Agency Strategic Plan
4/19/2014   7:56 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
Mission and Vision

Mission Statement
The Department of Behavioral Health and Developmental Services (the Department) provides leadership and service to improve Virginia's system of quality treatment and prevention services and supports for individuals and families whose lives are affected by mental health or substance use disorders or by intellectual disability. The Department seeks to promote dignity, choice, recovery, and the highest possible level of participation in work, relationships, and all aspects of community life for these individuals.
Vision Statement
We envision an individual-driven system of services and supports that promotes self-determination, empowerment, recovery, resilience, health, and the highest possible level of participation in all aspects of community life, including work, school, family and other meaningful relationships.
Agency Values

Executive Progress Report

Service Performance and Productivity
  • Summary of current service performance
    Virginia’s public behavioral health (mental health or substance abuse) and developmental (intellectual disability) services system includes the Department's central office, 16 state facilities operated by the Department, and 39 community services boards and one behavioral health authority (referred to as CSBs) that provide behavioral health and developmental services directly or through contracts with private providers.

    Prevalence: Using prevalence rates from national epidemiological studies and the 2007 National Household Survey on Drug Use and Health and Weldon Cooper Center for Public Service 2008 population estimates for Virginia, the Department estimates that 316,552 adults in Virginia have a serious mental illness, 66,211 children or adolescents have an extreme emotional disturbance with significant impairment, 71,526 individuals have intellectual disability, 18,495 young children (from 0 to 5 years) have developmental delays requiring early intervention services, and 284,687 individuals have an illicit drug or alcohol dependence disorder. While not all of these individuals will seek services from the public sector, many with the most serious disorders will do so.

    State Facilities: The Department operates nine state hospitals, five training centers, one medical center, and one residential treatment program for individuals who meet commitment criteria as sexually violent predators (SVPs). An unduplicated count of individuals served across all state facilities in FY 2009 totaled 6,866.

    State hospitals provide a variety of services and supports to adults with serious mental illnesses and youth 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 in an inpatient setting. 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. In FY 2009, the state hospital average daily census was 1,419 and hospitals served 5,306 individuals.

    Training centers provide 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 longer-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. 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. In FY 2009, the training center average daily census was 1,276 and training centers served 1,386 individuals.

    The Hiram Davis Medical Center (HDMC) provides medical and skilled nursing services to state facility consumers who have serious physical and medical care needs. In FY 2009, the center's average daily census was 46 and it served 122 individuals.

    The Virginia Center for Behavioral Rehabilitation (VCBR) provides evaluation and rehabilitation services in a secure setting to individuals committed as SVPs. In FY 2009, the center's average daily census was 114 and it served 152 individuals.

    Community Services Boards: The Department supports the provision of accessible and effective public behavioral health and developmental services and supports through a network of CSBs that are established by local governments. CSBs are the single point of responsibility and authority for assessing individual needs, providing a comprehensive array of services and supports, and managing state-controlled funds for community-based services. CSBs also perform preadmission screening for admission to state facilities and prepare discharge plans for individuals receiving state facility services and supports who are returning to the community.

    The total unduplicated count of individuals receiving CSB services in FY 2008 is 190,125. That year, 101,796 received mental health services, 25,053 received intellectual disability services, 43,657 received substance abuse services, and 73,123 received emergency, assessment and evaluation, motivational treatment, consumer monitoring, and early intervention or consumer-run services that are outside a specific program area. These counts are unduplicated within each program area but not across program areas. In FY 2008, the numbers of individuals receiving specific CSB services follow.
    • Emergency services: 55,718
    • Local inpatient services: 3,258
    • Outpatient services: 123,009
    • Case management services: 77,764
    • Day support services: 13,893
    • Employment services: 4,069
    • Residential services: 22,228
    • Infant and toddler intervention services: 10,185
    • Motivational treatment services: 2,324
    • Consumer monitoring services: 7,039
    • Assessment and evaluation: 17,347
    • Peer (consumer) run services: 1,057.

    Annually, the Department surveys individuals and families in the community regarding their satisfaction with the behavioral health and developmental services they received. Adults and families receiving behavioral health services are surveyed separately. The results of the October 2007 survey of adults, which had a 62 percent response rate, indicated that 87 percent of individuals receiving services expressed general satisfaction with the services they received. In the survey of families with a child or adolescent receiving behavioral health services, which had a 24 percent return rate, 78 percent of respondents were satisfied with the services that their child received. Beginning in January 2008, families containing an adult with intellectual disability who received services for at least 12 months were surveyed. With a response rate of less than 11 percent, the survey found that more than 95 percent of families felt that the individual with an intellectual disability was in a healthy and safe environment during the day. More than 85 percent of respondents were satisfied with family involvement in the development and provision of services to meet the needs of the individuals with an intellectual disability. The area which demonstrated a significant decline in satisfaction was the availability of supports and services for individuals with intellectual disability when needed, where the satisfaction rate went from more than 95 percent in previous years to 31.5 percent in 2008.

    Characteristics of Individuals Receiving Services: In FY 2009, 6,866 individuals were served in state facilities. Of these, 5,306 unduplicated individuals received 6,360 episodes of care in state hospitals; 1,386 unduplicated individuals received 1,436 episodes of care in training centers, and 152 unduplicated individuals were served at VCBR. In general, the individuals served in state facilities are Caucasian (64 percent), male (60 percent), between 18 and 64 years of age (79 percent), and receiving mental health services (78 percent).

    In FY 2008, 1,620 unique individuals with a forensic legal status were served in state hospitals. These individuals occupied the equivalent of 535 beds and had an average length of stay of 120.5 days compared to 73.6 days for non-forensic individuals. Between FY 2000 and FY 2008, state hospital bed days occupied by individuals with a forensic status increased from 133,440 to 195,273 bed days or from 22.6 to 35.2 percent of total state hospital bed days.

    The average age of individuals served in training centers was 48 years of age and their average length of stay was 28.6 years, with 2.6 percent of the episodes of care (38) being less than seven days and 10.1 percent (145) being more than 50 years. Most training center residents 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. A significant portion (34 percent) has at least one psychiatric diagnosis.

    During FY 2009, 61 individuals were admitted to VCBR and three individuals were discharged. All of the individuals were male and 95 percent were between 21 to 64 years of age.

    A significant number of individuals served by CSBs have severe disabilities. In FY 2008, of the individuals receiving mental health services, 42,529 adults (57 percent) had a serious mental illness and 19,448 youth (70 percent) had or were at risk of having a serious emotional disturbance. An additional 6,700 adults with serious mental illness and 2,000 youth with or at risk of serious emotional disturbance received only emergency services.
  • Summary of current productivity
    Following are specific improvements that the Department has implemented to increase productivity, improve service delivery, and achieve savings.

    • Energy Performance Contract: The Department recognized the need to modernize an aging, energy delivery system that was wasting energy and was costly to operate. It entered into five separate energy performance contracts at the Petersburg Complex (including Southside Virginia Training Center, Hiram Davis Medical Center and Central State Hospital), Southwestern Virginia Mental Health Institute, Central Virginia Training Center, Southwestern Virginia Training Center, and Catawba Hospital. All of these contracts have proved successful and have met their objectives in modernizing the energy delivery systems and reducing energy consumption. Subsequently, the Department signed a statewide agreement to re-assess its state facilities and look for additional energy savings projects that were not considered in the first efforts. As a result of this effort, capital funds have been melded with the energy performance contract to replace the entire HVAC system at Southside Virginia Training Center.

    • Renewable Energy Sources: Two state facilities have implemented renewal energy sources. Southwestern Virginia Training Center combined a capital project with the energy performance contract to convert its residential buildings to ground-source heat pumps; a system that uses the earth as an energy storage mechanism and is far more efficient in extreme temperatures. Piedmont Geriatric Hospital continues to seek the best energy alternatives and has obtained permission from the Department of Environmental Quality to utilize native warm season grasses (NWSG) as a source of fuel for its biomass boiler. This boiler alone was able to avoid more than $500,000 in fuel cost this past fiscal year by not burning fuel oil. With the addition of NWSG as a fuel source, the facility will have the flexibility of burning several, low-cost fuels while vastly mitigating the Department's carbon footprint.

    • Laundry Energy Improvements: One of the largest energy consumers at the state facilities is the laundry operation. A comparison of laundry operations yielded opportunities at Piedmont Geriatric Hospital and Central Virginia Training Center for reducing energy consumption and cost of operation. Piedmont Geriatric Hospital and Southside Virginia Training Center have regionalized their laundry operations. Central processing at SVTC is far more efficient and has saved both energy and cost at Piedmont Geriatric Hospital. Piedmont's energy plant was facing an increased demand due to the location of the new Virginia Center for Behavioral Rehabilitation at the Nottaway Complex with Piedmont Geriatric Hospital. At Central Virginia Training Center, most laundry is now processed through the Virginia Correctional Enterprise system. The central laundry facility has been eliminated, saving energy and cost of operation.

    • Building Area Reductions: At Eastern State Hospita (ESH), the construction of the new Hancock Geriatric Treatment Center has reduced the building area and provides a more energy efficient building to serve individuals. This has occurred while improving the environment of care at the facility. The construction of the hospital's new adult mental health treatment center will further reduce the energy consumption at this campus. When all phases of construction are complete, this will reduce the ESH building area by nearly 50 percent. At Central Virginia Training Center, consolidation has allowed several buildings to be closed and taken off the energy system. This is reducing operating costs and the energy consumption at this large facility. At Western State Hospital, the Department is in the design phase for a replacement facility. This new facility will have the same bed capacity but will vastly reduce the building area, operating costs, and energy costs. It is being designed to meet the U. S. Green Building Council’s LEED® criteria for SILVER.

    • Geriatric Treatment Services: By removing significant barriers to community-based care, the state geriatric centers have been able to treat almost a third more individuals over the last year with no additional resources. The centers have developed strong partnerships with private nursing homes around the state to support and encourage the transition of individuals residing in state geriatric centers to the community and have developed partnerships with private and university-affiliated psychiatric facilities to create a system where acute care can be provided in community hospitals and longer-term treatment provided in state geriatric centers.

    • State Facility Administrative Efficiencies: State facilities have implemented a variety of administrative efficiencies, including the regionalization of state facility human resources functions and sharing of specific services. In addition, the entire Hiram Davis Medical Center administrative function was absorbed by the Southside Virginia Training Center;

    • Central Office Administrative Efficiencies: The Department's reimbursement function was transitioned from field to regional offices. Central office employees throughout the agency have picked up additional responsibilities to absorb the work of 43 classified and wage positions that were eliminated as a result of budget reductions.

    • New Pharmacy Information System: Implementation by state facilities of a new pharmacy information system, scheduled to be completed by June 2010, will set the stage for later integration with a state facility electronic health record and support Department risk reduction efforts to mitigate errors and improve individual safety and pharmacy customer service.
Initiatives, Rankings and Customer Trends
  • Summary of Major Initiatives and Related Progress
    Following are major Department initiatives.

    • System Transformation Initiative: The Department has implemented the first phase of what was envisioned by the Governor and General Assembly to be a multi-year System Transformation Initiative (STI) to invest in community services and supports and reduce Virginia's historic reliance on state facilities. For the 2008-2010 biennium, just over $187.5 million in state general and Medicaid funds were used to support a wide array of community investments, including:
    o Emergency acute psychiatric inpatient, ambulatory and residential crisis stabilization, residential, case management, day treatment, rehabilitation, discharge assistance plan, and peer-provided services for adults with mental health or co-occurring mental health and substance use disorders;
    o An expanded array of behavioral health services for individuals involved in local criminal justice systems;
    o CSB clinical and case management staff in all 23 juvenile detention centers;
    o Four child and adolescent systems of care projects and an array of new services, including foster care prevention, intensive in-home services, therapeutic day treatment, alternative day support services, case management, crisis, and psychiatry services;
    o Expanded local early intervention services for infants and toddlers with disabilities;
    o An additional 654 community ID waiver slots, including 110 slots for children, 117 slots for training center residents, and increased waiver reimbursement rates for congregate residential and other selected services; and
    o Guardianship services through a partnership with the Department for the Aging.

    • Mental Health Law Reform Initiative: The Department has worked closely with the Virginia Supreme Court’s Commission on Mental Health Law Reform to reduce the need for involuntary commitment, improve access to behavioral health services, reduce criminalization of people with mental health disorders, make the process of involuntary treatment more fair and effective, increase choice for individuals receiving behavioral health services, and help young people with mental health problems and their families before these problems spiral out of control. In 2008, the General Assembly enacted a package of reforms that made major changes to Virginia’s involuntary commitment laws and enhanced access to services to ensure individuals with mental health disorders get the treatment they need. Accompanying these statutory reforms was an infusion of $28.3 million in the 2008-2010 biennium budget to build additional emergency mental health service capacity and address the impact of civil commitment reforms. In 2009, the major areas of statutory reform focused on allowing transportation by persons other than law officers, instructional advance directives to be executed in circumstances other than end-of-life situation, and short-term psychiatric admission of incapacitated persons without judicial order. In addition, new laws were enacted to create a comprehensive mandatory outpatient treatment procedure for minors.

    • Autism Spectrum Disorder and Developmental Disability Services: Two new Department positions, a specialist in autism services and a specialist in general developmental disabilities, were funded by the 2009 General Assembly. These positions will concentrate on promotion of employment and housing initiatives and non-waiver funded service development.

    • Peer-Provided Services and Supports: One aspect of Virginia’s commitment to consumer (or peer) involvement is financial support for direct services provided by individuals who have experienced mental health, substance use, or co-occurring disorders. Peer support is an important factor int he recovery process for many individuals with mental health or substance use disorders. Federal, state, and local funding in Virginia continues to be used to support peer-provided and peer-run services and supports delivered through CSBs, hospitals hiring their own peer staff and providing support for independent programs managed by peers through contracts or other partnership arrangements. The Department also contracts directly with several peer-run service programs throughout Virginia.

    • Virginia Services Integration Program (VASIP): The Department is in the final year of a five-year federal State Incentive Grant for the Treatment of Persons with Co-occurring Substance Related and Mental Disorders (COSIG) grant to improve Virginia’s ability to address the complex treatment needs of individuals with co-occurring mental health and substance use disorders. VASIP has promoted the use of validated instruments to screen for co-occurring disorders, built existing infrastructure capacity; provided training and technical assistance by nationally recognized experts on evidence-based and culturally competent treatment practices for individuals with co-occurring disorders; conducted workforce surveys of CSB and state facility staff; developed a workforce training and development plan to improve core competencies of staff providing services; trained consumers in a co-occurring self help model and provided support in establishing groups in their communities; trained a statewide network of trainers; and obtained training and consultation in the use of validated fidelity instruments to assist programs with evaluation and quality improvement.

    • Children's Services System Transformation Initiative: The Commonwealth initiated a Children's Services System Transformation Initiative in late 2007 to improve outcomes for children and their families who are involved with Virginia's child-serving systems. This initiative is being implemented in partnership with national experts such as the Annie E. Casey Foundation. Its intent is to strengthen permanent family connections for children and youth by transforming how children's services are delivered. The Department and CSBs, along with other Virginia state and local child serving agencies, private providers, family members, and advocates, are active participants in this transformation process.

    • Diversion and Treatment Services for Individuals Involved with the Criminal Justice System: In January 2008, the Governor issued Executive Order No. 62, establishing the Commonwealth Consortium for Mental Health and Criminal Justice Transformation. The Consortium has two goals: transformation planning to identify, evaluate, and support the development of jail diversion models and establishment of a Criminal Justice and Mental Health Training Academy for the Commonwealth. The Department is working with the Consortium to achieve these goals and is providing leadership in developing a comprehensive approach to addressing the needs of individuals at risk for or involved in Virginia’s criminal justice system. The 2008-2010 biennium budget included almost $6 million for jail diversion services. Ten localities are expanding their jail-based services; six are developing or enhancing Crisis Intervention Team (CIT) programs, three have established post-booking diversion programs, six are providing enhanced assessment and linkage to services at the post-booking/pre-trial stage, three are enhancing limited re-entry and linkage to services, and one is funding a full time probation position to serve individuals with behavioral health needs on state probation.

    • Behavioral Health Services for Virginia Veterans: Executive Order 19 (2006) calls on each state agency to identify opportunities for improving services and addressing the continuum of care needs of disabled veterans. The Department and CSBs have formed a strong partnership with the Virginia Department of Veterans Services (DVS) to implement the DVS Wounded Warrior Program (WWP), which was created in 2008 to ensure that behavioral health and brain injury services to veterans and their families are readily available in all areas of the state.

    • Intellectual Disability Initiatives: The Department continues to be actively involved in promoting quality supports through training, capacity development, and systems changes that would make person-centered practices the norm in Virginia. The Department is participating in two multi-agency projects funded by the Centers for Medicare and Medicaid Services (CMS) that support systems change. The Real Choice Systems Transformation grant continues to help the Department, the Department of Medical Assistance Services, and other state agencies and partners to collaborate on focused system change initiatives, including infrastructure improvements that will provide better and more accessible information to Virginians. The Money Follows the Person demonstration grant is building community capacity and rebalancing Virginia’s long-term support system to give individuals more informed choices and options about where they live and receive services and is supporting the transition of individuals from institutions to community-based alternatives. To continue its commitment to build community capacity, the General Assembly approved 600 ID waiver slots for FY 2009, 400 of which were distributed on July 1, 2008 and 200 were distributed in May 2009.

    • Provider Cultural and Linguistic Competency: In 2008, the Department established a new Office of Cultural and Linguistic Services in the central office and a statewide steering committee to promote and improveaccess to behavioral health and developmental services for multicultural individualss across Virginia. The initial focus of the Office is to develop infrastructure supports, including a mission statement, vision, and policy; provide outreach to and linking stakeholders with community-based individuals who could serve as cultural brokers; and establish state and local advisory councils.

    • High Performance Organization: The high performance organization (HPO) model introduces a series of lenses through which an organization can view itself and decide what changes may be necessary to improve its performance. State facilities and the central office have implemented unique plans of action to promote the HPO philosophy, and a statewide team for information sharing and guidance is in place. The statewide team, ALOT (Advancing Leadership and Organization Transformation), educates, motivates, and enhances leadership skill development. The central office team, LEEP (Leading through Empowerment, Excellence, and Partnership), works to continually improve the culture, operations, and environment of the central office by promoting empowerment, shared leadership, teamwork, collaboration, and quality.

    • CSB and State Facility Accountability Measures: Over the next three years, the Department will post performance and outcome data about CSBs and state facilities on its website. The web site postings will include reference points (e.g., averages, ranges, or benchmarks), where possible or applicable, and definitions of the data and explanations of its significance to make the measures more useful and meaningful. Placing this data on the web site will provide useful information to individuals receiving services, family members, CSBs and state facilities, advocates, and the public about the services system.
  • Summary of Virginia's Ranking
    The National Association of State Mental Health Program Directors (NASMHPD) Research Institute surveys the states mental health authorities to determine state-controlled expenditures. In 2006, the Research Institute reported that between 2001 and 2006, Virginia state-controlled expenditures for community mental health increased by 77.7 percent compared to a national average increase of 59.3 percent. During the same period, state-controlled expenditures for state psychiatric hospitals increased by 10.5 percent compared to a national average increase of 18.8 percent.

    The NASMHPD Research Institute reported that in FY 2006 Virginia ranked 9th in 2006 median state income but 31st in per capita state-controlled mental health expenditures. Virginia's state-controlled mental health expenditures were 1.9 percent of total state government expenditures compared to a national average of 2.3 percent, for a state ranking of 30. Virginia ranked 5th in state-controlled mental health expenditures for state psychiatric hospitals and 23rd in state-controlled mental health expenditures for community-based programs.

    The American Association on Intellectual and Developmental Disabilities publishes "The State of the States in Developmental Disabilities," a monograph that compares services and funding in the states for intellectual and developmental disabilities (I/DD). According to the 2008 monograph, public I/DD inflation-adjusted funding for community services in Virginia grew by 5.9 percent between 2004 and 2006, compared to a national average increase of 3.1 percent. In 2006, Virginia's ID waiver as a percent of total I/DD funding was 41 percent, compared to a national average of 45 percent. Virginia's federal-state per capita waiver spending per citizen of the general population ranked 47th.

    In 2006, Virginia had a larger proportion of individuals with intellectual or developmental disabilities in out-of-home settings who resided in 16+ person settings compared to a national average (34 percent vs 19 percent) and a smaller proportion of individuals who resided in 1-6 person settings compared to a national average (59 percent vs 70 percent). Virginia's utilization rate by individuals with I/DD in settings for 1-6 persons ranked 47th.

    Based on data from the National Survey on Drug Use and Health, Virginia compares very favorably to the national averages for the prevalence of substance abuse (for both illicit drug and alcohol) and treatment gaps. For example, the prevalence (2.31 percent) in Virginia for any illicit drug dependence or abuse in the past year by individuals ages 18 or older was the tenth lowest of the 50 states and the District of Columbia, based on 2005-2006 data. The national rate was estimated to be 2.62 percent. This was an improvement from the prevalence of 2.57 percent (ranking 16th lowest) found in 2004-2005. The survey also ranked Virginia well (7th lowest) in the percentage (2.01 percent) of individuals ages 18 or older who needed but were not receiving treatment for illicit drug use in the past year.
  • Summary of Customer Trends and Coverage
    State Hospitals: Between FY 1996 and FY 2009, excluding the HDMC and VCBR, admissions declined by 35 percent (from 7,468 to 4,884) and separations (discharges) declined by 33 percent (from 7,529 to 5,042).

    Training Centers: Between FY 1996 and FY 2009, training center admissions increased by 28 percent (from 87 to 111). Between FY 1996 and FY 2009, training center separations (discharges) decreased by 20 percent (from 223 to 179).

    CSBs: Between FY 1986 (the first year that annual performance contract data was submitted by CSBs) and FY 2008, the numbers of individuals receiving CSB mental health services grew from 135,182 to 161,046 (19 percent); individuals receiving intellectual disability services grew from 20,329 to 36,141 (77 percent), and individuals receiving substance abuse services grew from 52,942 to 57,226, (8 percent). In FY 2008, the Department added a new area, Services Available Outside of a Program Area and some mental health, intellectual disability, or substance abuse services (i.e., Emergency, Motivational Treatment, Consumer Monitoring, Assessment and Evaluation, Early Intervention and Consumer-Run Services) were moved to this fourth area. If the individuals served in this new area were added to the other three program areas, the reported growth would be even greater.
Future Direction, Expectations, and Priorities
  • Summary of Future Direction and Expectations
    The Department anticipates a variety of factors will converge to increase demand for services provided by the public behavioral health and developmental services system. These include:

    • Increasing services demand resulting from Virginia demographic trends, particularly the continued significant growth in Northern Virginia, Central Virginia, and Eastern Virginia; growing numbers of older adults who will require behavioral health services to enable them to reside in their homes or other community placements; and increasing cultural diversity of Virginia’s population;

    • Increasing numbers of veterans who are returning to Virginia from Iraq and Afghanistan and are experiencing behavioral health issues;

    • Increasing demand for specialized interventions and care by individuals with co-occurring combinations of mental health or substance use disorders, developmental disabilities or other cognitive deficits, chronic medical conditions, or behavioral challenges;

    • Evolving needs of individuals receiving behavioral health and developmental services who require ongoing preventive care, who have more complex medication regimes, or who are experiencing serious medical conditions requiring specialized health services;

    • Additional demands for specialized services resulting from the aging of current caregivers;

    • Increasing numbers of adults and juveniles in the criminal justice system with identified behavioral health issues; and

    • Emerging responsibilities of the behavioral health and developmental services system for serving individuals with developmental disabilities, including autism spectrum disorder.

    The policy agenda for Virginia's behavioral health and developmental services system for the 2010-2012 biennium will focus on sustaining the progress in implementing the vision of recovery and person-centered delivery of behavioral health and developmental services and investing in services capacity and infrastructure needed to address issues facing the services system. Department priorities for the biennium follow:

    • Initiatives to increase access to transitional and permanent community housing for individuals with behavioral health disorders or intellectual disability. Affordable community housing is the area most lacking in the Commonwealth's continuum of services and supports and is the primary barrier to individuals who are transitioning from state facilities to the community.

    • Initiatives to enhance the existing Medicaid waiver for individuals with intellectual disability to assure that they can receive “comparable services and supports” to those provided in an ICF/MR facility. This lack of comparability has increased family reliance on ICF/MR settings, which are more costly for the state and more restrictive and removed from individuals' family, friends, and their home communities.

    • Initiatives to build a Virginia behavioral health – medical health partnership that promotes a “one person, one team, one plan” approach to serving individuals. The need for such an integrated system of services and supports is well documented, yet there is little interface between these two systems, except at the crisis or emergency level of each system.

    • Initiatives to expand behavioral health and criminal justice partnerships and service delivery for individuals with mental health or substance use disorders who are at risk of or are currently involved in the criminal justice system. Diversion and intervention efforts will result in reduced reliance on jail beds and state facility beds devoted to forensic treatment needs.

    • Initiatives that advance a comprehensive system for health information exchange (HIE) across the behavioral health and developmental services system; with other providers that serve individuals with mental health or substance use disorders and intellectual disability; and with other state agencies that fund behavioral health or developmental services. A comprehensive HIE approach would produce improved efficiencies in service delivery, better service coordination, and enhanced capacity for performance measurement.
  • Summary of Potential Impediments to Achievement
    A major impediment is the Commonwealth's substantial revenue shortfall. State general fund reductions impede the ability of the Commonwealth to respond to increased demand for behavioral health services resulting from the economic crisis. Research suggests that factors such as higher unemployment that accompany economic crises are associated with increased prevalence and severity of some mental illnesses. Involuntary job loss increases the risk of psychiatric disorders, including clinical and subclinical depression, anxiety, substance abuse, and antisocial behavior.

    Additionally, health economists predict that factors related to the recession will contribute to the expansion of demand for public services including:
    o Increasing unemployment and associated loss of employer-provided health benefits;
    o Decreasing ability of employers to subsidize health benefits;
    o Decreasing ability of individuals with private insurance to afford increasing out-of-pocket expenses; and
    o Decreasing availability of private providers to offer sliding scale or charity care due to smaller profit margins, investment losses, and decreased donor support.

    These factors will place an additional strain on the public behavioral health care system at a time when state and local government revenues have been and are likely to continue to be cut in the near future.

    Community providers of behavioral health and developmental services, already strained to keep pace with existing caseloads, are likely to experience increasing demand for services. During the first four months of 2009, CSBs reported that 14,579 individuals were on waiting lists for CSB services. Of these, 6,072 were waiting for mental health services, 6,458 for intellectual disability services, and 2,049 for substance abuse services.
Service Area List

Service Number Title
720 197 08 Facility-Based Education and Skills Training
720 357 07 Forensic and Behavioral Rehabilitation Security
720 421 01 Aftercare Pharmacy Services
720 421 02 Inpatient Pharmacy Services
720 430 06 Geriatric Care Services
720 430 07 Inpatient Medical Services
720 430 10 State Intellectual Disabilities Training Center Services
720 430 14 State Mental Health Facility Services
720 445 01 Community Substance Abuse Services
720 445 06 Community Mental Health Services
720 445 07 Community Developmental Disability Services
720 498 00 Facility Administrative and Support Services
720 499 00 Administrative and Support Services
720 561 03 Regulation of Health Care Service Providers
720 787 01 Facility and Community Programs Inspection and Monitoring
Agency Background Information

Statutory Authority
State Statutes

• Article 31 (§ 2.2-2696 et seq.) of Chapter 26 of Title 2.2 of the Code of Virginia establishes the Substance Abuse Services Council to coordinate the Commonwealth’s public and private efforts to control substance abuse, requires the Office of Substance Abuse Services in the Department to provide staff assistance to the Council, and requires a Comprehensive Interagency State Plan (subsection G of § 2.2-2696).

• Chapter 53 (§ 2.2-5300 et seq.) 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 (§ 2.2-5304).

• Chapter 11 (§ 16.1-241 et seq.) of Title 16.1 of the Code of Virginia sets out the provisions of juvenile and domestic relations court law, including Article 16 (§16.1-335 et seq.), the Psychiatric Inpatient Treatment of Minors Act, authorizing the Department to conduct evaluations of the competency of juvenile defendants to stand trial.

• Chapters 11 (§19.2-167 et seq.) and 11.1 (§19.2-182.2 et seq.) of Title 19.2 of the Code of Virginia authorize the Department to provide forensic services to individuals in the criminal justice system, including evaluations of competency, determinations of sanity, restoration to competency services, and treatment services for individuals adjudicated not guilty by reason of insanity.

• Chapter 2 (§§ 37.2-200 to 37.2-204) of Title 37.2 of the Code of Virginia establishes the State Board of Behavioral Health and Developmental Services and outlines its duties and powers.

• Chapter 3 (§§ 37.2-300 to 37.2-319) of Title 37.2 of the Code of Virginia establishes the Department of Behavioral Health and Developmental Services under the supervision and management of the Commissioner. This chapter outlines duties and powers of the Commissioner, including supervising and managing the Department and its state facilities, which provide care and treatment of individuals with mental health disorders and treatment, training, or habilitation of individuals with intellectual disability (mental retardation). State facilities also provide inpatient pharmacy services, geriatric services for older adults, inpatient medical services, inpatient forensic services, education and training programs for school-age individuals, and facility administrative and support services. It also lists other responsibilities of the Department, including the development of a six-year comprehensive plan.

• Chapter 4 (§§ 37.2-400 to 37.2-440) 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 and the Department’s licensing of providers, and establishes the Office of the Inspector General for Behavioral Health and Developmental Services.

• Chapter 5 (§§ 37.2-500 to 37.2-512) of Title 37.2 of the Code of Virginia authorizes the establishment by local governments and operation of community services boards (CSBs) to provide community behavioral health and developmental services and authorizes the Department to contract with and fund CSBs.

• Chapter 6 (§§ 37.2-600 to 37.2-615) of Title 37.2 of the Code of Virginia authorizes the establishment by a specified county or city and operation of a behavioral health authority (BHA) to provide community behavioral health and developmental services and authorizes the Department to contract with and fund a BHA.

• Chapter 7 (§§ 37.2-700 to 37.2-721) 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) that serve individuals with mental health disorders or intellectual disability respectively.

• Chapter 8 (§§ 37.2-800 to 37.2-847) of Title 37.2 of the Code of Virginia addresses admissions to and discharges from state hospitals and training centers, involuntary commitment, and admissions to private facilities.

• Chapter 9 (§§ 37.2-900 to 37.2-920) of Title 37.2 of the Code of Virginia authorizes the civil commitment of sexually violent predators, requires the Department to operate or contract for a secure confinement facility to provide behavioral rehabilitation services to them, and requires the Department to implement conditional release orders.

• Section 54.1-3437.1 of the Code of Virginia authorizes the Board of Pharmacy to issue a limited manufacturing permit to the pharmacy directly operated by the Department that serves individuals receiving CSB services for the purpose of repackaging drugs.

Federal Statutes and Regulations

• 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) establishes certification requirements for all ICF/MR beds in training centers operated by the Department and acute care beds and skilled nursing beds at the CVTC.

Customers
Customer Group Customers served annually Potential customers annually
Adults receiving state hospital services 4,725 5,748
Children and adolescents receiving state hospital services 581 764
Community services boards and the behavioral health authority (CSBs) 40 40
Governor (Office of the Inspector General Reports) 1 1
Individuals civilly committed to the Virginia Center for Behavioral Rehabilitation (VCBR) 150 300
Individuals in state facilities receiving local inpatient hospital services through special hospitalization 618 618
Individuals meeting SVP criteria and conditionally released for SVP treatment 166 600
Individuals participating in training center vocational or educational services 700 1,175
Individuals receiving Community Resource Pharmacy (CRP) services 43,200 45,000
Individuals receiving CSB emergency, assessment and evaluation, early intervention, monitoring, motivational treatment, and peer (consumer)-run services services 85,896 94,486
Individuals receiving CSB intellectual disability services 25,053 31,511
Individuals receiving CSB mental health services 101,796 107,868
Individuals receiving CSB substance abuse services 43,657 45,706
Individuals receiving inpatient services provided by Hiram Davis Medical Center 122 150
Individuals receiving inpatient services provided on state hospital medical/surgical units 204 468
Individuals receiving inpatient services provided on the Central Virginia Training Center medical/surgical unit 171 502
Individuals receiving state facility inpatient pharmacy services 6,866 6,866
Individuals receiving state training center services and supports 1,386 1,500
Individuals with active criminal justice system involvement receiving secure forensic services 1,472 1,766
Infants and toddlers and their families receiving Part C early intervention services 12,066 18,622
Juveniles requiring restoration to competency treatment services 121 175
Local and regional jails 84 84
Members of the General Assembly (Office of the Inspector General Reports) 140 140
Members, State Behavioral Health and Developmental Services Board 9 9
Nursing homes 178 273
Older adults (65 and older) receiving state hospital services 615 785
Participants in community prevention programs and coalitions 660,522 660,522
Providers licensed by the Department (including CSBs and other public and private providers) 612 750
State facility employees 9,091 10,000
State hospitals and training centers 16 16
Virginia circuit and district courts 325 325

Anticipated Changes To Agency Customer Base
Following are anticipated changes to the Department's customer base.

• 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.

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

• The Commonwealth's publicly-funded services system will experience increasing demand for behavioral health services resulting from the economic crisis.

• A growing number of Virginians have either limited or no behavioral health insurance benefits, and this too often results in less than optimal treatment and care. These individuals will place increasing pressure the public services system.

• 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.

• Availability of Medicaid Early, Periodic, Screening, Detection, and Treatment (EPSDT) services for eligible children will increase the numbers of individuals seeking services.

Aging Population Impact

An estimated 1,758,655 Virginians (2008 Population Estimates) experience specific mental disorders that are not part of “normal” aging. New treatment models to serve older adults with mental health or substance use disorders or intellectual disability must be well coordinated and responsive to the unique needs of individuals with growing health issues and must promote new roles for individuals who seek to continue as productive members of their communities. The Department and CSBs have worked together and with other stakeholders to develop regional model programs in Northern Virginia and Eastern Virginia to provide innovative direct care services for older adults in their home communities with the goal of reducing the need for psychiatric hospitalization. These initiatives are collaborating with local service area providers to create programs that meet the needs of their communities, including:
o Regional specialized gero-psychiatric behavioral health mobile teams and specialized assisted living and nursing home teams;
o Discharge assistance funding,
o Regional private bed purchase funds
o Specialized services and supports that incorporate evidence-based and best practices, including on-site geriatric psychiatric services provided through a PACE program, partial hospitalization, intensive outpatient services and adult day care extensive outreach services, education/support and participation in advocacy; and
o Strategic planning activities.

Additionally, the state geriatric centers have developed strong partnerships with private nursing homes around the state to support and encourage the transition of individuals residing in state geriatric centers to the community. Cooperative arrangements that facilitate successful integration of center patients have been recognized as a best practice by the Virginia Healthcare Association, a professional organization for privately owned nursing homes and assisted living facilities. The state geriatric centers also have developed partnerships with private and university-affiliated psychiatric facilities to create a system where acute care can be provided in community hospitals and longer-term treatment provided in state geriatric centers. On an individual basis, this has enabled community hospitals to accept TDOs and provide acute treatment to individuals who otherwise would have been admitted to state geriatric centers for much longer average lengths of stay. On a systemic basis, the centers have freed resources they previously spent on acute care patients to develop relationships with nursing homes to discharge individuals who no longer require geriatric center services.

The Department has established a Geriatric Leadership Team that is working to develop and implement a Master Plan for Geriatric Services. This effort envisions an integrated model for the delivery of specialized clinical behavioral health services for older adults. It promotes continuity of care through a continuum of providers and shared commitment to ensure the proper level of care and recognizes the importance of ongoing collaboration with CSBs, community providers of aging services, and other community organizations to increase capacity for aging in place, when appropriate, for older adults. Implementation of the master plan will require energized collaborative partnerships with public and private providers and the academic community and sustained commitment to improving access to services and supports to the extent possible given available resources, ensuring service quality and effectiveness, and accountability for older adult service outcomes.

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
Federal agencies: The Department meets federal requirements associated with the receipt of block grants and other resources that support the provision of behavioral health and developmental services. The Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services awards grants to the Department to support community MH and SA services and provides technical assistance to the Department and the CSBs about requirements associated the receipt of the grant funds. The Office of Special Education Programs (OSEP) in the Department of Education awards grants to the Department to support Part C early intervention services for infants and toddlers and their families and provides technical assistance to the Department on requirements associated with receipt of these grant funds.
Individuals receiving services, family members, and advocacy organizations: Individuals receiving services, advocacy organizations, and family members provide important feedback to the Department, regarding policy, planning, and regulatory development for the services system. Individuals receiving services and family members serve on the State Board and CSB boards of directors. They work with the Department, CSBs, and state facilities to address issues of mutual concern. State facility staff and CSBs work closely with individuals receiving services and their families to assure their active and meaningful involvement in the delivery of services and supports and in discharge planning.
Local governments: Local governments establish CSBs and approve their CSBs’ performance contracts with the Department. 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. Through its licensing function, the Department works with local zoning, fire, health, taxation, social services and Comprehensive Services Act officials to implement regulations and share information.
Private providers (for profit and non-profit organizations): Private providers participate in policy, planning, and regulatory development activities. They contract with CSBs to provide community services, and they deliver Medicaid ID waiver services. CSBs purchase acute psychiatric services from local acute care hospitals. State facilities purchase inpatient medical care for individuals receiving their services. To ensure successful community transition and adjustment, CSBs work with state hospital staff to plan, coordinate and monitor community residential placements in nursing homes, group homes, and assisted living facilities. The Department works with private providers to ensure that they meet licensing and human rights requirements. The Commissioner enters into contracts with private providers to provide juvenile restoration services and conduct post restoration evaluations of juvenile competency. Through contracts with the Department, private community providers deliver sexually violent predator treatment, supervision, and monitoring services.
Provider associations: Provider associations participate in policy, planning, and regulatory development activities. They work with the Department to address issues of mutual concern.
State and local agencies: The Department works closely with many state 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, including the Departments of Medical Assistance Services, Social Services, Health, Rehabilitative Services, Housing and Community Development, Corrections, Juvenile Justice, Criminal Justice Services, Aging, and Education and the Offices of Comprehensive Services and of the Executive Secretary of the Supreme Court of Virginia. Central office and state facility 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 Department 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 (DPB) 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. Local agencies such as school systems, local social services, local health departments, and area agencies on aging are critical partners in the provision of 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. State and local agency representatives participate as members of various state and regional planning committees focused on transforming the services system.
Virginia institutions of higher education (colleges, universities, and community colleges): The academic medical centers, academic programs of other colleges and universities, and community colleges work with the Department to collaboratively 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. The Institute of Law, Psychiatry, and Public Policy at the University of Virginia provides training for juvenile and adult forensic evaluators and civil admission prescreeners and provides SVP civil commitment training.
Products and Services
  • Description of the Agency's Products and/or Services:
    Community Mental Health, Intellectual Disability, and Substance Abuse Services Provided by or through CSBs:

    A. Community Mental Health Services

    • Emergency services, including crisis intervention and preadmission screening
    • Local acute psychiatric inpatient services
    • Outpatient services, including therapy and counseling, medication services, and intensive in-home services
    • Assertive community treatment (PACT teams and ICT programs)
    • Case management services
    • Day treatment and partial hospitalization, including therapeutic day treatment for children and adolescents
    • Rehabilitation services, including psychosocial rehabilitation programs
    • Sheltered employment
    • Group supported employment
    • Individual supported employment
    • Highly intensive residential services, such as crisis stabilization programs and residential treatment centers
    • Intensive residential services, such as group homes
    • Supervised residential services, such as supervised apartments, domiciliary care, and sponsored placements
    • Supportive residential services, such as supported living arrangements
    • Prevention services
    • Early intervention services
    • Consumer monitoring services
    • Assessment and evaluation services
    • Consumer-run services
    • Motivational treatment services

    B. Community Intellectual Disability 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 services
    • Assessment and evaluation services
    • Medicaid ID waiver services reimbursed by the DMAS
    • Early intervention services for infants and toddlers under 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

    C. Community Substance Abuse Services

    • Emergency services, including crisis intervention
    • Local acute psychiatric inpatient services
    • Community-based substance abuse medical detoxification inpatient services
    • Outpatient services, including therapy, counseling, intensive outpatient, and medication assisted treatment
    • Day treatment and partial hospitalization
    • Rehabilitation services, including psychosocial rehabilitation programs
    • Sheltered employment
    • Group supported employment
    • Individual supported employment
    • Highly intensive residential services, such as substance abuse social detoxification services
    • Intensive residential services, such as primary care, intermediate and long-term habilitation, and group homes, and jail-based habilitation services
    • Supervised residential services, such as supervised apartments, domiciliary care, and sponsored placements
    • Supportive residential services, such as supported living arrangements
    • Prevention services, including community prevention coalitions
    • Early intervention services
    • Motivational treatment services
    • Consumer monitoring services
    • Assessment and evaluation services

    Services Provided by State Hospitals and Training Centers:

    A. Inpatient Medical Services Products and Services

    • Physician services
    • Nursing services
    • Skilled nursing care
    • Pathology lab
    • Radiology
    • EEG/EKG
    • Dental services and dental anesthesiology
    • Speech and audiology
    • Physical, occupational, and recreational therapy
    • Ophthalmology services
    • Respiratory therapy
    • Psychology services
    • Medical supplies
    • Detoxification
    • Special hospitalization (purchase of medical care from local hospitals)

    B. State Hospital Services

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

    C. State Training Center Services

    • Medical and psychiatric assessment
    • Occupational, speech, physical, and recreational therapies
    • Short–term respite and emergency care
    • Habilitation and skill acquisition for community integration
    • Person-centered planning
    • Regional Community Support Center services and supports, including 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

    D. Inpatient Geriatric Care Services

    • Psychiatric and medical assessment
    • Psychology services
    • Nursing services
    • Social work services
    • Recreational, physical and occupational therapies
    • Individualized treatment plans
    • Medication management and rehabilitation
    • Discharge planning and coordination

    E. Facility-based Education and Skills Training

    • Habilitation services
    • Occupational therapy
    • Physical therapy
    • Music and speech therapy
    • Recreation therapy
    • Therapeutic horseback riding
    • Vocational and Employment
    • Pre-vocational skills development
    • Sheltered workshop services
    • Work readiness training
    • Community based employment services
    • Educational
    • Functional academics required to implement the Individual Education Plan (for individuals 22 years of age and under)

    F. Forensic and Behavioral Rehabilitation Security

    Forensic Services

    • Expert inpatient and outpatient mental health evaluations and reports for the courts
    • Emergency treatment services
    • Treatment to restore competency to stand trial
    • Commitment for treatment for individuals acquitted of a criminal offense as Not Guilty by Reason of Insanity
    • Expert court testimony in forensic matters
    • Statewide training in forensic mental health evaluations for the criminal courts
    • Coordination with CSBs of public community mental health services for forensic consumers
    • Training, consultation, and assistance on forensic issues

    SVP Behavior Rehabilitation Services

    • Sex offender rehabilitation services within a maximum-security perimeter
    • Review of Commitment Review Committee (CRC) and SVP evaluations
    • Sex offender evaluation and treatment training (in collaboaration with the University of Virginia ILPPP)
    • Quality management feedback to CRC evaluators
    • Annual SVP commitment reviews for the courts

    Pharmacy Services

    A. Aftercare Pharmacy Service Area Products and Services

    • Funding for purchase of medications by CSBs

    B. Inpatient Pharmacy Service Area Products and Services

    • Medication selection and procurement
    • Medication management and education
    • Pharmacy service oversight and cost containment
    • Medication preparation and dispensing
    • Medicare Part D participation

    Facility Administrative and Support Services

    • Administrative leadership and regulatory compliance
    • Information technology support
    • Food services for state facility patients and residents
    • Housekeeping services to ensure a clean and safe environment
    • Linen and laundry services
    • Physical plant services, including building maintenance and security services
    • Power plan operations
    • Employee training and education services

    Central Office Administrative and Support Service Area Products and Services

    A. 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
    • Consumer surveys
    • Staff support to boards, councils, and committees established in state or federal requirements

    B. Consumer Protections:

    • Human Rights investigations and reports
    • Criminal background checks for prospective state facility and certain community employees

    C. Services System and Program Development and Oversight:

    • Training and technical assistance and general guidance to CSBs, state facilities, and providers
    • Performance Contracts with CSBs that fund services
    • 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
    • Quality assurance reports

    D. 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
    • Compliance with the HIPAA Privacy Rule and HIPAA Security Rule
    • General support services for central office operations (mail, parking, procurement)

    E. Management of the SVP Conditional Release Program:

    • Development of conditional release safety and treatment plans
    • Training to expand community treatment capacity
    • Recruitment, training, and management for community conditional release treatment teams

    F. Supervision of the Juvenile Competency Restoration Program:

    • 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
    • Quality assurance and compilation of service data and quality indicators

    G. Architectural and Engineering Services (State facilities and Woodrow Wilson Rehab. Center):

    • State facility capital master plans
    • Oversight of facility capital projects’ design and implementation
    • Energy audits

    Regulation of Public Facilities and Services Products and Services

    • Issue new licenses and renew provider licenses
    • Unannounced monitoring of licensed services
    • Complaint investigations of licensed services
    • Receive and review data on serious injuries and deaths in services
    • Revocation and sanction actions against licensed service
    • Information to the public about licensed providers
    • Verification to payment sources (DMAS and DSS) that a provider is licensed
    • Training of applicants to become licensed

    Facility and Community Program Inspection and Monitoring (Office of the Inspector General)

    • Reports of findings and recommendations regarding the quality of services that result from inspections of facilities operated by and programs licensed by the Department.
    • Investigations of complaints regarding abuse, neglect and quality of services
    • Consultation to state facilities and licensed programs regarding implementation of OIG recommendations
    • Review of Department instructions and regulations
    • Support to the Office of the Governor and the General Assembly, as requested
  • Factors Impacting Agency Products and/or Services:
    Factors Affecting Community MH, ID, and SA Services

    • Demands for community behavioral health and developmental services are expected to increase as Virginia's population grows.

    • As Virginia's population becomes more diverse, providers of community-based behavioral health and developmental services must improve their responsiveness to the needs of culturally and linguistically diverse groups.

    • Potential reductions in reimbursement rates for Medicaid State Plan Option and ID waiver services would make it increasingly difficult to sustain essential core services offered by CSBs and private providers.

    • The decreasing availability of adequate health insurance coverage for the treatment of mental health disorders and the increasing numbers of individuals without health insurance who do not qualify for Medicaid will increase the demand for services provided by CSBs.

    • Workforce shortages, particularly professionals and direct care staff, make it difficult for CSBs and private providers to maintain or expand service capacity; respond to the increasingly complex needs of individuals receiving services; maintain the most challenging individuals in the community; and implement evidenced-based practices.

    • Improved assessment and screening of adults and children with co-occurring disorders will increase demands for integrated services to treat these co-occurring conditions.

    • Increasingly complex federal requirements such as federal MH and SA National Outcome Measures will require additional staff resources for data collection and reporting and analysis.

    • A persistent lack of treatment services capacity adversely affects the services system’s ability to address unmet service needs.

    • Lack of state funds inhibits the ability of the services system to provide the range of the prevention programs and has precluded the Department, the lead state agency, to implement the "Suicide Prevention Across the Lifespan Plan."

    Factors Affecting Services Provided by State Hospitals and Training Centers

    • Demand for additional state hospital beds to serve individuals with forensic involvement in secure settings is likely to continue to increase over time, resulting in more people on waiting lists for admission to secure units and longer wait times. Demand for secure forensic services may be offset by jail diversion programs.

    • Future demand for state hospital civil beds will be decreased as community capacity is developed and methods for coordinating and integrating care with all relevant providers, including primary care, vocational, and social services agencies, are improved.

    • Future demand for state training center services will be decreased by the increased availability of community services and supports, including ID waiver group homes, community ICF/MR facilities, behavioral consultation, and medical and dental services provided through the Regional Support Centers. Training centers will focus on serving individuals with co-occurring severe intellectual disability and pervasive physical disabilities or medical conditions such as seizures, scoliosis, or gastrointestinal problems and individuals with co-occurring mental health disorders and challenging behaviors.

    • VCBR was designed to reflect a system based on four SVP predicate crimes and a projected commitment rate of about 2 individuals per month. However, changes to the Code of Virginia enacted in 2006 increased the number of predicate crimes from four to 23 and the SVP commitment rate from less than one (actual rate) to nearly 5 per month. At this accelerated rate, VCBR will reach capacity in 2012 and construction of a second secure SVP facility will be required

    • The reluctance of older adults to seek behavioral health services and limited service coordination among agencies providing services to this population often result in a more complicated clinical picture when a person finally does present for services. This reluctance to seek treatment early, coupled with the insufficient availability of specialized services and expertise in CSBs, increases demand for geriatric treatment center services.

    • The cost for facility-based education and skills training education services and associated materials is expected to increase, as will the cost to transport individuals to off-campus instruction services. Public school program costs, paid by the state facility to local public schools if the consumer’s needs are best met there, will continue to increase.

    • The current poor condition of state facility buildings will require signification infrastructure investment and replacement.

    • Clinical, environmental, and administrative standards set by the Centers for Medicaid and Medicare (CMS) and by the Joint Commission are likely to continue to become more complex and expensive to implement.

    Factors Affecting Pharmacy Services

    • The new state facility pharmacy computer system will improve efficiency and support agency risk reduction efforts to mitigate errors and improve individual safety and pharmacy customer service.

    • The Community Resource Pharmacy (CRP) will be transitioned from an operational pharmacy to a funding vehicle for direct purchase of medications by individual CSBs. This transition is consistent with the Department's vision of promoting the highest level of consumer participation in all aspects of community life.

    • Prescription drugs are the fastest growing segment in health care expenses in the United States. As new, more effective but expensive medications are introduced and prescribed, direct pharmaceutical costs will increase.

    • The Virginia and national pharmacist shortage continues, making recruitment and retention of pharmacists extremely difficult.

    • Pharmacies must comply with federal mandates, including the requirement to implement bar codes.

    Factors Affecting Administrative and Support Services (Central Office)

    • Virginia's economic condition has resulted in the elimination of 43 classified and wage positions to date. Until state revenues improve, this number is likely to increase, significantly limiting the ability of the central office to accomplish its responsibilities.

    • The average age of the central office workforce is just under 52 years old and the average length of central office employees' state service is almost 18 years. Almost 15 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.

    • New requirements in Governor’s Executive Orders and changes in regulations from external agencies such as DOA, DHRM, DPB, DGS, and VITA are often unfunded.

    • VITA IT transformation - laptop/desktop standardization, centralization of Help Desk functions, server consolidation, messaging, network security, data center, and voice and video investments when fully implemented should address long-standing technical deficiencies affecting the Department.

    • Department partnerships with organizations representing advocates, individuals receiving services, and family members, and state and local agencies will continue to influence central office operational priorities, plans, policies, and regulatory development activities.

    Factors Affecting Facility Administrative and Support Services

    • Virginia's current economic condition and the continuing shortage of state revenues will limit the ability of facilities to maintain staffing levels needed to accomplish basic facility administrative and support functions. Facilities are implementing a variety of administrative efficiencies, including the regionalization of state facility human resources functions and sharing of specific services.

    • The state facility workforce is aging. This is particularly true for facilities in rural areas where staff turnover is lower than that in more urban areas. Recruitment and retention of the facility workforce of the future will continue to be a challenge.

    • New requirements in Governor’s Executive Orders and changes in regulations from external agencies such as DOA, DHRM, DPB, DGS, and additional workload requirements from federal or state agencies are often unfunded.

    • Individuals with more complex and severe medical disabilities will place additional requirements and associated expenses on facility support services, including increased demand for special diets, additional laundry services, more frequent housekeeping, and specialized safety and security services.

    • Facility administrative and support services will be affected by the rapidly changing healthcare environment and annual increases in health care and operational costs, facility relationships with VITA/NG and implementation of technological changes such as the new pharmacy system and electronic health records, life safety code changes and aging capital equipment, and future potential outsourcing of state facility administrative and support functions.

    Factors Affecting Regulation of Health Care Service Providers

    • New or revised federal and state statutes and regulatory or funding requirements will affect licensing of behavioral health and developmental services.

    • Continued transformation to a more community-based system of services and supports will increase in the number of new services licensed by the Department

    • Licensing staffing levels and competitive pressures will affect recruitment and retention of new staff.

    • Consumers and advocacy group issues will affect licensing activities.

    • Media or community attention to licensed services as a result of serious incidents or community concerns will affect licensing activities.

    Factors Affecting Facility and Community Inspection and Monitoring (Office of the Inspector General)

    • Changes in the roles and responsibilities of state facilities and the increasing severity and complexity of the needs of individuals receiving state facility services.

    • The shift of care for many individuals with severe disabilities to the community

    • An increase in the number of community-based public and private providers

    • Limited staffing with which to carry out the responsibilities established in the Code of Virginia.
  • Anticipated Changes in Products or Services:
    Anticipated Changes in Community MH, ID, and SA Services

    • Ongoing collaborative efforts with CSBs and other stakeholders to transform the public behavioral health and developmental services system will increase the need and demand for existing and new types of community services and supports.

    • The identification and adoption of evidence-based or consensus-determined best practices, such as assertive community treatment, supported employment, illness management and recovery services, peer-specialist staff, multi-systemic therapy, functional family therapy, therapeutic foster care, and systems of care for children and adolescents with serious emotional disturbances.

    • Adoption and expanded use of pre-and post trial alternatives and community treatment services such as crisis intervention teams and crisis stabilization services to prevent behavioral health situations from requiring a criminal justice response.

    • Adoption and expanded use of peer-provided and peer-run behavioral health direct services and supports.

    • Implementation of trauma-informed emergency services.

    • Continued development of strategies that implement person-centered practices.

    • Implementation of new types of community outreach and services and clinical practices that meet the needs of more culturally and linguistically diverse populations.

    • Continued emphasis on building and maintaining the requisite capacity to manage their utilization of state facility and community inpatient psychiatric beds.

    • Implementation of new services and supports that address the needs of individuals with autism spectrum disorder or other developmental disabilities.

    • Implementation of specialized services and supports for older adults with mental health or substance use disorders and integration of behavioral healthcare into primary care and other generalist settings.

    • Implementation of practice changes and community-based approaches through the Commonwealth's Children's Services System Transformation Initiative will build local service capacity, restructure existing services, assure intensive care coordination, and support community-based alternatives to detention.

    Anticipated Changes in Services Provided by State Hospitals and Training Centers

    • Adoption and expanded use of peer-provided and peer-run behavioral health direct services and supports.

    • Continued development of strategies that implement person-centered practices.

    • Utilization of telecommunication for clinical consultation to isolated or distant community providers.

    • Improved process and procedures for managing the care provided to individuals who become involved with the criminal justice system and have mental health disorders that require state hospital services in a secure environment.

    Anticipated Changes in Pharmacy Services

    • Implementation of a new Pharmacy Information System and federal bar code label technology.

    • Direct provision of CPR funds for CSB purchase of medications.

    Anticipated Changes in Administrative and Support Services (Central Office)

    • Enhanced data collection and analysis capacity will improve the ability of the central office to monitor CSBs and state facilities through program and utilization reviews, implementation of accountability measures, and financial audits to ensure compliance with federal and state statutes and regulations.

    • Increased numbers of private providers and service locations licensed by the Department will affect the agency's ability to protect the human rights of individuals receiving services.

    • Increased SVP Conditional Release service needs as more individuals meeting the criteria as sexually violent predators are conditionally released, have their probation or parole obligation end, or are released from the Virginia Center for Behavioral Rehabilitation.

    • Increased court orders for juvenile competency restoration.

    Anticipated Changes in Facility Administrative and Support Services

    • Other than the potential further consolidation or privatization of specific services, no major changes in state facility administrative and support services are anticipated.

    Anticipated Changes in Regulation of Public Facilities and Services

    • Increased numbers of private providers and service locations licensed by the Department will affect the Department's ability to assure these programs meet licensing requirements.

    • Increased focus on community services may increase the likelihood of investigations by VOPA or media, which affects and generally increases licensing monitoring.

    Anticipated Changes in Facility and Community Program Inspections and Monitoring (Office of the Inspector General)

    • More inspections and reviews of licensed community-based programs operated by CSBs and private providers.

    • More inspections of state facilities on topical areas that enable a targeted look at specific functional areas rather that broad-based reviews of the facilities.
Finance
  • Financial Overview:
    Department of Behavioral Health and Developmental Services funding comes from state general funds, special revenue funds, and federal grants. State general funds support the Department’s 16 state facilities, finance the majority of the central office oversight functions, and partially fund community programs operated by Virginia’s CSBs and several private not for profit organizations.

    Special Revenue funds are derived predominantly from the collection of fees related to the provision of services in the Department’s inpatient facilities. These revenues consist of Medicaid reimbursement, Medicare reimbursement, private insurance reimbursement, private payments, and other federal entitlement programs.

    Federal funds consist of numerous grants from the federal government. The majority of the Department’s federal funds consist of the Substance Abuse Prevention and Treatment (SAPT) Block Grant and the Community Mental Health Services (CMHS) Block Grant, which are passed through to CSBs. With the exception of the National School Lunch, National School Breakfast, Education of Handicapped Children, and Virginia Department of Agriculture and Consumer Services Federal Food Distribution Programs, all grants are passed through to community programs. Those not passed through are administered by some state facilities.

    The Financial Resource Summary includes appropriations to the Office of the Inspector General in the amount of $357,213 in general funds and $179,083 in non-general funds for FY 2009 and for FY 2010.
  • Financial Breakdown:
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $574,360,830  $379,559,752     $574,360,830  $379,559,752 
    Change To Base    -$7,612,891  $10,190,850     -$7,612,891  $10,190,850 
               
    Agency Total $566,747,939  $389,750,602     $566,747,939  $389,750,602 
    This financial summary is computed from information entered in the service area plans.
Human Resources
  • Overview
    The Department depends on a complement of salaried and wage employees in a wide variety of classifications (over 125 roles). Of these employees, approximately three percent (232) are in the central office. The vast majority of Department employees provide direct services to individuals in the 16 state facilities, which operate 24 hours a day, seven days a week. Additionally, a considerable number of Department employees provide site support services necessary to maintain the state facility infrastructure and surrounding environments and to operate the facilities’ physical plants. A demographic profile of the total Department workforce shows the following characteristics:

    • Race: 46.4 percent Caucasian 53.6 percent other races
    • Gender: 75.4 percent female 24.6 percent male
    • Average Age: 44.7 years
    • Average Length of Service: 10.9 years

    Approximately 45 percent of the Department’s total classified workforce is employed as direct service associates. The demographic profile of this segment of the workforce shows the following characteristics:

    • Race: 38.7 percent Caucasian 61.3 percent other races
    • Gender: 78.2 percent female 21.8 percent male
    • Average Age: 43.2 years
    • Average Length of Service: 11.2 years

    This diversity of staffing skills mix, the complexity of direct service requirements, and facility and site support issues have posed a number of human resources challenges, including:

    • The aging and increasing cultural diversity of the current workforce;

    • Declining enrollments in key degree and specialty programs such as nursing;

    • The shortage of health care professionals and direct care workers; and

    • The increasing level of skills expected of the workforce in the future.
  • Human Resource Levels
    Effective Date 9/1/2009    
    Total Authorized Position level 9665.25    
    Vacant Positions -799.25    
    Current Employment Level 8,866.0    
    Non-Classified (Filled) 1    
    Full-Time Classified (Filled) 8790    breakout of Current Employment Level
    Part-Time Classified (Filled) 75    
    Faculty (Filled) 0    
    Wage 457.84    
    Contract Employees 25    
    Total Human Resource Level 9,348.8   = Current Employment Level + Wage and Contract Employees
  • Factors Impacting HR
    Factors impacting the Department's workforce follow.

    • Just over 10 percent of the Department’s workforce will be eligible to retire in the next five years and in some state facilities, this percentage is as high as 15 percent. Many of these employees are nurses. This loss of experienced and well-trained staff across many occupational groups could have an adverse effect on patient care and safety and will require significant recruitment and succession planning activities.

    • Seven of the 25 fastest growing occupations are in health care positions utilized within the behavioral health and developmental services system. These include: personal and home care aides, nurses, physical therapists, residential counselors, human services workers, teachers of special education, and other health service workers.

    • Demand for health care workers continues to rise. In FY 2008, the separation rate for direct care positions in state facilities was 55.6 percent of the total agency’s separations. This, coupled with the direct care staff turnover rate in state facilities averaging 25 percent and ranging as high as 65 percent, poses a significant challenge for the Department.

    • Lagging compensation and inadequate career mobility opportunities have resulted in increased turnover, resulting in exhaustive and expensive recruitment and staff training activities and extensive use of overtime. This situation has limited the Department’s ability to be a viable competitor in the marketplace.

    • Workforce training resources, particularly the Virginia Learning Management System and the web-based College of Direct Supports, provide cost-effective opportunities for Department employees to gain competencies that are critical to increasing the employee productivity and maintaining service quality.
  • Anticipated HR Changes
    Potential changes to the Department's workforce follow:

    • Although the average age of the Department's current workforce has remained the same over the last two years, the average age is expected to rise over the next six years. The average of the Department’s current workforce of nearly 9,323 employees is 45 years old. The average age of Department nursing positions is 49 years old.

    • New technologies such as electronic health records and increasing service demands will create a health care market that requires highly skilled and well-educated workers. Employees who can create and apply sophisticated new technologies will expect to be rewarded. In addition to technical or clinical skills and expertise, well-honed communication and reasoning capabilities will be needed.

    • Department vacancy and turnover rates in general are likely worsen. This will likely exacerbate staffing shortages and increase demand for overtime. As the population continues to age and the general availability of workforce resources declines, a widening "care gap" between those needing care and those available to provide care will occur.

    • Competitive base salaries complemented by the use of bonus systems that are closely connected to performance, demonstrated desirable behaviors, and the application of needed competencies will be needed to attract and retain new employees and encourage higher productivity of existing employees.

    • As increasing numbers of Department employees retire, new workers who replace them are likely to require training to develop needed core competencies.

    • Career progression and pathways that support employee advancement through the attainment and application of successively higher levels of competencies will be increasingly important.
Information Technology
  • Current Operational IT Investments:
    IT Investment Management: Adopting COV standards and procedures has required significant changes for both Department users of IT services and developers but is providing a considerably more stable and reliable technology environment. In December 2008, the Department implemented the COV Information Technology Investment Management (ITIM) process for central office technology initiatives. This process, which included the establishment of an Information Technology Investment Board, will enable the Department to identify potential business value in all proposed IT investments, select and prioritize IT investments that best meet Department business needs, monitor the progress and performance of technology initiatives, and determine if selected technology investments are continuing to deliver the expected business values of constituent service, operational and efficiency, and strategic alignment to Department and COV goals and performance measures. The Department's IT investment management efforts should result in greater accountability in its IT investment, formalized risk management and documentation of results, which are aligned with the strategic directions established in the COV IT Strategic Plan.

    The Department's IT program provides coordination, guidance, oversight, and support to central office and state facility IT programs, including IT infrastructure transformation activities, security, compliance, and web and application development. The central office technology team, comprised of 13 classified and 3 hourly (P-14) positions, strives to comply with Commonwealth of Virginia (COV) technology, application development, and project management standards for all IT activities. This has been challenging because the Department continues to face additional pressure from budgetary constraints that resulted in elimination of two FTE technology staff positions in FY 2009.

    IT Transformation: The Department’s IT program is working with the Virginia Information Technologies Agency (VITA) and Northrop Grumman (NG) partnership to implement the major goals of VITA transformation – desktop/laptop standardization, centralization of Help Desk functions, server consolidation, and messaging, network, security, data center and voice and video investments. IT transformation, when complete, will improve constituent services and address many of the long-standing technology challenges and operational efficiency issues affecting the Department should be addressed. The transformation process is approximately 70 percent complete. Messaging Transformation -- email and active directory conversion—is scheduled for completion by July 2010.


    IT Security: The Department's investment in IT security provides business value because it protects constituent information; assures appropriate access to information; and enables the Department to implement new and updated federal HIPAA requirements and COV security standards. The following standards and directives affect the IT Security initiatives:

    o VITA Security Standards 501-01
    o VITA Data Protection Standard 507-00
    o VITA IT Security Audit Standard SEC502-00
    o Comptroller's Directive 1-07 (ARMICS).

    This investment will support provision of safeguards and controls that are necessary to ensure effective operation of the Department's technology environment and data and, as such, remains a high priority for the Department.

    Department Enterprise Applications: The major enterprise applications for the agency are AVATAR (facility billing), FMS (facility and central office financial management), and CCS (CSB accountability reporting). CCS is an agency-developed application; the other enterprise applications are 3rd-party vendor solutions. The Department maintains 20 additional applications (developed in-house) to support CO, state facility, and community business functions including human rights, licensing, facility operations, quality management, risk management, Medicaid Waiver, infant services, SVP services, discharge planning, forensic services, community contracting, information technology, and public relations. The development team utilizes accepted industry standards.

    Major applications supporting these business functions map to the lines of business in the Department's Enterprise Business Model, as follows:

    AVATAR: this third-party vendor application that supports the agency billing functions for services delivered in our 16 state-operated facilities. In FY 2010, DBHDS projects revenues of $314,857,574 that will be generated from this application. Automated billing is done for Medicaid, Medicare, commercial insurance, patient income and private payers. Basic demographic and diagnostic data are maintained in AVATAR which are used to meet state, federal and agency reporting requirements. Customized applications have also been built which leverage the core AVATAR data for meeting clinical and monitoring business requirements.
    Business Value: AVATAR provides automated processes that that effectively integrates the facility reimbursement processes. The application continues to contain ongoing reimbursement operations and personnel costs. Monthly billing to 3rd-parties can be uniformly performed and payments and posted an applied to individual accounts in a consistent and efficient manner. Interfaces to the financial management system ensures timely posting of receipts.

    Lines of Business:
    111 health (40-health care services), 222 knowledge creation and management (20-general purpose data and statistics), 223 public goods creation and management (20-information infrastructure management), 335 revenue collection (10-debt collections, 40-user fee collection)

    CCS: the CCS application provides a mechanism for monitoring the services provided by the Community Services Boards (CSBs) in the Commonwealth and, to a limited degree, assists in determining the outcomes of those services. DBHDS provided over $295M (FY09) in state and federal dollars to the CSBs. Many federal and state reporting requirements are met through CCS data. CSBs provide monthly submissions of required data to Central Office.
    Business Value: The CCS application replaced burdensome manual CSB reporting requirements and improved the quality of data in CSB information systems. Ongoing operations costs to local CSBs have been reduced.

    Lines of Business:
    221 direct services for citizens (10-agency operations), 222 knowledge creation and management (20-general purpose data and statistics)

    ITOTS: a case management application used by the 38 local provider programs of Part C Early Childhood Intervention services in the Commonwealth. In addition to providing case managers tools for planning and coordinating services to infants and their families, the ITOTS application is used to meet federal and state reporting requirements.
    Business Value: ITOTS provides Part C local lead agencies (39) a consistent set of automated process and tools to manage caseloads of service coordinators. Data managed in ITOTS permits DBHDS to efficiently meet federal reporting requirements.

    Lines of Business:
    221 direct services for citizens (10-agency operations), 222 knowledge creation and management (20-general purpose data and statistics)

    FMS: this FMS third-party vendor application is the fiscal management system used by the sixteen BDHDS-operated facilities and Central Office to manage the $953M agency budget. FMS supports all aspects of the agency’s fiscal operations with automated interfaces for budgeting, ordering, inventory management, A/P and A/R.
    Business Value: The FMS application proves BBHDS with an automated means to manage its almost $2 Billion budget. The integrated tools increases agency staff efficiency and cost savings through a shared technology environment.

    Lines of Business:
    438 financial management (10-accounting, 20-asset and liability management, 30 funds control, 40-collections and receivables, 50-payments, 60-reporting and information, 70-cost accounting/performance management)

    Ten state facilities utilize KRONOS, a third-party vendor application, to for staff scheduling and staff time tracking. The food service operations in eleven of the state facilities are supported by CBORD (3rd party solution) for menu planning, food preparation and provides reporting to meet hospital accreditation requirements. Each of these applications, in part, provide efficiencies by common software solutions for the agency.

    Additional, smaller custom developed technology applications such as licensing, human rights, incident reporting, Medicaid Waiver and Core Measures enable the Department to provide constituent service value through better access to data and compliance with federal and state mandates; operational efficiency value and strategic alignment value to agency performance and productivity measurement reporting.

    The Department is implementing a pharmacy management system to replace an outdated pharmacy application. This application will improve operational efficiency and constituent services by improving customer experience, providing better access to information, increasing ease of use, improving service quality and reducing errors, and adding new services. A Request for Proposals, issued on March 24, 2008, solicited sealed proposals from qualified contractors to provide an Automated Pharmacy System Application and Support Services. The project was subsequently awarded to General Electric (GE) Healthcare. The GE Centricity Pharmacy application will be integrated with the existing state facility billing and the AVATAR Admission Discharge Transfer application. This project will effectively set the stage for later integration with the proposed electronic health record and will support the agency’s risk reduction efforts to mitigate errors and improve individual safety and pharmacy customer service. The scheduled completion date for the pharmacy application is April 2011.

    The Department’s IT environment and staff continue to support legacy applications using older technologies but utilize current technologies for all new development. As resources permit, the Department will replace outdated legacy systems and this will offer opportunities for cost savings and improved service and are aligned with strategic directions in the COV IT Strategic Plan.
  • Factors Impacting the Current IT:
    Factors influencing the Department's IT services include:

    • Federal and state regulation and requirements for accountability and performance measurement continue to increase. Federal reporting requirements for outcome measures will require changes to the Department's information technology services applications. Additional reporting requirements related to the Part C program must be in place by early 2011.

    • Federal requirements for an electronic heath record are being developed. These requirements would affect technology needs in state facilities and CSBs. Current federal guidelines indicate that electronic health records need to be in place by 2014-15. Medicaid reimbursement rates could be at risk if electronic records are not being utilized.

    • The Department continues to seek more effective avenues of communicating with the public, particularly in its use of the Department's website.

    • Security management (HIPAA, Homeland Security, and Commonwealth of Virginia) will require additional resources in the central office and in state facilities.

    • Staffing resources for both central office and the state facilities continue to pose problems for the information technology program at the Department. Development, maintenance, and support for the needed application continue to be problematic.
  • Proposed IT Solutions:
    The Department anticipates that there will be increased emphasis on specific agency deliverables related to a primary role of system monitoring and accountability in the upcoming years. This will impact a many areas of the agency including state facility operations, licensing, human rights, risk management, forensic services, early childhood services, mental health services, developmental services, substance abuse services, and administrative offices.

    Person-centered practices (PCP) are expected to change information processes in state facilities and community programs. PCP is a process-oriented approach to empowering individuals. It focuses on the people and their needs by putting them in charge of defining the direction for their lives, not on the systems that may or may not be available to serve them. This ultimately leads to greater inclusion as valued members of both community and society.
    The agency is assessing the impact of the 2010 Healthcare legislation. At a minimum, the requirements related to electronic health records will impact DBHDS.
    The Medicaid Information Technology Architecture (MITA) will impact future DBHDS applications either purchased or developed. The MITA initiative is intended to foster integrated business and IT transformation across the Medicaid enterprise and to improve the administration of the Medicaid program. MITA is a national framework to support improved systems development and health care management for the Medicaid enterprise.

    The Department will continue to seek ways to efficiently utilize all resources.

    The anticipated business changes coupled with extremely limited resources will require changes to existing applications or development of new or modified solutions. The desired technology state for the Department in the next two years includes:

    • Minimizing customized software development efforts by using COTs solutions, leveraging software and services used elsewhere in the Commonwealth or expanding on existing agency solutions whenever possible and appropriate. The Department will explore use of CRM solutions to meet requirements in licensing, Medicaid waiver, human rights, and Part C programs. The Department intends to expand its use of COV business intelligence reporting tools for data monitoring, analysis and reporting. Future applications relating to individuals served in state facilities will be developed using tools provided in AVATAR, if possible and cost-effective. The Department intends to continue to use .net for customized development and SQL Server for database management and upgrade these platforms to current versions.

    • Developing standard architecture for the secure exchange and management of health information (HIE) among behavioral health and developmental services system entities including the state facilities, CSBs, and the central office. HIE between state facilities and CSBs is required for appropriate pre-admission and discharge planning. HIE between central office and CSBs will be expanded to provide central office with improved CSB monitoring and accountability data and to improve efficiencies (through data exchanges) between central office applications and local CSB applications. Additionally there will be increased requirements for sharing data among state agencies to support specific programs. Designing secure consumer-specified data exchanges among the Department, DMAS, VDH, DSS and DOE are priorities. A critical incident management and reporting systems is envisioned for DSS, DMAS, VHD, and the Department.

    • Continuing efforts to improve compliance with COV security audit standards.

    • Designing data structures and access to Department data assets that provide needed monitoring and accountability information for use by agency staff, CSBs, and the public.

    • Designing new or modifying current technology solutions that support the evolving person-centered services model. This could include providing secure applications that are accessible by individuals receiving services.

    • Working with COV technology partners to design and develop secure processes that permit CSBs and private providers to access Department-managed technology applications.

    • Consolidating technology resources across state facilities whenever possible to gain efficiencies reduce cost and enhance security.

    The following are the priority funded agency technology initiatives:
    • Medication Management (implementation/major)
    • ITOTS Expansion (enhancement/non-major)
    • System Transformation Grant Goal 4 (new-enhancement/non-major)
    • Authenticate of CBS and private providers to access secure DBHDS applications (new <$100K)
    • Information Exchange with Business Partners(new/non-major)
    o Part C – local lead agencies
    o Part C – VDH/DOE/DMAS
    o Systems Transformation Grant – Critical Incident Reporting and Medicaid Waiver Tracking
    • Central Data Warehouse and Reporting Project (new/non-major)
    • Infrastructure Consolidation
    o KRONOS Consolidation Project (non-major)
    o AVATAR Database Upgrade and Hardware Migration (non-major)
    o SQLServer Statewide Consolidation and Upgrade
    The following are the priority non-funded agency technology initiatives:
    • Infrastructure Consolidation
    o CBORD application/server consolidation (proposed/non-major)
    • Seclusion and Restraint Reporting (enhancement/<$100K)
    • Juvenile Competency Application (enhancement/<$100k)
    • Jail Diversion Application (new/<$100k)
    • Licensing Application (enhancement/<$100k)
    • Clinical Apps/EMR (proposed/major)
  • Current IT Services:

    Estimated Ongoing Operations and Maintenance Costs for Existing IT Investments

    Cost - Year 1 Cost - Year 2
    General Fund Non-general Fund General Fund Non-general Fund
    Projected Service Fees $2,162,176 $336,350 $2,194,608 $341,395
    Changes (+/-) to VITA
    Infrastructure
    $100,000 $150,000 $150,000 $225,000
    Estimated VITA Infrastructure $2,262,176 $486,350 $2,344,608 $566,395
    Specialized Infrastructure $0 $0 $0 $0
    Agency IT Staff $1,275,970 $359,239 $1,275,970 $359,239
    Non-agency IT Staff $0 $0 $0 $0
    Other Application Costs $690,627 $0 $1,500,000 $0
    Agency IT Current Services $4,228,773 $845,589 $5,120,578 $925,634
    Comments:
    Changes to VITA Infrastructure are primarily for Pharmacy application

    Other application costs are 3rd Party Vendor Maintenance Fees Pharmacy maintenance costs begin in Year 2
  • Proposed IT Investments

    Estimated Costs for Projects and New IT Investments

    Cost - Year 1 Cost - Year 2
    General Fund Non-general Fund General Fund Non-general Fund
    Major IT Projects $0 $1,283,603 $0 $5,002,013
    Non-major IT Projects $157,000 $1,916,171 $490,000 $200,000
    Agency-level IT Projects $72,000 $133,000 $170,000 $70,000
    Major Stand Alone IT Procurements $0 $0 $0 $0
    Non-major Stand Alone IT Procurements $0 $0 $0 $0
    Total Proposed IT Investments $229,000 $3,332,774 $660,000 $5,272,013
  • Projected Total IT Budget
    Cost - Year 1 Cost - Year 2
    General Fund Non-general Fund General Fund Non-general Fund
    Current IT Services $4,228,773 $845,589 $5,120,578 $925,634
    Proposed IT Investments $229,000 $3,332,774 $660,000 $5,272,013
    Total $4,457,773 $4,178,363 $5,780,578 $6,197,647
Appendix A - Agency's information technology investment detail maintained in VITA's ProSight system.
Capital
  • Current State of Capital Investments:
    The Department operates 16 facilities in 12 localities. These facilities are comprised of 412 buildings encompassing about 6.5 million square feet with an average age of 49 years and a median age of 55 years. With the exception of state facility redesigns and replacements described below, maintenance and renovation funding has not been adequate to prevent a gradual decline in the condition of older facility infrastructure or to allow renovations to meet current treatment and code requirements.

    Many state facility buildings are inefficient to operate and require major renovations to comply with current life safety and code standards and certification requirements. Most buildings are in generally poor condition and replacements of major building systems are required, including fire alarm systems and fire sprinkler systems, renovations for appropriate emergency egress, hurricane hardening, and increased numbers of bathrooms.

    Increasingly, state hospitals are serving individuals with a forensic status who require secure environments. Training centers are serving more individuals with physical and complex medical conditions who require a range of assistive technologies including wheelchairs. Interior renovations will be necessary to accommodate these needs.

    Status of State Facility Redesigns and Replacements

    During the last biennium, the Department completed construction of two facilities:

    • Replacement of the Hancock Geriatric Treatment Center at Eastern State Hospital - This new 150-bed replacement facility was completed and occupied in April, 2008.

    • Virginia Behavioral Rehabilitation Center - This 300-bed facility, for the treatment of individuals committed to the Department as sexually violent predators, is complete and in operation. Phase 1 was completed on schedule and Phase 2 was completed 6 months ahead of schedule.

    A third facility replacement project is under construction:

    • Replacement of Eastern State Hospital’s Adult Mental Health Treatment Center - A new 150-bed facility is replacing the hospital’s adult mental health programs. This project is currently in the construction phase, using the same team that constructed the Hancock Geriatric Treatment Center. It is scheduled for occupancy in July 2010.

    The following facility replacement and renovation projects are in the design phase:

    • Replacement of Western State Hospital - The developer for Western State Hospital replacement has been selected and design efforts have begun on this project. The Department has signed an Interim Agreement with Balfour Beatty Construction, Inc. for the design and construction of a new 246-bed replacement facility. The completion is estimated at 36 to 42 months, depending on the site selected.

    • Replacement of Southeastern Virginia Training Center - The Department is supporting the efforts of the Department of General Services, Division of Engineering and Buildings, Bureau of Facility Management in the design and construction of a 75-bed replacement facility on the existing site of the facility. A PPEA proposal was received by the Department of General Services and has been advertised for competing proposals. A major component of this effort is the creation of additional community housing into which residents at the facility can move. The Appropriation Act calls for the development of 12 Intermediate Care Facilities and six waiver group homes.

    • Renovation of Central Virginia Training Center – The Department has been pursuing the path of renovating residences on campus to correct privacy and Life Safety Code issues. Building No. 11 has been fully renovated and is operation. Buildings No. 8 and No. 12 have been submitted for final code compliance review. Construction is expected to begin in the fall of 2009. In parallel with this effort is the creation of additional community housing into which residents of the facility can move. The Department has received a PPEA proposal to provide community housing.
  • Factors Impacting Capital Investments:
    Factor's impacting needed Department's capital investment follow:

    • Demand for additional state hospital beds to serve individuals with forensic involvement in secure settings is likely to continue to increase over time.

    • Training center replacements and renovations must accommodate the needs of residents with co-occurring severe intellectual disability and pervasive physical disabilities or medical conditions such as seizures, scoliosis, or gastrointestinal problems; and residents with mild to moderate levels of intellectual disability and co-occurring mental illness and challenging behaviors.

    • VCBR was designed to reflect a system based on four SVP predicate crimes and a projected commitment rate of about 2 individuals per month. However, changes to the Code of Virginia enacted in 2006 increased the number of predicate crimes from four to 23 and the SVP commitment rate from less than one (actual rate) to nearly 5 per month. At this accelerated rate, VCBR will reach capacity in 2012 and a new secure SVP facility will be required.
  • Capital Investments Alignment:
    Department-operated facilities continue to be critical components in the behavioral health and developmental services system. The Department must ensure that the facilities it operates are safe, efficient, well maintained, and appropriately designed to meet the needs of both the services providers and recipients.

    The Department’s proposed Six Year Capital Improvement Plan has two essential components that support the provision of quality care in state facilities. The first proposes projects necessary to keep operational buildings in use for the next three biennia, including roof, utility, HVAC, and environmental hazard abatement. The second component is a phased program of facility replacements to prove physical environments that appropriately address the needs of facility programs and individuals receiving services.
Agency Goals

Goal 1

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.

Goal Summary and Alignment

This goal envisions the alignment of services system policies, regulatory requirements, funding incentives, administrative practices, and services and supports arrangements with the core values of self-determination, empowerment, recovery, and resilience at the state and local levels. This includes implementation of recovery, resilience, and person-centered principles and practices in areas such as prevention and health promotion, individual and family involvement and inclusion, access and engagement, continuity of care, individualized recovery and person-centered planning, recovery support and personal assistance, community inclusion, housing and work, evidence-based or best and promising practices, cultural competency, quality assurance, and performance monitoring. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of an individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal Objectives
  • Increase the proportion of people served in intensive community-based services per occupied state facility bed.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • We will increase the proportion of persons served in intensive community services versus state facilities
      Measure Class:
      Agency Key
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Frequency Comment: Fiscal year

      Measure Baseline Value:
      3.61
      Date:
      6/30/2005

      Measure Baseline Description: Consumers in intensive community-based services per occupied state facility bed

      Measure Target Value:
      4.18
      Date:
      6/30/2010

      Measure Target Description: Consumers in intensive community-based services per occupied state facility bed.

      Data Source and Calculation: Sources: AVATAR provides state facility average daily census (ADC) and Community Consumer Submission (CCS) counts of consumers receiving community-based highly intensive services (i.e., local MH and SA inpatient, MH PACT, MH assertive community treatment, MH DAP, MH and ID highly intensive residential, and ID waiver services) Calculation: Number of individuals receiving intensive community-based services during the fiscal year divided by the state facility ADC calculated at the end of the state fiscal year. State facility ADC is the total number of state hospital and training center (excluding HDMC and VCBR) bed days utilized during the fiscal year divided by 365. To calculate the percent change from the baseline, subtract the baseline proportion of persons served in intensive community services from the current fiscal year proportion and divide the difference by the baseline proportion.

Goal 2

Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.

Goal Summary and Alignment

This goal envisions statewide availability of a core array of recovery and resilience-oriented and person-centered services and supports that are appropriate to the needs of individuals with mental health or substance use disorders or intellectual disability who are in crisis or who have severe or complex conditions, or both, and cannot otherwise access needed services or supports because of their level of disability, their inability to care for themselves, or their need for a structured environment. The goal also envisions services provided by state facilities that prepare individuals for successful integration back into the community. Recovery and resilience-oriented and person-centered services and supports would be flexible and provided as close to the individual’s home and natural supports as possible. Natural support systems, including networks of individuals receiving services and their families, services, and supports, would be strengthened wherever possible and emphasis would be placed on prevention and early intervention to avoid future crises. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of an individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal Objectives
  • Increase the community tenure of individuals served in state facilities.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • We will reduce the percent of individuals who are readmitted to state facilities by providing community-based services and supports that respond to their individual needs
      Measure Class:
      Agency Key
      Measure Type:
      Outcome
      Measure Frequency:
      Quarterly
      Preferred Trend:
      Down
      Measure Baseline Value:
      20
      Date:
      6/30/2005

      Measure Baseline Description: Individuals with previous long terms of care readmitted to state facilities within 365 days

      Measure Target Value:
      17
      Date:
      6/30/2012

      Measure Target Description: Individuals with previous long terms of care readmitted to state facilities within 365 days

      Data Source and Calculation: Source: AVATAR Calculation: The percentage of individuals with previous long terms of care who are readmitted to state facilities will be calculated by dividing the number of readmissions by the total number of discharges. Individuals with previous long terms of care are defined as individuals who have had a length of stay in a state hospital or training center (excluding HDMC and VCBR) of 60 days or longer. The number of discharges is calculated based on the number of individuals with previous long terms of care who discharged, exclude deaths and transfers to other Department facilities, during the previous fiscal year on a cumulative quarterly basis (year-to-date). The number of readmissions is calculated based on the number of individuals who discharged (see above) and subsequently readmit to a state hospital or training center within 365 days (excluding individuals who are readmitted for respite services). For example, the percentage for the first quarter of FY 10 will be calculated on the discharges in the first quarter of FY 09 and subsequent readmissions through the first quarter of FY 10. For the second quarter of FY 10, the percentage will be calculated on discharges in the first two quarters of FY 09 and subsequent readmissions through the second quarter of FY 10.

Goal 3

Align administrative and funding incentives and organizational processes to support and sustain quality individually-focused care, promote innovation, and assure efficiency and cost-effectiveness.

Goal Summary and Alignment

This goal envisions adequate amounts of stable state and local funding that can be used flexibly to meet the needs of individuals and their families. Behavioral health and developmental services funding streams would be integrated to the extent possible to create individualized, recovery-oriented, and person-centered services plans. Opportunities for self-directed care would be pursued and full advantage would be taken of federal funding opportunities, including Medicaid, to implement recovery- and resilience-oriented and person-centered services. Funding allocations would include incentives for efficient and cost-effective services that are consistent with evidence-based or best and promising practices. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of an individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal 4

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.

Goal Summary and Alignment

This goal envisions significant improvement in the adequacy and appropriateness of state and community capital infrastructure. State facilities would be upgraded to ensure safety and provide adequate and appropriate space designed to meet the needs of individuals receiving services and community housing capacity would be enhanced. The services system would take advantage of technologies to improve care coordination and continuity and increase access to services in underserved areas, including electronic health records and health information exchange, teletherapy, and teleconsultation. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of a individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal 5

Obtain sufficient numbers of professional, direct care, administrative, and support staff with appropriate skills and expertise to deliver quality care.

Goal Summary and Alignment

This goal envisions a behavioral health and developmental services system workforce that is culturally competent and skilled in the delivery of evidence-based or best and promising practices. The services system would have the resources necessary to competitively recruit and retain sufficient numbers of professional and direct care staff. Public-academic partnerships with Virginia universities, colleges, and community colleges would expand the pipeline for and skill levels of hard-to-fill professional and direct care positions. Cross-training programs would enhance provider skills necessary to meet the needs of the most challenging individuals receiving services, including individuals with co-occurring disorders. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of an individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal 6

Enhance service quality, appropriateness, effectiveness, and accountability through performance and outcomes measurement and service delivery and utilization review.

Goal Summary and Alignment

This goal envisions statewide implementation of clinical and management practices that reflect best and promising practices and promote stewardship and wise use of system funds, human resources, and capital infrastructure. The services system would implement consistent management practices that focus on and support the delivery of recovery-oriented and person-centered services and supports. Performance and outcomes systems would demonstrate quality, efficiency, and cost-effectiveness through clearly defined accountability measures that are posted on the Department's web site. Implementation of this goal is essential for transforming Virginia's behavioral health and developmental services system to one that fully realizes the Department's vision of an individual-driven system of services and supports.

Goal Alignment to Statewide Goals
  • Engage and inform citizens to ensure we serve their interests.
  • Inspire and support Virginians toward healthy lives and strong and resilient families.
Goal 7

Strengthen the culture of preparedness across state agencies, their employees and customers.

Goal Summary and Alignment

This goal ensures compliance with federal and state regulations, policies and procedures for Commonwealth preparedness, as well as guidelines promugated by the Assistant to the Governor for Commonwealth Preparedness, in collaboration with the Governor's Cabinet, the Commonwealth Preparedness Working Group, the Department of Planning and Budget and the Council on Virginia's Future. This goal supports achievement of the Commonwealth's statewide goal of protecting the public's safety and security, ensuring a fair and effective system of justice and providing a prepared response to emergencies and disasters of all knds.

Goal Alignment to Statewide Goals
  • Protect the public’s safety and security, ensuring a fair and effective system of justice and providing a prepared response to emergencies and disasters of all kinds.
Goal Objectives
  • We will be prepared to act in the interest of the citizens of the Commonwealth and its infrastructure during emergency situations by actively planning and training both as an agency and as individuals
    Objective Strategies
    • The agency Emergency Coordination Officer will stay in regular communication with the Office of Commonwealth Preparedness and the Virginia Department of Emergency Management.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Agency Preparedness Assessment Score
      Measure Class:
      Other
      Measure Type:
      Measure Frequency:
      Annual
      Preferred Trend:
      Maintain
      Measure Baseline Value:
      51.18
      Date:

      Measure Baseline Description: Agency Preparedness Assessment Score

      Measure Target Value:
      69
      Date:

      Measure Target Description: Agency Preparedness Assessment Score

      Long-range Measure Target Value:
      75
      Date:

      Long-range Measure Target Description: Agency Preparedness Assessment Score

      Data Source and Calculation: The Agency Preparedness Assessment is an all-hazards assessment tool that measures agencies' compliance with requirements and best practices. The assessment has components including Physical Security, Continuity of Operations, Information Security, Vital Records, Fire Safety, Human Resources, Risk Management and Internal Controls, and the National Incident Management System (for Virginia Emergency Response Team - VERT - agencies only).


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