Service Area Strategic Plan
4/16/2014   12:33 pm
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
State Intellectual Disabilities Training Center Services (720 430 10)
Description

State Training Center Services include medical and psychiatric assessment, preventive and general healthcare, medical stabilization, and supports focused on developing skills needed for successful community living to persons with intellectual disability who require highly intensive and structured environments of care. Although their traditional function has focused on long-term care, training centers also provide short-term respite and emergency care. All training centers have Regional Community Support Centers, which offer an array of dental, behavioral, and other therapeutic services and supports to individuals receiving community-based supports.

The Department operates five training centers: Northern Virginia Training Center (NVTC) in Fairfax, Southeastern Virginia Training Center (SEVTC) in Chesapeake, Southside Virginia Training Center (SVTC) in Petersburg, Central Virginia Training Center (CVTC) in Lynchburg, and Southwestern Virginia Training Center (SWVTC) in Hillsville. All training centers meet federal requirements for designation as Intermediate Care Facilities (ICF/MR) and one, CVTC, also operates skilled nursing and acute care beds.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    State training centers are an integral component in the continuum of care in Virginia. The training centers provide services and supports to persons with intellectual disability who present complex medical needs and behavioral challenges that require highly intensive and structured environments of care. Over the past two years, training centers have been implementing person-centered planning processes and have expanded their missions to make short-term and transitional facility-based services more readily available. All training centers have developed strong ties with the communities they serve and each provides a variety of specialized services that support community systems. These supports draw on staff expertise and experience available at the training center and have the goals of diverting potential admissions by stabilizing individuals in their community residences or utilizing the centers' residential capacities to provide time-limited therapeutic services to individuals for whom the community has reserved funding for community supports upon his or her discharge. .
  • Describe the Statutory Authority of this Service
    Chapter 3 of Title 37.2 of the Code of Virginia establishes the Department of Behavioral Health and Developmental Services.
    • § 37.2-304 outlines the duties of the Commissioner, including supervising and managing the Department and its training centers, which provide treatment, training, or habilitation of individuals with intellectual disability

    Chapter 7 of Title 37.2 of the Code of Virginia authorizes the Department to perform certain functions related to the operation of training centers.
    • § 37.2-707 authorizes the Commissioner to employ state facility directors; and
    • § 37.2-711 authorizes the Department and state facilities to exchange consumer-specific information for former and current consumers with CSBs to monitor the delivery, outcome, and effectiveness of services.

    The federal Centers for Medicaid and Medicare (CMS) certifies all ICF/MR beds in training centers operated by the Department and acute care beds and skilled nursing beds at the CVTC.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals receiving state training center services and supports Individuals served in state training centers 1,386 1,500

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

o The training centers primarily serve adults, but include residents who are over age 65, especially at CVTC and SVTC. Most training center residents (90 percent) are between 22 and 65 years of age, with only two percent below the age of 22 and eight percent over age 65. The average age of individuals served in training centers is 48 years of age, which is likely to increase as the average length of stay of current residents is just less than 30 years. The numbers of older adults served in training centers is expected to increase as the current resident population grows older.

o With the expansion of community services capacity and bed reductions resulting from the Medicaid Money Follows the Person (MFP) initiative and a smaller (75 bed) new SEVTC; training centers will increasingly serve two very distinct populations with intellectual disability: individuals with co-occurring physical risk factors or medical conditions such as seizures, scoliosis, or gastrointestinal problems and individuals with co-occurring mental illness and challenging behaviors.

o Most individuals have either a hearing or visual deficit, or both, or one or more neurological conditions in addition to their intellectual disability. Many are non-ambulatory (requiring specialized wheelchairs) or need significant staff assistance to walk.

o A significant portion (34 percent) has at least one psychiatric diagnosis and the frequency of individuals served in training centers with co-occurring mental illnesses or significant behavioral challenges is anticipated to increase.

o Admissions to training centers will be due primarily to one of two factors: there are changes in the behavioral patterns presented by the individual that are risking the health and safety of the individual or others in his or her community environment; or the individual has no place to go to receive supports needed to maintain his or her health and safety and funding does not exist for these supports to be provided in the community.
Partners
Partner Description
Advocacy groups: Statewide volunteer organizations such as ArcVA and Parents and Associates of the Institutionalized Retarded (PAIR) address various aspects of the service delivery system to promote quality, availability and accessibility of care to all persons with cognitive, developmental, physical, or mental disabilities.
Community services boards and behavioral health authorities (CSBs): The CSBs serve as the single points of entry into publicly funded intellectual disability services. They prescreen individuals for admission to training centers and prepare discharge plans for individuals being discharged from training centers. They also participate in case reviews and the treatment/habilitation planning process and provide case management (i.e., monitor and coordinate support services needed) to the individual in the community.
Office of the Inspector General (OIG): The OIG has statutory responsibility to inspect, monitor, and review the quality of services provided in training centers in order to prevent problems, abuses, and deficiencies in treatment and habilitation programs. OIG staff conduct on-site inspections of each facility and publish findings, making recommendations for changes.
Private residential services providers: Private providers offer residential services to individuals who are being discharged from training centers.
Regional partnerships and regional admission committees: The regional partnerships include representatives from state hospitals, training centers, and CSBs. These partnerships are engaged in strategic planning to restructure and enhance the delivery of developmental services and establishment of community resources.
Virginia institutions of higher education (universities, colleges, and community colleges): Universities, colleges, and community colleges partner with the training centers to conduct training of healthcare personnel and students; provide educational opportunities to staff for advancement; and provide, upon referral, consultative services.
Virginia Office for Protection and Advocacy (VOPA): VOPA has statutory responsibility to protect and advocate for the human and legal rights of persons with mental, cognitive, or developmental disabilities. VOPA services to consumers include legal services, advocacy, information and referral to programs and services. VOPA monitors services at state facilities for quality and safety.
Products and Services
  • Factors Impacting the Products and/or Services:
    o The emergence of person-centered principles and practices and the continued development of enhanced community-based supports in the Commonwealth have helped to change the provision of training center and community intellectual disability services and supports in Virginia. The 2007 Mental Retardation Services System Study recommended that smaller, more narrowly focused training centers serve individuals with higher needs while community services capacity is developed to serve individuals with behavioral and medical needs.

    o Training centers will continue to evolve over the next six years, as plans for the elimination of current waiver waiting lists are implemented; state-funded housing and other supports infrastructure is implemented in communities served by Southeastern Virginia Training Center and Central Virginia Training Center; and the Department and the DMAS work together to enhance the ID waiver. This will involve development of community-based residential support models of four or fewer beds, including sponsored residential placements with specialized expertise in crisis and behavioral supports or skilled nursing and medical oversight; implementation of a tiered system of day support rates; enhance the ability of the waiver to support people who have challenging behaviors; and development of incentives for the provision of community-based skilled nursing services required for medical oversight.

    o Future demand for state training center services will be affected by the increased availability of community intellectual disability services and supports, including ID waiver group homes and community ICF/MR alternatives, behavioral consultation, and medical, dental, and other services provided through the Regional Support Centers.

    o The increasing age of care givers for individuals with intellectual disability will increase future demand for alternative housing and structured support options, including training centers, as the large cohort of baby boomer parents become too old or disabled to continue their care giving responsibilities or they die.

    o The severity of physical plant conditions at all training centers requires immediate attention. Most training center buildings are in very poor condition and are inappropriately designed to serve the needs of current training center populations. Designs also have inherent inefficiencies for staff, utilities, and support services.

    o Clinical, environmental, and administrative standards set by the Centers for Medicaid and Medicare (CMS) are likely to continue to become more complex, burdensome, and more expensive to implement.
  • Anticipated Changes to the Products and/or Services
    o Long-term admissions will continue to be less common than they have been in the past. Training centers will increasingly provide services and supports for individuals who: present complex medical needs that cannot currently be met in community residences until an appropriate community residence is available; present behavioral challenges that require short-term, intensive intervention to return to the community; require short-term respite and/or stabilization; or require short-term medication stabilization. Training centers also will provide services and supports through the Regional Community Support Centers to individuals receiving facility or community services and supports.

    o The Department is working to replace one training center and significantly renovate a large, multi-building training center with smaller, safer, more effective and efficient facilities.

    o Advances in information technology will improve staff clinical communication, improve quality assurance, and reduce medication errors (e.g., an electronic health record).

    o Utilization of telecommunication for clinical consultation to isolated or distant community providers is likely to increase

    o Centers for Medicare and Medicaid Services (CMS) standards will continue to emphasize the provision of person-centered active treatment. The increasing complexity of the population in state training centers will require a well-trained workforce that is kept current with best clinical practices.

    o CMS standards will continue to increase inpatient standards for environmental safety. Training center buildings must be appropriate to consumer needs and must meet 2000 Fire/Life Safety Standards. Extensive renovations will have to be made to buildings at all training centers to meet these standards.
  • Listing of Products and/or Services
    • State Training Center Services: medical and psychiatric assessment; occupational, speech, physical, recreational therapies; short–term respite and emergency care; habilitation and skill acquisition for community integration; and person-centered planning.
    • Regional Community Support Center Services: specialized medical, dental, and clinical services provided to individuals living in the community; and training and case consultation to family members and community residential, healthcare, and vocational providers.
Finance
  • Financial Overview
    This service area is funded with 100 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.

    Note: The information on the following tables is presented at the service area level. However, funding by fund source is appropriated at a higher program level. This results in the allocation of the non-general fund amounts to the various service areas within the program level in accordance with reasonable allocation methodology. This methodology has been applied and is represented in these amounts.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $0 $133,380,902    $0 $133,380,902
    Change To Base $0 $10,000,000    $0 $10,000,000
               
    Service Area Total   $0  $143,380,902     $0  $143,380,902 
Service Area Objectives
 
  • Offer a comprehensive array of person-centered training and habilitation services and enrichment activities that promote self-determination and community participation and achieve the vision of a consumer-driven system of services.
    Objective Description
    This objective conforms to the Department's responsibility to operate training centers and its goal of promoting self-determination and creating person-centered training center services and supports. The objective also supports the HJR 76 study recommendations to provide individualized supports that are based on each individual's level of need and to involve individuals and their families as the guiding force in directing the types of needed supports.
    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
    • Establish best personnel practices that promote good attendance, professional and career development, intra-facility communications, leadership development, and creation of positive work environments and addressing relief factor needs to cover periods of staff absences.
    • Implement a career path for direct services associates to improve recruitment and retention efforts and provide training through the College of Direct Support.
    • Continue collaboration with CSBs, advocates, and other stakeholders to address the future role and purpose of state training centers.
    • Implement replacement and repair activities at training centers where there is a critical need to better align environments of care with individual safety, security, and habilitation needs.
    • Increase efforts to offer a comprehensive array of specialized services and supports and enrichment activities by continuously assessing and adjusting offered services and activities according to individual needs and interests.
    • Develop and implement strategies in each training center that facilitate person-centered planning and promote opportunities for self-determination and community participation.
    • Enhance the provision and use of best practice guidelines and evidence-based approaches in the provision of care to individuals receiving training center services.
    • Continue to expand the scope and depth of services, training, and consultation, provided by the Regional Community Support Centers (RCSC).
    • Promote a positive environment and leadership through development of preceptor and mentorship programs for new employees, model for employee forums, and improved communication facility-wide and between shifts and high performance organization.
    • Maintain sufficient numbers of trained staff in each training center to ensure services are appropriate to the populations served and sufficient to provide quality services and assure the safety of individuals receiving services.
    • Monitor vacancies, turnover and staff development and review staff-to-patient ratios to ensure levels and types of staff appropriate to meet the needs of individuals receiving services.
    • Monitor the age and length of service of staff in key positions at each training center and conduct trend analysis regarding potential retirements.
    • Implement a variety of training opportunities designed to increase staff knowledge and skills in recovery, resilience and person-centered principles and practices, dually diagnosed/co-occurring disorders (mental illnesses and intellectual disability and other developmental deficits).
    • Improve bed utilization in training centers through aggressive monitoring of service plans and discharge efforts that reduce lengths of stay and enable individuals to be integrated more quickly into the community.
    • Achieve operational efficiencies resulting from the replacement of Southeastern Virginia Training Center and the renovation of Central Virginia Training Center and the development of state-funded community residential services.
    • Initiate partnerships with state colleges and universities to adopt curricula and provide training to students and current professionals to expand the availability and accessibility of services to persons with intellectual and developmental disabilities.
    • Support the efforts of the OIG to monitor the progress of training centers in improving quality of care.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percentage of training center direct service associates who have completed fifteen (15) College of Direct Support core modules
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      10
      Date:
      6/30/2007

      Measure Baseline Description: Percentage of direct care staff who completed at least 11 College of Direct Support core modules

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

      Measure Target Description: Percentage of direct care staff who completed at least 15 College of Direct Support core modules

      Data Source and Calculation: College of Direct Support Program/Learning Management System records. Number of training center direct service associates who completed the core modules divided by the total number of training center direct service associates


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