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New Focus on Early Intervention and Psychiatric Care

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From the research committee meeting on January 16th:

After meeting with six local care providers and mental health organizations, our research committee has identified two reoccurring and urgent problem areas:

Psychiatric Care

Individuals have trouble accessing quality affordable psychiatric care for their children regardless of their income. There is a shortage of child psychiatric care in our area and many providers do not accept insurance and require private payment; limited providers accept Medicaid payments.

  • The average wait time for a psychiatric assessment through Region Ten is three months.
  • Region Ten only provides 9 hours of child psychiatric care each week for Charlottesville and Albemarle. They conduct only 3-8 psychiatric evaluations a month.
  • Care providers and mental health organizations shared that many kids are getting access to medication through their primary care physicians. Psychiatric medications are often outside their areas of expertise, and routine management is often outside their scope of service.
  • Anecdotal evidence from both our listening process and research visits alike has shown that there is a major lack in coordination between counselors and psychiatrists

Early Intervention

In the past, individuals have had trouble accessing preventive counseling services and do not know where to begin when they feel they are in need of help. Access to care and counseling early on is essential, seeing as one-half of all chronic mental illness begins by the age of 14; three-quarters by age 24.

  • 910 students utilized Student Assistance Program (SAP) counselors in public schools last year, which provide counseling for direct mental health problems (such as depression) as well as issues connected to mental health (such as bullying, family issues, or substance abuse).
  • SAP counselors are able to act as a central entry point in public schools, referring to 55 different mental healthcare providers and organizations.
  • Due to a loss in grant funding, the number of counselors in area schools will be reduced from 9 to 5 counselors in the 2014-2015 school year.

Last night’s committee meeting raised more specific questions about these two areas that we will continue to pursue in the coming weeks.

Mental Health Initiative Fact Sheet, 12/20/13

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IMPACT team and network members- please distribute this information to your congregations via phone calls, emails, letters or any way that you can think of to effectively engage your own congregation’s justice ministry and rodef tzedek networks!

The goal of research visits to this point has been to get a clearer picture of, and to clearly define the problem that we can take action on. After each visit, committee members in attendance shared the information about problems that they found to be the most glaring. The results are highlighted below.

Problems our community faces:

+ 376 students in Charlottesville and Albemarle public schools have seriously considered suicide at least once (SS/HS)

+ On average, families must wait three months to see a psychiatrist through Region Ten. Region Ten can only offer 9 hours of psychiatric care each week for all of Charlottesville and Albemarle families.

+ Due to a lack of psychiatric care, many individuals are being prescribed mental health medication through their primary care physicians who do not help with medication management (THC, CYFS).

+ Families and professionals both lack clarity on who can provide counseling and psychiatric services and at what price. As a result, finding services is done through word of mouth and informal networking (MHWC, THC, CYFS).

+ Access to counseling and other services often become inaccessible when a child turns 18 years old due to coverage changes (CYFS).

+ Student Assistance Programs, one of our community’s most effective preventive services that serves roughly 1,000 individual students each year, will be losing its grant funding in June (Region Ten, SS/HS).

This information has been gleaned from visits with:

+ Region Ten Child and Family Services: Our local Community Service Board (CSB). A CSB is the point of entry into the publicly-funded system of services for mental health, intellectual disability, and substance abuse in the state of Virginia. CSBs fall under the Virginia Department of Behavioral health and developmental services. Region Ten serves mostly provides services for people who are eligible for Medicaid or with low-income.

+ UVa Teen Health Center (THC): A UVa clinic that serves area teens. While they provide many other health services, in the area of mental health their main contributions are mental health assessments, referrals to other providers, and medication prescriptions by nurse practitioners.

+ Mental Health and Wellness Coalition (MHWC): a coalition of 17 agencies and organizations that work to improve mental health services in the region. They work specifically to improve care and access to care for adults.

+ Children, Youth and Family Services (CYFS): A local non-profit agency that provides free counseling to children, teens and families in crisis.

+ Safe Schools/Healthy Students (SS/HS): a federal grant program which seeks to gather information about student needs in local schools and develop appropriate programs from that information. In conjunction with Region Ten, they have funded 9 counselors in 13 schools who have collectively seen roughly 1,000 students a year.

Mental Health Jargon and Abbreviations

CHIP- Comprehensive Health Investment Program CHIP of Virginia is a non-profit organization responsible for the development, implementation and maintenance of a statewide network of community-based child health and family support programs in Virginia. In Charlottesville, they provide mostly home visits to help parents to navigate health care for their children.

CSA- Comprehensive Services Act The Comprehensive Services Act for At-Risk Youth and Families (CSA) is a law enacted in 1993 that establishes a single state pool of funds to purchase services for at- risk youth and their families. The state funds, combined with local community funds, are managed by local interagency teams who plan and oversee services to youth

CSB- Community Service Board A community services board (CSB) is the point of entry into the publicly-funded system of services for mental health, intellectual disability, and substance abuse. Our local CSB is Region Ten. CSBs fall under the Virginia Department of Behavioral health and developmental services

CSU- Court Service Unit Locally- or state-operated entities that provide services to a juvenile court, including intake, investigations and reports, probation, parole, case management, and other related services in the community. There are 35 CSUs in Virginia. In our district (16), services offered by the CSU and through community resources include: Shoplifting Program, Community Service Work Program, Community Attention Program, Restorative Justice, home-based counseling and substance abuse services provided through CSA funds.

CYFS- Children, Youth and Family Services A local nonprofit organization that addresses critical issues such as: child abuse and neglect, parenting support and education, childcare quality, teen and family conflict, and early learning opportunities for children.

Estimating Local Prevalence of Mental Health, (Study by Steven Stern) Focuses only on potential recipients of public mental health services and makes no attempt to estimate individual demand. Studies adult populations only.

FAPT- Family Assessment and Planning Team Develops service plans for eligible youth and families and reviews cases funded by the Comprehensive Services Act to determine progress, prepare transition plans, and adjust services as needed. The FAPT studies and discusses information from case managers, parents and/or guardians, psychological reports, school records, and other pertinent data sources. The youth’s family is strongly encouraged to attend and participate in the FAPT meeting.

Integrated Care (Information gleaned from meeting with the Mental Health and Wellness coalition) A whole care team working with a patient, having a full spectrum of care within one agency. This results in “warm hand-offs” from one provider to another. When this happens patients are more likely to return for mental health services. This is being best developed for adults with the coalition, however we haven’t found an agency or group that is building this for children.

MHA- Mental Health America The main goals of MHACA have been and continue to be education and advocacy for protecting and improving the mental health of persons in the local region of Charlottesville City and Albemarle County. They are connected to the Mental Health and Wellness Coalition via a community nurse who conducts screenings and refers patients to appropriate care.

MHI- Mental Health Initiative State funds used to cover kids who do not qualify for Medicaid. Region Ten uses these funds.

NAMI- National Alliance on Mental Illness A non-profit self-help support and advocacy organization made up of consumers, families and friends of people with severe mental illnesses. Part of a national network.

Region Ten Our local Community Service Board. Mostly provides services for people who are eligible for Medicaid or with low-income.

Safe Schools/Healthy Schools Program funded by a federal grant-making program to stop violence and risk behaviors in schools. Safe Schools/Healthy Students has worked with our schools and grant partners to identify needs and gaps. Neta Davis at Region Ten said that their Student Assistance Program (SAP) is one of the most effective prevention programs our community has, but that the grant funding for this program runs out in June.

SAP- Student Assistance Program Counselors A program of Safe Schools/Healthy Schools. By placing counselors in all of the Albemarle County and Charlottesville City middle and high schools, support is making access to quality mental health care possible for all students. Services can be initiated by teachers, parents, counselors, students themselves, or other school professionals. Nine Counselors across 13 schools are seeing almost 1,000 students each year.

 TDT- Therapeutic Day Treatment An elementary and middle school-based program that helps children who are having behavioral difficulties. Through in-class behavioral coaching, problem solving and daily positive reinforcement, kids learn how to be aware of and change their behavior, enabling them to be more successful as students. Region Ten currently has 40 staff in 26 schools. Also know as Educational Support Services (ESS).

TJHD- Thomas Jefferson Health District Falls under the Virginia Dept. of Health. Provides public health services to Charlottesville, Albemarle, Fluvanna, Greene, Louisa, and Nelson