RD140 - Office of the Inspector General for Behavioral Health and Developmental Services Semiannual Report October 1, 2011 – March 31, 2012


Executive Summary:
The Office of the Inspector General created this Semi-Annual Report In Brief (SAR) to provide a synopsis of the key issues covered in greater detail in the full-length SAR for the period ending March 31, 2012. The complete SAR is located at: www.oig.virginia.gov.

The challenges identified in this Semi-Annual Report (SAR) reflect both system vulnerabilities, as outlined in recent OIG reports, as well as new and emerging issues identified by DBHDS and the OIG. The following summary of management challenges is discussed in greater detail in the full Report.

THE DOJ SETTLEMENT AGREEMENT: During this reporting period, the Commonwealth and the U. S. Department of Justice reached a settlement regarding Virginia’s compliance with the "Americans with Disabilities Act" (ADA) and as interpreted by the "Olmstead" decision.

It was agreed that Virginia would provide services for persons with intellectual disabilities in the most integrated setting appropriate to meet an individual’s needs, and that the state would pursue the goals of community integration, self-determination, and quality services.

The ten-year Agreement requires an expansion of community-based ID waiver slots, strengthening quality and risk management systems, closing four of Virginia’s five training centers, and additional appropriations to support these initiatives.

INCREASING SYSTEMIC ACCOUNTABILITY: As stewards of the state’s limited resources, agencies are obliged to hold themselves accountable to the public for the caliber of care they provide.

The development of a viable state-wide quality assurance system serves as a pledge to the public that the various components that comprise the behavioral health and developmental services system of care will work towards the goal of achieving excellence in the services rendered to all qualified persons.

The DBHDS lacks an active broad-based and centralized quality assurance system, and it has had difficulty recruiting and retaining an Assistant Commissioner for Quality Management and Development. The creation of a robust quality assurance system is a necessary ingredient if the DBHDS is to comply with the terms of the recent Settlement Agreement with DOJ and to implement the strategies agreed to in past OIG Reports.

INCREASING CRISIS INTERVENTION SERVICES: DBHDS’s "Creating Opportunities Implementation Plan" observed that “too many Virginians do not have access to a basic array of emergency and crisis response services” and concluded that “a safety net of basic services is indeed widely available in Virginia, but just barely.”

During this semi-annual reporting cycle, the OIG documented that, while basic safety net services may be available to most citizens, safety net services were not accessible for 72 individuals who, despite meeting statutory criteria for temporary detention, could not be detained for their own safety because no private provider, or state operated facility, would admit them.

CREATING AND SUSTAINING INDIVIDUALIZED AND PERSON-CENTERED SERVICES: The DBHDS has been instrumental in facilitating person-centered and recovery-oriented services for persons who receive services in both the facility and community-based systems of care. The Office of Developmental Services (ODS), in cooperation with other agencies, has led the resurgence of person-centered services in Virginia; however, person-centered and recovery-oriented services in the community are not as consistently developed and monitored as the services provided in the state facilities.

The recent increase in service providers, combined with the anticipated expansion over the next decade in response to the DOJ Settlement Agreement, suggests important challenges keeping up with the demand to provide and monitor ongoing person-centered and recovery-oriented services.

During this reporting period, the OIG began its review of residential services for persons with intellectual disabilities to understand how the person-centered initiative is actually being realized by the individual residing in the community. We believe having this current baseline measure will be critical to helping support this initiative, and the recent DOJ settlement makes it clear that everyone shares an interest in this culture becoming the norm.

Specific details are not yet available, as we still have a number of visits scheduled, but so far the OIG has visited 85-90 Waiver Group Homes, Sponsored Residential Homes, and Intermediate Care Facilities for Individuals with Intellectual Disability licensed by DBHDS.

In early May, the OIG received a complaint of abuse that has caused us to reconsider our approach to this survey, and we will be conducting additional surveys of sponsored placements and folding in those results to the final report scheduled for release in June, 2012.

THE EFFECTIVE USE OF STATE RESOURCES: A rebalancing of state funds will be required for the DBHDS to satisfy its commitment to protect the assets of the Commonwealth’s system of care for persons receiving behavioral healthcare and developmental services, and to deploy the Commonwealth’s limited resources in the most effective and efficient manner.

A six-month review of the barriers to discharge from state-operated facilities for persons deemed discharge ready determined that inadequate community-based supported housing was the primary barrier to discharge for scores of individuals who could have been served in the community for roughly one-fifth of the annual $214,000 cost of serving a person in a state facility.

The barriers to discharge study revealed that on average 165 individuals, or 13% of the state behavioral health facility census, could have resided in the community.

Moreover, serving this discharge ready cohort in the community would not only be less costly, it would have created bed availability for the additional scores of individuals, meeting TDO criteria, who were denied admission to a state hospital during another recent OIG study.

CRITICAL INCIDENTS: This SAR reflects that, during this reporting period, the OIG received 343 critical incident reports and followed-up on 58 of these incidents. The OIG monitored the 38 deaths that occurred in state-operated facilities during this period, and reviewed all 26 autopsies forwarded by the Medical Examiner’s Office.

COMPLAINTS: The OIG responded to 11 complaints from citizens, service recipients, and state employees.

Office of the Inspector General

The Office of the Inspector General (OIG) is established in the VA Code § 37.2-423 to inspect, monitor and review the quality of services provided in the facilities operated by the Department of Behavioral Health and Developmental Services (DBHDS) and providers as defined in VA Code § 37.2-403. This definition includes all providers licensed by DBHDS including community services boards (CSB) and behavioral health authorities (BHA), private providers, and mental health treatment units in Department of Correction facilities.

It is the responsibility of the OIG to conduct announced and unannounced inspections of facilities and programs. Based on these inspections, policy and operational recommendations are made in order to prevent problems, abuses and deficiencies and improve the effectiveness of programs and services. Recommendations are directed to the Office of the Governor, the members of the General Assembly and the Joint Commission on Healthcare.

If you would like more information about these issues, or other activities of the Office of the Inspector General for Behavioral Health and Developmental Services during this reporting period, please refer to the full-length SAR at www.oig.virginia.gov, call (804) 692-0276, fax your questions to (804) 786-3400, or write to:

Office of the Inspector General
P. O. Box 1797
Richmond, Virginia 23218-1797