Reforming Virginia’s Behavioral Health System:

System Transformation Excellence and Performance (STEP-VA)

System Transformation Excellence and Performance (STEP-VA) initiative seeks to improve Virginia’s public mental health system by building a set of core services, referred to as STEPS, that will be consistent across all 40 Community Services Boards (CSBs) throughout the Commonwealth. Based on the Certified Community Behavioral Health Clinic (CCBHC)model, a national best-practices model for behavioral health services, STEP-VA creates a roadmap to consistent, comprehensive, high-quality community-based services for those facing mental health and substance use issues. CSBs serve as the primary point of entry into Virginia’s public mental health system and are the primary provider of services and supports to individuals with Serious Mental Illness (SMI) and Serious Emotional Disturbance (SED). Written into the Code of Virginia in 2018, STEP-VA increased the number of services mandated services from two to nine, with an overall goal of building out a more comprehensive system of community based behavioral health services with improved access, quality, consistency, and accountability. Since its inception in 2018, STEP-VA has undergone a phased implementation, which now includes initial implementation for all nine STEPs, and full implementation for the first six STEPs.

The nine core services in STEP-Virginia are:

  1. Same Day Access – creates a way for Virginians to engage in an initial assessment for intake and treatment services the same day they contact their local CSB.
  2. Primary Care Screening – collecting key data to identify health risks and coordinate with medical care providers for individuals with SMI and SED.
  3. Outpatient Services – considered the core of behavioral health services, this includes both mental health and substance use therapy for adults and children, as well as psychiatry services.
  4. Crisis Services – builds out a comprehensive crisis system situated to provide the right service at the right time to individuals nearing crisis, experiencing crisis, or stabilizing after a crisis.
  5. Peer and Family Services – incorporates certified professionals with lived experience into the full array of behavioral health services.
  6. Service Members, Veterans, and their Families (SMVF) – requires that all clinical staff of CSBs have SMFV training, in addition to identifying Virginians with a connection to military service, at entry to public mental health services, and offers referrals to appropriate services and resources.
  7. Psychiatric Rehabilitation – services that build or rebuild the skills and supports necessary for successful life in the community for individuals with SMI and SED.
  8. Case Management – a comprehensive service that coordinates and links key resources and care planning for individuals with SMI and SED.
  9. Care Coordination – person-centered, holistic care planning that connects resources and services across the continuum of care for all individuals served by the CSBs.

Reforming the System

To reform the system, DBHDS designed System Transformation Excellence and Performance (STEP-VA), an innovative initiative for individuals with behavioral health disorders featuring a uniform set of required services, consistent quality measures, and improved oversight in all Virginia communities. STEP-VA is based on a national best practice model that requires the development of a set array of deliberately chosen services that make up a comprehensive, accessible system for those with serious behavioral health disorders. An extensive stakeholder initiative then helped define the services that are needed in Virginia.

STEP-VA is designed to incorporate services over multiple years, each providing the infrastructure and expertise needed to build on the next. To implement these changes, STEP-VA will expand certain existing services and implement new services to maximize impact.

These are the current estimates for implementation dates. These are best estimates as of 3/1/2022.

Anticipated Outcomes

The implementation of STEP-VA services will improve access, increase quality, build consistency and strengthen accountability across Virginia’s public behavioral health system. Also, STEP-VA services are intended to foster wellness among individuals with behavioral health disorders in everyday life to prevent crises before they arise. Additional outcomes would include fewer admissions to state and private hospitals, decreased emergency room visits, and reduced involvement of individuals with behavioral health disorders in the criminal justice system.

STEP-VA Team and contacts:

Meredith Nusbaum, Director, Office of Adult Community Behavioral Health

Larissa Carpenter, Program Manager, Office of Adult Community Behavioral Health