were likely to benefit from an integrated health care approach for preventative and
well-care services.
“As behavioral health providers, we’ve long
known those we serve have greater health disparities than persons without a serious mental
illness,” said Sandy O’Dell, PD1-BHS Executive
Director. “Consumers with serious mental illness
often suffer more medical co-morbidities and a
shortened lifespan. These pilots will help us adVirginia Association of Community Services Boards
Pam Tillson, Jackie Johnson and Teresa Beverly
dress disparities as we co-locate direct primarycare in the behavioral health facility.”
Care coordination involves the mental health
case manager, primary care coordinator and both
the psychiatric and primary care provider who
work closely with each other and the consumer
to improve access to care and follow-up care.
INTEGRATED CARE
Children &
Youth
Primary & Behavioral Health
Behavioral
Health
Developmental
Services
Region Ten CSB teams with local hospital to
open integrated care facility in Charlottesville
healthcare. Integrating mental health, substance
abuse, and primary care services produces the
best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.
People, Services
& Funding
2015 Annual Report
Regional
Programs
New River Valley Community Services (NRVCS)
partnered with New River Valley Pediatrics in May
2015 to have an integrated behavioral health staff
in their clinics four days a week.
NRVCS’ Integrated Healthcare Liaison provides
on-site triage, assessment and counseling services for patients of the pediatric practice.
The providers at NRV Pediatrics and NRVCS have
also begun to utilize a collaborative model of care
that works to serve clients of both of agencies on
a continuum of care. This allows NRV Pediatrics
clients to have access to psychiatric consultations
and services, and facilitates professional consultation between the physicians at NRV Pediatrics and
NRVCS to provide optimal services for all patients.
Workforce
Development
NRVCS forms integrated
care partnership with
local pediatric practice
Integrated
Care
In February of 2015, Region Ten Community
Services Board and Martha Jefferson Hospital opened the Peterson Health Center, an integrated
care facility located in Charlottesville.
Recognizing that integrated health care marks
the development of a best practice model of behavioral health and primary health care, the partnership of Region Ten Community Services Board
and Martha Jefferson Hospital represents a significant step toward promoting health and wellness
to consumers of Region Ten services. According to the Substance Abuse and Mental Health Services Administration, people with
mental and substance use disorders may die decades earlier than the average person mostly from
untreated and preventable chronic illnesses like
hypertension, diabetes, obesity, and cardiovascular disease that are aggravated by poor health
habits such as inadequate physical activity, poor
nutrition, smoking, and substance abuse.
Barriers to primary care, coupled with challenges in navigating complex healthcare systems,
have been a major obstacle to care.
The solution lies in integrated care, the systematic coordination of general and behavioral
healthcare
Support
Services
Officials conduct a ribbon cutting ceremony for the new Peterson Health Center in Charlottesville: Pictured are
(from left) Region Ten CSB Board Chair Peter DeMartino, Consumer Advisory Council Chair Eddie Banks, Region
Ten CSB Executive Director Robert Johnson, Retired Region Ten CSB Executive Director Jim Peterson and Charlottesville Mayor Satyendra Huja.
25
Children &
Youth
Behavioral
Health
Developmental
Services
Support
Services
Virginia’s challenge - Serving behavioral health and
developmental disability needs with shrinking workforce
Communities are being challenged to meet
the need for behavioral health services in a variety of ways. In its 2014-2020 State Plan, DBHDS
identifies multiple concerns about the supply of
behavioral health professionals, including health
professional shortages, an aging workforce, and
the need for professionals equipped to deliver
linguistically and culturally appropriate services.
As of 2013, waiting lists for services in CSBs/BHA
included more than 13,000 individuals waiting for
mental health, substance abuse and/or developmental services (with some individuals on multiple waiting lists).
Further indication of provider shortages can be
found in the Federal Mental Health Professional
Shortage Area (MHPSA) designation, which identifies an area or population as having a shortage
of mental health care providers (see map below).
The process for designating a MHPSA takes into
account the supply of psychiatrists, clinical psychologists, clinical social workers, psychiatric
nurse specialists, and marriage and family therapists. The U.S. Health Resources and Services Ad-
ministration (HRSA) defines a MHPSA designation
which identifies a geographic area, population
group or facility as having a shortage of mental
health professionals.
Each of the three MHPSA’s has it’s own set of
designation criteria, and unfortunately has such a
high population threshold for the acceptable ratio
of professionals to population density that Virginia’s most rural areas do not qualify as MHPSA’s because their population falls below the threshold.
As of 2014, Virginia had 52 MHPSA designations,
many of which cut across city and county lines.
(Source: excerpts from Virginia Health Workforce
Development Authority, Meeting the Challenge of
Behavioral Health Care, May 6, 2015)
The MHPSA map below does however support the fact that Virginia has a critical shortage
of licensed mental health workers. Virginia’s challenge is to develop strategies to develop and retain a workforce based on utilizing current staff
who are experienced and willing to serve the SMI
population.
Federally Designated Mental Health Professional Shortage Areas
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
WORKFORCE DEVELOPMENT
26
Workforce development is a critical issue in Virginia due to a shortage of
licensed providers of mental health services and mental health workers in general.
The shortage of licensed mental health workers is not just a problem in Virginia,
but has been reported to be a global issue.
Virginia Association of Community Services Boards
HPR III
PPR 3
HPR IV
PPR 4
HPR V
PPR 5
HPR 3
PPR 6
HPR 3
PPR 7
Totals
Local Inpatient Purchase of
Service (LIPOS) Adult
Individuals
437
607
215
601
1,094
282
355
3,591
Bed Days
1,760
2,524
903
2,529
5,807
1,015
1,084
15,622
LIPOS Youth*
Individuals
-
67
-
-
-
-
-
67
Bed Days
-
457
-
-
-
-
-
457
State Hospital Adult
Individuals
545
822
659
550
246
213
3,035
Bed Days
42,266
46,679
38,322
73,771
13,506
15,216
249,929
State Hospital Older Adult
Individuals
36**
20
65
34
197
13,892
4,107
7,671
95,131
12
32
368
20,169
78
Bed Days
11,400
10,781
Individuals
232
92
Bed Days
3,174
1,573
1,273
2,796
2,806
610
452
12,684
Discharge Assistance Plan
(DAP)
Individuals
309
137***
62
120
262
112
23
888
REACH Crisis
Therapeutic Home
Individuals
138
144
134
92
76
Included in HPR III
State Hospital Youth
20,125
27,155
Developmental
Services
HPR II
PPR 2
Behavioral
Health
HPR I
PPR 1
PROGRAM
Children &
Youth
REGIONAL PROGRAMS
584
Programs listed below were not developed as regional partnership programs, but may serve more than one CSB within a region.
Individuals
Crisis Stabilization Units
(CSU) Adult
Individuals
1,484
872
Bed Days
13,232
8,599
Child CSU
1,795
502
3,629
752
675
1,642
198
5,623
4,942
1,377
41,819
4,311
9,358
Individuals
129
163
Bed Days
1,374
Individuals
Service Units
299
217
24
10,226
838
292
1,374
700
1,240
11,064
Community Crisis Beds
(MPNN) - HPR V only
Individuals
39
39
Transitional Living (VB) HPR V only
Individuals
63
63
Regional
Programs
People, Services
& Funding
2015 Annual Report
Workforce
Development
Notes:
• HPR = Virginia Health Planning Regions
• PPR = (DBHDS) Partnership Planning Regions to facilitate Transformation Initiative
• Individuals admitted to State Hospitals = civil admissions from all CSB’s in the PPR to the state facility in the PPR;
forensic admissions are not included in the report unless noted otherwise
• PPR 3 admissions for older adults include Catawba and/or PGH admissions
• HPR 5 CIT Assessment Center data = the Portsmouth/Chesapeake shared assessment site only
• HPR 5 Community Crisis Beds (MPNN) = pre or post-hospitalization diversion providing step-down crisis stabilization
and support prior to returning home or other housing
• HPR 5 Transitional Living = temporary housing for individuals transitioning from state hospitals
• Child CSU = All five HPRs have implemented crisis stabilization programs for children but only HPR IV has a CSU
• Red Cells = data not available at the time of publication
• Blank Cells = data not available to the Region Managers or programs not available in the region
• Black Cells = programs that are not available in the Regions
• *LIPOS funds are not used for youth in all regions only as reported
• **HPR I data includes Catawba only; awaiting number of Piedmont Geriatric admissions at time of publication
• ***HPR II DAP includes 111 ongoing clients and 26 one-time
Integrated
Care
Child Mobile Crisis
1,332
Support
Services
CIT Assessment Center
27
Children &
Youth
People & Services
TOTAL INDIVIDUALS SERVED STATEWIDE IN FY2015 (UNDUPLICATED COUNT) = 232,079
Emergency & Ancillary Services
Behavioral
Health
TOTAL EMERGENCY SERVICES
Motivational Treatment Services
5,455
Consumer Monitoring Services
8,336
Early Intervention Services
2,620
Assessment and Evaluation Services
79,653
TOTAL ANCILLARY SERVICES
96,064
Mental Health
Services
SERVICES
Developmental
Services
69,153
Acute Psychiatric or SA Inpatient Services
Consumer run programs also served 8,401 individuals in FY 2015.
These services are not reported to CCS3 (DBHDS’ database) and are not
included in the totals of this table.
Total unduplicated count receiving Ancillary Services = 90,007
Developmental
Services
2,474
SA Inpatient Medical Detox
TOTAL INPATIENT SERVICES
2,474
Outpatient Services (includes pharmacy
medication supports for 12,266 individuals)
95,666
614
People, Services
& Funding
Regional
Programs
Workforce
Development
Integrated
Care
Support
Services
Intensive Outpatient
Medication-Assisted Treatment
Assertive/Intensive Community Treatment
Total
23
2,497
256
256
279
2,753
25,393
121,673
1,887
1,887
2,090
2,090
1,862
1,862
TOTAL OUTPATIENT SERVICES
97,528
614
29,370
127,512
CASE MANAGEMENT SERVICES
60,404
18,513
10,037
88,954
701
6,256
Day Treatment/Partial Hospitalization
5,555
Ambulatory Crisis Stabilization Services
2,315
409
Rehabilitation
4,695
2,833
43
7,571
12,565
3,242
744
16,551
53
2,704
TOTAL DAY SUPPORT SERVICES
Sheltered Employment
2,724
27
683
Transitional or Supported Employment
1,510
1,141
Supported Employment - Group Model
65
746
1,602
2,570
53
4,225
87
262
3,179
3,528
Residential Crisis Stabilization Services
4,906
319
124
5,349
Intensive Residential Services
473
957
1,935
3,365
Supervised Residential Services
1,021
479
352
1,852
TOTAL EMPLOYMENT SERVICES
Highly Intensive Residential Services
710
811
Supportive Residential Services
4,794
1,081
138
6,013
TOTAL RESIDENTIAL SERVICES
11,281
3,098
5,728
20,107
TOTAL INDIVIDUALS SERVED WITHIN
PROGRAM & SERVICE AREA
(Individuals may have received more than one
service within program)
185,854
28,037
46,211
260,102
The figures below indicate the unduplicated count of individuals who received services within each program area.
The last column is the statewide unduplicated count of individuals served in any program area at the CSB level
(including emergency and ancillary services) and is not the total of the other three columns.
UNDUPLICATED COUNT OF INDIVIDUALS
SERVED WITHIN PROGRAM AREA
118,919
Sources: DBHDS 2015 CCS data
28
Substance Use Disorder
Services
Virginia Association of Community Services Boards
21,235
32,964
232,079
People & Services
Children &
Youth
All 40 Infant and Toddler-PartC Programs served a total of 17,022 individuals.
30 CSBs offer Infant and Toddler - Part C services.
Behavioral
Health
Source: DBHDS PART C data, 2015
Individuals Served by Program & Age Group FY 2015
Mental
Health
Developmental
Substance Use
Disorder
Emergency
Ancillary
Unduplicated
Total
0 - 17
36,034
4,202
2,035
11,784
33,632
63,355
18 - 64
77,777
16,058
30,652
52,347
54,576
158,117
65+
5,092
975
274
4,737
1,775
10,292
Unknown
16
-
3
285
24
315
118,919
21,235
32,964
69,153
90,007
232,079
SMI
0 - 17
18 - 64
49,838
65+
3,719
53,557
At-Risk
23,762
3,943
23,762
3,943
Workforce
Development
TOTAL
SED
Integrated
Care
Individuals Served by Age Group & SMI/SED FY 2015
Support
Services
TOTAL
Developmental
Services
Age
Group
Developmental
Substance Use
Disorder
Emergency
Ancillary
Total
Individuals
118,919
21,235
32,964
69,153
90,007
Medicaid
65,124
18,201
8,322
21,318
41,475
Percent
of Total
55.0%
86.0%
25.0%
31.0%
46.0%
People, Services
& Funding
Mental Health
Regional
Programs
Unduplicated Individuals with Medicaid Coverage FY 2015
Source: DBHDS 2015 CCS data
2015 Annual Report
29
People, Services
& Funding
30
State
Mental Health
Local
Virginia Association of Community Services Boards
Medicaid
Developmental Disabilities
$41,492,263
Federal
Federal
Other
Substance Use Disorders
$3,992,262
54,018,261
5%
$5,325,865
Medicaid
$12,525,998
$220,735,981
Local
$243,056,184
$38,804,871
State
$13,413,700
$121,691,869
Support
Services
Developmental
Services
277,255,917
26%
$95,148,707
$47,874,478
Integrated
Care
Behavioral
Health
Children &
Youth
Funding Sources
FY 2015
$6,000,802
$0
Workforce
Development
$204,207,305
$25,174,134
Regional
Programs
Funding
477,205,865
44%
255,645,447
24%
15,319,429
1%
Other
Funding by Program
FY 2015
VACSB Policy & Budget Priorities
2016 - 2018
Developmental Disability Services and Supports
•
Fund 200 Developmental Disability Waiver slots in FY16 as required by the DOJ
settlement agreement
•
ContinuetofundI/DDWaiversrequiredbytheDOJsettlementagreement
(300 in FY17 & 325 in FY18)
•
Fund800IndividualandFamilySupportWaiverslotsinbothFY2017&FY2018
•
Increaseflexiblefamilysupportsfundingtoreducecrisissituations&keepfamiliestogether
in their own homes
Behavioral Health Services and Supports
•
Provide evidence-based Medication Assisted Treatment (MAT) for individuals addicted to opiates
by supporting expanded use of buprenorphine in all 40 CSBs
•
ExpandcurrentcapacityofMedicalDetoxificationadministrationinmedicalfacilitiesstatewide
•
Supporthiringand/orcontractingforadditionalpsychiatricservicestoincrease
immediate access
•
Fundreintegrationservicesforyouthandadultswhoarehigh-riskforre-hospitalizationand/or
criminal justice involvement due to the degree and acuity of their behavioral health challenges
Early Intervention and Prevention Services
•
Provide Part C Early Intervention services to Virginia’s infants and toddlers with disabilities ages
birth to 3 years
•
Buildonregionalsuicidepreventionplanstoexpandcapacityandtocreateaninstructor
collaborative that decreases stigma and increases mental health literacy
•
Developastatewidemediacampaigntobringawarenesstosuicideprevention,includingwebsite
development and evidence-based program promotion
Workforce Development
•
Retain and recruit Licensed Mental Health Professionals (LMHPs) and license eligible staff
•
SupportcostsassociatedwithLMHPsupervisionhoursand/orloanrepaymentprogramsforstaff
hired by CSBs
•
Fundadditionalpeerstoincreaseaccesstoservicesanddecreasepsychiatrichospitalizations,
repeated detox admissions and arrests
2015 Annual Report
31
VIRGINIA ASSOCIATION OF COMMUNITY SERVICES BOARDS
ALEXANDRIA CSB
GOOCHLAND POWHATAN CSB
ALLEGHANY HIGHLANDS CSB
HAMPTON- NEWPORT NEWS CSB
ARLINGTON COUNTY CSB
HANOVER CSB
City of Alexandria
(703) 746-3400
Alleghany County; City of Covington
(540) 965-2135
Arlington County
(703) 228-5150
BLUE RIDGE BEHAVIORAL HEALTHCARE
Botetourt, Craig & Roanoke Counties;
Cities of Roanoke & Salem
(540) 345-9841
CHESAPEAKE INTEGRATED
BEHAVIORAL HEALTH
City of Chesapeake
(757) 547-9334
Counties of Goochland & Powhatan
(804) 556-5400
Cities of Hampton & Newport News
(757) 788-0300
County of Hanover
(804) 365-4222
HARRISONBURG-ROCKINGHAM CSB
City of Harrisonburg;
County of Rockingham
(540) 434-1941
HENRICO AREA MENTAL HEALTH AND
DEVELOPMENTAL SERVICES
Charles City, Henrico & New Kent Counties
(804) 727-8500
CHESTERFIELD CSB
HIGHLANDS CSB
COLONIAL BEHAVIORAL HEALTH
HORIZON BEHAVIORAL HEALTH
County of Chesterfield
(804) 748-1227
James City & York Counties;
Cities of Poquoson & Williamsburg
(757) 220-3200
CROSSROADS CSB
Amelia, Buckingham, Charlotte,
Cumberland, Lunenburg, Nottoway &
Prince Edward Counties
(434) 392-7049
CUMBERLAND MOUNTAIN CSB
Buchanan, Russell, & Tazewell Counties
(276) 964-6702
DANVILLE-PITTSYLVANIA CSB
Pittsylvania County; City of Danville
(434) 799-0456
DICKENSON COUNTY
BEHAVIORAL HEALTH SERVICES
Dickenson County
(276) 926-1680
DISTRICT 19 CSB
Dinwiddie, Greensville, Prince George, Surry &
Sussex Counties;
Cities of Colonial Heights, Emporia,
Hopewell & Petersburg
(804) 862-8054
EASTERN SHORE CSB
Accomack & Northampton Counties
(757) 442-3636
FAIRFAX-FALLS CHURCH CSB
County of Fairfax; Cities of Fairfax &
Falls Church
(703) 324-7000
Washington County & City of Bristol
(276) 525-1550
Amherst, Appomattox, Bedford, &
Campbell Counties; Cities of Bedford
& Lynchburg
(434) 847-8050
PIEDMONT CSB
Franklin, Henry & Patrick Counties;
City of Martinsville
(276) 632-7128
PLANNING DISTRICT ONE
BEHAVIORAL HEALTH SERVICE
Lee, Scott, & Wise Counties; City of Norton
(276) 679-5751
CITY OF PORTSMOUTH DEPT OF
BEHAVIORAL HEALTHCARE SERVICES
City of Portsmouth
(757) 393-8618
PRINCE WILLIAM COUNTY CSB
County of Prince William; Cities of
Manassas & Manassas Park
(703) 792-7800
RAPPAHANNOCK AREA CSB
Caroline, King George, Spotsylvania & Stafford
Counties; City of Fredericksburg
(540) 373-3223
RAPPAHANNOCK-RAPIDAN CSB
Culpeper, Fauquier, Madison,
Orange & Rappahannock Counties
(540) 825-3100
REGION TEN CSB
County of Loudoun
(703) 777-0378
Albemarle, Fluvanna, Greene,
Louisa, & Nelson Counties;
City of Charlottesville
(434) 972-1800
MIDDLE PENINSULANORTHERN NECK CSB
RICHMOND BEHAVIORAL HEALTH
AUTHORITY
LOUDOUN COUNTY CSB
Essex, Gloucester, King & Queen,
King William, Lancaster, Mathews,
Middlesex, Northumberland, Richmond &
Westmoreland Counties
(804) 758-5314
MOUNT ROGERS CSB
Bland, Carroll, Grayson, Smyth, &
Wythe Counties; City of Galax
(276) 223 -3200
NEW RIVER VALLEY
COMMUNITY SERVICES
Floyd, Giles, Montgomery &
Pulaski Counties; City of Radford
(540) 961-8300
City of Richmond
(804) 819-4000
ROCKBRIDGE AREA CSB
Bath & Rockbridge Counties;
Cities of Buena Vista & Lexington
(540) 463-3141
SOUTHSIDE CSB
Brunswick, Halifax & Mecklenburg Counties
(434) 572-6916
VALLEY CSB
Augusta & Highland Counties;
Cities of Staunton & Waynesboro
(540) 887-3200
NORFOLK CSB
VIRGINIA BEACH HUMAN SERVICES
NORTHWESTERN CSB
WESTERN TIDEWATER CSB
City of Norfolk
(757) 823-1600
Clarke, Frederick, Page,
Shenandoah, & Warren Counties;
City of Winchester
(540) 636-4250
City of Virginia Beach
(757) 385-0505
Isle of Wight & Southampton Counties;
Cities of Franklin & Suffolk
(757) 255-7100