SJR 96: Comprehensive Services Act and the At-Risk Youth and Families Program

October 31, 2006

SJR 96 establishes the joint subcommittee to study the cost effectiveness of the Comprehensive Services Act (CSA) and Comprehensive Services for At-Risk Youth and Families Program (Program) and to collaborate with JLARC regarding its evaluation of the administration of the Comprehensive Services Act.

The study will be conducted in two phases. In the first phase of the study, during the 2006 interim, the joint subcommittee and JLARC will:

• Review the administration of the CSA by state and local governments, including projections of caseloads, service needs and costs, and quality of services provided.
• Make recommendations for improvement of program services and strategies for cost containment.
• JLARC is charged by HJR 60 with completing a comprehensive study of the CSA and the Program.

During the second phase of the study in the 2007 interim, JLARC will brief the joint subcommittee regarding its findings and will assist the joint subcommittee in developing recommendations relative to collective findings and assessments regarding the administration of the CSA and the cost effectiveness of the Program.

The joint subcommittee will ultimately develop appropriate recommendations in consultation with JLARC. Throughout the process, the joint subcommittee and JLARC will work collaboratively to minimize duplication and fragmentation.

Presentations

Kim McGaughey - Executive Director, Office of Comprehensive Services
Ms. McGaughey presented an overview of Virginia's Comprehensive Services Act and Comprehensive Services for At-Risk Youth and Families Program. Ms. McGaughey discussed the impetus for the CSA and the CSA statutory framework. She then provided overview of the demographics of the population served, the services provided, and annual program expenditures. Additionally, Ms. McGaughey discussed major challenges faced by the CSA and the Comprehensive Services for At-Risk Youth and Families Program. These included ensuring access to appropriate community services and creating an array of community services. Ms. McGaughey offered several key initiatives intended to meet these challenges, including:

• Expanding community expertise in serving children with serious emotional and behavioral problems.
• Expanding service in families, schools and communities to prevent placements in more restrictive settings.
• Returning children from residential placements, or keeping children out of residential placements, who can be served effectively in homes, schools, and communities.
• Eliminating the need for families to relinquish custody of children in order to access behavioral health services.
• Creating a system of care for "mandated" and "nonmandated" children, regardless of which agency "door" they walk through.
• Improving results and performance accountability with CSA by implementing performance measures, strengthening the role of Community Policy and Management teams, and increasing CSA administrative funds for communities.

Dr. Brian Meyer - Executive Director, Virginia Treatment Center for Children and Chairman, Child and Family Behavioral Health Policy and Planning Committee
Dr. Meyer gave a presentation that identified the strengths, as well as the problems associated with the CSA and offered six specific recommendations.

CSA Strengths:

• Pools funds to serve children.
• Develops systems of care where services and providers work together to help troubled and at-risk children and their families.
• Provides that local community teams decide what is best for their children.
• Provides flexible use of funds, allowing children to receive services that public and private insurance coverage does not fund.

  Problems Associated with the CSA:

• The CSA does not serve much of its target population.
• The current funding formula, created in 1994 and based on locality population and need, as measured by poverty, creates inequity.
• Insufficient community-based and intermediate-level services, with too great reliance upon residential care.

  Recommendations:

• The Office of Comprehensive Services should continue to work to return CSA to its original intent of serving troubled and at-risk children.
• The Office of Comprehensive Services should officially eliminate the distinction between mandated and nonmandated children.
• The General Assembly should require that the CSA funding formula be recalculated after each decennial census.
• The General Assembly should provide an amount equal to 2.5% of total CSA expenditures to help start up new community-based services, particularly intermediate-level services.
• The General Assembly should authorize the Office of Comprehensive Services to use CSA funds flexibly to help start up new community-based services (for example, to allow several communities to pool their funds to start up a service that none could have individually).
• The General Assembly should fund four child psychiatry fellowship and four child psychology internship slots with payback provisions to work in underserved areas in Virginia at a cost of $493,000 annually.

Nathalie Molliet-Ribet - Joint Legislative Audit and Review Commission.
Ms. Molliet-Ribet presented an overview of the Joint Legislative Audit and Review Commission's study of children's residential services delivered through the comprehensive services act, pursuant to House Joint Resolution 60 and in conjunction with the joint subcommittee pursuant to Senate Joint Resolution 96. Ms. Molliet-Ribet discussed the scope, activities and topics of the final report, which will be released on December 11, 2006, at 9:00 a.m.

Data for the study was collected through site visits to 17 localities; surveys of every local CSA coordinator, every local Community and Policy Management Team, case managers of 360 CSA participants and all Virginia residential providers; site visits and meetings with residential providers, financial analyses of residential facilities; and analyses of licensing compliance data and residential program characteristics. The final report will include findings and recommendations related to:

• Factors affecting residential expenditures, including availability of lower cost, community-based alternatives to residential care, adequacy of local infrastructure to secure the most cost effective services, and effectiveness of markets in controlling rates of residential facilities;
• Adequacy of licensing standards or regulatory enforcement, to ensure that quality services are provided, including the adequacy of licensing standards to ensure health and safety of children and the effectiveness of regulatory agencies in enforcing compliance with licensing standards;
• Importance of tracking child outcomes, including current availability of information to measure the impact of the CSA program.

Next Meeting

The next meeting of the joint subcommittee will be held on December 11, 2006, in Richmond.

Chairman:
The Hon. Emmett W. Hanger, Jr.

For information, contact:
Sarah Stanton and Ellen Weston, DLS Staff

Website:
http://dls.state.va.us/CSA.htm

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