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Behavioral Health Commission Discusses Implementation of STEP-VA

The Behavioral Health Commission dedicated its July 26 meeting to exploring the implementation of STEP-VA, receiving briefings from the state Department of Behavioral Health and Developmental Services (DBHDS) as well as from two Community Services Boards (CSBs), representing urban and rural perspectives. STEP-VA is a phased initiative that requires nine services to be offered by all CSBs when fully implemented. Common themes among the three presentations included the challenges posed by workforce shortages and the importance of data collection and other administrative infrastructure to successful implementation of the new services.

Dr. Lisa Jobe-Shields of DBHDS explained that the Department has worked with CSBs to implement the nine services that make up the STEP-VA initiative in three phases. Phase 1 is the planning stage, in which definitions and metrics are finalized; in Phase 2, services begin to be implemented, although the Department’s oversight is of a qualitative nature at this stage, since data is not yet considered reliable. Phase 3 represents full implementation and DBHDS is able to use validated data to verify that the service is being implemented in accordance with shared definitions. CSBs are either in Phase 2 or Phase 3 for five services of the STEP-VA array; the final three steps, case management, psychiatric rehabilitation, and care coordination, are in Phase 1, with initial implementation scheduled for July 2023 and full implementation scheduled to begin July 1, 2024. (Crisis services were discussed separately, as there are major investments in the crisis system, such as implementation of the Marcus Alert, that are outside the STEP-VA framework.) The state is working to upgrade its data systems, using federal funding, to allow receipt of data directly from CSBs’ electronic health records. Dr. Jobe-Shields presented information on the metrics in place for the earlier “steps,” including same-day access to assessments and engagement in substance use disorder treatment, and metrics for CSB staff training.

Representatives from a large, rural CSB (New River Valley CSB) and a small, urban CSB (Colonial Behavioral Health) spoke about their experiences implementing STEP-VA. While both directors pointed to advances in the state’s behavioral health system facilitated by STEP-VA (such as encouraging the deployment of evidence-based services), both directors also discussed the significant workforce challenges facing their agencies, as well as the administrative costs involved in data collection and billing managed care organizations. Jennifer Faison, Executive Director of the Virginia Association of Community Services Boards, said that CSBs are “laser focused” on workforce issues; she also pointed to the importance of ensuring that funding reflects the true costs of providing services and that outcome measures account for the interconnectedness of the “steps.”

VACo Contact: Katie Boyle

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