RD161 - 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 2013 Appropriation Act - July 31, 2013

Executive Summary:
This report was developed to meet the requirements set forth in both Virginia Code § 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 accordance with the Settlement 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 November 1, 2012 – June 30, 2013, and describes expenditures associated with the Agreement for FY12 and FY13.

Implementation Status Update

General Assembly Actions:
• 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 for implementation through Item 315 V.1.

• The 2013 General Assembly provided additional funding for adult crisis services ($3.8M) and children’s crisis services ($1.25M).

• Waiver slots in addition to those required by the Settlement Agreement were created for the FY13?14 biennium. A total of 75 additional community ID waivers slots were authorized for FY 2013 and 350 slots authorized for FY 2014. A total of 50 additional DD waivers slots were authorized for FY 2013 and 105 slots authorized for FY 2014.

Major Accomplishments:


* In October 2011, 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. For the period November 2011 – June 30, 2012, 61 individuals moved from these two training centers to the community using enhanced discharge processes.

* During that same time period, 15 individuals moved from Virginia’s other three training centers to the community.

* All training centers have been actively engaging individuals and families in enhanced discharge processes since March 2012 when the Settlement Agreement was temporarily entered by Judge Gibney. As a result, during fiscal year 2013, 157 individuals moved from Virginia’s training centers to the community.

* The table shown on page iv of the report shows where individuals have moved by type of setting and geographic location since November 2011.

• The table shown on page iv of the report reflects the current and historical census in all five training centers:

• IMPLEMENTATION OF CASE MANAGEMENT STANDARDS: The Settlement Agreement requires enhanced case management for individuals receiving Home and Community Based (HCBS) waiver services under the Agreement who meet certain criteria (Section V.F.3.a?f). DBHDS issued guidance in early December to CSB case managers and DD case managers regarding these criteria and their implementation. The enhanced case management standards took effect on March 6, 2013. CSBs began reporting on the number, type, and frequency of case management visits that month.

• ISSUING CASE MANAGEMENT CORE COMPETENCY?BASED TRAINING CURRICULUM: Six core-competency based training modules were completed and released for case managers across Virginia to complete on?line. Module 7 on Accountability was added on February 15, 2013. As of May 30, 2013 over 4,100 have completed Modules 1?6 and 3,200 have completed Module 7. The Settlement Agreement required Virginia to develop a core?competency based curriculum for case managers by March 6, 2013.

• IMPLEMENTATION OF THE INDIVIDUAL AND FAMILY SUPPORT PROGRAM: On March 11, 2013, DBHDS launched the Individual and Family Support Program (IFSP) for individuals on the ID and DD waiver wait lists. These individuals can apply annually to receive up to $3,000 in support for services that will prevent institutionalization or removal from their home. Examples include respite care, assistive technology, and environmental modifications. Over $1.4M have been distributed to over 650 applicants in FY13 to?date. In FY14 the program is expected to provide up to 1,000 individuals and families with these supports.

• VIRGINIA’S PLAN TO INCREASE INDEPENDENT LIVING OPTIONS ISSUED: On March 6, 2013, Virginia published this plan in accordance with the requirements in Section III.D.3 of the Settlement Agreement. This plan, referred to as the Housing Plan, outlines goals and recommended action items to address issues related to integrated housing for individuals in the target population. The Housing Plan also describes a rental assistance demonstration pilot that will begin in September 2013 using $800,000 in one?time funds to support up to 20 individuals in the Northern Virginia and Hampton Roads areas in independent apartments for up to a three year period (see Appendix B).

• GRANT FOR PEER TO PEER EDUCATION PROJECT AWARDED: On June 10, 2013, DBHDS received $52,000 in grant funds from the Virginia Board for People with Disabilities (VBPD) to establish a peer education project in partnership with The Arc of Virginia, Hope House Foundation, and VAULT (Virginia Advocates United in Leadership Together). The project will develop a peer mentor training curriculum, train 15 peer mentors (3 in each of the 5 regions of the state), and pair the mentors with 2 individuals living in the training centers and soon to leave or who have left the training centers and are now living in the community each over the course of the 18 months to learn about ways to increase their level of independence and to advocate for themselves.

• IMPLEMENTATION OF REGIONAL SUPPORT TEAMS: The Settlement Agreement requires the operation of Regional Support Teams to work with personal support teams and community integration managers to identify and resolve barriers to community placement. The Regional Support Teams were established in January 2013 in all five regions and are meeting at least monthly. As of June 25, 2013, 112 referrals have been received by the Regional Support Teams.

The body of the report describes in detail these and other activities that DBHDS and its partner agencies are undertaking to implement the Settlement Agreement.

Barriers to Implementation:

The following items are either delayed in implementation or will require additional attention to address:

• CRISIS PROGRAM: The Independent Reviewer has made several recommendations related to Virginia’s crisis program, called START. They can be reviewed in “Report of the Independent Reviewer on Compliance with the Settlement Agreement” for the period October 7, 2012 – April 6, 2013, located at http://www.dbhds.virginia.gov/Settlement.htm. DBHDS is examining the current crisis program and the recommendations of the Independent Reviewer to determine action steps required to address the concerns described below and ensure adequate crisis response.

* 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 should include children. DBHDS is currently implementing the START program for adults with ID/DD. The 2013 General Assembly approved $1.25M to provide crisis services for children in the target population. DBHDS will be working with stakeholders to distribute these funds in FY14.

* CRISIS STABILIZATION PROGRAMS: The crisis stabilization programs as designed in the Settlement Agreement were to be established on or before June 30, 2012. The crisis stabilization programs, which are dependent on the construction or renovation of homes in each of the five regions, have been delayed. Three programs have been operating since February 2013. Two programs, Regions IV and Region V, are delayed due to zoning and construction issues. Both regions will be establishing temporary programs within their regions by September 2013.

* MOBILE CRISIS RESPONSE: The Independent Reviewer has noted concerns with the adequacy of the crisis program’s ability to respond to individuals in crisis on?site, regardless of type of setting.

• CHILDREN IN NURSING FACILITIES (NFs) AND INTERMEDIATE CARE FACILITIES (ICFs): The Settlement Agreement requires DBHDS and DMAS to target waiver slots for children younger than 22 years old who reside in NFs or ICFs and would like to transition to the community. The Agreement requires 25 children to transition using the ID waiver in FY13 and 15 children using the DD waiver. At the time of this report, only 11 children have transitioned this fiscal year. DBHDS and DMAS are meeting with NFs and ICFs that serve children in order to discuss these transitions and learn how the agencies can work directly with families to discuss moves to the community. A workgroup including Centers for Independent Living (CILs), The Arc, and VBPD is assisting in these efforts.