Summary of "Behavioral Health Redesign: Community Psychiatric Support and Treatment - Youth (Home/Community)"

Summary of Key Wellness Strategies, Self-Care Techniques, and Productivity Tips from the Webinar on Community Psychiatric Support and Treatment (CPST) for Youth

Overview of CPST for Youth

Community Psychiatric Support and Treatment (CPST) is a redesigned Medicaid behavioral health rehabilitative service set to replace intensive in-home services and therapeutic day treatment starting July 1, 2026. CPST is a multicomponent, person-centered service that includes:

Assessment and diagnostic interviews
Treatment planning
Crisis support and prevention
Care coordination
Skill building
Counseling and psychotherapy

Two Tiers of Service Intensity

CPST services are delivered in two tiers based on the youth’s level of functional impairment:

Tier 1:

3 to 8.7 hours of service per month
Moderate functional impairment
Weekly interventions focusing on skill building and community integration
Crisis prevention primarily through planning and proactive skills
Delivered by 1-2 staff members with supervision

Tier 2:

9 to 28 hours of service per month
Significant functional impairment, serious mental illness, or emotional disturbance
More intensive skill building, crisis support, and care coordination
May include behavioral health technicians for repetition and practice of skills
Higher frequency and longer sessions, including in-person crisis interventions

Comparison with Other Services

CPST offers more comprehensive, real-world supports than outpatient therapy and medication management.
It fits within a continuum of care, ranging from outpatient therapy (less intense) to assertive community treatment and intensive outpatient programs (more intense).
Tier 2 CPST aims to provide a level of support close to assertive community treatment but less intense than intensive outpatient or partial hospitalization.

Collaborative Behavioral Health Service Model

CPST is delivered through a team-based approach involving:

Licensed Mental Health Professionals (LMHPs)
Qualified Mental Health Professionals (QMHPs)
Behavioral Health Technicians (BHTs)

Teams provide coordinated care including assessment, treatment planning, skill-building, crisis support, and care coordination. Supervision and collaboration are required to maintain quality and fidelity to the model.

Training and Competency Development

Training requirements vary by professional type and include:

Licensed clinical supervisors: 40 hours MAP direct services curriculum
LMHPs/LMHP-Rs: 10 hours foundational skills curriculum (FSC) + MAP curriculum + portfolio review
QMHPs: 10 hours FSC + CPST Q/B curriculum
BHTs: Behavioral Health Tech Academy + CPST Q/B curriculum

Key training skills include:

Motivational interviewing
Crisis management
Person-centered planning
Professional ethics
Understanding serious emotional disturbance (SED)

The use of MAP practice guides and dashboards assists in treatment delivery and monitoring progress.

MAP Practice Guides

MAP practice guides serve as practical, step-by-step tools for clinicians and families. Examples include:

Parent training on positive attention
Cognitive interventions for trauma-related distorted thoughts

These guides are designed to be used during sessions and as take-home references for ongoing skill practice.

Case Examples Highlighting CPST Application

7-year-old with ADHD and Oppositional Defiant Disorder (ODD): Standard outpatient therapy focuses on parent management training and positive behavior reinforcement. CPST adds in-home coaching, crisis planning, and care coordination to support skill practice and manage crises. Tier 2 may involve behavioral health technicians for more intensive practice and crisis support.
10-year-old with Traumatic Stress: Evidence-based treatments include trauma-focused CBT and EMDR. CPST supports real-world skill building, relaxation techniques, crisis prevention, and care coordination. Tier 2 involves more frequent, longer sessions and possibly behavioral health technician involvement.
14-year-old with Anxiety and Depression: Psychotherapy (CBT, family systems) and medication management are standard. CPST provides additional support for behavioral activation, crisis planning, and community integration. Tier 2 offers more frequent sessions and skill repetition with behavioral health technicians as needed.

Productivity and Caseload Management

Example caseloads for QMHPs include blended mixes of Tier 1 and Tier 2 clients.
Virtual sessions are allowed for many components, increasing flexibility.
Caseload caps are set at 20 clients, with recommended caseloads lower to maintain quality.
Staff schedules include direct care, crisis support, care coordination, and supervision.

Key Takeaways / Wellness & Productivity Tips

Person-centered, collaborative care enhances treatment effectiveness by involving youth and families actively in planning and skill-building.
Skill building in real-world environments (home, school, community) is crucial for sustainable behavioral change.
Crisis prevention and planning are integral to treatment, reducing emergency interventions.
Team-based approaches improve service delivery and allow for tailored interventions based on intensity needs.
Ongoing training and use of practical tools (MAP guides) support staff competency and consistent care quality.
Flexible service delivery including virtual options and blended caseloads helps maintain productivity while addressing client needs.
Tiered service intensity ensures youth receive the appropriate level of support without over- or under-servicing.

Presenters / Sources

Lisa Job Shields, Behavioral Health Division Director, Virginia Medicaid
Carrie Savage, Director, Office of Child and Family Services, DBHDS
Katherine Hunter, Child and Family Behavioral Health Program Manager, Office of Child and Family Services, DBHDS
Karen Grabowski, Office of Child and Family Services, DBHDS