Service Area Strategic Plan
4/17/2014   11:43 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Community Developmental Disability Services (720 445 07)
Description

Community Intellectual Disability Services funds public community intellectual disability services provided by 39 community services boards and one behavioral health authority, hereafter referred to as CSBs, throughout the Commonwealth. CSBs function as the single points of entry into the publicly funded services system. CSBs also provide preadmission screening of all requests for admission to training centers. Finally, each CSB provides discharge planning for all individuals who reside or will reside in cities or counties served by the CSB before they are discharged from training centers. CSB responsibilities for services to individuals and for other administrative and operational requirements are identified in, reported on, and monitored through community services performance contracts negotiated annually by the Department with each CSB and associated contract reports. Community intellectual disability services are integrated with other direct services and supports at the local level for individuals with special needs, those receiving services from multiple agencies, and individuals with co-occurring disorders such as an intellectual disability and a mental health disorder or an intellectual disability and a substance use (alcohol or other drug dependence or abuse) disorder.

This service area includes infant and toddler intervention (Part C) services, which are provided through contracts with local lead agencies (LLAs) across Virginia. LLA councils include representatives from a variety of agencies, including CSBs, serving infants and toddlers eligible for services under the Part C program. LLAs provide federally required information about Part C services to the Department through the Infants and Toddlers Online Tracking System (iTOTS).
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Community intellectual disability and Part C services align directly with the Department’s mission and are required to implement the vision of a consumer-driven system of services and supports that promotes an individual's self-determination, empowerment, recovery, resilience, health, inclusion, and participation in all aspects of community life, including work, school, family, and other meaningful relationships.
  • Describe the Statutory Authority of this Service
    Chapter 5 of Title 37.2 of the Code of Virginia authorizes the establishment and operation of community services boards (CSBs) by local governments to provide community intellectual disability services and authorizes the Department to fund CSBs.
    • § 37.2-500 authorizes the Department to provide funds to assist local governments in the provision of intellectual disability services; it requires every city and county to establish or join a CSB; it specifies the core of services to be provided by CSBs; and it requires CSBs to function as the single points of entry into publicly funded intellectual disability services.
    • § 37.2-505 requires CSBs to provide preadmission screening and discharge planning services.
    • § 37.2-508 requires the Department to negotiate the performance contracts through which it provides funds to CSBs to provide services pursuant to this chapter.
    • § 37.2-509 requires the Department to allocate available state-controlled funds to CSBs for disbursement in accordance with procedures established by the Department and performance contracts approved by the Department.

    Chapter 6 of Title 37.2 of the Code of Virginia authorizes the establishment and operation of a behavioral health authority (BHA) by a specified city or county to provide community intellectual disability services and authorizes the Department to fund a BHA.
    • § 37.2-601 authorizes the Department to provide funds to assist certain cities or counties in the provision of intellectual disability services; it specifies the core of services to be provided by a BHA; and it requires a BHA to function as the single point of entry into publicly funded intellectual disability services.
    • § 37.2-606 requires a BHA to provide preadmission screening and discharge planning services.
    • § 37.2-608 requires the Department to negotiate the performance contract through which it provides funds to a BHA to provide services pursuant to this chapter.
    • § 37.2-611 requires the Department to allocate available state-controlled funds to a BHA for disbursement in accordance with procedures established by the Department and performance contracts approved by the Department..

    Chapter 53 of Title 2.2 of the Code of Virginia establishes the Early Intervention Services System to implement Part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.) and describes the lead agency’s responsibilities. The Department is the lead agency and provides funds to local lead agencies (LLAs), which coordinate the provision of local infant and toddler intervention services.

    Part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.) and 34 CFR 303.303.11-325 under the Individuals with Disabilities Education Act authorize the state to implement a statewide, comprehensive, coordinated, multidisciplinary, interagency system of early intervention services for infants and toddlers with disabilities and their families. The federal Office of Special Education Programs provides federal funds to the Department, as the lead state agency for the Part C program, for these early intervention services.

    The Nursing Home Reform provisions of the Omnibus Budget Reconciliation Act of 1987 allow for preadmission screening evaluations and determinations for OBRA eligibility.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals receiving CSB intellectual disability services Individuals with intellectual disabilities served by the CSBs 25,053 31,511
Infants and toddlers and their families receiving Part C early intervention services Infant and toddlers and their families served in Part C early intervention services 10,704 18,622

Anticipated Changes To Agency Customer Base
o Virginia's population is increasing, becoming more culturally diverse, and growing older. The customer base for the Commonwealth's behavioral health and developmental services system will change to reflect these demographic trends.

o The continued significant growth in Northern Virginia, Central Virginia, and Eastern Virginia will significantly increase the consumer base for community intellectual disability services.

o Growing numbers of individuals with older care givers who will require community intellectual disability services to enable them to continue to reside in their homes or other community placements.

o Community intellectual disability services providers are serving proportionately greater numbers of individuals with significant and complex services and supports needs. This includes individuals with co-occurring combinations of intellectual and mental health and substance use disorders and other related developmental disabilities who will require more complex, specialized services and supports.

o Anticipated significant increases in the number of private providers and service locations will affect the Department’s ability to license programs and protect the safety and human rights of individuals receiving services.

o Based on national research on the prevalence of intellectual disability and 2008 Population by Age and Sex Estimates, the Department estimates that 71,526 individuals age 6 and over in Virginia have an intellectual disability. Approximately 18,495 infants, toddlers, and young children (birth through age 5) have developmental delays requiring early intervention services. While not all of these individuals will seek services from the public sector, many of them will do so.

o Individual counts provided by CSBs for the 2010-2016 Comprehensive State Plan identify 6,458 individuals who are currently on waiting lists for community intellectual disability services because they are not receiving needed services provided by or through CSBs. Virginia’s ongoing population growth will result in the need for additional community intellectual disability services.

o On August 4, 2009, there were 4,823 individuals on the Statewide Waiting List for ID waiver Services, 2,518 were on the urgent waiting list and 2,316 were on the non-urgent list.

o The Department had employed a specialist in autism services and a specialist in general developmental disabilities to concentrate on promotion of employment and housing initiatives and non-waiver funded service development for these populations. Approximately 139,844 individuals in Virginia have a developmental disability and 1 in 150 have an autism spectrum disorder.

o Virginia Department of Education counts made on December 1,2008, identified 10,863 students age six to 22+ with a primary disability (as defined by special education law) of intellectual disability who are receiving special education services. Counts for children age three to five identified 7,605 children who had a developmental disability and 881 children with autism spectrum disord
Partners
Partner Description
Community services boards and behavioral health authorities (CSBs): The Department provides state funds to the 40 CSBs to support the provision of community intellectual disability services and supports. CSBs participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the public services system.
Federal agencies: The Office of Special Education Programs in the Department of Education provides grants of federal funds to the Department that support Part C early intervention services for infants and toddlers and their families, and the office provides technical assistance to the Department and LLAs about requirements associated with the receipt of grant funds that support the provision of these services.
Individuals receiving services, family members, and advocacy organizations: Individuals receiving services, advocacy organizations, and individual and family groups such as the Arc of Virginia, Parents and Associates of the Institutionalized Retarded (PAIR), and the Partnership for People with Disabilities, individually and through the Advisory Consortium on Intellectual Disabilities (TACID), provide important feedback to the Department and CSBs on service needs, services, and policy, planning, and regulatory development activity for the public services system. Some individuals and family members serve on CSB boards .
Local governments: Local governments approve their CSBs’ performance contracts, which provide the basis for funding community intellectual disability services. They also provide financial resources for those services through the local matching funds that they appropriate to their CSBs, pursuant to §§ 37.2-509 and -611 of the Code of Virginia.
Other federal, state and local agencies: Local and state agencies, such as the Centers for Medicare and Medicaid Services (CMS) and Departments of Medical Assistance Services (DMAS), Social Services, Health, Rehabilitative Services, and Housing and Community Development, school systems, and area agencies on aging provide or fund many services or supports that are critical to the success of community intellectual disability services. These include Medicaid ID waiver services, auxiliary grants for assisted living facilities, Medicaid/Medicare eligibility determinations, various social services, guardianship programs, health care, vocational training, and housing assistance that respond to the needs of individuals with intellectual disability. Many of these agencies also participate in Part C local lead agencies (LLAs) and provide services to infants and toddlers in Part C services.
Private providers (for profit and non-profit organizations): Private providers are critical components of the publicly funded intellectual disability services. Private providers deliver a significant portion of community intellectual disability services through contracts with CSBs. Many private providers deliver Medicaid ID waiver services directly to individuals, pursuant to individualized plans of care developed and approved by CSBs. Private providers also offer important feedback to the Department and CSBs on service needs, services, and policy, planning, and regulatory development activity for the public services system through organizations like the Virginia Network of Private Providers and vaACCESS.
Virginia institutions of higher education (universities, colleges, and community colleges): The academic medical centers, academic programs of other colleges and universities, and community college courses offer education or training for the CSB and private provider workforce that provides community intellectual disability services.
Products and Services
  • Factors Impacting the Products and/or Services:
    o Demands for community behavioral health and developmental services are expected to increase as Virginia's population grows.

    o Through cooperative efforts of several state agencies, the Commonwealth has increased the number of ID waiver slots available to individuals. The Department continues to work closely with DMAS to enhance the waiver program, with the recent approval by CMS of the ID waiver five-year renewal, upcoming promulgation of related emergency regulations and policy manual. .

    o As Virginia's population becomes more diverse, providers of community intellectual disability services must improve their responsiveness to the needs of culturally and linguistically diverse groups.

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

    o Potential reductions in reimbursement rates for Medicaid intellectual disability services would make it increasingly difficult to sustain essential core services offered by CSBs and private providers.

    o Decreasing availability of qualified professionals, particularly direct support staff, make it difficult to maintain or expand existing services or develop new services to address unmet demands for services, to deliver quality services, to maintain persons with the greatest challenges in the community, or to develop new service modalities or approaches, such as evidence-based practices. Community-based practitioners of positive behavioral supports, along with a better trained and more stable direct support work force are critical needs throughout the state.

    o An increasing focus at federal and state levels on improving assessment and screening of adults and children with co-occurring disorders will increase demands for integrated services to treat these co-occurring conditions.

    o A persistent lack of residential treatment services capacity adversely affects the services system’s ability to address unmet service needs.
  • Anticipated Changes to the Products and/or Services
    o The Department continues to advocate for the implementation of the 2007 Mental Retardation Services System Study recommendations in order to expand Virginia’s investment in ID services (both waiver and non-waiver) and increase the flexibility and quality of those services. The study proposes to implement changes in consort with the recent award of a CMS Money Follow the Person initiative, thus maximizing the benefit of additional federal dollars to help Virginia build community capacity. In addition, the Money Follows the Person (MFP) demonstration project has resulted in 42 individuals exiting institutions for community-based services in the past year, with more to follow in the next few years.

    o The Systems Transformation Grant (STG), a collaborative effort between the Department, DMAS and several other state agencies, has resulted in the development and adoption of a person-centered plan and process for statewide use, statewide training on the plan, processes and “person-centered thinking.” Future anticipated STG-related developments include additional training across the state to reach all providers and the development of an electronic preauthorization/wait-list/ enrollment system for the ID and Day Support waivers.

    o The Department’s ongoing collaborative efforts with CSBs and other stakeholders to transform the public services system will increase the need and demand for existing and new types of community intellectual disability services as state training center capacity continues to be reduced, through the MFP project and legislatively required downsizing of SEVTC, while community service capacity is increased.

    o The identification and adoption of evidence-based best practices, such as the implementation of the Supports Intensity Scale and person-centered processes, will require additional resources to implement, monitor, and evaluate these practices and services.

    o Pressures to increase the capacity and quality of community-based services will continue. While the Commonwealth has consistently identified funds to expand the number of Medicaid ID waiver slots, the ID waiver urgent waiting list is projected to grow. Approximately 2,000 students graduate annually from special education classes and need community ID services. 167 individuals in nursing homes are currently receiving OBRA services, although funding for their services has been decreased recently due to budget cuts.

    o CSBs also serve a large number of infants and toddlers in programs funded by the local lead agencies (LLAs) through the Part C program. The number of infants and toddlers is expected to grow over the biennium as a result natural population growth, better outreach and case finding efforts, and enhanced Part C child find activities.

    o Demand for family support services, which keep these families intact and reduce the need for costly out-of-home placements, is expected to grow over the biennium.

    o Changes in the infrastructure from a more facility-based system of care to a system of more community services and supports will continue to cause dramatic increases in the number of licensed providers of community ID services. This increase in new providers and emerging evidence-based practices will require increased training of personnel in order to maintain minimum standards of quality.
  • Listing of Products and/or Services
    • Outpatient services, including behavioral management and consultation and medication services
    • Case management services
    • Habilitation services
    • Sheltered employment
    • Group supported employment
    • Individual supported employment
    • Highly intensive residential services, such as community ICF/MR programs
    • Intensive residential services, such as group homes
    • Supervised residential services, such as supervised apartments, domiciliary care, and sponsored placements
    • Supportive residential services, such as in-home respite care and supported living arrangements
    • Prevention services
    • Early intervention services
    • Consumer monitoring
    • Assessment and evaluation services
    • Medicaid ID waiver services reimbursed by the DMAS.
    • Infant and toddlers intervention services (Part C), including audiology, family training, counseling and home visits, health, medical, nursing, nutrition, occupational therapy, physical therapy, special instruction, psychological, speech-language pathology, vision, and transportation services
Finance
  • Financial Overview
    This area is funded with 73 percent general and 27 percent federal funds. The federal funds are from the Program for Infants and Toddlers with Disabilities (Early Intervention) grant that is passed through to community programs. CSBs also receive funds from other sources such as local funds, Medicaid, other fees, and other revenues. These funds are not appropriated by the Commonwealth and are not included in the Appropriation Act and, therefore, are not included in the following table.

    The information on these 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 $28,764,805 $9,324,795    $28,764,805 $9,324,795
    Change To Base -$3,884,804 $35,000    -$3,884,804 $35,000
               
    Service Area Total   $24,880,001  $9,359,795     $24,880,001  $9,359,795 
Service Area Objectives
 
  • Implement community intellectual disability services and supports that promote self-determination and community participation and achieve the vision of an individual-driven system of services consistent with services system transformation.
    Objective Description
    The Department, its state facilities, CSBs, individuals receiving services and families, advocacy groups, and other stakeholders have been involved in a multi-year effort to restructure and transform the public intellectual disability services system to fully implement the vision of an individual-driven system of supports. These initiatives will increase individual and family member participation and involvement, the self-determination orientation of providers, and the availability of services crucial to system transformation. These initiatives also will assist in the transition of individuals from state training centers to community services through funding start up costs for ID waiver services and support of guardianships for individuals who need them. System transformation initiatives also will have a dramatic impact on reducing the extremely large projected capital needs identified for training centers operated by the Department. System transformation initiatives emphasize the flexible use of resources by CSBs within regions in collaboration with their partners to develop and implement programs that meet their unique needs and circumstances within the larger framework and goals of the vision and the Integrated Strategic Plan. A key principle in any system transformation efforts is the retention within the system of any savings from cost avoidance or cost offsets to support those efforts and encourage additional transformation activities.
    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: Align administrative and funding incentives and organizational processes to support and sustain quality individually-focused care, promote innovation, and assure efficiency and cost-effectiveness.
    • 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 intensive community capacity and behavioral consultation services that promote community integration and provide alternatives to training center admissions.
    • Expand the number of guardianships CSBs support for individuals who require substitute decision makers to facilitate their transition from training centers to community services or to enable them to receive services for which informed consent is required.
    • Support efforts to screen and refer children who are between 0-3 years old and who may exhibit or are “at-risk” for developmental delay or mental health issues
    • Increase the number of individuals receiving ID waiver services to address current waiting lists.
    • Build community housing capacity that will enable residents of Southeastern Virginia Training Center and Central Virginia Training Center to move to the community.
    • Increase opportunities at the system and individual levels for individuals and family members to determine the developmental services and supports they receive.
    • Work with DMAS to implement the ID and DD waivers in a manner that is flexible and responsive to the needs of individuals with intellectual or developmental disabilities.
    • Pursue opportunities to move forward in the development of a more comprehensive developmental disabilities system through ongoing dialogue with DMAS concerning the ID and DD waivers and promotion of autism spectrum disorder and developmental disability employment and housing initiatives.
    • Expand Part C early intervention services for infants and toddlers (ages 0-3) and their families to prevent or alleviate later developmental or learning problems
    • Develop innovative ways to serve children and adults who have intellectual disabilities but who are not eligible for the ID waiver.
    • Develop and implement community services for youth who are transitioning from children’s services to young adult (ages 17-21) services.
    • Support training efforts across systems to increase providers’ knowledge regarding best practices, development of person-centered-environments, and necessary skill development.
    • Implement the Service Intensity Scale (SIS) and person-centered planning practices for individuals receiving developmental services.
    • Provide cross training for state facility and community clinicians and direct care workers aimed at identifying and appropriately responding to the needs of individuals with co-occurring intellectual disability and mental health disorders, clarifying service responsibilities and reconciling differences in language, philosophy, and expected outcomes among services providers.
    • Increase the capacity of the behavioral and developmental services system to provide culturally and linguistically appropriate services and supports to diverse populations across Virginia.
    • Collaborate with VHDA, DHCD, and other housing agencies in the design and implementation of affordable housing development plans for low-income and homeless Virginians with mental health or substance use disorders or intellectual disability.
    • Promote continuous quality improvement for the Department and behavioral health and developmental services system providers.
    • Improve the level of consultation, collaboration, and integration among providers of intellectual disability services and other community supports around policy, funding, staffing, and programming issues.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Number of individuals who are endorsed to provide Positive Behavioral Support consultation
      Measure Class:
      Other
      Measure Type:
      Output
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      16
      Date:
      6/30/2007

      Measure Baseline Description: Number of individuals endorsed to provide PBS consultation

      Measure Target Value:
      75
      Date:
      6/30/2012

      Measure Target Description: Number of individuals endorsed to provide PBS consultation

      Data Source and Calculation: Source: Number of individuals endorsed through the Partnership For People With Disabilities Calculation: People successfully completing the endorsement process


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