Service Area Strategic Plan
4/17/2014   9:06 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Forensic and Behavioral Rehabilitation Security (720 357 07)
Description

State hospitals provide evaluation, emergency inpatient treatment, and treatment to restore competency to individuals who are involved with the criminal justice system in the Commonwealth. The most secure forensic treatment location is the Maximum Security Forensic Unit at Central State Hospital (CSH) in Petersburg, which has levels of perimeter and internal security and security personnel that are equivalent to a medium security correctional center. An Intermediate Security Unit at CSH has medium correctional security levels of perimeter security, a less restricted internal milieu, and security staffing. Two minimum-security units, at Eastern State Hospital (ESH) and Western State Hospital (WSH), have a physical structure that includes, at a minimum, two levels of locked security to prevent escape and a specialized staff complement.

The Department also operates the Virginia Center for Behavioral Rehabilitation (VCBR), which provides evaluation and rehabilitation services in a secure setting to individuals found by the court to meet the statutory criterion of sexually violent predator (SVP). Sexually violent predators are convicted sex offenders who are civilly committed to the Department at the end of their confinement in the Department of Corrections because of their histories of habitual sexually violent behavior and because their ability to control their violent tendencies is compromised by the presence of a “mental abnormality” or “personality disorder”. The VCBR prepares residents, when appropriate, for eventual return to their home communities, working with community providers to develop realistic and appropriate conditional release and monitoring safety plans.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    The Department must, by statute, provide secure confinement of individuals under criminal charge who are admitted directly from law enforcement custody. It also is required by statute to operate a secure treatment facility for individuals found by the courts to be sexually violent predators. The Department acts to ensure that treatment promotes public safety and provides a full array of treatment services within a setting that is no more restrictive than is required to meet those goals. To this end, the Department's forensic secure placement program makes use of multiple levels of security and access that are determined by the unique combination of legal constraints and treatment needs that apply in each case.
  • Describe the Statutory Authority of this Service
    Chapter 11 of Title 16.1 of the Code of Virginia sets out the provisions of juvenile and domestic relations court law.
    • § 16.1-356 of the Code of Virginia authorizes the Department to conduct evaluations of the competency of juvenile defendants to stand trial.

    Chapters 11 and 11.1 of Title 19.2 of the Code of Virginia authorize the Department to provide forensic services to individuals in the criminal justice system, including evaluations of competency, determinations of sanity, restoration to competency services, and treatment services for individuals adjudicated not guilty by reason of insanity.
    • § 19.2-169.1 of the Code of Virginia authorizes the Department to conduct evaluations of the competency of defendants to stand trial on a criminal charge.
    • § 19.2-169.2 of the Code of Virginia authorizes the Department to provide inpatient treatment of individuals found to be incompetent to stand trial who need restoration to competency.
    • § 19.2-169.3 of the Code of Virginia authorizes the Department to provide treatment of individuals found to be unrestorably incompetent who have been involuntarily admitted pursuant §37.2-817.
    • § 19.2-169.5 of the Code of Virginia authorizes the Department to conduct evaluation of a defendant’s mental status at the time of the offense.
    • § 19.2-169.6 of the Code of Virginia authorizes the Department to provide inpatient treatment for a criminal defendant transferred from a jail to a hospital if the defendant is found to be mentally ill and imminently dangerous to himself or others.
    • § 19.2-176 of the Code of Virginia authorizes the Department to evaluate and provide emergency treatment to a person who has been convicted or has pled guilty to a crime and is being held in jail to await sentencing.
    • § 19.2-177.1 of the Code of Virginia authorizes the Department to provide inpatient treatment of a jail inmate who has been sentenced, is in a local or regional jail, and has been found to be mentally ill and imminently dangerous to themselves or others.
    • § 19.2-182.2 of the Code of Virginia authorizes the Department to conduct evaluations of individuals found not guilty by reason of insanity to determine whether they should be kept in the hospital for further treatment, placed on conditional release in the community, or released to the community without conditions.
    • § 19.2-182.3 of the Code of Virginia authorizes the Department to provide inpatient treatment to individuals found to be not guilty by reason of insanity and committed by the court.
    • § 19.2-301 of the Code of Virginia authorizes the Department to conduct evaluations of sexual abnormality.

    Chapter 9 of Title 37.2 of the Code of Virginia authorizes the civil commitment of sexually violent predators and authorizes the Department to operate or contract for a secure confinement facility to provide behavioral rehabilitation services to them
    • § 37.2-908 requires the Department to monitor a conditionally released sexually violent predator’s compliance with a course of treatment ordered by the court.
    • § 37.2-909 requires the Department to provide care, control, and treatment of sexually violent predators committed to it pursuant to Chapter 9 in a secure facility that it operates or contracts for.
    • § 37.2-910 requires the Department to prepare discharge plans and conditional release plans if the committing court finds that the person is no longer a sexually violent predator.
    • § 37.2-912 requires the Department to implement the court’s conditional release orders and submit written reports on the committed person’s progress and adjustment
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Community services boards and the behavioral health authority (CSBs) Community services boards and behavioral health authority (CSBs) 40 40
Individuals civilly committed to the Virginia Center for Behavioral Rehabilitation (VCBR) Individuals meeting SVP criteria and civilly committed to the Virginia Center for Behavioral Rehabilitation (VCBR) 150 300
Individuals meeting SVP criteria and conditionally released for SVP treatment Individuals meeting SVP criteria and conditionally released for SVP treatment 166 600
Individuals with active criminal justice system involvement receiving secure forensic services Individuals with active criminal justice system involvement who require secure forensic services 1,472 1,766
Local and regional jails Local and regional jails 84 84
Virginia circuit and district courts Virginia Circuit and District Courts 325 325

Anticipated Changes To Agency Customer Base
o Virginia’s population is increasing, becoming more culturally diverse, and growing older. The customer base for state hospital forensic services will change to reflect these demographic trends.

o State hospitals will serve proportionately greater numbers of individuals with significant or complex service needs who will require specialized treatment services and ongoing preventive care.

o State hospitals will serve proportionately greater numbers of individuals with co-occurring disorders (mental health and substance use disorders, intellectual disability and/or other developmental disabilities), increased individual acuity, and complicated acute and chronic medical needs.

o The lack of community crisis intervention and crisis stabilization services and the complexity of process for accessing inpatient treatment for individuals in crisis often results in individuals being arrested and incarcerated in lieu of community-based or state hospital treatment under a civil status.

o State hospital adult beds are likely to be increasingly filled by individuals who are involved with the criminal justice system. In FY 2008, 1,620 unique individuals with a forensic legal status were served in state hospitals. These individuals occupied the equivalent of 535 beds and had an average length of stay of 120.5 days compared to 73.6 days for non-forensic individuals. Between FY 2000 and FY 2008, state hospital bed days occupied by individuals with a forensic status increased from 133,440 to 195,273 bed days or from 22.6 to 35.2 percent of total state hospital bed days.
Partners
Partner Description
Advocacy organizations: NAMI Virginia is actively involved on Department work groups addressing forensic issues.
Commitment Review Committee (CRC): Department staff serves on the CRC committee, which is operated by the Department of Corrections.
Commonwealth Consortium for Mental Health and Criminal Justice Transformation: The Department is working with this Consortium, established by Executive Order 62 in 2008, to identify, evaluate, and support the development of jail diversion models and establish a Criminal Justice and Mental Health Training Academy for the Commonwealth.
Community services boards and behavioral health authority (CSBs): CSBs provide case management and treatment services to individuals who are involved with the criminal justice system. They are actively involved with the Department in coordinating referrals to and planning for the discharge of individuals who have a forensic status from state hospitals.
Indigent Defense Commission: Most forensic patients have court-appointed or public defender representation in the courts. Commission members are actively involved in developing diversion alternatives to arrest and incarceration for these individuals and consult frequently with Department forensic experts on matters related to specific cases before the court and with regard to program needs.
Office of the Attorney General (OAG): The OAG provides consultation on forensic issues, makes the final decision on which SVP cases to take forward to court for civil commitment, provides expert testimony in civil commitment trials, conducts annual reviews, and provides specialized training to evaluators, treatment providers, and community corrections personnel.
Provider associations: The Department works closely with the Virginia Sheriffs Association, the Virginia Association of Regional Jails, and the Virginia Hospital and Healthcare Association participate on Department forensic workgroups. Members of the Commonwealth’s Attorneys Service Council consult frequently with Department forensic experts on matters related to specific cases before the court and with regard to program needs.
State Agencies: The Department of Corrections (DOC) screens SVP-eligible inmates for Commitment Review Committee review beginning 10 months before their release date and administers a sex offender re-offense risk protocol. It also works closely with the Department to improve access to hospital and community treatment resources for parolees who have been released from DOC facilities. The Department of Criminal Justice Services has partnered with the Department in developing and implementing a program of cross training in MH evaluation and treatment methods aimed at law enforcement personnel, including jail security staff. The Office of the Executive Secretary of the Supreme Court of Virginia provides valuable data regarding the numbers of forensic consumers who have been diverted from inpatient status for MH evaluations for the courts.
University of Virginia Institute of Law, Psychiatry, and Public Policy (ILPPP): The ILPPP, in consultation with the Department, develops and provides training for CRC evaluators and others relating to SVP civil commitment. The ILPPP also has partnered with the Department's forensic program for more than 25 years to develop improved evaluation and treatment services for forensic consumers and promote community-based, outpatient approaches to service delivery.
Products and Services
  • Factors Impacting the Products and/or Services:
    o Many individuals with mental health disorders who are at risk for or are currently involved in the criminal justice system are poor, uninsured, disproportionately representative of minority populations, homeless, or living with co-occurring mental health and substance use disorders. These individuals, when incarcerated, frequently do not receive adequate behavioral health services and, upon release, have difficulty re-entering and reintegrating into the community. They are highly likely to recycle through the behavioral health and criminal justice systems and to require more intensive levels of care in both systems. Many lose their income supports and health insurance benefits are not provided with adequate linkages to behavioral health services and supports. A similar situation exists for youth with serious emotional disturbances who are in the juvenile justice system.

    o Current demand for forensic evaluation and treatment services exceeds the capacity of Eastern State Hospital and, to a lesser extent, Western State Hospital. Additionally, the Department continues to maintain a waiting list for the maximum-security treatment beds at Central State Hospital, which has a statewide service area.

    o The manner in which community behavioral health agencies, law enforcement, and the courts respond to the behaviors of individuals with mental illness in community settings effects demand for secure forensic services. Once an individual is arrested, individuals with mental illness often require a year or more of inpatient treatment to render them able to stand trial for criminal charges that could have been avoided by using pre- and post-booking, or pre-trial alternatives and community treatment services.

    o Implementation of community and jail-based options such as those listed below should reduce the need for inpatient forensic resources.

    • Pre- and post-booking, pre-trial alternatives, and community treatment services such as crisis intervention teams and crisis stabilization programs that prevent behavioral health situations from requiring criminal justice response, divert individuals from incarceration or detention whenever legally possible, and link individuals to community-based services and supports.

    • Improved methods for delivering an array of behavioral health treatment in Department of Corrections (DOC) facilities, Department of Juvenile Justice (DJJ) correctional centers and half-way houses, juvenile detention facilities, and local and regional jails.

    • Court-ordered evaluation and treatment services that are provided in the least restrictive setting possible, including services in the community or in local jails and hospitals where appropriate.

    • Post-incarceration and re-entry services that include appropriate clinical services and supports at the time of release.

    o Statutory changes to the definition of SVP qualifying crimes and SVP screening criteria enacted in 2006 have increased the number of inmates who meet the SVP civil commitment standards by approximately 300 percent, necessitating the expansion of civil commitment resources and secure beds as well as community treatment and supervision resources for conditionally released sexually violent predators.

    o About one-third of SVP cases are considered for conditional release. About half of all individuals reviewed for SVP conditional release are rejected and committed to the VCBR because no suitable housing is available. In order to divert as many individuals as safely possible from the VCBR to SVP conditional release in the community, suitable and cost effective transitional housing would need to be developed for these individuals to facilitate successful community placement.
  • Anticipated Changes to the Products and/or Services
    o The Department and its partner agencies will work to actively implement proposed changes to the current process of managing the delivery and utilization of services provided to individuals with mental illness who become involved with the criminal justice system in Virginia. This includes efforts to further promote the goal of diversion from arrest and criminal prosecution of persons with mental illness who are in crisis.

    o Under the initial four SVP predicate crimes, VCBR experienced a commitment rate of about two individuals per month. The 2006 statutory changes increased the number of predicate crimes to 23 and the SVP commitment rate rose from less than one (actual rate) to nearly five per month. At this accelerated rate, VCBR will reach capacity in 2012.
  • Listing of Products and/or Services
    • Forensic Services: expert inpatient and outpatient mental health evaluations and reports for the courts, emergency treatment services; treatment to restore competency to stand trial; commitment for treatment for individuals acquitted of a criminal offense as Not Guilty by Reason of Insanity; expert court testimony in forensic matters; statewide training in forensic MH evaluations for the criminal courts; coordination with CSBs of public community MH services for forensic consumers; and training, consultation, and assistance on forensic issues
    • SVP Behavior Rehabilitation Services: sex offender rehabilitation services within a maximum-security perimeter; review of Commitment Review Committee (CRC) and SVP evaluations; annual and as needed sex offender evaluation and treatment training in collaboration with the ILPPP; quality management feedback to CRC evaluators; and annual SVP commitment reviews for the courts
Finance
  • Financial Overview
    This service area is funded with 99 percent general funds and 1 percent non-general funds. Non-general funds are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to patient care.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $25,461,219 $308,098    $25,461,219 $308,098
    Change To Base $0 $0    $0 $0
               
    Service Area Total   $25,461,219  $308,098     $25,461,219  $308,098 
Service Area Objectives
 
  • Provide sufficient secure forensic evaluation and treatment services that meet the demands of jails and courts and specialized behavioral rehabilitation services to civilly committed sexually violent predators.
    Objective Description
    This objective aligns with the statutory mandate of the Department to provide the secure forensic services. Effective service delivery and utilization management assures that consumers receive accountable and quality secure forensic services and supports that are appropriate to their individual needs. By reducing the average length of stay for in-patient forensic consumers, the Department will be able to better address the needs of Virginia's jails and courts. The objective also aligns with the statutory mandate authorizing the Department to operate or contract for a secure confinement facility to provide behavioral rehabilitation services to individuals who have been civilly committed as sexually violent predators. Effective service delivery and utilization management assures that consumers receive accountable and quality secure forensic services and supports that are appropriate to their individual needs
    Alignment to Agency Goals
    • Agency Goal: Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.
    • Agency Goal: Obtain sufficient numbers of professional, direct care, administrative, and support staff with appropriate skills and expertise to deliver quality care.
    Objective Strategies
    • Strengthen state and local behavioral health and criminal justice partnerships and criminal justice/behavioral health collaborative programs.
    • Work with the Consortium for Mental Health and Criminal Justice Transformation to support and enhance collaboration, education, and criminal justice-behavioral health partnerships at the state, regional, and local levels.
    • Increase efforts to offer a comprehensive array of forensic treatment and behavioral rehabilitation services by continuously assessing and adjusting services and activities according to individual needs and interests.
    • Continue to integrate recovery values to the extent possible into the day-to-day activities of individuals receiving forensic and behavioral rehabilitation services.
    • Increase the numbers of individuals who receive education on wellness and recovery.
    • Maintain sufficient numbers of trained professional and direct care staff necessary to deliver quality forensic treatment and behavioral rehabilitation services and assure the safety of individuals receiving services on secure forensic units or VCBR.
    • Provide the minimum number of appropriately trained personnel at VCBR to staff every security post for three shifts.
    • Implement a career path for forensic direct service associates to improve recruitment and retention efforts.
    • Review and modify, as appropriate, inpatient programs for individuals found Not Guilty by Reason of Insanity (NGRI).
    • Support CSB efforts to develop community alternatives that provide a higher level of support and services for individuals receiving forensic services in state hospitals, thereby decreasing their need for prolonged and more restrictive hospitalization.
    • Expand the array and capacity of jail diversion services, including pre-and post-booking, pre-trial alternatives, and community treatment services that prevent or divert individuals from incarceration.
    • Expand jail-based behavioral health services that reduce demand for secure forensic treatment and prevent re-hospitalization of inmates.
    • Continue to work with CSBs and private providers to expand the provision of forensic evaluation services in the community.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • The proportion of individuals receiving secure forensics services in state hospitals to individuals receiving CSB services who are referred by criminal justice agencies.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down
      Measure Baseline Value:
      .031
      Date:
      6/30/2009

      Measure Baseline Description: The proportion of individuals receiving secure forensics services in state hospitals to individuals receiving CSB services who are referred by criminal justice agencies.

      Measure Target Value:
      .029
      Date:
      6/30/2012

      Measure Target Description: The proportion of individuals receiving secure forensics services in state hospitals to individuals receiving CSB services who are referred by criminal justice agencies.

      Data Source and Calculation: Source: AVATAR and CCS3 Calculation: Number of individuals admitted with a forensic status divided by the number of individuals served by CSBs with CCS referral codes 10-15 and 24 annually


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