- Report Published -
|U. S. Department of Justice Implementation Update Pursuant to Code of Virginia § 37.2-319 (HB2533/SB1486, 2011) and Item 315.V.1. of the 2012 Appropriation Act - July 23, 2012|
|Department of Behavioral Health and Developmental Services|
|Appropriation Act - Item 315 V.1. (Special Session I, 2012)|
|*This report was replaced in its entirety by the Department of Behavioral Health and Developmental Services on August 6, 2012.|
This report was developed to meet the requirements set forth in both Code of Virginia § 37.2-319 (HB2533/SB1486, 2011) and Item 315.V.1. of the 2012 Appropriation Act. Specifically, Item 315.V.1 addresses the management of the general fund appropriation for the expansion of community-based services in anticipation of an Agreement with the U.S. Department of Justice (DOJ), and states:
"The Department of Behavioral Health and Developmental Services shall provide updates on July 1 and December 1 of each year to the Governor and the Chairmen of the Senate Finance and House Appropriations Committees regarding expenditures and progress in meeting implementation targets established in the agreement."
The enactment clause associated with § 37.2-319 addresses the plan to transition individuals with [intellectual disability] from state training centers to community-based settings, and states: The Secretary shall submit reports on the development and implementation of the plan to the Governor and the Chairmen of the House Committee on Appropriations and the Senate Committee on Finance on the first of July and December of each year beginning July 1, 2011.
This report addresses Virginia’s progress in meeting the milestones in the Settlement Agreement for the period of March 6, 2012 – June 30, 2012, and describes expenditures associated with the Agreement for FY12.
Current Legal Status of the Settlement Agreement
In August 2008, DOJ initiated an investigation of the Department of Behavioral Health Developmental Services (DBHDS) Central Virginia Training Center (CVTC) pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA). In April 2010, DOJ notified the Commonwealth that it was expanding its investigation to focus on Virginia’s compliance with the Americans with Disabilities Act (ADA) and Olmstead. It first began this phase of the investigation at CVTC and then expanded it to the statewide system serving individuals with intellectual and developmental disabilities.
In February 2011, DOJ submitted a findings letter to Virginia, concluding that the Commonwealth fails to provide services to individuals with intellectual and developmental disabilities (ID and DD, respectively) in the most integrated setting appropriate to their needs. DOJ found that Virginia lacks the community capacity to support individuals who would choose to live there and prevent unnecessary institutionalization. It also found that Virginia’s current discharge process from training centers was flawed, inconsistent, and not timely.
In March 2011, Virginia entered into negotiations with DOJ. On January 26, 2012, Virginia and DOJ reached a 10 year Settlement Agreement resolving DOJ’s findings. On joint motion of the DOJ and the Commonwealth, the Settlement Agreement was filed with the U.S. District Court for the Eastern District of Virginia for entry as a court order. Several family members of current training center residents were granted permission by the court to intervene in the case.
On March 6, 2012, Judge John A. Gibney, Jr., signed a temporary order entering the Settlement Agreement. Virginia and DOJ agreed to use this date, pending final signature, as the effective date of the Agreement. Throughout this document that date is used as the start date for purposes of implementation.
On June 8, 2012, Judge Gibney conducted a hearing to listen to arguments regarding the Agreement. He expressed a willingness to sign the Agreement at the close of the hearing if three proposed language changes were made to the Agreement. These changes were considered by the parties and discussed with Judge Gibney during a conference call on June 29, 2012. As of the publication of this report, the Judge has not issued a final order entering the Agreement.
Implementation Status Update
Virginia is moving forward with implementation of the Agreement. The 2011 General Assembly provided funds to begin implementation through the Behavioral Health and Developmental Services Trust Fund (the ‘Trust Fund,’ §§ 37.2-316 through 319). The 2012 General Assembly continued these efforts by appropriating additional funds through Item 315 V.1. for implementation. DBHDS is moving forward with implementation based on these directives.
• SIXTY-ONE (61) INDIVIDUALS MOVING FROM TRAINING CENTERS TO THE COMMUNITY: In November 2012, 60 waiver slots were established out of the Behavioral Health and Developmental Services Trust Fund to move 40 individuals from Southside Virginia Training Center (SVTC) and 20 individuals from Central Virginia Training Center (CVTC) to the community. As of June 30, 2012, 61 individuals have moved from these two training centers to the community. Twenty-two of the 60 waiver slots were used for these individuals. Thirty-four individuals moved using Money Follows the Person (MFP) waiver slots. The remaining individuals chose a community ICF or had an existing waiver slot that was used. The following reflects the current and historical census in all five training centers:
2000 Census: 679
2005 Census: 564
2010 Census: 426
Current Census: 350
2000 Census: 189
2005 Census: 182
2010 Census: 170
Current Census: 153
2000 Census: 194
2005 Census: 192
2010 Census: 143
Current Census: 106
2000 Census: 465
2005 Census: 371
2010 Census: 267
Current Census: 201
2000 Census: 218
2005 Census: 214
2010 Census: 192
Current Census: 173
2000 Census: 1,745
2005 Census: 1,523
2010 Census: 1,198
Current Census: 983
*Southeastern Virginia Training Center (SEVTC)
**Southwestern Virginia Training Center (SWVTC)
• ESTABLISHING CRISIS SERVICES: DBHDS is implementing the Systemic Therapeutic Assessment Respite and Treatment (START) program to provide crisis services to individuals with ID/DD statewide. Program operations in all five regions of the Commonwealth will begin in July 2012 and full operations will be online in all regions by January 2013.
The program will provide 24 hour/7 day a week support to individuals in crisis, including a face-to-face assessment with an individual within one hour in urban regions and two hours in rural areas. The program will provide in-home supports and out-of-home crisis respite services when they are needed. The goal of the program is to maintain individuals in their home and prevent crises when possible. At the time of this report, over 60 individuals had been referred to these programs for assessment and support.
• TRANSFORMATION OF DISCHARGE PLANNING PROCESSES: DBHDS has moved to a standardized discharge process at all five training centers and is currently training staff at the facilities as well as Community Services Boards (CSBs) and service providers on the new process. The new process is consistent with the terms of the Settlement Agreement that discharge processes be person-centered and timely and that they provide individuals and authorized representatives with informed choice about community-based options.
Today, all training centers are following a 12 week process for discharge planning. This process engages individuals, the authorized representative, clinical professionals at the training centers, and CSB case managers to identify what is important to individuals when they move to the community, what clinical supports are needed, and what health and safety supports must be in place prior to a move. These desires and needs are compiled in a discharge plan. Individuals and authorized representatives are presented, if available, at least three options for consideration, and allowed to make several visits, including overnights stays with a potential provider to determine if the placement is the best choice.
The discharge process includes active Post-Move Monitoring at 3, 7, 10, 17, and 30 day intervals post-move from a combination of training center staff, licensing specialists, human rights staff, and the CSB case manager to ensure the discharge plan has been implemented properly by the new provider. The discharge process and post-move monitoring were successfully implemented for the 61 individuals transitioning from SVTC and CVTC.
The body of the report describes in detail these and other implementation activities that DBHDS and its partner agencies are undertaking to move the Settlement Agreement forward.
Barriers to Implementation:
At the time of this report, Virginia has encountered few barriers to implementing the milestones in the DOJ Settlement Agreement for the period of March 6, 2012 – June 30, 2012. One item that will need additional consideration is in the area of Crisis Services:
• CRISIS SERVICES FOR CHILDREN WITH ID/DD in the TARGET POPULATION: Virginia is required to implement a “statewide crisis system for individuals with intellectual and developmental disabilities.” This system would include children. DBHDS is currently implementing the START program for adults with ID/DD. Expanding the program to include children will likely create new challenges and barriers for DBHDS to overcome.
Virginia continues to move forward with implementation of the DOJ Settlement Agreement and the directives established by the 2011 and 2012 General Assembly related to transitioning individuals who currently reside in training centers to the community. Virginia is largely on track with meeting the major milestones of the Agreement for the period of March 6, 2012 – June 30, 2012. Virginia is actively working to address the major milestones of the Settlement Agreement for FY13 as outlined in Appendix B.