Presentation to the Community Integration Advisory Commission (CIAC) June 12, 2012 1.

Slides:



Advertisements
Similar presentations
Senate Criminal Justice Committee Interim Charge 1 June 21, 2006.
Advertisements

Discussion topics Dr Layth Delaimy. Assessing suicide risk Why do we assess? How could we intervene? Should we prevent suicide? Ethical Dilemmas.
Ex-Offenders and Housing
DHSS DSAMH Department of Health and Social Services Division of Substance Abuse and Mental Health.
SLOWING THE GROWTH OF MEDICAID SPENDING IN VIRGINIA STRATEGIES DESIGNED TO CONTROL CHILDREN’S MENTAL HEALTH SERVICES EXPENDITURES.
Massachusetts Department of Correction Bridgewater State Hospital Luis S. Spencer, Commissioner.
Georgia Department of Human Resources Blueprint for a New Mental Health System.
The Vital Role of State Psychiatric Hospitals. NASMHPD Medical Directors Council Technical Reports Series began 1997 – This is the 18th Goals – Assure.
Re-Balancing the Service System for People with Mental Illness, Developmental Disabilities and Addictive Diseases (MHDDAD)
Psychiatric Mental Health Nursing in Acute Care Settings.
Mental Health Law Reform Office of the Vice President for Government Relations and Health Policy.
Delaware Health and Social Services Delaware’s Delivery of Long Term Services and Supports The Need for Change Delaware Health Care Commission January.
Youth Empowerment Services (YES) A Medicaid Waiver Program for Children with Severe Emotional Disturbances Clinical Eligibility Determination Texas Department.
Outpatient Services Programs Workgroup: Service Provision under Laura’s Law June 11, 2014.
1 CIVIL COMMITMENT CRITERIA Jane D. Hickey Office of the Attorney General June 4, 2008.
Children’s Mental Health Crisis Response Services Presentation to the Allied Health Caucus, Virginia General Assembly February 24, 2012.
Comprehensive Integrated Mental Health Plan and Alaska Scorecard
Page 1 DBHDS Virginia Department of Behavioral Health and Developmental Services Systemic Therapeutic Assessment Respite and Treatment (START) Bob Villa.
Northern Virginia Crisis Stabilization Services for Children and Youth Status Report Regional Partnership Meeting November 19, 2010.
Preventing Family Crisis Finding the Assistance that your Family Needs.
In Crisis: Clinical Solutions for the Revolving Door Mary Ruiz MBA, CEO Melissa Larkin Skinner LMHC, CCO Florida's Premier Behavioral Health Annual Conference.
1 APPEARING BEFORE THE MENTAL HEALTH TRIBUNAL. 2 Index The Provisions of the Act relating to Tribunal hearings3 – 6 What is Evidence 7 Section 24 Continuing.
Child and Adolescent Task Force Report Charlotte V. McNulty, Vice Chair Presentation to House Health, Welfare and Institutions General Assembly Building.
January 25, 2011 Georgia Behavioral Health Caucus Community Care Joseph Bona, MD, MBA Chief Medical Officer DeKalb Community Service Board.
Creating a New Vision for Kentucky’s Youth Kentucky Youth Policy Assessment How can we Improve Services for Kentucky’s Youth? September 2005.
Medicaid and Behavioral Health – New Directions John O’Brien Senior Policy Advisor Disabled and Elderly Health Programs Group Center for Medicaid and CHIP.
Presented by Sherry H. Snyder Acting Deputy Secretary August 10, 2011 FY Governor’s Enacted Budget.
Ohio Justice Alliance for Community Corrections October 13, 2011.
FY 2005 Indigent Care Trust Fund Disproportionate Share Hospital Program Presented to House Appropriations Health Subcommittee June 23, 2005.
DBHDS Virginia Department of Behavioral Health and Developmental Services Improving Discharge Processes Updates on Waiver Changes Heidi Dix Assistant Commissioner.
D B H D S Virginia Department of Behavioral Health and Developmental Services Creating Opportunities for People with Substance Use Disorders a presentation.
DAUPHIN COUNTY ADULT MH RESIDENTIAL PROGRAM HIGHLIGHTS.
North Carolina TASC NC TASC Bridging Systems for Effective Offender Care Management.
President’s New Freedom Commission on Mental Health Executive Summary Recommendations.
GEORGIA CRISIS RESPONSE SYSTEM- DEVELOPMENTAL DISABILITIES Charles Ringling DBHDD Region 5 Coordinator/ RC Team Leader.
Medi-Cal 1115 Demonstration Waiver 14 th Annual ITUP Conference February 10, 2010.
Agency for Persons with Disabilities Overview House Health Care Appropriations Subcommittee February 12, 2013 Barbara Palmer Director Rick Scott Governor.
Testimony To The HEALTH CARE TASK FORCE Jim Rehder, Chairman Region II Mental Health Board.
Behavioral Health DATA BOOK A quarterly reference to community mental health and substance abuse services Fiscal Year 2010 Quarter 2 March 30, 2010.
ADOLESCENTS IN CRISIS: WHEN TO ADMIT FOR SELF-HARM OR AGGRESSIVE BEHAVIOR Kristin Calvert.
Carbon-Monroe-Pike Developmental Services Department The region encompassed by C-M-P is comprised of 1,557 miles. Estimated average driving time from one.
VIRGINIA RESIDENTIAL PSYCHIATRIC TREATMENT ASSOCIATION (“VRPTA”) Presentation to the House Health, Welfare and Institutions Committee July 30, 2007 Jim.
RHODA MEADOR, PHD ASSOCIATE DIRECTOR OUTREACH AND EXTENSION, COLLEGE OF HUMAN ECOLOGY CORNELL INSTITUTE FOR TRANSLATIONAL RESEARCH ON AGING Project Home.
Mandatory Outpatient Treatment Following Involuntary Inpatient Admission Allyson K. Tysinger Office of the Attorney General May 2010.
Mental Health Law Reform 2008 Procedural Changes Allyson K. Tysinger Assistant Attorney General June 4-5, 2008.
D B H D S Virginia Department of Behavioral Health and Developmental Services A Plan for Community-Based Children’s Behavioral Health Services in Virginia.
March 12,  May 2010 Governor Bob McDonnell signed Executive Order 10 calling for a Housing Policy Framework  The Homeless Outcomes Policy Report.
A LEGISLATIVE UPDATE ON BEHAVIORAL HEALTH AND INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Mental Health Needs Council by Amanda Jones, J.D. Legislative.
Access Task Force Report Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007.
Prince William County The CSB serves residents of these localities: Total population has increased by 7.3% since 2010 Census (454,096). Locality Total.
Behavioral Health DATA BOOK A quarterly reference to community mental health and substance abuse services Fiscal Year 2015 Quarter 1 March 10, 2015
DMH Continuing Care Admissions, Referrals & Utilization Behavioral Health Data Task Force December 18,
Proposed 2016 Olmstead Plan Overview 1. What is an Olmstead Plan? Integration mandate: Americans with Disabilities Act (ADA) requires state and local.
Update on Medicaid Integration in SW Washington January 7, 2016 Erin Hafer, MPH Director, New Programs Integration & Network Development.
March 9, 2015 Best Practice Themes Franklin County Task Force on the Psychiatric and Emergency System (PCES)
ACCESS & AUTHORIZATION. HOUSEKEEPING Food Restrooms Cell phones and calls Questions.
THE IMPACT OF STRENGTHENING MEDICAID ON MISSOURI’S MENTAL HEALTH SYSTEM March 2013.
Health and Social Care Mental Health Act 2007 Deprivation of Liberty Safeguards (MCA / DoLS) What is Depriving a Person’s Liberty?
Independent Examination June 4, 2008 Jill Milloy, Ph.D. Independent Examiner Fairfax-Falls Church CSB.
House HSS - 1 Bringing (Keeping) the Kids Home Update – February 2009 A collaboration of Department of Health and Social Services, Alaska Mental Health.
Chippewa County Department of Human Services 2014 Budget Summary State of Wisconsin Joint Finance Action Health & Human Service Board.
1 Bring (& Keep) the Kids Home (BTKH) An update related to Education February 2009 A collaboration of Department of Health and Social Services, Alaska.
Mental Health & Criminal Justice: The Challenge to Provide For Justice Involved Virginians with Behavioral Health Issues.
Presented by Tishaun Harris-Ugworji, DARS Adult Services Program Consultant Kathryn O’Connell-Raymond, VDSS Medicaid Consultant May 5, 2016 Catch the Wave.
Virginia CIT Assessment Sites
Department of Juvenile Justice
Behavioral Health DATA BOOK A quarterly reference to community mental health and substance abuse services Fiscal Year 2012  Quarter 2  April.
Managing Bed Capacity in Florida’s Forensic System of Care
2014 Legislative Changes to Virginia’s Civil Commitment Laws
Presentation transcript:

Presentation to the Community Integration Advisory Commission (CIAC) June 12,

Virginia’s System of Behavioral Health Care In FY 2011, through its 40 CSB/BHAs and 8 state- operated behavioral health facilities, the Commonwealth served citizens with behavioral health problems: CSBs served 108,892 individuals. State-operated facilities served 5,200 people. As of December 31, 2011, there were 1,252 persons in the state-operated facilities. 2

The Recovery Model The recovery model of treatment affirms that people can recover from serious mental illness and it supports self-determination, empowerment, resilience, and the highest level of participation in all aspects of community life. [DBHDS State Board Policy 1036] Emotional states are not static. Thousands of the 114,000 persons served by the behavioral health system statewide move from community settings to state facilities and back to the community. 3

The Community and Facility Systems are Interdependent There were 4,366 admissions & 4,421 separations from state facilities in FY2011. The “front door” and the “back door” to state facilities. The constant movement of over 4,000 individuals from the community – to the state facilities – and back to the community means that if the community system, or the state facility system, is beyond capacity the entire system will be frozen or, at best, sluggish. 4

Two Recent OIG Reports Review of Emergency Services: Individuals meeting statutory criteria for temporary detention not admitted to a psychiatric facility for further evaluation and treatment. [Report No ] Review of the Barriers to Discharge in State-Operated Adult Behavioral Health Facilities [Report No ] 5

The Front Door Failed TDO Report This Report summarized the results of a three-month study and was issued in February, It found that: – 72 persons meeting criteria for temporary detention (TDO) were denied the level of care deemed clinically appropriate because no state facility, or private psychiatric facility, would admit these individuals. There were approximately 5,000 TDOs successfully executed during this three-month study; – The study also found that 273 persons received TDO’s after the 6- hour time limit imposed by Code for converting an ECO into a TDO; – The criteria for a TDO are spelled-out by the Code of Virginia and include: “A substantial likelihood…in the near future” that a person is at risk for “serious harm to himself or others…lacks capacity to protect himself [and is] in need of hospitalization or treatment.” 6

Additional Findings and Recommendations: Failed TDO Report Hampton Roads and Southwest Virginia accounted for 75% of the failed TDOs and the state behavioral health facilities in these two regions were routinely at capacity and unable to provide safety net psychiatric beds for individuals needing temporary detention and further evaluation; Hospital emergency department directors and CSB emergency services directors around the state agreed that the standards for medical screening and assessment needed to be standardized and updated; The system sometimes discriminates against the people who are the most challenging to serve by limiting whom they will serve based on age, gender, psychiatric profile, history of assaultive behaviors, suicidal ideation, substance use, security concerns, medical complications, hours of operation, self-care ability, and psychiatric support staff availability; Accountability for emergency services is fragmented; OIG Recommended increasing regional accountability, standardizing medial screening and assessment guidelines, considering the creation of “intensive psychiatric beds” with private psychiatric hospitals, and further evaluation of the unique issues in Hampton Roads and Southwest Virginia. 7

The Back Door Extraordinary Barriers to Discharge Report This Report summarized the results of a six-month study and found: – That an average of 165 individuals, or 13% of the 2011 facility census, who were deemed clinically ready for discharge could not be discharged because of “extraordinary barriers to discharge;” – At the conclusion of this study, in December 2011, these 165 individuals had been on the discharge ready list for roughly eight months; – The most often cited barrier to discharge from state facilities was the lack of community-based supported housing. 8

The U. S. Department of Justice The review found that, based on DOJs 2011 findings in the State of New Hampshire, Virginia is at risk for a similar finding of non-compliance with the relevant aspects of the Americans with Disabilities Act as interpreted by the Olmstead decision; The behavioral health systems in Virginia and New Hampshire are similar in the following salient respects: – The lack of community based housing is a barrier to discharge from state-operated facilities; – The failure to develop sufficient community services is a barrier to discharge for individuals who could be served in a more integrated community setting; – The lack of community housing places disabled persons with mental illness at risk for unnecessary institutionalization; – Both states continue to fund more expensive institutional care when less expensive and therapeutically effective community-based care could be developed. 9

Fiscal Impact The average annual cost of serving a person in a state operated facility is $214,000; The average annual cost of serving a person in the community is conservatively estimated at $44,000; The difference of $170,000/year for serving people in the community vs. the state facilities for 165 individuals exceeds $28 million per year. 10

Impact on Safety Net Admissions The Failed TDO study confirmed that 54 people were denied admission to state-operated facilities in Hampton Roads and Southwest Virginia during the same time that ESH and SWVMHI had 51 and 8 beds, respectively, occupied by individuals deemed discharge ready and waiting for a community placement. 11

Safety Net Services It could be plausably argued that, if community services – including supported housing – had been available in Hampton Roads and Southwest Virginia, ESH and SWVMHI could have admitted many of the 54 persons meeting TDO criteria who were denied admission and referred to less intensive services than had been determined to be clinically necessary. 12

Additional Findings and Recommendations The Commonwealth does not offer community services and supports in sufficient quantities to serve all Virginian’s; An average of 165 adults remained institutionalized for roughly eight months during this study; Recommended that DBHDS publish a quarterly summary of individuals on the EBL; That DBHDS identify the housing requirements of each region to curtail the extraordinary barriers list; That DBHDS evaluate best practices at all state hospitals and replicate the most effective that have produced measurably superior outcomes; That DBHDS seek to expand funding for discharge assistance to help individuals transition back to the community. 13