Question: What substance abuse services does the Commonwealth of Virginia offer for court involved youth? What do other states provide? What are the trade-offs between the use of contract services and a staff position to provide substance abuse services? (Mayor Wilson, Councilman Aguirre)
Response:
Services Provided by the Commonwealth of Virginia
The Virginia Department of Behavioral Health and Developmental Services (DBHDS) publicizes RIGHT HELP, RIGHT NOW - A Transformational Behavioral Health Plan for Virginians and offers an array of services, including those which are available through local Community Service Boards. According to the DBHDS, “Virginia’s community services boards (CSBs) are the primary point of entry into the Commonwealth’s public behavioral health and developmental services system. CSBs provide treatment for mental health issues, substance use and addiction, and intellectual and developmental disabilities for adults and children. Every county and city in the state has an assigned CSB.” Court involved youth may have access to such substance use disorder services.
DBHDS provides support for court-involved youth locally, through the Alexandria CSB, which receives $80,000 a year to provide behavioral health assessment and treatment services for youth in the Northern Virginia Juvenile Detention Center (NVJDC) and their families. This funding is used to partially fund two Licensed Mental Health Professionals, one bilingual Spanish/English, who dedicate part of their time to seeing youth at NVJDC. This is the only dedicated state funding stream for court involved youth through the CSB.
Court-involved youth, like those who are not court involved, are also referred for services through the Children’s Services Act (CSA) for a determination and provision of service needs.
The Virginia Department of Juvenile Justice (DJJ) does not offer specific substance use disorder services. DJJ oversees community-based services for youth receiving services through state and local funding, including Virginia Juvenile Community Crime Control Act (VJCCCA) services (e.g., Alexandria designates its VJCCCA funding to support Sheltercare).
DJJ utilizes mental health initiative funds that are used to pay for individual services for court-involved youth on probation and parole, including substance use disorder abuse services, contracting with two coordination companies to process referrals for probation and parole services and matching youth to sub-contracted providers of contracted services (substance abuse evaluations, substance abuse outpatient services/treatment to include relapse prevention, substance abuse intensive outpatient services). During FY 2024, DJJ will also seek to increase the number of providers that use a more intensive evidence-based substance abuse model called Adolescent Community Reinforcement Approach (A-CRA).
DJJ utilizes mental health initiative funding to support local positions co-mingled at the CSUs. DJJ has available funding to reimburse services for DJJ youth, a resource that requires a Memorandum of Agreement (MOA). Agreements are often made via the local CSB; however, MOAs involving City positions at the CSU are possible.
Services Provided by Other States
Other states vary in what is provided or available to court-involved youth with substance use concerns. From initial research, it seems that most states strive to incorporate six basic components as best practice: proper assessment and diagnosis, tailored treatment based on the youth’s risks and needs, an integrated approach to include family involvement, evaluation of outcomes, appropriate treatment based on developmental needs, and public safety considerations. Further research regarding substance use services provided by other states would require additional time and resources.
Each locality from each state varies in how these components are integrated based on factors such as local resources and expertise and funding availability. In a 2020 Health and Justice article[1], researchers conducted a national survey of how substance use prevention services are implemented in juvenile justice settings. From a national standpoint, the survey found that most juvenile justice agencies primarily work with their local behavioral health providers for substance use treatment. Approximately one third of those surveyed had resources within their juvenile justice agency. The primary recommendation of the article based on the national survey was that evidence-based prevention services should be expanded in juvenile justice settings given the high rates of substance use among juvenile-justice involved youth and the increased risk factors that come with the substance use.
Many states and localities also utilize juvenile drug courts which include treatment elements such as court supervision, family engagement, drug testing, and community linkages for youth with substance-related charges. These treatments can include evidence-based treatment such as Motivational Interviewing or Cognitive Behavioral Therapy. The Office of Juvenile Justice and Delinquency Prevention (OJJDP) has provided over $24 million in funding for juvenile drug treatment court programs throughout the country since 2015. There are approximately 142 juvenile drug courts throughout the country.[2]
Trade-offs Between Use of Contract Services and a CSU Staff Position
Trade-offs between contracted services and a full-time position can be listed as follows:
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Quality of Services: The quality of services provided by a bilingual psychologist to court-involved youth and families would not be compromised through a contracted position versus a staff position. Youth and families will still be able to receive comprehensive services in English, Spanish, American Sign Language or Spanish Sign Language.
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Cost of services: Contracted services incur administrative fees as the CSU’s current psychologist is paid through a temp agency. Through the temp agency, CSU currently pays $121.44/hour for an $85/hour salary. The difference accounts for the service fees paid to the temp agency. Alternatively, a full-time staff position would cost approximately $166,380 annually, including salary and benefits. This is equivalent to $80/hour salary rate.
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Capacity: Temporary/Contracted position allows for services such as substance use evaluations and written reports, case consultation with CSU colleagues, and the facilitation of evidence-based therapeutic “stages of change” groups. Evaluations are prioritized with the temporary contracted position to ensure timely completion for service recommendations and delivery. The trade-off with the temporary contracted position is that capacity will continue to be limited and services will need to be triaged. A full-time position would also allow for more capacity to serve more youth and families which naturally relieves some burden on community partners such as Northern Virginia Juvenile Detention Center. In addition, a full time Bilingual Psychologist could provide additional services such as early identification and prevention, with the hope of providing timely assessment and treatment in the community rather than utilizing City funding sources such as those which are available through the Children’s Service Act. For example, to place a male youth in a residential treatment program, the average cost is $1,174.50/day, with the typical length of stay being five to seven months. Additionally, alternative substance use assessment and treatment often requires coordination of multiple vendors to provide needed evaluation, treatment planning and services and wait times for receiving recommended service can be months long. If funded, the CSU’s psychologist can provide most needed services within the CSU, with little to no wait times and with the availability of crisis management.