What’s in it for kids?

Analysis of the proposed FY 2010

Department of Mental Health (DMH) budget

Budget analysis
The mayor’s proposed FY 2010 budget for the Department of Mental Health (DMH) is $216.8
million, 5.1% less than the FY 2009 approved budget of $228.5 million.

The net of the following changes to programs for children and youth is a reduction of
~$2,142,000:
 The budget for the Children & Youth Services Activity in the Mental Health Authority Program
increased by 56%, or $2.8 million, between FYs 2009 and 2010. The FY 2010 proposed budget is
$7.8 million; the FY 2009 approved budget was just under $5 million. The increase is the result of a
new billing system for MST, or multi-systemic therapy, a community-based intervention for teens.
The new system will result in $2 million in additional funding from Medicaid.

 The budget for the School Mental Health Program Activity in the Mental Health Authority Pro-
gram increased by 21%, or $839,000, between FYs 2009 and 2010. The FY 2010 proposed
budget is $4.9 million; the FY 2009 approved budget was $4.1 mil-
lion. One important change that results in part of the increase is
billing Medicaid. A significant number of children who receive ser-
vices through the School Mental Health Program are on Medicaid; April 7, 2009
their Medicaid Managed Care Organization (MCO) receives money
every month to pay for mental health services. Billing the MCOs Proposed budget
will save $400,000 in Local funds. There is also a savings in the Go to budget.dc.gov, then to
school mental health program of $683,000 resulting from adjusting Fiscal Year 2010. Next, click
staffing from a 12-month position to a 10-month, or school-year on Volume 3 and go to docu-
position. This does not reduce services but does save the city ment page 161. Additional
money. information is in Volume 5,
document page 189.
 The budget for the Children Youth & Family Services—CSA Ac-
tivity in the Community Services Agency Program budget Council budget hearing
was eliminated in the FY 2010 budget. In FY 2009, funding for  Watch online by going to
this activity was $5.8 million. This is not a cut; the funds were oct.dc.gov, selecting “On
moved to another Program and Activity. Demand Video” in Chan-
nel 13. Go to the week
 The proposed budget includes a reduction of $170,000 in the of March 30 and select
Mental Health Authority Program’s Children & Youth Services the CM Catania hearing
Activity. It is described as a “cost decrease” meaning that services on March 30.
are the same but cost less. The reduction represents the savings
for the Assessment Center contracts, as their will be a shift of ser- More information
vices to the Choice Provider network. In this case, children in the available from
custody of the Child and Family Services Agency will be assessed by DC ACT
Tyra Williams, Policy Counsel
Choice Providers.
(202) 234-9404, Ext. 217
twilliams@dckids.org

DC Action for Children

1616 P Street, NW * Suite 420 * Washington, DC 20036
(202) 234-9404 * (202) 234-9108 FAX * www.dckids.org
What’s in it for kids? Analysis of the proposed FY 2010 DMH budget

Outstanding issues
Alignment of budget allocations and Agency Performance Measures
There are four measures related to children and youth. DMH’s performance related to the goals is de-
tailed in the table below. Aside from the Dixon-related exit criteria, which DMH director Steve Baron
reports are achievable and have funding directed to them, the budget does not clearly articulate how
the projections will be achieved.
Change in service delivery mechanism

Agency Performance Measures Related to Children and Youth

in the Department of Mental Health Budget, FYs 2007 - 2011

Agency Performance FY 2007 FY 2008 FY 2008 FY 2009 FY 2010 FY 2011

Measure Year-End Original Year-End Projection Projection Projection
Actual Target Actual

Number/percent of 42 48 58 58/23.7% 68/27.7% 78/31.3%

schools with school-
based mental health
program

Total number of 3,101 5,375 2,777 5,525 5,775 6,000

children served

Percent of MHRS 45% 80% 46% 60% 70% 80%

eligible children
discharged from
inpatient psychiatric
hospitals who receive a
community-based non-
emergency service
within 7 days of
discharge
Number of Dixon exit 1 10 3 23 15 19
criteria targets met and
approved for inactive
monitoring by the Court
Monitor

More information about one Agency Performance Measure: Number of Dixon exit criteria targets
met and approved for inactive monitoring by the Court Monitor; four of the seven targeted in FY
2010 relate to children and youth. These are:
 Exit Criterion 5—Services to Children and Youth
 Exit Criterion 6—Services to Children and Youth with Serious Emotional Disturbance
 Exit Criterion 14—Services to Children and Youth in Natural Settings
 Exit Criterion 15—Services to Children in Own or Surrogate Homes (Testimony of DMH director
Steve Baron, March 20, 2009, p. 4)
What’s in it for kids? Analysis of the proposed FY 2009 CFSA budget

Perhaps the most significant change from FY 2009 to FY 2010 is the elimination of the DCCSA, the DC
Community Service Agency. In FY 2010, services which had been part of the DCCSA are moved to the
Mental Health Authority Program and Community Contract Providers Program. There has been a sig-
nificant degree of concern about the change.

The closing of the DC CSA is a step in the right direction for ensuring access to the mental health ser-
vices for children in the District of Columbia. The reorganization of the DCCSA, as recommended by
the KPMG report is a step in the right direction for ensuring the delivery of mental health services for
children, youth, and families. The services that will be transferred to private providers should be
monitored for compliance and to ensure children are properly placed. Since many families have close
ties to their existing providers, regular follow up for the children transferred is necessary to ensure the
right fit for services. DMH should involve families with the transition to the greatest extent possible,
allowing for a smoother transition. Close monitoring is necessary to:(1) confirm the availability of
community-based providers who are able and willing to provide or link prevention, early intervention,
and treatment services; and (2) identify the resources and institutional structures essential to support
the children and ensure proper oversight.

To learn more about the changes are online:

 The Department of Mental Health’s “Transition of Consumers from the DC Community Services
Agency”, online at http://www.dmh.dc.gov/dmh/cwp/view,a,3,q,643247.asp
 Recommendations for the Governance of the District of Columbia Community Services Agency,
September 26, 2008, along with other information online at http://www.dmh.dc.gov/dmh/cwp/
view,a,3,q,642365.asp

20,000

15,000

10,000

5,000

0
FY 2008 Actual FY 2009 Approved FY 2010 Proposed
Community Services Agency 4,983 5,792 0
- Children Youth & Family
Services - CSA
Mental Health Authority - 0 4,076 4,915
School Mental Health
Program
Mental Health Authority - 9,625 4,994 7,805
Children and Youth Services

Advocacy on the issue

The Department of Mental Health has already had its budget reviewed publicly by the Committee on
Health; the public hearing was on March 30, 2009. The mark-up on the budget is scheduled for April
29 from 10:00 am—Noon in Room 500, JAWB. More information is available from the committee;
contact Jennifer Barry, 724-8170, jbarry@dccouncil.us.