agenda september by zic15018


									       Joint Commission on Health Care

Behavioral Health Care Subcommittee
General Assembly Building
Senate Room A

Wednesday, October 7, 2009
1:00 p.m.

       Delegate Harvey B. Morgan, Co-Chair

       Kim Snead, Executive Director

       Richard J. Bonnie, L.L.B., Commission Chair

       Ray Ratke
       Special Advisor on Children's Services

       Meena Dayak
       Vice President of Marketing and Communications
       Susan Partain
       Outreach Associate
       National Council for Community Behavioral Healthcare

       Jaime H. Hoyle, Senior Staff Attorney/Health Policy Analyst

       Delegate Harvey B. Morgan

       Senator L. Louise Lucas, Co-chair
       Delegate Harvey B. Morgan, Co-chair

       Senator George L. Barker                            Delegate Robert H. Brink
       Senator Ralph S. Northam                            Delegate David L. Bulova
       Senator Linda T. Puller                             Delegate Rosalyn R. Dance
       Senator Patricia S. Ticer                           Delegate Phillip A. Hamilton
       Senator William C. Wampler, Jr.                     Delegate Algie T. Howell, Jr.
                                                           Delegate David A. Nutter
       Senator R. Edward Houck (ex-officio)                Delegate John M. O’Bannon, III

                                                           The Honorable Marilyn B. Tavenner
                   Progress Report to Joint Commission on Health Care
                                     October 7, 2009

                                   Richard J. Bonnie
                     Chair, Commission on Mental Health Law Reform

I.         Key Accomplishments

       •   Coordination, consensus-building and habits of collaboration
       •   Data needed for informed policy-making and oversight
       •   Common understanding of problems we face and key elements of the solutions

II.        Unfinished Business in Emergency Services and Commitment Reform

       •   Continue to enhance opportunities for intensive intervention services to prevent,
           ameliorate and stabilize crises without invoking commitment process or initiating
           criminal process
       •   Lengthen TDO period to facilitate thorough evaluation and stabilization before
           scheduled hearing
       •   Facilitate discharge or conversion to voluntary status in clinically appropriate
       •   Based on experience and available resources, identify most appropriate role for
           mandatory outpatient treatment (MOT)
       •   Develop integrated, stand-alone “Psychiatric Treatment of Minors Act”
       •   Continue to reduce reliance on law enforcement transportation through
           Alternative Transportation Orders

III.       Empowerment and Self-Determination

       •   Implementation and dissemination of revised Health Care Decisions Act,
           especially new advance directive provisions for mental health care
       •   Clarification and refinement of HCDA

IV.        Upcoming Plans

       •   2009 Progress Report
       •   Report on Access to Services (2010)
       •   Commission Final Report (2010)
        Virginia Department of
   Behavioral Health and
   Developmental Services

         Recent Improvements in the
        Delivery of Services to Children
                  and Families
                                   Presentation to the
                            Joint Commission on Health Care
                            Behavioral Health Subcommittee
                                    October 7, 2009

                                                                   Raymond Ratke
                                             Special Advisor for Children’s Services

 Virginia Department of
Behavioral Health and
Developmental Services
                                 Key Events in Children’s Services
    • Annie E. Casey Foundation’s findings on child welfare made public
    • First Lady Anne Holton spearheaded the “For Keeps” Initiative
    • “Systems of Care and Evidence-Based Practices” Conference attended by
      600 people – September
    • JLARC Study of CSA Children in Residential Treatment
    • Children’s Services System Transformation – begun December 2007
    • Special Advisor for Children’s Services position created to lead the
    • Early Childhood Transformation
    • The Office of the Inspector General issued its Review of Community
      Services Board Child and Adolescent Services – September 2008
    • Inspector General James Stewart briefed this subcommittee on the report
      in November 2008

                                                                         Page 2
        DBDHS                  Office of the Inspector General Review –
      Virginia Department of
     Behavioral Health and
     Developmental Services
                                              Key Findings

• Availability of MH services varies widely among communities;
• Support and cooperation of the local Community Policy and
  Management Team and the other child serving community agencies is
  a leading factor in developing community services
• Medicaid is the largest source of funding for children’s services in
  CSB budgets
• CSB case-related involvement with and collaboration with other
  agencies was mostly limited or did not occur
• CSBs have difficulty recruiting and retaining qualified clinical staff,
  especially psychiatrists.
• Leadership is a primary factor that influences development of
  community systems of care for children in CSBs:

                                                                  Page 3

      Virginia Department of
     Behavioral Health and
     Developmental Services
                               Office of the Inspector General Review


1.          DBHDS lead an interagency process
2.          Every CSB have a single point of leadership for children
3.          Provide leadership in training and staff development
4.          CSBs with more comprehensive systems of services
            share factors of their success with other CSBs
5.          CSBs should assess children with mental health or
            intellectual disabilities for substance abuse to assure
            integrated care

                                                                  Page 4
     DBDHS                   Children’s Service System Transformation –
   Virginia Department of
  Behavioral Health and
  Developmental Services
                                         Interagency Process

• The Children’s Service System Transformation has established an
  interagency process as called for in the OIG review.
• The collaborative effort goes beyond CSBs to include: Social
  Services, Education, Juvenile Justice and CSA.
• Virginia’s child-serving agencies are improving the way they help
  at-risk children and their families to achieve:

                                       Success in life;
                            Safety for children and communities;
                                   Life in the community;
                              Family based placements; and
                               Life-long family connections.

                                                                               Page 5

   Virginia Department of
  Behavioral Health and
  Developmental Services
                                 Council on Reform (CORE)
• Partnership started: December 2007
• Membership: 13 geographically diverse, targeted localities to
  develop a shared vision for Children’s Services and implement best
  practices at the state and local level
                • Charlottesville, Chesterfield, Dinwiddie, Fairfax, Henrico,
                  Newport News, Norfolk, Prince William, Richmond City,
                  Roanoke County, Roanoke City, Virginia Beach and
                  Washington County
                • These localities account for almost 50% of statewide foster
                  care population.
• Workgroups focused on the development of a Practice Model and
  implementation of “Building Blocks” of Transformation
• The Annie E. Casey Foundation has been providing extensive
  financial and consultative assistance in this work.

                                                                               Page 6
 Virginia Department of
Behavioral Health and
Developmental Services
                                                    From This…

                                     VDSS                 DMHMRSAS

                                                                     Office of
                          Juvenile                                 Comprehensive
                           Justice                                   Services

                                              Department of

                                                                                     Page 7

 Virginia Department of
Behavioral Health and
Developmental Services
                            …To Cross Agency Collaboration


                                                          Office of
                            VDSS                       Comprehensive

                          Justice             Department of


                                                                                     Page 8
     Virginia Department of
    Behavioral Health and
    Developmental Services
                              Virginia Children’s Services Practice Model

         We have developed a common philosophy that will
          help to shift practice to achieve better outcomes
                        for youth and families.

We believe:
• All children and communities deserve to be safe.
• In family, child, and youth-driven practice.
• Children do best when raised in families.
• All children and youth need and deserve a permanent family.
• In partnering with others to support child and family success in a
  system that is family-focused, child-centered, and community-based.
• How we do our work is as important as the work we do.

                                                                   Page 9

     Virginia Department of
    Behavioral Health and
    Developmental Services
                                Building Blocks of the Transformation

Community-Based Continuum – Developing, funding and sustaining a
  continuum of services that will meet the needs of every child and
  ensure that when at all possible children receive the services that they
  need within their own home and community.
Statewide Training System – A comprehensive, competency based
   training system built on the practice model and accessible across
Resource Family Recruitment, Development and Support – Finding,
  training and supporting resource and adoptive families to provide
  permanent connections for youth in foster care
Managing by Data – Using data to guide our decision making and using
  our desired outcomes to drive practice
Family Engagement Model – Engaging families in a deliberate way by
  giving them a voice in what happens to their families and their children

                                                                   Page 10
    Virginia Department of
   Behavioral Health and
   Developmental Services
                                       CSB Community Services to Children

         Fiscal Year                      Children Served in                      Expenditures
                                          Mental Health and
                                       Substance Abuse Services
          FY 2006                                 40,991                         $64,604,278

          FY 2007                                 48,687                         $70,523,325

          FY 2008                                 60,577                         $87,746,038

                                                                                          Page 11

    Virginia Department of
   Behavioral Health and
   Developmental Services
                                          Family Based Placements

78.00%                                                                       77.50%


                                                                                        Family Based Dec 2007
                                                                                        Family Based Sep2009
72.00%               71.43%                 71.43%                  71.43%



                        CORE Totals          Statewide Totals       Non CORE Totals

                                                                                          Page 12
          Virginia Department of
         Behavioral Health and
         Developmental Services
                                                      Discharges to Permanency

                                                         Discharges to Permanency:
                                                       December 2007 - September 2009

                                                   68.29%                                           68.16%

                                                                                                                    Dec. 07
                                                                                                                    Sept, 09
   62.00%                          60.96%




                                            CORE                                        Statewide

                                                                                                                    Page 13

          Virginia Department of
         Behavioral Health and
         Developmental Services              Use of Group Care is Decreasing

                       25.53%                               25.43%                         25.37%

20.00%                                                                18.10%
                                                                                                                     Group Care Dec 2007
                                                                                                                     Group Care Sep 2009
                                                                                                                     National Average
                                                                                                                     Best Practice


                           CORE Totals                      Statewide Totals               Non CORE Totals

                                                                                                                   Page 14
 Virginia Department of
Behavioral Health and
Developmental Services
                            Numbers of Children in Group Based Care


2000                                          1922

                                                      1224                                   Group Care Dec 2007
                                                                                             Group Care Sep2009
                      763                                                         807

  500                       417

                     CORE Totals             Statewide Totals           Non CORE Totals

                                                                                                    Page 15

   DBDHS                             Decrease in the Number of Children
 Virginia Department of
Behavioral Health and
Developmental Services
                                               in Foster Care

            6000                    2989
            2000                    4568                         4138
                                   Dec. 07                      Sept. 09

                                                                                                    Page 16
 Virginia Department of
Behavioral Health and
Developmental Services
                                                          CSA Expenditures 2001 - 2009

                                                            CSA Pool Fund Expenditures
                                                                   2001- 2009



      Expenditures in Millions






                                           2001   2002      2003      2004       2005       2006   2007     2008   2009 (proj)
                                                                             Program Year

                                                                                                                          Page 17

   DBDHS                                                       CSA Expenditures –
 Virginia Department of
Behavioral Health and
Developmental Services
                                                         Group Care vs. Community Based

                                                                   Dollars in Millions



                                                                                                          Group Care
$100.00                                           $189.30


                                                  2008                         2009

                                                                                                                          Page 18
     DBDHS                         Incidence of Repeat Maltreatment
   Virginia Department of
  Behavioral Health and
  Developmental Services
                                       of Children in Foster Care



                        1.00%                           Maltreatment


                                Dec. 2007   Aug. 2009

                                                                       Page 19

   Virginia Department of
  Behavioral Health and
  Developmental Services        Transformation – Moving Forward
Training and Technical Assistance
    • Transformation Academy
    • Agents of Change – Leadership Development Training
    • Transformation Sustainability Summit – October 2009
    • Governor’s Conference on Children’s Services Transformation –
      December 16-17
    • Family Engagement training
    • Resource Family Training
    • Meetings of CORE localities
    • Intensive Care Coordinator Network

Targeted Supports
   • Consultations and assistance to individual communities
   • Support for intensive care coordination

Policy Directions to assure continued progress

                                                                       Page 20
     DBDHS                    Intensive Care Coordination –
   Virginia Department of
  Behavioral Health and
  Developmental Services
                            Key Transformation Role for CSBs

• Opportunity for CSBs to take a leadership role in keeping children in
  the community, as called for in the OIG report

• Reimbursable by CSA effective July 1, 2007

• Coordination and small caseload necessary to transition children
  home from residential placements or keep them from being placed

• CSB is the local agency for behavioral health, public entry point
  for children and has the clinical expertise to plan for and arrange
  clinical services in the community

• CSB may contract with another entity to provide Intensive Care

• CSB maintains full responsibility for Intensive Care Coordination,
  including monitoring the services provided under the contract

                                                                     Page 21

     DBDHS                  Intensive Care Coordination (ICC) –
   Virginia Department of
  Behavioral Health and
  Developmental Services
                             Key Transformation Role for CSBs

 Status of ICC Implementation September 2009

 • 25 CSBs with CPMT collaboration have at least one ICC

 • 8 other CSBs have begun planning regarding ICC

 • DBHDS support for ICC:
           – Network meetings of intensive care coordinators
           – List serve to share information
           – Facilitate learning among intensive care coordinators

                                                                     Page 22
               A Collaborative Partnership

               NATIONAL COUNCIL
               for Community Behavioral Healthcare

               Maryland State Department of Mental

               Missouri Department of Mental Health


 About the National Council
Represent 1,700 community-based
organizations that care for more
than 6 million adults and children
with mental illnesses and addiction
• Policy
• Practice
• Public education                               2

 What Is Mental Health First Aid

  The help provided to a
  person developing a
  mental health problem
  or experiencing a crisis
  until professional
  treatment is received or
  the crisis resolves.                 3

          What You Learn
• Overview of mental health problems
  – Depressive disorders
  – Anxiety disorders
  – Psychotic disorders
  – Substance use disorders
  – Eating disorders
• Mental Health First Aid for crisis
• Mental Health First Aid for non-crisis
  situations                           4

           Program Origins
• Created in Australia in 2001
• Auspiced at the University of
• Expanded to 14 countries, including
  Scotland, China, Canada, Finland,
  Singapore, Ireland, Wales, England,
  Cambodia, Japan, South Africa,
  Thailand and New Zealand.
• Piloted in the U.S. in 2008           5

      Evidenced Effectiveness
• Four published randomized control
  trials and a qualitative study (in
   –Increases mental health literacy
   –Expands individuals’ knowledge of
    how to help someone in crisis
   –Connects individuals to needed
   –Reduces stigma                      6

        Potential Audiences
  – Hospitals and health centers
  – Employers
  – Faith communities
  – Schools/universities
  – Law enforcement/first responders
  – Nursing home staff
  – Families and caring citizens
  – Mental health authorities
  – Policymakers                         7

      People Are Saying . . .
• “I now feel better prepared for what
  might happen.”
         Homeless Shelter Volunteer
• “This info can help a person become
  more understanding, rather than
  judgmental, of someone with a
  mental illness”
                   Community Member

       People Are Saying . . .
• “Just weeks after attending the
  training, I’ve already used the skills I
  learned in Mental Health First
               Hospital Employee
• “I think any professionals who deal
  with people should take this course,
  especially emergency personnel,
  teachers, . . .”
     Employment Services Professional        9

     Community Connections
  “Mental Health First Aid – with its
  new emphasis on recovery – has
  the power to transform
  communities, the power to change
  beliefs and the ability to connect
  people in ways they never would
  have connected otherwise.”
           Larry Fricks
           National Consumer Leader          10

          By the Numbers

• 3,000+ Mental Health First Aiders
• 180+ community trainings
• 360 instructors certified
• 36 states
• 1,000,000 media impressions


                By 2020, Mental
                Health First Aid
                in the USA will
                be as common
                as CPR and First
                Aid.                  12

           How it Works

Training Components
• 12-hour community program
  offered by instructors
• 5-day instructor certification
  training offered by the National

Implementation & Sustainability
• Web-based technical assistance
• Program evaluation
• Expansion to all 50 states
• National media campaign


    State Implementation Steps
• Experience Mental Health First Aid —
  attend a course.
• Develop rollout strategy — define key
  target audiences and how to reach them.
• Certify instructors.
• Get key influencers — community partners,
  policymakers, media, funders — to support
  and endorse.
• Offer/organize 12-hour programs.       15

        For More Information

          Meena Dayak

           Susan Partain
           202.684.3732                  16

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             Joint Commission on Health Care

    Staff Update: Review of Statutory
    Language on Barrier Crimes

October 7, 2009                                                                Jaime Hoyle
                                                   Sr. Staff Attorney/Health Policy Analyst

   Barrier Crimes Study
         A two-year study was undertaken by JCHC in 2006, at the request of
         Senator Devolites-Davis.
         The study found that a number of individuals with serious mental
         illness have assault convictions and that often these assaults occurred
         when they were going through an involuntary commitment process.
         •     There is no statutory provision to review the circumstances surrounding
               the assault convictions, so these convictions keep individuals from
               being employed even as peer counselors in adult treatment programs.
         •     Being employed is obviously crucial to the individual’s recovery
         •     In addition, being able to employ additional peer counselors would help
               to address the workforce need for mental health staff.
                o    Community Services Boards (CSBs) estimated that more than 40 mental
                     health consumers would qualify for employment, if misdemeanor assault
                     convictions were not an absolute barrier and the consumers could be
                     assessed for rehabilitation in the same manner that Virginia allows
                     individuals with a substance use disorder to be assessed.
 Joint Commission on Health Care

  2008 Legislative Action

        In 2008, HB 1203 and SB 381 were introduced on behalf of JCHC in
        order to ease a few restrictions related to employment in adult
        substance abuse or mental health treatment programs.
        One provision of the introduced bills sought to allow an individual
        with a misdemeanor conviction of assault or assault and battery
        against a family member to be assessed by a CSB or a
        DMHMRSAS-licensed provider for possible employment in an adult
        •     To be considered for employment, the assessment would have to
              determine that the individual’s offense was substantially related to his
              mental illness and that subsequently he had been successfully
        •     This type of assessment has been allowed for individuals seeking to
              work in adult substance abuse programs since 2001 (Code of VA §§
              37.2-416 and 506).
Joint Commission on Health Care

  2008 Legislative Action on HB1203/SB381

        The Health, Welfare and Institutions Committee voted to
        remove from both bills, the provision that would allow
        for a conviction of assault and battery against a family or
        household member.
        •     HB 1203 was amended appropriately.
        •     However, in SB 381, the provision was removed from Code §
              37.2-416 (addressing employment by DMHMRSAS-licensed
              providers) but was not removed from Code § 37.2-506
              (addressing employment by CSBs).
               o    The mistake was not discovered until after both bills were signed
                    by the Governor, and since SB 381 was signed last, its provisions
                    became law on July 1, 2008.
               o    Approximately 90 felonies and 20 misdemeanors continued to be
                    barriers to employment.
Joint Commission on Health Care

  2009 Legislative Action
        During the 2009 General Assembly Session HB 2288
        and SB 1228 were introduced on behalf of the JCHC.
        Both bills sought to remove the provision allowing an
        individual with a conviction of assault and battery
        against a family member to be assessed for employment
        by community services boards.
        •     Both bills were left in the Senate Education and Health
              Committee with the intent that the JCHC would continue to look
              at the issue.
               o    Keeping the provision for CSBs, and having it also apply to
                    licensed providers, adheres to the findings of the JCHC study, the
                    preferences of CSBs and private providers, and the
                    recommendation of the JCHC in 2008.

Joint Commission on Health Care

  Policy Options
        Option 1: Take no action.
        Option 2: Introduce legislation to amend the Code of
        Virginia § 37.2-416.C to allow an individual with a
        conviction of assault and battery against a family or
        household member to be assessed for employment by
        providers licensed by the Department of Behavioral
        Health and Developmental Services.
        Option 3: Introduce legislation to amend the Code of
        Virginia § 37.2-506.C to remove the provision allowing
        an individual with a conviction of assault and battery
        against a family or household member to be assessed for
        employment by community services boards
Joint Commission on Health Care

  Public Comments
        Written public comments on the proposed options may
        be submitted to JCHC by close of business on November
        4, 2009.
        Comments may be submitted via:
        •     E-mail:
        •     Fax:    804-786-5538
        •     Mail:   Joint Commission on Health Care
                      P.O. Box 1322
                      Richmond, Virginia 23218

        Comments will be summarized and included in the
        Decision Matrix considered by JCHC during its
        November 12th meeting.
Joint Commission on Health Care

  Internet Address

                Visit the Joint Commission on Health Care website:

Contact Information
900 East Main Street, 1st Floor West
P. O. Box 1322
Richmond, VA 23218
804-786-5538 fax

Joint Commission on Health Care


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