As mental health problems rise in schools, providers pull out of southwest districts

Several southwestern Virginia school districts have less than a month to go before losing a major mental health service provider, citing how the state has pushed out the provision of such services as the reason. handles as

Family Protection Services announced in an October 27 letter that it will begin providing school-based services – Therapeutic Day Treatment Services for Children Enrolled in Medicaid – to address behavioral, emotional and mental health issues for children and adolescents on December 12. Will shut it down Procedural and fiscal challenges.

“For years, FPSs and other providers of (therapeutic day treatment), including our local community service boards/behavioral health authorities, have been advocating for a review and update of TDT to reflect a service (Virginia Department of Medical Assistance Services) that is more in line with our inclusive education system today,” wrote Andy Kitzmiller, state director of Family Protection Services, in the October letter. “However, these changes have not been made, nor does it appear that they will be in the foreseeable future. I will be.”

The Roanoke-based provider has been in operation for more than 20 years and serves 11 localities including Wise, Dickenson and Buchanan counties and the city of Norton.

State researchers reported less than a month ago that student behavior and mental health problems in schools have skyrocketed since the pandemic.

Norton City Schools Superintendent Gina Wohlford said that after the loss of service staff dealing with students with behavioral issues last year, she is concerned about her ability to get enough health staff for next semester.

“A lot of the staff have been the same workers who have really developed some strong relationships with our students, so that’s what really worries me,” Wohlford said.

managed care

Over the past several years the Virginia Department of Medical Assistance Services, which administers the federal Medicaid program in Virginia, began moving mental health services into a managed care system.

Previously, mental health providers submitted records of their services to Medicaid for reimbursement. Now, they must first request authorization from the managed care organization to provide the service.

Christina Nuckols, a spokeswoman for DMAS, said the move helped avoid confusion and gaps in coordination, where individuals received some services through a managed care health plan and others through fee-for-service.

But since the agency’s decision, the number of people receiving therapeutic day treatment has dropped by 81% from 2019 to 2021. according to statistics From DMAS. A total of 19,303 members received such services in 2019 as compared to 3,633 in 2021.

A table showing the expenditure for medical day treatment over the past five years across the state. (Data courtesy of the Virginia Department of Medical Support Services)

Mindy Carlin, executive director of the Virginia Association of Community-Based Providers, said that since Virginia’s 2019 change, managed care organizations have become more “strict” about authorizing therapeutic day treatment.

However, Carlin said at the same time, the way schools handle children with severe mental illness has also changed since the rules and reimbursement rates were first established.

Therapeutic day treatment and reimbursement rates were designed to serve groups — but schools no longer separate students with behavioral issues, Carlin said, meaning providers are often left working with individuals. Is.

“The rates are not even close to being high enough to cover the cost of providing a service directly to a child, and therefore it is not economically viable,” Carlin said.

According to spokesman Kyle McMahon, Family Protection Services is working with the school divisions affected by their decision on other ways to meet the needs of the students.

The provider is not alone. Carlin said Intercept Health, one of the largest private providers of student mental health services in Virginia, is no longer offering therapeutic day treatment. An employee answering the phone at The Intercept confirmed Friday evening that the provider was no longer offering the service, but the director did not respond to a request for comment.

Agency calls for review

In early fall, DMAS requested $850,000 to secure a contractor to evaluate costs related to ongoing and needed changes to Medicaid behavioral services.

As part of its request, the agency is asking for a review of the state’s medical day treatment services, saying it has a “problematic rate and unit structure that has made it impossible for providers to deliver the service.”

“The service was geared toward young people with severe emotional problems. Mainstream out of self-contained orbits,” the agency wrote. Additionally, “the service is written as a group-based service, but the structure of the school day makes that delivery method nearly impossible and thus providers have to deliver it as an individual service. needs to be transformed into evidence-based school services with appropriate rates and rate structures.”

The agency is calling for services to be redesigned for a more evidence-based program “with an appropriate rate and rate structure.”

“Our system is facing unprecedented stress due to the impact of the pandemic on the behavioral health workforce, which has led to the crippling and cascading effects of our ongoing psychiatric bed crisis and addiction epidemic,” the agency wrote.

Carlin said she is pleased to see that DMAS is making the request, but is concerned that it will take too long to process, especially for children with extensive needs.

“It’s concerning to me because you’re going to see more and more suicide attempts and more kids walking into the ER for mental health reasons,” Carlin said.

‘Huge amount of mental health needs’

Keith Perrigan, superintendent of Bristol Virginia Public Schools, said Southwest Virginia schools are facing a crisis in mental health services and are using federal COVID-19 response funds to fill the gaps.

However, those lump sum funds will soon run out.

The Joint Legislative Audit and Review Commission, in a study of the effects of the COVID-19 pandemic on education, recently found that school staff rated student behavior as the most serious problem, as they were more likely to interfere with individual learning. come back for. The majority of students “feel nervous, anxious or on edge,” JLARC said.

Perrigan said staff at Bristol have noticed an increase in students’ behavior and mental health.

“But to see the sheer volume of mental health needs in the Commonwealth, I think it was eye-opening,” he said.

JLARC recommended that lawmakers provide the division with funding for training on behavioral issues and classroom management. He also suggested that the General Assembly “help reduce the amount of time counselors spend on non-counseling activities and allow qualified and licensed psychologists in other areas to become provisionally licensed” Consider amending state law to clearly define “direct school counseling”.

School psychologist positions have one of the highest vacancy rates among all staff vacancies in Virginia.

“Unfortunately, this is not just a school issue, this is a community issue,” Perrigan said. “And whether you’re talking to law enforcement or school teachers or health providers, mental health may be the biggest challenge we’re experiencing right now. And we need to find a way to start filling these holes and bridging the gap.” must find.”

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