As mental health issues in schools soar, provider withdraws from South West districts

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Several school districts in southwestern Virginia have less than a month before losing a key provider of mental health services, who cite changes in how the state handles the provision of such services as a reason for stepping down. .

Family Preservation Services announced in an Oct. 27 letter that it would stop providing daytime therapeutic treatment services — school-based services for children enrolled in Medicaid to treat behavioral, emotional and mental health issues — for children and adolescents on December 12 due to “procedural and fiscal challenges.

“For years, the FPS and other providers of (daytime therapeutic treatment), including our local community service boards/behavioral health authorities, have advocated for the TDT to be reviewed and updated by (the Virginia Department of Medical Assistance Services) to reflect a service that more closely aligns with our inclusive education system today,” Andy Kitzmiller, state director of Family Preservation Services, wrote in the October letter. “However, these changes have not been made, nor does it appear that they will be in the near future.”

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

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

Superintendent of Norton City Schools Gina Wohlford said after the loss of duty officers caring for pupils with behavioral problems last year she is concerned about her ability to get enough of health workers for the next semester.

“A lot of workers have been the same workers who have really developed strong relationships with our students, so I’m really concerned,” Wohlford said.

Care protocol

In recent years, the Virginia Department of Medical Assistance Services, which administers the federal Medicaid program in Virginia, has begun to integrate mental health services into a managed care system.

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

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

But since the agency’s decision, the number of people on therapeutic day hospitalization has fallen, falling 81% from 2019 to 2021, according to data of DMAS. A total of 19,303 members received such services in 2019, compared to 3,633 in 2021.

A chart showing day therapy treatment expenditures over the past five years statewide. (Data courtesy of Virginia Department of Medical Assistance Services)

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

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

Day therapy treatment and reimbursement rates were designed to serve groups, Carlin said — but schools no longer segregate students with behavioral issues, which means providers often have to work with individuals.

“The rates don’t even come close to being enough to cover the cost of providing the service which may be direct to a child, and so it’s not financially feasible,” Carlin said.

Family Preservation Services is working with school divisions affected by its decision on other ways to meet the needs of students, according to spokesperson Kyle McMahon.

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

The agency requests a review

In early fall, DMAS demand $850,000 to find a contractor to assess costs related to ongoing and necessary changes to Medicaid behavioral services.

As part of its application, the agency is asking for a review of the state’s daytime therapy treatment services, saying it has “problematic pricing and a unit structure that has made it impossible for providers to provide the service”.

“The service was designed before young people with serious emotional problems were integrated out of self-contained classrooms,” the agency wrote. Additionally, “the service is designed as a group service, but the structure of the school day makes this method of delivery almost impossible and therefore providers must provide it as an individual service. This service needs to be redesigned as evidence-based school services with appropriate pricing and fee structure.

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

“Our system is under unprecedented pressure due to the impacts of the pandemic on behavioral health staff which have led to attrition and burnout and the cascading effects of our ongoing psychiatric crisis and the epidemic. addiction,” the agency wrote.

Carlin said she was glad to see DMAS making the requests, but worried the process might take too long, especially for children with high needs.

“It worries me because you’re going to see the trends continue with more and more suicide attempts and more kids in the ER for mental health reasons,” Carlin said.

“The sheer volume of mental health needs”

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

However, these one-time funds will soon run out.

The Joint Audit and Legislative Review Commission, in a study of the impacts of the COVID-19 pandemic on education, recently found that school staff viewed student behavior as the most serious issue facing teachers. divisions faced when returning to in-person learning. Most students “feel jittery, anxious, or jittery,” JLARC noted.

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

“But seeing the sheer volume of mental health needs across the Commonwealth, I think was an eye opener,” he said.

JLARC recommended that lawmakers provide divisions with funding for training on behavioral issues and classroom management. They also suggested that the General Assembly consider amending state law to clearly define “direct school counseling” to help reduce the time counselors spend on non-counselling activities and to allow psychologists qualified and licensed in other fields to obtain a provisional license.

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

“Unfortunately, it’s not just a school issue, it’s a community issue,” Perrigan said. “And whether you’re talking to law enforcement, teachers, or healthcare providers, mental health may be the biggest challenge we’re facing right now. And we have to find a way to start filling those holes and closing the gap.

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