Service Area Strategic Plan
4/21/2014   12:50 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Administrative and Support Services (720 499 00)
Description

Administrative and Support Services include functions of the central office, which provides leadership and strategic and policy direction to the publicly funded behavioral health and developmental services system. The central office oversees the operation of the nine state hospitals, five training centers, a medical center, and a residential treatment program for sexually violent predators. It provides general guidance and technical assistance to, negotiates contracts with, and funds the 39 CSBs and one behavioral health authority, hereafter referred to as CSBs; protects the human rights of consumers in services licensed, operated, or funded by the Department; develops comprehensive and strategic plans; provides financial management and controls for all state and federal funds appropriated to and allocated through the Department; defines performance measures for the public services system; conducts program and financial audits; performs quality and compliance assurance activities; and performs workforce management and development activities. It also coordinates terrorism and disaster behavioral health preparedness, response, and recovery activities for the service system.
The central office administers three programs:
• A Juvenile Competency Restoration Program that provides competency evaluations and treatment services to restore competency to stand trial of juveniles under criminal charge in Juvenile and Domestic Relations courts;
• A community-based Conditional Release program for individuals who have been found by the courts to be sexually violent predators but who do not need secure residential care; and
• The Pre-Admission Screening and Resident Review process required by the Nursing Home Reform provisions of OBRA 87.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Central office administrative and support services are required to meet the operational needs of the Department and to implement the agency’s vision of services and supports that promote consumer 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
    State Statutes

    Chapter 2 of Title 37.2 of the Code of Virginia establishes the State Board of Behavioral Health and Developmental Services.
    • § 37.2-200 authorizes the employment of a secretary to assist in the Board’s administrative duties; and
    • § 37.2-202 outlines the powers and duties of the Board, which include establishing programmatic and fiscal policies governing the operations of state facilities and community services boards (CSBs), adopting regulations, ensuring development of long-range programs and plans for mental health, mental retardation, and substance abuse services, ensuring development of public education programs, reviewing and commenting on Department budget requests, advising the Governor, Commissioner, and General Assembly, and ensuring that the Department assumes the responsibility for providing for education and training of school-age consumers in state facilities.

    Chapter 3 of Title 37.2 of the Code of Virginia establishes the Department of Behavioral Health and Developmental Services.
    • § 37.2-300 establishes the Department in the executive branch under the supervision and management of the Commissioner;
    • § 37.2-304 outlines the duties of the Commissioner;
    • § 37.2-306 directs the Commissioner to promote research into the causes of behavioral health and developmental services throughout the Commonwealth;
    • § 37.2-308 directs the Department to report data related to child and adolescent inpatient acute care psychiatric and residential treatment beds;
    • §§ 37.2-309 through 37.2-311 prescribes powers and duties of the Department related to substance abuse, including the establishment of an Office of Substance Abuse Services;
    • § 37.2-314 directs the Department to conduct background checks of state facility employees;
    • § 37.2-315 directs the Department to develop and biennially update a six-year Comprehensive State Plan for mental health, mental retardation, and substance abuse services;
    • § 37.2-316 directs the Commissioner to establish community consensus and planning teams for system restructuring in instances where a state hospital may be closed or converted to another use; and
    • §§ 37.2-318 and 37.2-319 establish the Mental Health, Mental Retardation, and Substance Abuse Services Trust Fund and outline the responsibilities of the Commissioner to administer the fund.

    Chapter 4 of Title 37.2 of the Code of Virginia describes the protections available to individuals receiving behavioral health and developmental services, including their human rights.
    • § 37.2-400 defines the human rights of consumers and the regulatory responsibilities of the Department to protect these rights; and
    • § 37.2-402 directs the Commissioner to report on human research projects.

    Chapter 5 of Title 37.2 of the Code of Virginia authorizes the Department to fund community services boards (CSBs) to provide community mental health, mental retardation, and substance abuse services.
    • § 37.2-500 authorizes the Department to provide funds to assist local governments in the provision of mental health, mental retardation, and substance abuse services.
    • § 37.2-508 requires the Department to negotiate the performance contracts through which it provides funds to CSBs and provides for performance monitoring by the Department of CSBs’ compliance with their contracts.
    • § 37.2-509 requires the Department to allocate available state-controlled funds to CSBs.

    Chapter 6 of Title 37.2 of the Code of Virginia authorizes the Department to fund a behavioral health authority (BHA) to provide community mental health, mental retardation, and substance abuse services.
    • § 37.2-601 authorizes the Department to provide funds to assist certain cities or counties in the provision of mental health, mental retardation, and substance abuse services.
    • § 37.2-608 requires the Department to negotiate the performance contract through which it provides funds to a BHA and provides for performance monitoring by the Department of a BHA’s compliance with its contract.
    • § 37.2-611 requires the Department to allocate available state-controlled funds to a BHA.

    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 and training centers (state facilities).
    • § 37.2-700 authorizes the Commissioner to determine the need for and design of any new state facility, to construct any new building at an existing state facility, and to employ architects and other experts or hold competitions for plans and designs for such purposes;
    • § 37.2-701 authorizes the Commissioner to examine the condition of state facilities operated by the Department;
    • § 37.2-703 authorizes the Commissioner to prescribe a system of records, accounts, and reports of how money is received and disbursed and of consumers admitted to or residing in each state facility;
    • § 37.2-704 authorizes the Commissioner to receive and expend social security and other federal payments for consumers in state facilities;
    • § 37.2-707 authorizes the Commissioner to employ state facility directors;
    • § 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;
    • §§ 37.2-717 through 37.2-721 direct the Department to investigate and determine which consumers or parents, guardians, conservators, trustees, or other persons legally responsible for consumers are financially able to pay for care; to assess or contract with such individuals to recover expenses; and to pursue payment of such expenses.

    Chapter 26 of Title 2.2 of the Code of Virginia establishes the Substance Abuse Services Council as an advisory council in the executive branch of state government.
    • § 2.2-2690 and 2.2-2691 establish the Substance Abuse Services Council to coordinate the Commonwealth’s public and private efforts to control substance abuse, require the Office of Substance Abuse Services of the Department of Behavioral Health and Developmental Services to provide staff assistance to the Council, and require a Comprehensive Interagency State Plan

    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.
    Federal Statutes
    • Public Law 102-321 authorizes the federal Substance Abuse and Mental Health Services Administration to provide federal funds to the Department for community mental health services.
    • The Nursing Home Reform provisions of the Omnibus Budget Reconciliation Act of 1987 allow for preadmission screening evaluations and determinations for OBRA eligibility.
    • 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 Individuals with Disabilities Education Act also defines who receives special education services in state facilities.
    • Sections 1921-1954 of the Public Health Services Act authorize the federal Substance Abuse Treatment and Prevention (SAPT) Block Grant, providing federal funds to the Department for community substance abuse treatment and prevention 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
Community services boards and the behavioral health authority (CSBs) Community services boards and behavioral health authority (CSBs) 40 40
Individuals meeting SVP criteria and conditionally released for SVP treatment Individuals meeting SVP criteria and conditionally released for SVP treatment 166 600
Juveniles requiring restoration to competency treatment services Juveniles requiring restoration to competency treatment services 121 175
Members, State Behavioral Health and Developmental Services Board Members State Behavioral Health and Developmental Services Board 9 9
Nursing homes Nursing homes 178 178
Providers licensed by the Department (including CSBs and other public and private providers) Providers licensed by the Department (including CSBs, other public, and private providers) 612 750
State hospitals and training centers State hospitals and training centers 16 16
Virginia circuit and district courts Virginia Circuit and District Courts 325 325

Anticipated Changes To Agency Customer Base
The Department has employed a specialist in autism services and a specialist in general developmental disabilities to promote employment and housing initiatives and non-waiver funded service development.
Partners
Partner Description
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): The Department contracts with, provides consultation to, funds, monitors, licenses, and regulates CSBs. CSBs participate in Department in policy, planning, and regulatory development for the services system. The Commissioner enters into contracts with CSBs to provide juvenile competency evaluation and restoration services. CSBs participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the services system.
Federal agencies: The central office meets federal requirements associated with the receipt of block grants and other resources that support the provision of behavioral health and developmental services and for the development of services system capacity and technology.
Individuals receiving services, family members, and advocacy organizations: Individuals receiving services, advocacy organizations, and peer and family groups provide important feedback to the Department and CSBs on service needs and issues of mutual concern. These organizations participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the services system. Some peers and family members serve on CSB boards.
Local governments: Because they establish CSBs, local governments have an important relationship with the central office through the CSBs. Local governments approve their CSBs’ performance contracts that provide the basis for funding the CSBs. They also provide financial resources to the CSBs to match state funds, and, in some instances, may provide administrative services that are essential to CSBs’ efficient operation.
Private providers (for profit and non-profit organizations): The Commissioner enters into contracts with private providers to provide juvenile restoration services and conduct post restoration evaluations of juvenile competency. Also through contracts with the Department, private community providers deliver sexually violent predator treatment, supervision, and monitoring services. The central office works with private providers to ensure that they meet human rights requirements. Private providers also participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the services system.
Provider associations: The central office meets with provider associations to address issues of mutual concern. These associations participate in central office efforts to implement its mission and vision and have a voice in policy, planning, and regulatory development for the services system.
State and local agencies: The central office works closely with many state and local agencies that provide or fund services and supports that respond to the needs of individuals with mental health or substance use disorders or intellectual disability. These include partnerships with the Departments of Medical Assistance Services, Social Services, Health, Rehabilitative Services, Housing and Community Development, Corrections, Juvenile Justice, Criminal Justice Services, Aging, and Education; Office of Comprehensive Services; and of the Office of the Executive Secretary of the Supreme Court Executive Secretary. Central office staff work with the Virginia Office for Protection and Advocacy (VOPA) to ensure protections and advocacy for the human and legal rights of individuals with mental, cognitive or developmental disabilities. The central office works closely with the Office of the Attorney General, which provides legal consultation, training, and technical assistance to the Department; with the Department of Planning and Budget around budget development and operations; with the Department of Accounts, which provides accounting and processing services, financial reporting guidance, and payroll expertise; and with the Department of General Services around guidance regarding facility physical plant services. The central office works closely with the Office of the Attorney General, which provides legal consultation, training, and technical assistance in a number of important areas, including civil commitment training; serving as counsel to the Department on the State Board and Human Rights Committee; assisting the Department in the development or revision of legislation; reviewing Department regulations, State Board policies, and key departmental instructions; and providing specialized training, expert testimony, and consultation various forensic and sexually violent predator issues. Central office partnerships with local agencies such as school systems, local social services, local health departments, and area agencies on aging are critical to the success of community behavioral health and developmental services. These agencies provide auxiliary grants for assisted living facilities, various social services, health care, vocational training, housing assistance, and Part C early intervention services. Some of these local agencies also provide Part C early intervention services to infants and toddlers and may serve as Part C local lead agencies (LLAs). State and local agency representatives participate as members of various state and regional planning committees focused on transforming the services system.
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.
Virginia institutions of higher education (universities, colleges, and community colleges): The central office to collaboratively with academic medical centers, college and university academic programs, and community colleges to address workforce issues, to promote the implementation of evidence-based and other promising practices, and to train the services system’s existing and emerging workforce.
Products and Services
  • Factors Impacting the Products and/or Services:
    The average age of the central office workforce is slightly over 52 years old and the average length of central office employees' state service is more than 17 years. Almost 30 percent of central office employees will be eligible to retire in the next five years. This level of turnover, especially in key positions, could significantly affect central office operations.

    o The continuing economic downturn affecting the Commonwealth will limit and the resulting loss of 43 classified and wage positions have significantly limited the ability of the central office to maintain the level of staff needed to accomplish the objectives of the service.

    o Changes in legislation and the Code defining SVP qualifying crimes and SVP screening have increased the number of inmates who qualify for SVP civil commitment by approximately 300 percent, necessitating the expansion of community treatment and supervision resources for conditionally released sexually violent predators.

    o New requirements in Governor’s Executive Orders and changes in regulations from external agencies such as DOA, DHRM, DPB, DGS, and VITA. Additional workload requirements, often unfunded, from federal or state agencies could affect central office administrative and support services.

    o Central office administrative and support services may be affected by new federal performance measurement requirements, VITA IT systems transformation, and Commonwealth of Virginia IT standards.

    o Individuals receiving services, family members, and advocacy organization issues could affect central office operational priorities, strategic and comprehensive planning, and policy and regulatory development activities.
  • Anticipated Changes to the Products and/or Services
    Administrative and support services have become more complex over the years as the services system has expanded, Virginia’s behavioral health industry has changed, and new services technologies and medications have been introduced. The complexity of and accountability requirements associated with central office funding also has expanded significantly as federal funding opportunities have been pursued and as state funds have been increasingly earmarked for specific initiatives and individualized services. This is expected to continue.
  • Listing of Products and/or Services
    • Policy, Legislation, Strategic and Comprehensive Plans, and Studies: State Board and operational and programmatic policies, regulations, and guidance documents; legislative analysis, proposal development, and studies; strategic, comprehensive, and continuity of operations plans; surveys of individuals receiving services; and staff support to boards and councils established in State Code or by federal requirements.
    • Consumer Protections: Human Rights investigations and reports and criminal background checks for prospective employees of state facilities and certain community programs.
    • Services System and Program Development and Oversight: training and technical assistance and general guidance to CSBs, state facilities, and providers; Performance Contracts with CSBs; Medicaid ID waiver pre-authorization of services; nursing home pre-admission screening and resident reviews (PASRR); terrorism and disaster preparedness, response, and recovery operations; compilation and analysis of service data and quality indicators; grant application development and implementation of grant-funded projects; and quality assurance reports.
    • Agency Operations: financial management, reporting, and allocation and disbursement of state and federal funds; development of central office contracts and business agreements; revenue collection; internal audits, audits of data and reports, and compliance reviews; information technology systems development and support; workforce management, recruitment, training, and development; risk management and HIPAA compliance; and general support services for central office operations (mail, parking, procurement).
    • Management of the SVP Conditional Release Program: development of conditional release safety and treatment plans; training to expand community treatment capacity; and recruitment, training, and management for community conditional release treatment teams.
    • Supervision of the Juvenile Competency Restoration Program: implementation of juvenile forensic evaluation and juvenile competency restoration procedures; arrangements for Competency to Stand Trial restoration treatment services; administration of fee-for-services contracts with CSBs and private providers; technical assistance, training, supervision, oversight, and general guidance to services providers; and quality assurance and compilation of service data and quality indicators.
Finance
  • Financial Overview
    This service area is funded with 66 percent general funds and 34 percent non-general funds. About 63 percent of the non-general funds are federal funds appropriated for administrative oversight functions within federal grants including the Community Mental Health Services (CMHS) grant and Substance Abuse Prevention Treatment (SAPT) Block Grants. The remaining non-general funds are from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to indirect services costs of patient care.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $29,209,879 $15,658,262    $29,209,879 $15,658,262
    Change To Base $969,433 $0    $969,433 $0
               
    Service Area Total   $30,179,312  $15,658,262     $30,179,312  $15,658,262 
Service Area Objectives
 
  • Support implementation of the vision of an individual-driven system of services that promotes self-determination, empowerment, recovery, resilience, and community participation through central office leadership and administrative and support functions.
    Objective Description
    A priority of the central office is to transform Virginia’s publicly funded behavioral health and developmental services system to fully realize self-determination, empowerment, recovery, resilience, and person-centered core values. Successful transformation requires the inclusion, participation, and partnerships of consumers and families in daily operations at all levels of the services system. The central office provides stewardship in the use of funding, human resources, and capital infrastructure across the public services system to assure that services and supports are delivered in a manner that is efficient, cost-effective, and consistent with best and promising practices.
    Alignment to Agency Goals
    • 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: Assure that services system infrastructure and technology efficiently and appropriately meet the needs of individuals receiving publicly funded behavioral health and developmental services and supports.
    • Agency Goal: Obtain sufficient numbers of professional, direct care, administrative, and support staff with appropriate skills and expertise to deliver quality care.
    • Agency Goal: Enhance service quality, appropriateness, effectiveness, and accountability through performance and outcomes measurement and service delivery and utilization review.
    Objective Strategies
    • Adopt and promote evidence-based, best, and promising practices that are effective, demonstrate positive outcomes, and promote recovery, resilience, and person-centered principles and practices.
    • Initiate financial management and internal controls to demonstrate compliance with federal and state statutory and regulatory requirements
    • Provide for the increased statewide demand for juvenile competency restoration services.
    • Promote and increase the central office’s utilization of E-procurement and products and services provided by small businesses and businesses owned by women or minorities.
    • Investigate all possibilities of additional revenue collection.
    • Complete the replacement of Eastern State Hospital's adult mental health treatment center and the design replacements of Western State Hospital and Southeastern Virginia Training Center and the renovation of Central Virginia Training Center.
    • Work with the CSBs, Southeastern Virginia Training Center, Central Virginia Training Center, the Department of General Services, family members, advocates, and community stakeholders to design and construct community housing into which residents of the training centers can move.
    • Work with state facilities to identify and implement initiatives that generate energy efficiencies.
    • Continue to update individual state facility master plans to respond to the programming needs of individuals.
    • Conduct program reviews to monitor service provider accomplishment of defined performance expectations and consumer outcomes and to promote quality improvement.
    • Increase the effectiveness and efficiency of the Department's licensing and human rights programs.
    • Work with the regional utilization management committees to establish more uniformity in utilization management protocols and practices for psychiatric inpatient services provided in state hospitals or purchased in local hospitals.
    • Enhance central office presence in the field, monitor existing programs' performance and services recipients' outcomes, and maintain compliance with federal block grant and CMS expectations.
    • Manage information technology operations, security, and reliability efficiently in an environment that is responsive to the needs of users and protects identifiable health information.
    • Deliver efficient and effective information technology services and shared solutions to central office, state facility, and community partners.
    • Work with CSBs and stakeholders to design and implement a system wide continuous quality improvement process based on a consistent shared vision and with measurable and realizable implementation processes.
    • Implement the Web CSB and State Facility Accountability Measures.
    • Reach out to all organized parent groups and other stakeholder organizations whose efforts are concentrated on autism spectrum disorder or developmental disabilities initiatives to increase communication, collaboration, and mutual support.
    • Support efforts of the Children's Services System Transformation Initiative to implement the continuum of behavioral health and developmental services for children and adolescents and enhance linkages with local schools and community providers to fill gaps and build community capacity for youth who are transitioning from children’s to adult services.
    • 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.
    • Strengthen state and local behavioral health and criminal justice partnerships and criminal justice/behavioral health collaborative programs in order to 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.
    • Implement training and other learning opportunities that develop provider skills necessary to meet the needs of the most challenging consumers, including individuals with co-occurring disabilities.
    • Participate with Virginia Department of Veteran's Services in the implementation of the Virginia Wounded Warrior Program.
    • Continue to fund and support Virginia’s statewide network of peer organizations and family alliances that increase the voice and representation of individuals receiving services and supports.
    • Work with the Department of Medical Assistance Services to implement recovery and resilience practices in Medicaid behavioral health and developmental service policies and expand opportunities for individual and family participation in individual-directed services.
    • Explore the potential for public-academic partnerships to develop centers of excellence or training institutes that support statewide implementation of evidence-based practices.
    • Continue to participate in the ongoing work of the Commission on Mental Health Reform.
    • Increase the capacity of the behavioral and developmental services system to provide culturally and linguistically appropriate services and supports to diverse populations across Virginia.
    • Initiate implementation of the Suicide Prevention Across the Lifespan Plan for the Commonwealth of Virginia.
    • Work with the Community Integration Oversight Advisory Committee and Community Integration Implementation Team to monitor implementation of the Olmstead Task Force Report recommendations.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percent of administrative measures marked as "meets expectations" (green indicator) for the agency
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Frequency Comment: Fiscal year

      Measure Baseline Value:
      20
      Date:
      6/30/2005

      Measure Baseline Description: Percent of administrative measures marked as "meets expectations" (green indicator) for the agency

      Measure Target Value:
      100
      Date:
      6/30/2012

      Measure Target Description: Percent of administrative measures marked as "meets expectations" (green indicator) for the agency

      Data Source and Calculation: Source: There are currently 13 administrative measures organized into five categories. Each measure has a different data source. The administrative measures data source information table provides the data sources for each measure. The table is located in Virginia Performs/Agency Planning and Performance/Administrative Measures. Calculation: The appropriate colored indicator (green, yellow, red) will be selected for each measure, depending on results. A gray indicator is used for measures where data is unavailable. The agency administration measure is the percent of the administrative measures that have a green indicator (meets expectations). Items with a gray indicator are excluded from the calculation.


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