ARLINGTON COUNTY, VIRGINIA County Board Agenda Item Meeting of November 17, 2018 DATE: November 15, 2018 SUBJECT: Virginia Hospital Center grant for youth crisis stabilization services C. M. RECOMMENDATIONS: 1. Authorize the County Manager or his designee to accept $500,000 in Virginia Hospital Center funds for Diversion First: A Pilot to Divert Arlington Youth with Behavioral Health Crises from Hospitalization, and to execute the attached agreement with Virginia Hospital Center providing for the establishment of, and funding for the Diversion First pilot program, in a form approved by the County Attorney. 2. Appropriate $500,000 in Virginia Hospital Center funds (101.350900) to the Department of Human Services (101.56002) for execution of a pilot to divert youth with behavioral health crises from hospitalization and other restricted settings. 3. Authorize the creation of 1.0 temporary FTE Mental Health Therapist to staff the project. ISSUES: This is a request to approve an agreement with Virginia Hospital Center (VHC) providing for the establishment and funding of the Diversion First pilot program, and to accept and appropriate VHC funds and create a temporary Mental Health Therapist position within the Department of Human Services (DHS). The funding ($500,000) will be provided in five equal payments over the course of the five-year pilot program. Funding will support 1.0 FTE Mental Health Therapist in the Department of Human Services and related program costs. The estimated annual cost of a licensed clinician (salary + benefits) is $122,000; per the agreement with Virginia Hospital center, Arlington County would absorb ancillary program costs beyond the VHC contribution level. See attachment. SUMMARY: The Diversion First pilot program will meet an emerging community need by providing services to children, youth, and young adults up to age 22 in psychiatric crisis. The goal is to keep this population in the community with their families by: Intervening at crisis points when youth present at VHC or the CSB s Crisis Intervention Center County Manager: ##### County Attorney: ***** 34. Staff: Deborah Warren, DHS Deputy Director
De-escalating the situation Assessing the family s strengths and needs Providing intensive care coordination to ensure engagement in wraparound services. BACKGROUND: Arlington Community Services Board (CSB), the Arlington Mental Health Alliance, and the Arlington community are concerned about the lack of resources for children, adolescents, and young adults in psychiatric crisis. Many of these youths have emerging behavioral health issues of a complex nature. Over the past two fiscal years, Arlington CSB evaluated 477 adolescents for hospitalization resulting in 44 Temporary Detaining Orders and 67 known voluntary admissions. In addition, Virginia Hospital Center has an average of 15 youth per month waiting in the Emergency Department for medical screening and placement in a psychiatric bed for hours and sometimes days due to the scarcity of community-based emergency behavioral health interventions. Services available through the Department of Human Services and the Children s Regional Crisis Response (CR2) program are effective, but do not meet the current level of need. DISCUSSION: Virginia Hospital Center and the Arlington CSB jointly developed this pilot program, in consultation with the Arlington Mental Health Alliance and other community advocates, after recognizing the need to divert Arlington youth from psychiatric hospitalization, residential treatment, and the juvenile justice system. Targeted funding will support a licensed clinician who will provide crisis services, pre-screening (if required), and intensive care coordination. The goal is to keep our target population in the community with their families. Priority Populations Arlington residents through age 22 who present in the VHC Emergency Department with behavioral health issues Non-Arlington residents who present in the VHC Emergency Department through age 22 Arlington youth referred to the CSB for assessment for psychiatric hospitalization Arlington youth at risk of residential placement Arlington youth at risk of penetration of the juvenile justice system due to behavioral health issues Priority will be given to children and young adults who present with the most acute behavioral health needs, individuals with developmental disabilities, and vulnerable and/or under-resourced populations. Additionally, VHC patients (up to age 22) who have been discharged after receiving treatment for a behavioral health issue will receive intensive case management to avoid future hospitalizations. Services One licensed clinician will provide: Pre-screening for children and youth if appropriate Mobile de-escalation and crisis stabilization of child and family Intensive care coordination to include strengths/needs assessment and high-fidelity - 2 -
wraparound services Liaison between VHC, CSB, and community resources Collaboration with CSB, VHC, the Arlington Pediatric Center, Children s Services Act (CSA) staff, Arlington Public Schools, Court Services Unit, and other partners Collection of quantitative and outcome data to be reported quarterly PUBLIC ENGAGEMENT: The concept for this pilot program emerged from ongoing, longterm dialogue within the Community Services Board and was further sparked by discussions related to potential opportunities related to the Virginia Hospital Center expansion project. Community advocates identified limited resources for children, youth, and young adults as a known gap that could be addressed as part of the hospital expansion. After exploring several options and providing significant opportunities for input, the Diversion First pilot program was agreed to by VHC, CSB, and County staff as the best path forward. FISCAL IMPACT: This action appropriates the full amount ($500,000) of a five-year award in FY 2019 because expenditures fluctuate based on client demand throughout the year. VHC will pay $100,000 annually for the period of the five-year pilot for a total of $500,000, and the County will absorb any ancillary costs. DHS will bill Medicaid and use any accrued revenue to offset costs related to the program. Any unexpended funds in a fiscal year will be carried over into subsequent fiscal years. - 3 -