Virginia Department of Behavioral Health and Developmental Services

BACKGROUND: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure-Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

OBJECTIVE: This article examines engagement with a mobile application ("mCare") for wounded Service Members rehabilitating in their communities. Many had behavioral health problems, Traumatic Brain Injury (TBI), and/or post-traumatic stress disorder (PTS). The article also examines associations between Service Members' background characteristics and their engagement with mCare. MATERIALS AND METHODS: This analysis included participants who received mCare (n = 95) in a randomized controlled trial. mCare participants received status questionnaires daily for up to 36 weeks. Participant engagement encompasses exposure to mCare, percentage of questionnaires responded to, and response time. Participants were grouped by health status-that is, presence/absence of behavioral health problems, PTS, and/or TBI. Histograms and regression analyses examined engagement by participants' health status and background characteristics. RESULTS: Exposure to mCare did not differ by health status. Participants usually responded to ≥60% of the questionnaires weekly, generally in ≤10 h; however, participants with behavioral health problems had several weeks with <50% response and the longest response times. Total questionnaires responded to and response time did not differ statistically by health status. Older age and higher General Well-Being Schedule scores were associated with greater and faster response. DISCUSSION: The sustained response to the questionnaires suggests engagement. Overall level of response surpassed trends reported for American's usage of mobile applications. With a few exceptions, Service Members engaged with mCare irrespective of health status. CONCLUSION: Mobile health has the potential to increase the quantity and quality of patient-provider communications in a community-based, rehabilitation care setting, above that of standard care.

Neighborhood-level socioeconomic variables, such as the proportion of minority and low-income residents, have been associated with a greater density of tobacco retail outlets (TROs), though less is known about the degree to which these neighborhood indicators are related to vape shop outlet (VSO) density. Many studies of TROs and neighborhood characteristics include only a small set of variables and also fail to take into account the correlation among these variables. Using a carefully curated database of all TROs and VSOs in Virginia (2016-2018), we developed a Bayesian model to estimate a neighborhood disadvantage index and examine its association with rates of outlets across census tracts while also accounting for correlations among variables. Models included 12 census tract variables from the American Community Survey. Results showed that increasing neighborhood disadvantage was associated with a 63% and 64% increase in TRO and VSO risk, respectively. Important variables associated with TRO rates included % renter occupied housing, inverse median gross rent, inverse median monthly housing costs, inverse median monthly housing costs, and % vacant housing units. Important variables associated with VSO rates were % renter occupied housing and % Hispanic population. There were several spatial clusters of significantly elevated risk for TROs and VSOs in western and eastern Virginia.

Evaluations of legal sanity are some of the most complex and consequential mental health evaluations that forensic clinicians perform for the courts. Thus, there is strong reason to monitor the wide-scale process and conclusions of sanity evaluations. In this study, we review 1,111 court-ordered sanity evaluation reports submitted by 74 evaluators in Virginia from the first year after the state initiated an oversight system that allowed for such comprehensive review. Overall, the base rate of insanity findings was 16.9%, although base rates of insanity findings among individual evaluators varied from 0% to 50%. Similarly, most evaluators cited the cognitive (rather than volitional) criteria of the insanity defense as the basis for their insanity findings, although evaluators varied in their patterns of citing these underlying insanity criteria. Our review revealed other trends in practice, such as the rarity of psychological testing (2% of cases) and the frequency of conveying conclusions in "ultimate issue" format (76%). Overall, findings reveal that a majority of reports seem reasonably consistent with practice guidelines, but also reveal some idiosyncratic practices or patterns that suggest there is opportunity for improvement.

Abstract Police receive extensive training due to the complexity and challenges of their work. Surprisingly, most police officers receive minimal training on how to understand and interact with adolescents. The current study included data from 1,030 law enforcement officers from 24 police departments evaluating perceived readiness to interact and work with adolescents in the community. We examined overall training needs, and then tested how experience in law enforcement and position or rank impacted self-identified training needs. Rank was associated with police officer perceptions of adolescents and related training needs. Compared with patrol officers, school resource officers indicated that they believed they had the skills needed to effectively work with adolescents [P = 0.001, odds ration (OR) = 2.5]. Beat or area patrol officers were significantly less likely than school resource officers to report feeling equipped to work with adolescents who have experienced trauma compared with new recruits (P &amp;lt; 0.001, OR = 0.3) and other non-patrol police officers (P = 0.001, OR = 0.6). School resource officers were significantly more likely to view adolescents as positive assets to the community (P = 0.003, OR = 2.8), and were significantly less likely to understand why Black adolescents or other adolescents of colour might mistrust police compared with both new recruits (P &amp;lt; 0.001, OR = 0.2) and patrol officers (P &amp;lt; 0.001, OR = 0.5). Overarching training needs are illuminated by these unique data.

Research has examined differences between psychologists and psychiatrists in opinions on trial competency and criminal responsibility, but there is little research on such differences in risk assessment. This study examined the impact of disciplinary affiliation on opinions regarding whether new insanity acquittees should be hospitalized or released, and the risk factors given the most weight by each discipline. There was no significant difference between disciplines in the frequency of recommendations for hospitalization versus release. However, the concordance rate at the individual case level was only moderate when controlling for chance, which raises questions about the reliability and validity of forensic risk assessments in real-world settings. A number of variables emerged as significant in the decision-making of each discipline, with some differences noted.

Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.

Our study examines the experiences of 563 youth ordered into restoration services after a judicial finding of adjudicative incompetence. Among this group, 72% were determined to be restored to competence usually within 90 to 120 days of services provided in the least restrictive environment allowed by the courts. These outcomes were achieved using an individualized psycho-educational intervention that combined intensive case management, developmentally informed interactive educational tools, and case integration and mentoring by specially trained restoration counselors. These individualized services were provided to each youth on average three times a week by the restoration counselor contracted to provide services in the location where the youth was residing. No juveniles were admitted for inpatient hospitalization for the purpose of restoration only. Five percent were hospitalized based upon civil commitment criteria or for further psychiatric evaluation or stabilization. Chi-square Automated Interaction Detector (CHAID) analyses were used to create decision trees of the restoration pathways demonstrated by four subgroups of youth: Mental Illness Only (MIO), Mental Retardation Only (MRO), Mental Illness and Mental Retardation (MI-MR), and No Mental Illness and No Mental Retardation (NMI-NMR). The interaction of individual characteristics and interventions varied across the four groups with the highest rates of restoration being achieved by youth in the NMI-NMR group (91%) and the lowest rate among youth in the MRO group (47%). These rates of restoration are comparable to those achieved using residential treatment for youth and inpatient hospitalization for adults.

INTRODUCTION: Regulations of the sale of tobacco products to minors have been effective at reducing adolescent tobacco use overall. However, these efforts may not be uniformly enforced in all areas, creating uneven protection against adolescent smoking. Knowledge regarding factors associated with tobacco retail outlet (TRO) violations could help inform better enforcement strategies. METHODS: In this study, we used Bayesian index regression models to determine if tobacco sales to minors violations across Virginia (2012-2021) were related to store characteristics and neighborhood deprivation and identify geographic areas at significantly elevated risk for violations after adjusting for these factors. RESULTS: Results show that there were multiple factors associated with a higher likelihood of tobacco sales violations. Store type was an important factor, as grocery stores and pharmacies had significantly lowered likelihood of violations compared with convenience stores. Being located near another TRO was significantly associated with increased risk of sales to a minor. Neighborhood deprivation was also positively associated with TRO sales violations. Further, there were statistically higher likelihood of sales violations occurring in specific areas (e.g., southwest and southeast) of the state that were not explained by neighborhood deprivation and store attributes. CONCLUSIONS: Together, results highlight the need to better understand where and why TRO sales violations are occurring in order to improve efforts aimed at monitoring and remediating TRO sales violations.

OBJECTIVE: Our study examined officers' attitudes and perceptions of adolescents in general (and challenges in policing adolescents) and the degree to which community variables affect those perceptions. HYPOTHESES: Our examinations of officers' descriptions of adolescents and challenges in policing adolescents were exploratory. We hypothesized that community characteristics would significantly influence officers' perceptions of adolescents, such that working in more impoverished, higher crime, and more proportionally Black communities would be associated with more negative perceptions of adolescents. METHOD: Data were obtained from 1,112 active law enforcement officers representing 30 police agencies/departments across the United States. Participating officers completed a survey about adolescents and challenges in policing adolescents. Publicly available data sets were used to measure select community and police agency/departmental characteristics. We examined qualitative data using an inductive methodological approach. RESULTS: Police officers' descriptions of adolescents were significantly more negative than positive. Negativity was observed in the relative frequency of negative versus positive comments about adolescents as well as the use of inherently problematic descriptors. Police officers working in more impoverished, higher crime, and more proportionally Black communities displayed significantly more problematic attitudes and significantly fewer positive attitudes compared with those in less proportionally Black communities. The findings related to race were partially-but not completely-explained by other community variables. CONCLUSIONS: Officers' negative descriptors, their occasional use of inherently problematic terms, and the intensification of those tendencies when working in communities with more poverty, higher crime, and a larger proportion of Black residents suggest an urgent need for intervention to help officers better understand youth. Training that would help police officers better understand youth, recognize developmental influences, and see each youth individually rather than as a representative of a group could help officers interact more supportively with youth, be less likely to inadvertently create confrontation, and more effectively de-escalate situations involving distressed or activated youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Our study examines the outcomes of remediation services provided to 1,913 juveniles who have been determined to be incompetent to stand trial and ordered into remediation services by the court. These services were offered based upon statutory guidelines legislated in 1999, through a statewide, community-based program maintained by the Virginia Department of Behavioral Health and Developmental Services (VA DBHDS). Recipients of these services were eight through 18-years-old and were predominantly African-American (73%), Caucasian (21%), and Hispanic (3%). Our outcome data indicate that 76% of the youth ordered into remediation services were determined by the court to have been remediated, 19% unlikely to attain competency, and 5% had their charges dismissed. Remediation services were offered within the community and received by the majority of the youth within three months at an estimated cost of $5,000 per juvenile. Rates of remediation differed based upon the age and mental status of the youth receiving services with 7% of youth aged eight to 10 years being remediated compared to 44% of those aged 14 to 16 years of age. Youth with a diagnosis of both intellectual disability and mental disorder were the least likely to be remediated with 51% determined to be unlikely to attain competency and an additional 28% having their charges dismissed. These outcomes are similar to those obtained with incompetent adult defendants, often through costly periods of inpatient hospitalization, raising the question of why states would not provide these due process protections to the most vulnerable youth within the juvenile system.

State hospitals are experiencing significant increases in pretrial forensic admissions, resulting in forensic waitlists and a "battle for beds," necessitating daily census management procedures. This column describes strategies designed and implemented at a state hospital in Virginia to address the bed crisis, with a focus on identifying and reducing barriers that affect the flow of admissions and discharges for persons ordered for competency restoration. Essential to this process is the forensic coordinator, who provides oversight across internal processes within the state hospital and engages in "boundary spanning," which strengthens collaboration with courts, jails, and local providers to address the competency crisis.

This study addressed the need for improved police training in the context of police-community relations, with a specific focus on interactions with youth. Data were collected from active police across the US to understand their perceptions of adolescents and identify training needs. We examined the impact of police roles (e.g. patrol, command) on their descriptions of adolescents, challenges policing adolescents, and training requirements. Findings reveal that police working as school resource officers (SROs) had a more positive view of adolescents and expressed interest in acquiring specific skills for effective interactions. Commanders viewed policing skills as challenging, whereas others viewed adolescent attributes as most challenging in police-adolescent encounters. Experience did not significantly influence police perceptions; beliefs remained consistent across veteran and less experienced police. Findings underscore the necessity for new training protocols for all law enforcement personnel, regardless of tenure, to mitigate negative and potentially harmful police-adolescent interactions.

OBJECTIVE: We examined the prevalence of criminal defendants facing only misdemeanor charges and referred for forensic mental health evaluations of legal sanity (criminal responsibility) in a state-wide sample of sanity reports. We sought to describe this population of defendants, particularly as compared to defendants facing felony charges and referred for evaluation of legal sanity. HYPOTHESES: We hypothesized that, among those referred for sanity evaluations, defendants facing only misdemeanor charges would have higher rates of serious mental illness than would defendants charged with felonies, as evidenced by their mental status during the evaluation and at the time of alleged offenses. We also hypothesized that defendants charged with only misdemeanors would be more often opined insane, as compared to those charged with felonies. METHOD: We reviewed a statewide sample of 926 court-ordered sanity evaluation reports in Virginia and coded numerous variables describing the defendants, sanity evaluation process, resulting reports, and legal opinions offered within the reports. RESULTS: Approximately 22.3% of sanity evaluations involved defendants charged only with misdemeanor offenses. Defendants facing only misdemeanor charges were 1.82 times more likely to be opined insane than were defendants facing only felony charges, primarily due to their increased likelihood of experiencing psychotic symptoms at the time of the offense (1.83 times more likely than defendants facing felony charges). CONCLUSIONS: The merits of pursuing the insanity defense in response to misdemeanor charges are questionable given the cost- and resource-intensive outcomes associated with insanity acquittals. Diversion strategies may be a more efficient response to those defendants with serious mental illness facing only misdemeanor charges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract This article examines the Inventory of Problems – 29 (IOP-29) in terms of the Daubert standards. The three majority opinions (i.e., Daubert v. Merrell Dow Pharmaceuticals, General Electric Co. v Joiner, and Kumho Tire Co. v. Carmichael) that constitute the so-called Daubert trilogy represented a sea change in judicial awareness of the relevance of empirical methodology in providing probative expert testimony in court. Specifically, they brought forth a set of factors that may be considered during trial to assess the admissibility of proffered expert testimony. The first section of the present article briefly describes the current state of negative impression management assessment in psycho-legal context, with particular reference to the development of the procedures and expectations for expert testimony. Next, Daubert factors are defined and applied, one by one, to IOP-29-based testimony. This led to the conclusion that the IOP-29 has been thoroughly and empirically tested in different contexts and countries, and across different psychopathological conditions (1st Daubert standard); it has been peer-reviewed and publications on it have showed continued growth in recent years (2nd Daubert standard); based on the many empirical studies, its error rate is potentially knowable (3rd Daubert standard); this information, along with standards for controlling its operation, are available in the IOP-29 Professional Manual (4th Daubert standard); there is growing evidence of the general acceptance that the IOP-29 has received within the scientific community currently and over the years (5th Daubert standard). Finally, recommendations are proposed on the use of the test within the forensic field.

The role of psychology (and ergo, psychologists) within the public sector has shifted considerably over the preceding decades to include increasingly versatile and psychology-adjacent leadership positions. This publication focuses on brief leadership stories within a state mental health system, with an emphasis on the unique roles that women psychologists have advocated for over the years. The authors provide foundational knowledge of this state's mental health system in order to spotlight the ongoing need for effective leadership within this organization, identifying common ethical and public administration challenges, and ultimately using a structured questionnaire with women psychologists within this system to highlight their leadership roles. These stories expand upon the education and training they felt foundational to their growth in these roles, how they advocated for change and navigated organizational challenges, and how they hope their role can inspire junior (women) psychologists to take increasingly active roles in public service leadership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The present qualitative study explored perspectives from youth, caregivers, and community partners who lived in or worked with organizations that served two low-income, urban communities exposed to disproportionate rates of firearm violence. The purpose of the study was to (a) identify changes that community members and community partners would like to see in terms of safety, (b) compare the similarities and differences in responses across the three participant groups. Youth (n = 11), caregivers (n = 20), and community partners (n = 41) participated in semi-structured interviews as part of a larger study evaluating community strategies to reduce community-levels of youth violence. Perspectives on changes related to safety were represented across four themes: (1) Changes to policing, (2) Increasing safety, (3) More opportunities for youth and family programs and activities, (4) Structural and resource investments in communities. Overall, qualitative findings offered a context-specific picture of desired areas for change to improve community safety. The results contribute to a framework for community mobilization and have implications for the development of comprehensive community violence prevention initiatives.

Governments and companies rely heavily on information technology (IT) to perform even the most basic functions of the business. The technology is, however, only a piece of an overall strategy that must be considered for success. The need for a strong cyber security culture is an equally vital part. So how does the modern cyber security professional create, nurture and sustain such a culture across the organisation? With over 69 per cent of cyber-aware trained employees knowingly bypassing security controls to conduct their critical business functions and achieve their objectives quicker, the answer to a more secure environment is not just the addition of more security technology, but cultivating a culture of cyber judgment to empower and enable the business to fulfil its mission in the most secure way possible without hindering outcomes. This paper delves into the importance of cyber security in today’s digital landscape, and suggests ways to overcome the challenges and develop a successful cyber security culture as a strategic asset.