Mental Health & Substance Use Services
The Agency of Human Services envisions a Vermont in which everyone is healthy - physically and mentally. AHS delivers services and supports to individuals, families, and communities to promote positive mental health as well as to prevent, reduce, and eliminate the issues caused by alcohol and drug use through prevention, treatment, and recovery services.
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Tobacco use is the number one preventable cause of death, but about 800 Vermonters still die each year from tobacco-related diseases. Given this morbidity and mortality, three goals guide the work of the Tobacco Control Program: prevent youth smoking; reduce adult smoking; reduce exposure to second-hand-smoke. The Health Department Tobacco Control Program employs Centers for Disease Control and Prevention best practice in four key areas to address these goals:
Cessation services help Vermonters quit smoking through the Quitline, Quit Partners, or Quit Online as part of 802Quits. These services are evidence-based and greatly increase the changes a smoker will quit successfully. The program also partners to provide nicotine replacement therapy
Mass Reach Media, including hard-hitting ads, is shown to be effective in reaching those who smoke and inciting them to reach out to 802Quits. This includes television, radio, and social media efforts.
State and community interventions raise awareness on the actions decision makers can take to reduce the toll of tobacco. These include educating decision makers about passing smoke-free policies at local parks and playgrounds, which reduce secondhand smoke exposure and create positive social norms around tobacco use, and changing the tobacco retail environment, where exposure to product and advertising causes youth tobacco initiation. The Vermont Department of Health and the Agency of Education fund two youth tobacco prevention groups – Our Voices Xposed (OVX) in high schools and Vermont Kids Against Tobacco (VKAT) in middle schools.
Surveillance and evaluation ensure the program stays on track and uses data to drive programmatic decision making. The Tobacco Control Program invests in data collection, analysis, and dissemination to partners in and outside of government.
Who We Serve
The Tobacco Control Program is committed to serving all Vermonters seeking to reduce and quit their tobacco use. Some populations, including pregnant smokers, Medicaid-insured, those with mental illness or substance abuse disorders, less education, and lower income, are a focus of the Health Department. Additionally, supervisory unions with a higher burden of tobacco use are a targeted sector supported by this program. Tobacco use and the morbidity and mortality it causes disproportionally impact those with fewer resources and results in large health disparities.
How We Impact
By employing CDC Best Practices for Comprehensive Tobacco Control Programs with fidelity, the work of the Tobacco Control Program and partners should, over time, impact the number of Vermonters who smoke and therefore reduce deaths from tobacco-related diseases. Quitting tobacco has beneficial short and long term health impacts no matter one’s age. Three behaviors - no physical activity, poor diet, and tobacco use - lead to cancer, heart disease, diabetes, and lung disease accounting for more than 50% of premature deaths in Vermont. Reaching Vermonters that want to quit and supplying the needed cessation support will reduce, over time, the number of Vermonters suffering and dying from chronic disease.
Together with population indicators, the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
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The Adult Mental Health (AOP) program serves adults experiencing mental health challenges. The array of services available for people in the AOP program vary by DA and may include:
- clinical assessment
- service planning and coordination
- community supports
- individual, group, and/or family therapy
- medication evaluation and management, and consultation with primary care
- emergency care and crisis stabilization
- psychoeducation/recovery education
Who We Serve
Any adult (18+ years old) is eligible to receive adult outpatient (AOP) supports and services.
How We Impact
Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
Budget Information
Budget Description: Adult Services to include Emergency Services Investment, CRT (all expenses), Adult Case Rate, Homeless, MISC Adult Grants, Emergency Outreach, Case Management, Workforce Training, Forensic System of Care
| FY 22 Actual | FY 23 Budget | FY 24 Draft Governor Recommend |
| $93,927,952 | $99,771,295 | $101,648,524 |
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Emergency (or Crisis) Services are time-limited, intensive supports provided for individuals and families who are currently experiencing, or may be expected to experience, a psychological, behavioral, or emotional crisis. Services may also be provided to the individual's or family's immediate support system. These services are available 24 hours a day, 7 days a week.
Who We Serve
Any person in Vermont is eligible to receive support through the Emergency Services (ES) program.
How We Impact
Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
Budget Information
There is no budget information specific to Emergency Services. It is emeshed in the following budgets:
- Suicide Prevention
- Childrens Community Services to include Emergency Services, Childrens case rates, peer services and Misc. Grants
- Adult Services to include Emergency Services Investment, CRT (all expenses), Adult Case Rate, Homeless, MISC Adult Grants, Emergency Outreach, Case Management, Workforce Training, Forensic System of Care
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The Vermont Psychiatric Care Hospital provides excellent care and treatment in a recovery-oriented, safe, respectful environment that promotes empowerment, hope and quality of life for the individuals it serves.
Who We Serve
The Vermont Psychiatric Care Hospital (VPCH) serves adults who require a hospital level of care and who are held involuntarily by a civil or a forensic order. VPCH is considered a Level 1 inpatient facility, meaning it serves those who are highly acute and require additional services and supports.
How We Impact
Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
Budget Information
DMH Program budget (summary level)
| FY 22 Actual | FY 23 Budget | FY 24 Draft Governor Recommend |
| $28,065,553 | $24,833,519 | $31,355,689 |
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The Community Rehabilitation and Treatment (CRT) programs provided at Vermont's Designated Agencies help individuals and their families to develop skills and supports important to living the life they want for themselves.
Who We Serve
Vermont’s Community Rehabilitation and Treatment (CRT) programs assist adults that have been diagnosed with a severe and persistent mental illness. Symptoms may be mild or substantially disabling, and long-term or short term.
How We Impact
Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
Budget Information
Budget Description: Adult Services to include Emergency Services Investment, CRT (all expenses), Adult Case Rate, Homeless, MISC Adult Grants, Emergency Outreach, Case Management, Workforce Training, Forensic System of Care
| FY 22 Actual | FY 23 Budget | FY 24 Draft Governor Recommend |
| $93,927,952 | $99,771,295 | $101,648,524 |
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Appropriation ID - 15000 Global Commitment
What We Do
The DVHA strives towards the Institute for Healthcare Improvement’s “Triple AIM":
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
One of the strategies the DVHA has adopted to move towards the “Triple AIM” is utilization management of our most intensive and high-cost services, which include inpatient psychiatric hospitalization. Inpatient psychiatric services, which include detoxification, are paid on a per day basis, unlike hospitalization on traditional medical inpatient units. This per day payment methodology has the potential to create a dis-incentive for providers to make efficient use of this high cost, most restrictive level of care. While CRT members’ hospital costs are included in their case rate payment to the Designated Agencies (DAs), which creates an incentive for the DAs to work efficiently with the inpatient units to transition their members back to their existing community services and supports, no such incentives exists for children or non-CRT enrolled adults.
Partners
- Department of Mental Health Adult and Children and Families Units,
- Department of Disabilities, Aging and Independent Living,
- Department for Children and Families,
- Integrated Family Services,
- Designated Hospitals,
- Designated Agencies,
- Special Service Agencies,
- Vermont Chronic Care Initiative
How We Impact
Historically, as a part of an acute care management program that was developed in response to the 1115b Waiver, children’s inpatient admissions at the Brattleboro Retreat were managed through a concurrent review process, however this oversight ended in late 2006 and during this “unmanaged” period the average length of stay and inpatient costs grew substantially. In 2010 the Department of Vermont Health Access began a utilization management (UM) system for children and adolescents, adults ages 18-22 admitted to the Brattleboro Retreat, and all adults admitted to out of state facilities. In 2011, the DVHA added inpatient detoxification admissions and adult psychiatric admissions (excluding CRT and Involuntary) to the UM program. In 2012 the Department of Mental Health (DMH) and the Department of Vermont Health Access (DVHA) collaborated to create a unified utilization management system for all Medicaid funded inpatient psychiatric and detoxification services. The goals for the utilization management system are as follows:
- Clinical care is provided only as long as necessary for safety and/or other acute needs.
- There are standardized criteria for admission, continued stay and discharge throughout the system of care.
- Care is continuous between the ongoing community treatment teams and episodes of inpatient or residential care. Ideally the hospital or residential facility and community teams develop and share a common treatment plan developed in partnership with the individual and their family, beginning within 24 hours of admission.
- Resources of the public system are effectively and efficiently used.
- The system of care will ensure access to effective, appropriate, recovery-based services that promote an individual’s health, wellness and resiliency and will support successful integration into the community.
Collaboration between VCCI and DVHA utilization review staff helps ensure timely communication with inpatient facilities and supports beneficiaries being able to successfully re-integrate with outpatient supports and services.Collaboration between DVHA and DMH UR staff and DCF, DAIL and DMH adult Care Managers and DMH CAFU Care Managers helps to ensure that active and appropriate aftercare planning is facilitated between the Designated Hospitals and the outpatient providers, this allows for aftercare services to be in place and ready to receive beneficiaries as soon as they are ready to be discharged and return to their communities. Our Agency partners are also invaluable in holding their preferred providers accountable to the tenets of the “Triple AIM”.
Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.
