Tag Archive: children’s mental health

  1. Bill and Budget Explainer: School-based Mental Health Services

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    Virginia is poised to make significant progress in children’s mental health during the 2023 legislative session. Virginia ranked as 48th in Youth Mental Health access according to Mental Health America and recommendations were identified by JLARC in their report Pandemic Impact on K-12 Public Education. School-based mental health services are an integral component to address the youth mental health crisis as schools are often where children and youth form positive and trusting relationships with adults and peers to address their needs. However, we have seen too many incidents where schools are not fully equipped to address mental health needs of students. We also must look to the future where federal ESSER funds that have boosted school-based mental health responses are scheduled to end.

    Actions taken by the General Assembly in recent years to improve the ratio of counselors to students, create school-based mental health integration programs, seek the reversal of the “free care rule” to bill Medicaid for school-based services, integrate mental health into Standards of Learning and regional Recovery High Schools have created the positive momentum for further action this year. In addition, we have seen the expansion of federal grants included in the Bipartisan Safer Communities Act and recent guidance from the Centers on Medicaid and Medicare Administration to leverage Medicaid to pay for school-based services. Read more about Medicaid funding for school-based services here.

    Legislation Considered by Education Committees

    SB1043 (McPike) | HB2124 (Wilt) | HB2187 (Rasoul) – School mental health and counseling, definitions, licensure requirements – SUPPORT

    The Senate version of this legislation incorporates the two policy changes in the House bills to refine the roles of school counselors and to provide flexibility in staffing for school psychologists. To help improve coordination of services, the Senate version also includes a directive to the Department of Education (DOE) to work with Department of Behavioral Health and Developmental Services (DBHDS) to develop a model Memorandum of Understanding for school-based partnerships with community-based mental health providers.

    SB1300 (Deeds) – Elementary & secondary school teachers, public: requirements, trauma-informed care training – SUPPORT

    This Senate bill outlines a training program for classroom teachers to receive training every three years developed by the DBHDS related to recognizing and addressing childhood trauma. This bill was conceived by a youth advocate, Elijah Lee. A budget amendment in the Senate budget provides funds to DBHDS to develop the training.

    SB1325 (McClellan) – Standards of Quality Specialized Support Positions – SUPPORT

    While there is shared interest in building on the Standards of Quality in the General Assembly, SB1325 that has passed the Senate and is being considered in the House specifically addresses the specialized student support positions (school social workers, school psychologists, school nurses, licensed behavior analysts, licensed assistant behavior analysts, and other licensed health and behavioral positions) intended to address student mental health and behavior supports. The budget conference committee negotiators should include $57 million in additional resources to improve the ratio of specialized student support personnel.

    SB818 (Spruill) – Programs of instruction on mental health education – SUPPORT

    This legislation adds additional specificity to the 2018 legislation that added mental health to the physical and health education Standards of Learning. This legislation outlines more specific curriculum guidelines to improve technical guidance to school divisions for age-appropriate sequential instruction and for local school boards to develop and implement policies related to mental health instruction.

    Budget Amendments Considered by House Appropriations and Senate Finance and Appropriations Committee

    Department of Behavioral Health and Developmental Services/Department of Education

    School Based Mental Health Integration Grants

    Last year, the General Assembly approved the first state-funded school-based mental health integration grants allowing DBHDS to offer grants to school divisions to expand school-based mental health services and community partnerships. Lawmakers should encourage DOE and DBHDS to collaborate on these efforts and should help define the roles for each agency. DOE should have oversight for school division implementation and DBHDS should provide expertise on  mental health services. In comparison, federal efforts for school-based mental health services are designed as a collaboration among Education and Health and Human Services. For example, both DBHDS and DOE have been awarded additional resources under the Bipartisan Safer Communities Act to implement school-based mental health services.

    • Recommendation: Establish grant funds at both DBHDS and DOE to leverage the expertise of DOE and DBHDS to expand school-based mental health partnerships. The General Assembly should create two grant funds this year of up to $15 million at both the DOE and DBHDS with specialized focus areas that utilize existing partnerships and centers of excellence. The focus of DBHDS should be on clinical expertise for developmental practice, screening and assessment tools, integration with community violence and substance abuse prevention services, and evidence-informed practices for mental-health treatment services in school-based settings. The focus of DOE should be on expanding the use of school-based mental health professionals, providing technical assistance for collaboration among school-based professionals (VPSMH), and integration with the Virginia Tiered Systems of Support (VTSS).

    Department of Education

    Virginia Tiered Systems of Support (VTSS)

    The House and Senate budgets both include additional funding to expand the Virginia Tiered Systems of Support in conjunction with recommendations from the Behavioral Health Commission. Currently, 58 school divisions participate in VTSS and have reported declines in school discipline referrals and school suspension. The Senate budget includes $1.5 million and the House includes $500,000 to expand VTSS.

    School Safety and Security Funding

    The House and Senate budgets both include additional resources to improve school safety and security. However, in light of several incidents of violence on school campus, or within a school community, such as the incidents at Richneck Elementary, we recommend that the purpose of these funds be expanded to not only to make school environments secure, but to also help respond to schools and communities when violence occurs.

  2. Prioritizing Youth Mental Health Requires Intention and Investment

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    Whether you are a young person, a parent, a mental health professional, or an educator, you have likely heard about the youth mental health crisis in the United States—it is being discussed everywhere, from kitchen tables to news stations to the Governor’s office. And while there is finally urgency around addressing the mental health needs of Virginians, we continue to see a catch-all response for adult and children’s mental health needs in our current policies. It is undoubtedly easier to design mental and behavioral health systems and services for adults and retrofit young people into them, but this results in supports that inadequately meet the needs of children and youth. To truly invest in the mental health of young people, policymakers must do so with intention. It requires centering the needs and experiences of young people—especially those who are Black, Latino, and LGBTQ+—and developing mental health services that prioritize healing and well-being.

    The past few years have been particularly difficult for young people. The Joint Legislative Audit & Review Commission’s (JLARC) November 2022 report shared several alarming statistics that articulate the dire need to intervene and support young people right now: 

    • Self-harm-related emergency department visits among Virginia youth, ages 9 to 18, more than doubled from 2016 to 2021, with the largest increase in self-harm visits occurring in 2021, according to the Virginia Department of Health, and   
    • Youth deaths by suicide, ages 9 to 18, averaged 4.9 deaths per 100,000 youth from 2015–2019, and were 6.2 per 100,000 youth in 2020 and 5.6 per 100,000 in 2021.

    Graph showing youth emergency room visits for self-harm have risen over time; increasing substantially in 2021

    This constitutes a youth mental health crisis. In order to meet this moment for youth mental health, there must be major shifts in how children and youth are prioritized in our system. Historically, new initiatives and service expansions have delayed the implementation of child- and youth-focused plans until phase two—a step that often takes too long to achieve. Mental health resources that are not intentionally designed to reach children and youth will not reach them.

    Capacity to build up the infrastructure at local Community Services Boards, particularly for children and youth, is needed. The ideal system offers young people mental health support when and where they need it, but the reality is children and youth do not have access to a comprehensive array of crisis response services depending on where they live, who pays for their care, and who helps them identify resources.

    Currently, there are only three Residential Crisis Stabilization Units (RCSUs) specifically for young people across the Commonwealth. One goal of Governor Youngkin’s “Right Help. Right Now.” behavioral health transformation initiativeis to add more youth RCSUs and to develop 23-hour Crisis Receiving Centers (CRCs) to serve as a “behavioral health urgent care”, both of which are critical components of the crisis services continuum. However, if the locations and services are not developed with young people’s needs in mind, they will not be as effective of a resource. Having a cross-lifespan model for RCSUs and CRCs that only incorporate child-sized recliners does not make a space child- and youth-friendly. The design of RCSUs and CRCs must be fundamentally different from the design of a traditional hospital, which are often sterile and unwelcoming environments. Young people need culturally and developmentally appropriate resources in these locations, such as places for their family members to rest, blankets, sensory toys and comfort items, and a warm and inviting environment to encourage healing and create emotional and physical safety.

    Virginia lawmakers have a chance to reimagine what it means to put young people’s needs at the forefront of their decision-making during the 2023 General Assembly session. Between Governor Youngkin’s proposed budget and several budget amendments before the legislature, there are opportunities to ensure behavioral health services are available in every region and designed with the needs of children and youth in mind. This includes expanding crisis response services with components specific to children and youth and providing adequate resources to build the capacity of the system.

    TAKE ACTION: We urge lawmakers to prioritize young people’s healing and well-being. This can be done by making a targeted investment in youth mental health through the state budget.

    Build out crisis response and stabilization services that offer young people support when and where they need it.

    • Continue the expansion and modernization of the statewide crisis services system by investing in crisis receiving centers and crisis stabilization units. Hire a staff member to oversee Children’s Crisis Response Services.
      • Support the Governor’s proposed budget to increase funding for a comprehensive crisis services system | $58,345,204
    • Fund contracts with private providers to establish mobile crisis units in underserved areas.
      • Support the Governor’s proposed budget to provide one-time funds for mobile crisis units | $20 million

    Prioritize young people in the design and implementation of mental health services.

    • Build upon the base of $8.4 million the legislature has provided since SFY2017 to expand or enhance children’s behavioral health services in all five Department of Behavioral Health and Developmental Services (DBHDS) health planning regions and keep a dedicated focus on infrastructure specific to children and youth services within DBHDS’s Office of Child and Family Services.
      • Support budget amendments for Children’s Behavioral Health Services: Item 313 #1h (Price)/Item 313 #6h (Seibold); Item 313 #5h (Rasoul); Item 313 #3s (Favola)

  3. Improving Medicaid Reimbursement for Children’s Mental Health Services

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    Nearly half of Virginia’s children are enrolled in Medicaid for their health insurance coverage. To ensure that these young people have access to mental health providers, and for those providers to adequately compensate staff, reimbursement rates for behavioral health must be increased this year.

    Medicaid-funded services for children’s behavioral health has declined by $100 million since the beginning of the pandemic, largely due to the phase-out of Therapeutic Day Treatment Services in schools. While the dollar amount of funding has decreased, more children and youth have sought mental health services since the pandemic, meaning that services have not adequately kept pace with needs. Furthermore, only 14% of children on Medicaid are receiving behavioral health services, a significant gap below the need expressed in the general population of children and youth where 30% or more of young people express mental health concerns. Black and Latino children are disproportionately enrolled in Medicaid and report more barriers to accessing mental health care.

    Medicaid reimbursement for children’s mental health services has declined by $100 million since the pandemic, despite an increase in children seeking services. (Bar on the far right does not represent a full year.)

    The members of the General Assembly will consider several proposals to improve Medicaid reimbursement for behavioral health services. The options below can put Virginia on a path forward to bringing more behavioral health resources into schools and reaching more students who need mental health support.

    The Solutions:

    Medicaid rates must keep pace with inflation and ensure adequate staff compensation.

    Short-term solution: increase community behavioral health services rates in FY24

    • Support 304 #9s (Deeds)/304 #23h (Farriss): Medicaid Reimbursement Rates for Community-Based Behavioral Health Services

    This proposal would provide:

    • 25% rate increase for:
      • Intensive In-Home, Mental Health Skill Building, Psychosocial Rehabilitation, Therapeutic Day Treatment, Outpatient Psychotherapy, Peer Recovery Support Services — Mental Health.
    • 10% rate increase for BRAVO services:
      • Comprehensive Crisis Services (which include 23-hour Crisis Stabilization, Community Stabilization, Crisis Intervention, Mobile Crisis Response, and Residential Crisis Stabilization), Assertive Community Treatment, Mental Health – Intensive Outpatient, Mental Health – Partial Hospitalization, Family Functional Therapy and Multisystemic Therapy.

    And a long-term solution: conduct a rate study to determine inputs to delivering care and suggest a process for annual rate increases based on inflation.

    Modernize reimbursement rates for school-based mental health.

    Long-term solution: conduct a rate study on school-based mental health services to replace the currently offered service—therapeutic day treatment “TDT”. The future of behavioral health redesign planned to look at this service and develop new school-based services connected to multi-tiered systems of support in school. 

    • Support Medicaid Rate Studies for Behavioral Health 308#7s (McClellan)/ 308#11s (Brewer)

    This proposal provides a long-term solution to modernizing school-based mental health services and empowers young people to help design those services.

    • Youth voice/choice: this amendment specifies that students and school-based stakeholders must be involved in the design of school-based services.

    Provide TA to School Divisions to Implement Medicaid Reimbursement

    In a follow-up to the 2021 legislation proposed by Sen. Dunnavant to implement the “Free Care Rule” in Virginia, our state Medicaid agency has an application pending approval at the federal level to allow school divisions to bill Medicaid directly for school-based health and mental health services outside of a students’ IEP. This would enable school divisions to pull down a dollar-for-dollar match for the health services provided or initiated by schools. There is a catch though. School divisions will have to take on extra administrative tasks in order to seek reimbursement. This proposal allows DMAS to provide resources to DOE and school divisions to provide technical assistance and professional development to seek reimbursement.

    • Support Technical Assistance to School Divisions to Implement Medicaid Reimbursement Item 308#13s (McClellan)

  4. 9-8-8 is Just One Step Towards a Comprehensive Crisis Services System

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    This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.

    For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.

    The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people

    The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.

    Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.

    four level call matrix

    This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.

    At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.

    For 9-8-8 to be truly transformative, investments are needed now.

    While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:

    • Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
    • Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
    • More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
    • Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
    • Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
    • Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
    • Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.

    Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.

    To learn more about Virginia’s plan for crisis system transformation, visit these resources: Virginia’s Crisis System Transformation and Marcus Alert and STEP-VA.

  5. Youth Mental Health Crisis

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    Written by Voices’ intern Abby Aquije

    Increasing mental health resources and access to behavioral health services is a necessary step to mend our youth mental health crisis. If we are truly committed to ending this crisis, we must also consider what factors lead to the situation getting this bad. What is different about our youth today? What has gotten us to this crisis point?

    Youth are feeling alone and disconnected

    Our youth are facing an unprecedented number of stressors that can explain rising rates of depression and anxiety among children and adolescents. Gen Z youth are experiencing stress from sources ranging from school demands to family issues, and even “eco anxiety.” Though these statistics tell us that most youth are struggling with similar hardships, those that work closest to them assure us that this is not how they see it. Recent conversations with Virginia youth directors have made it clear that a key element in this crisis is that youth are feeling alone and disconnected from those around them.

    Most of us have been there, feeling as if we are the only ones stressing about school, social image, or family issues, when in reality the majority of us go through similar issues. As a society, we are becoming more open about mental health issues, yet, there is more to be done. If youth do not feel comfortable talking about their struggles, they will continue to feel alone. Think of a student falling behind in a class. On top of feeling the academic stress, they may also feel shame, which could lead to feelings of isolation and then more serious mental health issues. Even in the Netherlands – whose COVID-19 response included short lockdowns, equitable funding, and high rates of broadband access – student test results revealed a learning loss. How can a student blame themselves for something that is happening globally, even in “best case” scenarios? Why is it that they feel shame rather than solidarity?

    The COVID-19 pandemic has worsened the already concerning rates of loneliness

    Loneliness is being described as an epidemic, with over 60% of young adults feeling it. They are unable to connect with those around them and have to tackle their challenges alone. This all makes the perfect recipe for deteriorating physical and mental health issues that must be addressed.

    High rates of youth loneliness can easily be attributed to the COVID-19 pandemic: the nationwide lockdowns, social distancing, and virtual schooling all caused disconnection. Efforts to boost human connection were admirable, but the damage is done. No amount of virtual connection can make up for the formative middle school years, high school celebrations, and other important in-person experiences youth missed. While it is easy to point fingers at the pandemic, we cannot forget that these rates were rising prior to it. Social media and changing family structures also play a role in limiting the connections youth build with one another.

    Program Response: Employ connectedness strategies

    As we move forward, we have to be more intentional about forming and maintaining connections. Those that work with youth should prioritize creating spaces for youth to meet and truly connect with one another. Youth thrive when they feel they belong, they need to know that people hear and care about them.

    Most parents and caregivers know the importance of forming secure attachment in early childhood and actively work toward developing it. Attachment building paves the way for healthy and independent children, however, as they grow up there is less of an emphasis on developing and maintaining these sorts of connections. It is important for kids to learn independence, but no one can survive on their own, not physically or mentally. It is no surprise that youth connectedness is a protective factor for negative mental health outcomes and that the CDC supports the implementation of connectedness strategies, policies, and activities. As we move forward, we must value building youth connections just as much as we do infant attachment building.

    Policymakers should push for Peer Support Services before crises arise

    Peer support is an evidence-based practice used to help individuals cope with mental health challenges and improve quality of life. In addition to being cost-saving, it has been shown to be more effective than usual care for treating depression, and is especially engaging for “difficult to reach” individuals. Virginia already has qualified peer support providers that use their lived experience with mental health and substance use disorders to help others with their recovery. These providers are important for recovery once mental health challenges arise; however, their experience can also be beneficial for preventative measures before the issues arise. Programs like Hoos Connected, at the University of Virginia, use a form of peer support by having upperclassmen facilitators bring students together to develop meaningful connections with one another.  Students that participate in these programs report feeling significantly less depressed and as a former facilitator, I can attest to the difference the 9-week program makes. Despite its limitations – mainly the challenge of enrolling youth into a “feelings” class – there is a lot of promise to programs like these.

    Combating the loneliness epidemic will take time as it requires youth buy-in and societal shifting. Working alongside young people as we continue to research and develop solutions will be essential as we move forward in an effort to improve the overall mental health of our youth.

  6. How the 988 Hotline Can Break Down Systemic Barriers to Health Care

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    This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.

    **This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.

    On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.

    Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.

    The Need for a Lifesaving Hotline

    Suicide is the second-leading cause of death among young people aged 10 to 24. However, deaths from suicide are only part of the problem. Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at emergency departments across the U.S.

    The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.

    In Virginia, the percentage of students who experienced feeling sad for two weeks or more increased significantly from 2011 (25.5%) through 2019 (32.4%). And among those who reported feeling sad for two weeks or more, 39.1% reported that they considered attempting suicide, 29.5% made a suicide plan, 18.0% attempted suicide and 4.9% made an injurious suicide attempt.

    The pandemic is deteriorating children’s mental health to new lows, with more than 25% of high school students nationally having reported worsened emotional and cognitive health.

    Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019

     

    Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021

     

    Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021

    Barriers to Accessing Mental Health Services

    Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.

    As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”

    LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).

    LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.

    Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.

    These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.

    As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.

    Stay tuned for more on the 988 hotline and children’s mental health.

  7. General Assembly 2022: Mental Health Wrap-Up

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    The momentum was in place for children’s mental health in Virginia. The US Surgeon General and key advocates declared a national emergency to confront a decade-long decline in children’s mental health. Despite widespread concern, Governor Northam’s original budget proposal did not fund new programs in schools for children’s mental health. To meet the moment, a bipartisan group of legislators and advocates from various communities lobbied for investments in psychological services and counseling. Additional resources of $1.4 million per year will expand the Virginia Mental Health Access Program to integrate services in health care settings. Noted below are other new investments integrating mental health in school settings, increasing reimbursement rates, and supporting the workforce.

    A First Step for School-Based Mental Health Integration 

    Over the last three years, the General Assembly has focused on improving school-based mental health by funding specialized student support positions—counselors, social workers, and psychologists. While students have benefited from better relationships with faculty, COVID presented unanticipated disruptions, rapidly increasing needs, and barriers to vital care. School divisions have responded by allocating federal recovery funds into training, coaching, and even bringing community-based mental health professionals into schools.

    However, federal support during this emergency is impermanent and mental health threats are ongoing. School divisions need resources to continue to support these efforts. Voices led advocacy for additional state general fund resources supporting school-based mental health in flexible ways to assist school divisions in identifying key partnerships and resources. The General Assembly allocated $2.5 million in FY23 to begin supporting school-based mental health services and included language asking the newly established Behavioral Health Commission to study how schools can better integrate mental health services with sustainable funding streams such as Medicaid.

    The General Assembly also approved funding to establish a regional Recovery High School based in Chesterfield where substance abuse recovery is incorporated into the school day. The proposal by Delegate Carrie Coyner was finally approved after the 2020 COVID response cut funding. Other high schools will be able to look toward this model to support health needs in the classroom.

    Senator Jennifer McClellan has been a significant leader on school based mental health and increasing resources for school-based professionals. Read more in her Op/Ed in the Fredericksburg FreeLance Star.

    Addressing Workforce Shortages

    The lynchpin to support the social and emotional well-being of students is having an appropriate workforce. We are excited about two changes that will help address pressing workforce challenges.

    The House and Senate approved HB829, proposed by Del. Tony Wilt, that will provide flexibility on a provisional basis for licensed mental health professionals without certification to work in school-settings. This flexibility will ensure that school divisions can hire more mental health staff.

    The budget adopted by the General Assembly includes funding for a new initiative to help mental health professionals seeking licensure when they must pay for their supervision time out-of-pocket. The new initiative, Boost200, will provide resources to cover out-of-pocket expenses for licensure and match them with approved supervisors. This initiative is poised to make a significant impact on removing barriers towards licensure and diversifying the mental health field. Learn more about participating to address licensure costs or to work as a supervisor.

    Improving Medicaid Reimbursement Rates

    The third area that the legislature improved on mental health services was improving Medicaid reimbursement rates for several mental health services. Federal funds from the current “public health emergency” have increased payment rates for community-based services by 12.5%. The General Assembly approved resources to continue financing those services. The General Assembly also improved rates for psychiatric residential treatment facilities. Many facilities served children from other states and lacked placements for children in Virginia, leading to greater instability for the hardest to place children, who are the focus of the Safe and Sound Task Force. The increased rates should help caregivers meet immediate needs, but challenges remain to ensure that children are not placed in inappropriate and lengthy stays in congregate settings. While increasing Medicaid rates is a positive step, adequate reimbursement is essential to looking after the mental health of economically disadvantaged children and vulnerable children in the foster care system.

  8. General Assembly 2022: Health and Wellness Wrap-Up

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    Understanding the social determinants of health (SDOH) that impact children’s lives informs how we advocate for policies that improve the health and well-being of all children, especially children of color and economically disadvantaged children. During the 2022 General Assembly Session, Voices joined partners, advocates, and youth in asking lawmakers to invest in equity and provide access to language services across state agencies, healthy and nutritious foods, and comprehensive health care.

    After months of negotiation, the legislature has reached an agreement on the state budget, including many of these initiatives. Policy changes in legislation and budget language have made progress towards holistically addressing the inequities and disparities faced by Virginia’s children and families.

    Creating an Equitable Health Care System

    • HB 987, sponsored by Delegate Tran, was signed into law and requires the Board of Medical Assistance Services to ensure that all medical assistance program information provided to applicants is made available in a manner that is timely and accessible to individuals with limited English proficiency through language access services. This includes oral interpretation, written translations, and auxiliary aids and services for individuals with disabilities as a reasonable step to provide meaningful access to health care coverage.
    • HB 229, sponsored by Delegate Coyner, was signed into law and requires the Department of Health to collect and analyze information, including demographic data, regarding social determinants of health and their impact on health risks and health outcomes of Virginians.
    • To address Medicaid enrollment, language is included in the budget directing the Secretary of Health and Human Resources to establish a Task Force on Eligibility Redetermination. This task force will help plan and advise the Department of Medical Assistance Services on the unwinding process to ensure Virginians do not lose healthcare coverage. The language also adds American Rescue Plan Act (ARPA) funding to be used for operational challenges linked to eligibility redetermination, such as technology needs and paying staff overtime at local DSS agencies.
    • The legislature has directed $2.5 million in FY23 to continue the contract for an integrated e-referral system for one year. It is expected that the e-referral system will continue beyond FY23 with user fees supporting its operations. The purpose of the system is to connect government agencies, health care providers, and community-based partners to enable participants in the system to refer patients to public health and social services.

    Increasing Language Access and Equity

    • While the funding amount was reduced from the original budget, $2.5 million per fiscal year remains in the current budget to be provided to state agencies for facilitating and improving language access. This funding will allow each state agency to designate a language access coordinator who will be responsible for making sure that agency materials and communications are accessible to all Virginians, especially those who have limited English proficiency.

    Increasing Food Access and Nutrition Security

    • To ensure access to healthy and nutritious foods and boost the buying power of the Supplemental Nutrition Assistance Program (SNAP) benefit for fruits and vegetables at farmers markets and food stores, $1 million per fiscal year will be directed to Virginia Fresh Match.
    • HB 582, sponsored by Delegate Roem, was signed into law and requires public institutions of higher education to ensure that young people in college have access to information on SNAP benefits, including eligibility and how to apply. The bill also requires each institution to advertise information on the SNAP benefit process on their website and in orientation materials distributed to students.
    • HB 587, sponsored by Delegate Roem, was signed into law and requires every public elementary or secondary school to process web-based or paper-based applications for participation in the School Breakfast Program or the National School Lunch Program, administered by the U.S. Department of Agriculture, within five working days after the date of receipt of the application.

    Creating a future where Virginia’s children can thrive will require intersectional approaches, including equitable, healing-centered policies that dismantle systemic barriers so that all young people can lead long, healthy, and successful lives. While the budget takes important steps forward, we must continue uplifting youth voices to improve policies impacting their health and well-being.

  9. 2022 General Assembly Budget Passes with Bipartisan Progress for Kids

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    Click here to register for our upcoming Zoom webinar on June 14 as we discuss General Assembly results and what they mean for children and families in Virginia.

    After several months of negotiations and discussions among key decision makers, the General Assembly has reached an agreement on the budget. This year’s budget had notable investments in early education, foster care, and children’s mental health through bipartisan support. Since budgets are a reflection of priorities, we believe there are improvements Virginia can make to demonstrate its commitment to young people in the commonwealth.

    Notable investments in the final budget compromise include:

    • Expanding affordable, accessible early childhood education for young children around the state. The budget builds on Governor Northam’s vision to expand early childhood programming and provides funding for regional initiatives in Southwest Virginia and early intervention services for infants and toddlers with developmental delays.
    • State funding for school-based mental health integration projects linking mental health services into schools. The legislature approved $2.5 million for school-based mental health projects as well as the first regional recovery high school in Virginia.
    • New initiatives to address long-standing challenges in the child welfare system include replacing the outdated child welfare data tracking system and the iFoster web-based portal for youth, expanded regional collaboration for foster placements, and additional support for foster youth seeking associate’s degrees to participate in Great Expectations.
    • $1 million each year to boost the buying power of SNAP benefits to purchase fruits and vegetables at farmers markets and community retailers.

    We are proud to stand by the youth and young adults who advocated with us for these investments. And we will continue to speak up for policy changes designed to meet their needs.

    As one of our youth advocates said,

    “Mental health is the same thing as your physical health. It’s just as important, if not more important, so we really need to prioritize that and make it so that everybody has equal opportunities.”

    – (Aaliyana, 16 years old).

    While these initiatives will continue to create new opportunities for young children to grow and thrive, the foundation of their success is economic stability. The rate of children experiencing poverty has remained consistent for decades in Virginia with persistent racial disparities in the percentage of Black and Latino children living in poverty than their White peers. A solid foundation for child well-being rests on a solid financial foundation for their families.

    As a significant commitment to families, the General Assembly approved a partially refundable Earned Income Tax Credit (EITC):

    • Low-income working families who have a higher-than-average tax burden will see 15% of the value of their federal refund returned as a state tax credit.
    • In addition, this summer, taxpayers will receive one-time rebates of $250 for single families and $500 for married couples.

    The refundable EITC for families demonstrates that lawmakers can take necessary action to address long-standing challenges for families that were exacerbated by the pandemic. There will be more work to do to ensure that families receive economic support and stability that will address decades-long trends in child poverty and ever-increasing material hardship experienced by families across the state.

  10. A National State of Emergency in Children’s Mental Health

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    Advocates, school personnel, mental health clinicians, and families have been saying for years – even before the pandemic –  that children’s mental health access is in a state of emergency. Over the summer, we heard from outpatient treatment clinicians who had months-long waiting lists and emergency departments that were filling up with children in mental health crisis without other options. As school returned, more reports of mental health and behavioral disruptions resonated across the Commonwealth. Now, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association are declaring a “National Emergency” in children’s mental health.

    Virginia lawmakers are paying attention too. During a discussion about education funding in a Senate Finance Committee meeting, Senator Jennifer McClellan stated, “the kids are not okay.” The compounded effect of the pandemic, racial trauma, and individual traumatic experiences are causing anxiety, depression, and more severe mental health issues in students. It was evident to Senator McClellan as a parent that mental health is causing major distress and barriers to learning.

    Young people are ready for policymakers and leaders to address this emergency.

    Justice, a young adult in Richmond told us this week, “I believe that if we can put more free mental health services out there for young people to turn to if they don’t have somebody to talk to they won’t just keep things in and one day just explode… It’s okay to not be okay.”

    Children’s Mental Health Discussion Paper: October 2021

    Children’s mental health needs touch all systems and all aspects of life. To fully address children’s mental health issues, we need an “all-hands-on-deck” approach.  There are no easy solutions to address a “state of emergency” but there are many points to begin trying.

    Voices has released a discussion paper for lawmakers to tackle children’s mental health issues from the perspective of the child-student and outside any one silo. This paper is relevant for lawmakers serving on the education funding committee, health and human resources funding committees, and the newly formed Behavioral Health Commission. It also creates a framework for the incoming governor to tackle a pressing issue and create some opportunities to continue collaborative efforts such as the Children’s Cabinet.

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    The most important steps lawmakers must take to address the current emergency include:

    • Addressing workforce shortages. Children’s clinical workforce shortages existed even before the pandemic, but overall workforce shortages are contributing to even longer waits for care. We need to retain the current workforce, attract a future workforce, and align the current workforce to opportunities for licensure and appropriate reimbursement. We support a proposal in front of the Behavioral Health Committee and consideration for the governor’s budget to assist clinicians in paying for supervision towards licensure to help meet immediate needs. Additionally, retention bonuses proposed for providers in the public mental health system and loan repayment programs are critical. In the longer term, stakeholders and leaders should spend time defining the best fit for certain roles, particularly the roles that can be filled by Qualified Mental Health Professionals (QMHPs) in schools and community settings.
    • Building out the capacity of health providers to address mental health issues. Continuing efforts to expand the Virginia Mental Health Access Program to reach more health providers, such as emergency department staff, and enhancing awareness of early childhood mental health issues are necessary. Additional recruitment and professional development for the health care workforce to identify and address mental health needs can help children who might not have robust school-based services.
    • Facilitating connections between schools and community providers. School have gotten very creative at finding ways to meet mental health needs during the pandemic. And thanks to investments from state lawmakers, many have been able to add additional school counselors and specialized support staff. For these new initiatives to meet increased demand and increased severity of need, the schools will need support to implement trauma-informed and multi-tier support from the state Department of Education and from their school divisions.

    Additional federal resources and Medicaid reimbursement will be critical to supporting school-initiated services in the long-term. There are several opportunities to create strong support systems for student mental health with American Recovery Act funds, the recalibration of Medicaid-funded mental health services through Project BRAVO and the ability for schools to bill for health and mental health needs outside a students’ IEP through the “free care” rule. Stakeholders, students, providers and schools should come together on some ideal plans and programs to implement at the school and child care level to meet student needs.

    Read the paper in its entirety and continue to follow Voices on social media for updates.