STAUNTON –Thirteen employees at Valley Community Services Board lost their jobs this month.
Shenandoah Clubhouse is closing at the end of February.
Five employees who work at the clubhouseare "displaced" — told they can apply for other jobs within the public agency.
Six employees decided to pursue other employment opportunities and left.
One employee retired.
That’s 20 fewer people working at Valley Community Services Board,already understaffed in an underserved area with a significant need for mental health support services.
Twelve worked in the Therapeutic Day Treatment program which provides intensive mental health services to students in the school environment.
Two worked at the Shenandoah Clubhouse psychosocial rehabilitation program for individuals who need mental health and social development support. The remaining five staff members will either find other positions at Valley Community Services Board or leave the public agency.
Shenandoah Clubhouse closes
After more than 30 years, the board of directors determined they cannot sustain the losses at Shenandoah Clubhouse and decided to close the program.Members of the Shenandoah Clubhouse work with an advocate and receive vocational training as well as othermental health support services.
In mid-December, VCSB’s Executive DirectorDavid Deering, announced the layoffs, but the financial deficit was announced months ago.
“Yes, we have had multiple layoffs,” said Deering. “This all relates back to Medicaid and their change in payment rates.”
Earlier in the year, August2019 financials at VCSB showed a $496,000 deficit due to the impact of Managed Care Organizations within Medicaid denying authorizations and services for the Therapeutic Day Treatment program and Shenandoah Clubhouse, according to Oct. 23, 2019 and Dec. 4, 2019 board of director meeting minutes.
When the staff found out about the half-million dollar deficit, six people decided to find other jobs and left by the end of October, said Deering.
As of July 1,for fiscal year 2020, Managed Care Organizations (MCOs) work on behalf of Virginia Medicaid.
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“With no change in rates and no change in the announced interpretations of how these rates are going to be evaluated, they just started reducing rates,” said Deering. “This has had a very significant impact on us.”
Read:Pediatric health crisis: Severe shortage of child psychiatrists in the Valley
Deering said these changes occurred without any announcements or warnings. Since 59% of funding for VCSB is provided by Medicaid, they incurred a massive budget shortfall.
Therapeutic Day Treatment
Therapeutic Day Treatment is an intensive daily program for children with social, emotional or behavioral problems that interfere with their ability to function at school, home and in the community.
At the end of 2018-19 school year, VCSB was serving 14 schools in Staunton, Waynesboro and Augusta County. Thirty two staff members were serving more than 200 kids.
“We had anticipated the next year, looking forward to another year of being able to serve children in need and being successful,” said Deering. “Those services generated $600,000 in revenue.”
According to Deering, between July 1 through Oct. 21, 2019, VCSB was only allowed to serve 100 children.
“The amount of service/units of service — in the past, we were allowed three units a day. That had been cut back to two units. The revenue generated was $300,000. It had been cut in half.”
After revenue and services were cut in half, Deering said he talked with Senator Creigh Deeds (D-25th District) and Senator Emmett Hanger (R-24th District), Karen Kimsey, director of VA Dept. of Medical Assistance Services, Delegate John Avoli (R-20th District)and former Delegate Steve Landes (25th District) and asked if something was going to change.
“The legislators couldn’t offer anything,” said Deering.
Schools losing services, schools keeping them
Valley Community Services Board will stop providing Therapeutic Day Treatment programservices in all Waynesboro schools and Wilson Elementary School onJan. 31.
Therapeutic Day Treatment program services will continue at:
- Wilson, Stuarts Draft and Staunton high schools
- Wilson Middle School
- Cassell, Bessie Weller and Ware elementary schools
Instead of being in 14 schools, they are now in seven. Currently, there are 11 VCSB staff members providing services. One staff member will be eliminated.
Therapeutic Day Treatment program services include classroom support, individual and group sessions, crisis intervention and family/parent involvement.
As a result of this significant step, they had to reduce their staff by another 12 individuals, Deering said.
“Also, our manager of the program retired. And we promoted someone from a supervisor position and her position was not replaced. That’s 13 people and six had voluntarily left already.”
Agencies filling the gap
In December, Deering met with special education administrators at schools in Staunton, Waynesboro and Augusta County and told them Valley Community Services Boardwas going to be reducing five programs.
“Obviously we’re upset that we’re not able to provide the services, but when funding is cut back, you have to respond to them,” said Deering.
Valley Community Services Boardand school administrators arrived at a solution for all of the schools in Waynesboro to transition to Family Preservation Services, a private behavioral health agency.
“Family Preservation was interested in hiring staff to work for them,” said Deering. “It will provide consistency for the kids in the schools.”
School-based outpatient services
VCSB will continue to provide outpatient services in all Waynesboro schools and Wilson Elementary School.Outpatient services typically entail 30-minute counseling sessions twice a week, said Deering.
In a similar fashion to what Managed Care Organizations have done to the Therapeutic Day Treatment program in schools, they also reduced the number of authorization and services they can provide to their psychosocial resources at Shenandoah Clubhouse.
“The specifics of the reduction to the Therapeutic Day Treatment program and the closure of the Shenandoah Clubhouse psychosocial rehabilitation program will have an impact on real people in need, but these actions are only symptoms of the larger problem which is the significant underfunding of the Virginia publicly funded behavioral health system,” said Deering.
Behavioral health system redesign
Changes to mental health services are the beginning of a statewide behavioral health system redesign to implement a new behavioral health delivery system. A redesign that is going to take years to be successfully implemented in the state, said Deering.
“I don’t think I will be very far wrong to say it will most likely be a decade if the funding is provided by the General Assembly,” said Deering.
According to Virginia Departmentof Behavioral Health and Developmental Services, 28% of Medicaid members have either a primary or secondary behavioral health diagnosis. Yet Medicaid Managed Care Organizations are deeming mental health support services as not medically necessary.Almost half of the cases at VCSB have been deemed as not medically necessary, said board member Dan Sullivan.
Deering points out the Medicaid–Managed Care Organization conflict:
“You've got to make an investment in community services,” said Deering. “You've got the DMAS (Department of Medical Assistance Services) saying we want to make this change.But their Managed Care Organizationsare cutting back on the very services that need to be built.”
The redesign outlines changes needed to address the mental health crisis.The goal is to move toward a preventive continuum services program to address the lack of mental health support services which leads to crisis and ultimately theovercrowding of state hospitals.
Virginia ranks 40th in the country for overall access to mental health care and 41st in the country for mental health workforce supply, according to Mental Health America. Medicaid is the largest payer of behavioral health services in the state.
David Deering announced his retirement this week and will be leaving Valley Community Services Board on April 22.
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Health reporter Monique Calello can be reached at mcalello@newsleader.com. Follow her on Twitter@moniquecalelloandFacebookto stay current on health news in the Valley.
