With mental health issues on the rise in schools, the service provider has pulled out of the Southwest Territories

Several school districts in Virginia’s southwest have less than a month before they lose a major mental health provider, which cite changes in how the state handles the provision of such services as a reason for pulling out.

Family Support Services announced in an Oct. 27 letter that it will stop providing day therapy services — school-based services for children enrolled in Medicaid to address behavioral, emotional, and mental health issues — to children and adolescents on Dec. 12 due to “procedural and financial challenges.”

“For years, FPS and (Therapeutic Day Therapy) providers, including local community service boards/behavioral health authorities, have been advocating for a revision and update of the TDT by (Va. Department of Medical Assistance Services) to reflect a service that is more in line with our comprehensive education system today. Andy Kitzmiller, state director of Family Preservation Services, wrote in an October letter. “However, these changes have not been made, and it does not 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 local locations including Wise, Dickinson, Buchanan and Norton counties.

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

Gina Woolford, superintendent of Norton City Schools, said that after losing service workers who dealt with students with behavioral problems last year, she was worried about being able to get enough health workers for the following term.

“A lot of the workers were the same workers who had already developed some strong relationships with our students, so I’m really worried,” said Woolford.

Managed care

In the past several years, the Virginia Department of Medicaid Services, which administers the federal Medicaid program in Virginia, has begun to transition mental health services into a managed care system.

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

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

But since the agency’s decision, the number of people receiving daily therapeutic treatment has fallen, dropping 81% from 2019 to 2021, according to the data from DMAS. A total of 19,303 members accessed these services in 2019 compared to 3,633 in 2021.

A table showing daily medical expenses over the past five years at the state level. (Data provided by the Virginia Department of Medical Assistance Services)

Since Virginia’s change of 2019, managed care organizations have become more “strict” about licensing day therapy, said Mindy Carlin, executive director of the Virginia Association of Community Service Providers.

At the same time, however, Carlin said, the way schools deal with children with serious mental illnesses has also changed since regulations and reimbursement rates were first put in place.

Therapeutic day therapy and reimbursement rates are designed to serve groups — but schools no longer segregate students with behavioral problems, Carlin said, meaning providers are often left to work with individuals.

“The prices are nowhere near enough to cover the cost of providing the service that would be directly to one child, and so it’s not financially feasible,” Carlin said.

Family Preservation Services is working with affected school departments as they decide on other ways to meet students’ needs, according to spokesperson Kyle McMahon.

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

Agency requests for review

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

As part of its application, the agency is asking for a review of the state’s remedial therapy services, stating that it had a “problematic rate and unit structure that made it impossible for providers to provide the service.”

The service is designed by young people with serious emotional problems circulate it Outside of self-contained classrooms,” the agency wrote. In addition, “the service is being written as a group-based service but the structure of the school day makes this method of delivery nearly impossible, and thus providers have to offer it as a one-on-one service. This service needs to be redesigned into evidence-based school services with a modified structure and appropriate rate.”

The agency is asking that services be redesigned into a more evidence-based program “with an appropriate rate and rate structure.”

“Our system is under unprecedented stress due to the effects of the pandemic on the behavioral health workforce that has led to attrition and burnout and the cascading effects of the ongoing family psychological crisis and addiction epidemic,” the agency wrote.

Carlin said she is pleased to see that DMAS is submitting applications but is concerned the process will take too long, especially for children with significant needs.

“It worries me because you’re going to see more suicide attempts going on and more children going into emergency situations for mental health reasons,” Carlin said.

‘The sheer scale of mental health needs’

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

However, this one-time money will soon run out.

The Joint Legislative Review and Audit Committee, 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 issue facing departments as they return to in-person learning. JLARC notes that most students “feel stressed, restless, or restless.”

Berrigan said staff at Bristol had noticed an increase in students’ behavioral and mental health.

“But to see the sheer scale of mental health needs across Commonwealth countries, I think it was an eye opener,” he said.

JLARC has recommended that legislators provide departments with funding for behavioral issues training and classroom management. They also suggested that the General Assembly consider amending state law to clearly define “direct school counseling” to help reduce the amount of time counselors spend in non-counseling activities, and to allow qualified and licensed psychiatrists in other fields to obtain temporary licensure.

School psychologist jobs have some of the highest vacancy rates among all job openings in Virginia.

“Unfortunately, this isn’t just a school issue, it’s a societal issue,” Berrigan said. “Whether you are talking to law enforcement, school teachers, or health providers, mental health may be the biggest challenge we face right now. And we have to find a way to start filling those holes and closing the gap.”

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