o Individuals served state hospital civil beds should continue to decline as more community-based crisis intervention services become available. Through the Services System Transformation Initiative, the Department funded a number of services that are intended to transform the way state hospital resources are integrated into their regions. These services will enable individuals to be served in the community where possible, to use community hospital beds and return these individuals quickly to their communities, and to provide longer-term care and specialized treatment in state hospitals where this is not possible.

o Demand for beds to serve individuals with forensic involvement is likely to continue to increase over time as Virginia's population grows and new commitment criteria are fully implemented. Because individuals with a forensic status tend to have longer lengths of stay, more complicated discharge needs and fewer supports, and higher acuity, the percentage of state hospital beds used by this group is anticipated to increase.

o Children and adolescents served in state hospitals will continue to have extreme needs or some interaction with criminal justice system. The Department has convened a planning group comprised of families, community providers, advocates, and others, to examine the current and future role of the Commonwealth and private providers in providing acute psychiatric services for children and adolescents and to develop strategies for promoting high-quality community-based care while maintaining a safety net of services for children and adolescents who need acute psychiatric services.

o State hospitals will continue to transition to person centered planning and recovery oriented treatment models. Providing support to an individual will be key to the orientation and ongoing training of the staff at each hospital.

o Individuals who have co-occurring disorders (mental illnesses and substance use disorders, intellectual disability and/or other developmental disabilities) will require more complex and specialized interventions, a highly trained and diversified work force, and carefully designed discharge plans that will provide integrated services and supports.

o Improved methods of coordinating and integrating care with all relevant providers, including primary care, vocational and life skills agencies, funding agencies, and community providers are essential to removing barriers to successful discharge from state hospitals and to promote continuity of care within which communication and transitions are seamless for individuals receiving state hospital services.

o A number of state hospitals have significant physical plant problems that require immediate attention. Older buildings and large multi-building campuses are inappropriately designed to safely meet the needs of individuals and have inherent inefficiencies for staff, utilities, and support services.

o Clinical, environmental, and administrative standards set by the Centers for Medicaid and Medicare (CMS) and by the Joint Commission require heightened vigilance and resources to maintain adequate physical plants and compliance with standards.

The Department is working to replace two large, multi-building state hospital campuses with smaller, safer, more effective and efficient single-building facilities.

o State hospitals are advancing the concept of a recovery oriented system to include the provision of integrated care for those with co-occurring mental illness and substance use disorders.

o State hospitals are working to improve the cultural and linguistic competence of staff so they can better address the recovery and communication needs of individuals and families in a culturally relevant manner.

o State hospitals are improving their ability to provide services that demonstrate competence in trauma-informed care.

o The increasing complexity of consumers receiving care in state hospitals will require the recruitment and retention of a well-trained workforce, knowledge about best clinical practices.

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 The Commission and CMS standards will continue to emphasize the provision of person-centered active treatment. Both The Joint Commission and CMS will continue to increase inpatient standards for environmental safety. State hospital buildings must meet 2000 Fire/Life Safety Standards

• Psychiatric assessment, stabilization and medication management
• Psychosocial rehabilitation programming, including psycho-education and recovery-oriented programming
• Psychology services
• Nursing services
• Social work services
• Recreational, physical and occupational therapies
• Peer support services

Objective Description

This objective conforms to the Department's responsibility to operate state hospital and its goal of creating a recovery-oriented, person-centered, and hopeful setting within which an individual’s most critical needs and goals are incorporated into a plan for recovery that will serve as a guiding document in aiding the individual’s return to his community, family, and life. Over the past three years, state hospitals have made significant progress in changing their culture to one that supports recovery, self-determination, empowerment, and person-centered planning.

Alignment to Agency Goals

Objective Strategies

Link to State Strategy

Objective Measures