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Reforming Virginia’s Behavioral Health System System Transformation Excellence and Performance (STEP-VA)

Over the past three years, Virginia has made significant improvements in the quality and accountability of community services through legislative and administrative efforts. However, Virginia’s overall behavioral health system remains underfunded and patched together in well-meaning responses to crises with services that are not always sustainable or consistently funded. Together with the Administration, the General Assembly and stakeholders, DBHDS is working to transform Virginia’s system in a cohesive, strategic manner.

Reforming the System

To reform the system, DBHDS designed System Transformation Excellence and Performance (STEP-VA), an innovative initiative for individuals with behavioral health disorders featuring a uniform set of required services, consistent quality measures, and improved oversight in all Virginia communities. STEP-VA is based on a national best practice model that requires the development of a set array of deliberately chosen services that make up a comprehensive, accessible system for those with serious behavioral health disorders. An extensive stakeholder initiative then helped define the services that are needed in Virginia. The following services are included in STEP-VA:


STEP-VA is designed to incorporate services over multiple years, each providing the infrastructure and expertise needed to build on the next. To implement these changes, STEP-VA will expand certain existing services and implement new services to maximize impact. The STEP-VA model is shown below:

Anticipated Outcomes

The implementation of STEP-VA services will improve access, increase quality, build consistency and strengthen accountability across Virginia’s public behavioral health system. Also, STEP-VA services are intended to foster wellness among individuals with behavioral health disorders in everyday life to prevent crises before they arise. Additional outcomes would include fewer admissions to state and private hospitals, decreased emergency room visits, and reduced involvement of individuals with behavioral health disorders in the criminal justice system.

Progress Implementing STEP-VA

In 2017, Governor McAuliffe and the General Assembly set STEP-VA in motion by providing $4.9 million in general fund dollars and $4 million through the Governor’s Access Plan (GAP) for an initial group of CSBs to implement Same Day Access, a program that allows a person who calls or appears at a CSB to be assessed that same day instead of potentially waiting weeks for an appointment. In addition, the General Assembly required the remainder of STEP-VA services to be implemented over the next two biennia, and funding should be allocated in the coming years.

Next Steps

The next phase among STEP-VA’s remaining services includes implementing Same Day Access in the rest of the CSBs, installing primary care screening and tight linkages to medical providers in all CSBs, addressing existing gaps in outpatient services, including medication assisted treatment for substance use disorders, and improving targeted case management services for children.

As additional phases of STEP-VA are implemented, Virginia is now on the precipice of making deeply needed changes to its system to finally focus intently on timely access to quality, consistent behavioral health services, and on ensuring consistency and accountability across the Com