Service Area Strategic Plan
4/18/2014   4:46 pm
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
State Mental Health Facility Services (720 430 14)
Description

State Hospital Services are individualized to best meet each individual’s goals for recovery and include: psychiatric assessment and stabilization; medication management, recovery-oriented, person-centered programming; psychiatric and rehabilitative therapies; and, in collaboration with the CSBs, discharge planning. State hospital services focus on stabilizing acute psychiatric symptoms, developing skills needed for successful community living, and enhancing other fundamental life skills, such as identifying and developing positive community supports, increasing hope, motivation, and confidence, and making informed choices. State hospital services are further specialized by the age groups and legal status served at a facility.

State hospitals include Catawba Hospital (CH) near Salem, Central State Hospital (CSH) in Dinwiddie, Commonwealth Center for Children and Adolescents (CCCA) in Staunton, Eastern State Hospital (ESH) in Williamsburg, Northern Virginia Mental Health Institute (NVMHI) in Falls Church, Southern Virginia Mental Health Institute (SVMHI) in Danville, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and Western State Hospital (WSH) in Staunton.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    State hospitals continue to be an integral component in the continuum of behavioral healthcare care in Virginia and provide a variety of clinical services that are not available in all communities. State hospitals provide services and supports to adults with serious mental illnesses and children and adolescents with serious emotional disturbances who are in crisis, who present with acute or complex conditions, or both, and who require the highly intensive and structured environments of care provided in an inpatient setting.
  • 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 state hospitals, which provide care and treatment for persons with mental illness.

    Chapter 7 of Title 37.2 of the Code of Virginia authorizes the Department to perform certain functions related to the operation of state hospitals.
    • § 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.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Adults receiving state hospital services Adults served in state hospitals 4,725 5,748
Adults receiving state hospital services Children and adolescents served in state hospitals 581 764

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 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 illnesses and substance use disorders, intellectual disability and/or other developmental disabilities), increased individual acuity, and complicated acute and chronic medical needs.

o State hospitals will serve proportionately greater numbers of individuals who have some level of involvement with the criminal justice system. Although the proportion of forensic individuals varies by hospital, typically these individuals comprise between 25 and 50 percent of state hospital bed utilization and many of these individuals are served on civil units.

o A growing number of Virginians have either limited or no behavioral health insurance benefits. These individuals will place increasing pressure the public behavioral health and developmental services system.
Partners
Partner Description
Advocacy groups: These statewide volunteer organizations, such as the Mental Health Association of Virginia (MHAV), the National Alliance for the Mentally Ill of Virginia (NAMIVa), VOCAL, the Virginia Federation of Families, address various aspects of the service delivery system to promote quality, availability and accessibility of care to all persons with cognitive, developmental, physical and/or mental disabilities.
Community services boards and behavioral health authority: CSBs serve as the single points of entry into publicly funded mental health services in the areas they serve. They prescreen individuals for admission to state hospitals and prepare discharge plans for individuals being discharged from state hospitals. As members of the treatment team, CSBs participate in the recovery planning process. They also provide case management (i.e., monitoring or coordinating needed support services) to individuals served in state hospitals when they are discharged into the community.
Individuals receiving services and family members or significant others: These individuals are members of each individual's treatment team and participate in treatment planning throughout the facility stay.
Office of the Inspector General: The Office of the Inspector General has statutory responsibility to inspect, monitor and review the quality of services provided in state hospitals to prevent problems, abuses and deficiencies in treatment programs. OIG staff conduct on-site inspections of each facility and publish findings, making recommendations for changes.
Private residential services providers These providers offer residential services to individuals served in state hospitals at discharge.
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 mental health services and develop community resources. The partnerships often engage in inpatient bed utilization management.
Virginia institutions of higher education (universities, colleges, and community colleges): Universities, colleges, and community colleges partner with the state hospitals to conduct training of healthcare personnel and students; provide educational opportunities for staff development; and provide, upon referral, case consultation 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 hospitals for quality and safety.
Products and Services
  • Factors Impacting the Products and/or Services:
    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.
  • Anticipated Changes to the Products and/or Services
    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
  • Listing of Products and/or Services
    • 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
Finance
  • Financial Overview
    This service area is funded with 96 percent general funds and 4 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 indirect services costs of 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 $138,038,818 $5,572,554    $138,038,818 $5,572,554
    Change To Base -$3,065,796 $0    -$3,065,796 $0
               
    Service Area Total   $134,973,022  $5,572,554     $134,973,022  $5,572,554 
Service Area Objectives
 
  • Offer a comprehensive array of person-centered inpatient treatment and rehabilitation services that promote self-determination, resilience, recovery, and community participation and achieve the vision of a individual-driven system of 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
    • Agency Goal: Fully implement self-determination, empowerment, recovery, resilience, and person-centered core values at all levels of the system through policy and practices that reflect the unique circumstances of individuals receiving behavioral health and developmental services.
    • 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
    • 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 substance use disorders, or intellectual disability and/or other cognitive deficits).
    • 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.
    • 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.
    • Review current state hospital psychosocial rehabilitation programs for quality and appropriateness to consumer skill development and recovery and provide, or contract for, technical assistance/training to staff so that improvement in individual participation and outcomes occur.
    • Ensure suficient numbers of trained staff and equipment to assure person-centered traing, recovery oriented active treatment, rehabilitation, and activities consistent with best evidence-based practices.
    • Fund and implement a registered nurse professional advancement program which will facilitiate enhanced competencies and patient care by allowing career advancement based on direct care skills
    • Enhance the provision of specialized state hospital services and use of best practice guidelines and evidence-based approaches in the treatment and care of individuals receiving state hospitals services.
    • Increase efforts to offer a comprehensive array of treatment, rehabilitation, and enrichment activities by continuously assessing and adjusting offered services and activities according to individual needs and interests.
    • Integrate recovery principles in state hospital operations and implement strategies in each state hospital that increase the recovery experience for individuals receiving services.
    • Incorporate and implement strategies such as peer-to-peer supports; treatment planning partnerships, choice, and involvement in valued roles; provision of a supportive environment and relationships that support recovery; and inclusion of educational, career development, and job training opportunities in service plans of individuals receiving state hospital services.
    • Maintain sufficient numbers of trained staff and equipment in each state hospital to ensure services are appropriate to the populations served and sufficient to provide quality services and assure the safety of individuals receiving services.
    • Implement a career path for direct service associates to improve recruitment and retention efforts.
    • Engage private psychiatric inpatient service providers as partners in the development of strategies for integrating recovery principles in an inpatient setting.
    • Implement wellness programs with activities designed to lower obesity, hypertension, diabetes, and heart disease and to facilitate exercise and other health lifestyle choices for individuals receiving state hospital services.
    • Improve bed utilization in state hospitals 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 Eastern State Hospital and Western State Hospital.
    • Support the efforts of the OIG to monitor the progress of state hospitals in improving quality of care.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Ratio of hours of restraint per 1,000 hours of service
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down

      Frequency Comment: The ratio of hours of restaint per 1,000 hours of service will be calculated for FY 09 and the FY 12 target will be a 6% reduction

      Measure Baseline Value:
      TBD
      Date:
      6/30/2009

      Measure Baseline Description: Ratio of hours of restraint per 1,000 hours of service

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

      Measure Target Description: Ratio of hours of restraint per 1,000 hours of service

      Data Source and Calculation: Source: Core Measures report to The Joint Commission Calculation: The hours of physical restraint use at each state hospital will be derived from AVATAR and other reporting systems divided by the number of service hours provided multiplied by 1,000.


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