Thousands of children across Virginia who have serious mental and behavioral disorders are not getting the services and treatment they need from the state, according to a new report.
The report, commissioned by the Virginia mental health department and issued by a state mental-health work group, stated that an estimated 62,000 young people with mental illness, behavioral disorders and emotional problems are not being adequately served.
"The system is very crisis-oriented -- we have an emphasis on the intensive services for children who have really acute needs," said Margaret Crowe, policy director of Voices for Virginia's Children, a nonprofit advocacy organization. "We are not very good at intervening early in trying to catch children when they first have signs of problems that would prevent them from getting to a crisis point."
The report, prepared by the Child and Adolescent Special Populations Workgroup, cites a lack of funding and limitations of the state's Comprehensive Services Act. The law, passed in 1992, pooled funding for services for a selected group of young people, including those in foster care and special education. However, officials said it is difficult for adolescents who are not in the mandated group to get funding for treatment.
Combined state and local spending under the Comprehensive Services Act was $235.5 million in fiscal 2003, according to the state.
Crowe, a member of the work group, said teenagers in the juvenile justice system are particularly vulnerable because they are not covered by Medicaid when they are incarcerated. Medicaid, a state- and federally-funded health care program for the poor, also does not provide for substance abuse treatment, she said.
As a result, jurisdictions across the state have been forced to find patchwork solutions to address the demands, Crowe said.
In Northern Virginia, as in the rest of the state, additional funding and a more systematic program are needed to catch children early who may be suffering from emotional disorders, officials said.
In Fairfax County, Gail Ledford, manager of services mandated by the Comprehensive Services Act in Fairfax and Falls Church, said resources are available to meet some of the needs but still not enough.
"Do all children with a serious disorder get access in a timely, effective way in Fairfax County? The answer is likely no," Ledford said. "It's still a fragmented system."
Under the act, about 1,063 children were treated in fiscal 2004, but Ledford said other children who get treatment are not funded under the law because they are not part of the mandated groups. Local jurisdictions and families have to come up with the money for their treatment.
In Alexandria, Mike Gilmore, of the Alexandria Community Services Board, said the city has funding only "to meet the needs of the seriously troubled children."
"There is a whole group out there that are not getting the services they need, especially family therapy," Gilmore said.
Arlington County has expanded its services in the past two years, said Valerie Cuffee, the county's chief of child and family services.
Cuffee said some new services include a school-based mental health prevention program at selected schools, mental health services at the county detention center and some funding to help about 10 children a year who are not covered under the law.
However, she said, there is a shortage of case managers -- who often are requested by parents of children who need treatment. A case manager can help coordinate services provided by schools, therapists and doctors, she said.
Alicia Bush, of the Community Services Board in Prince William County, said the county "is no different from other jurisdictions. When we run out of non-mandated money, we can't get additional state funds for those services."
She said some families are forced to turn their children over to the state -- put them in foster care, for example -- to get them the treatment they need.
In Loudoun County, there is no money for long-term care for children who do not fall in the mandated categories, officials said.
"Our department does not have money to send kids to long-term residential care," said Roger Biraben, division director of mental health and substance abuse services for Loudoun. "The big issue is that there is very little money for non-mandated services. It's like spitting in the wind. . . . We have to do whatever we can think of to try to stabilize the situation."
Besides a request for more funding, the report recommends early intervention programs to help "stem the tide," so fewer children reach a crisis point before they get treatment, Crowe said. The report also calls for a parent support and information network and establishment of a pilot program to restructure how services are delivered.
"It's going to take an overhaul for the system to become more seamless," Crowe said. "Clearly, the way we have it set up right now is not working."
The report and recommendations have been submitted to James Reinhard, commissioner of Virginia's Department of Mental Health, Mental Retardation and Substance Abuse Services.
Reinhard said the report will be streamlined into a plan that "will inform future legislative and budget proposals."
"We do need to transform our system to make it more user friendly and to address these issues with earlier interventions," he said.