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Enhancing public mental health in Central Virginia |
History of the Reinvestment Project |
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Self-determination, Empowerment and Recovery Bridge Funding The Department was required to identify up to $500,000 in bridge funding to address one-time, non-recurring expenses associated with each reinvestment project. The Initiative was aimed at a planful reduction of state institution bed censuses with savings reinvested in new and expanded community-based services. Governor Mark Warner proposed regional reinvestment projects in each of five Health Planning Regions. Each HPR received funding to develop region-specific projects. HPR IV contains Richmond Behavior Health Authority, Chesterfield, Crossroads, Henrico, Hanover, Goochland-Powhatan, and District 19 Community Services Boards, Central State Hospital, Southside Virginia Training Center, Piedmont Geriatric Hospital, and a large array of private service providers. The General Assembly clearly stated its intent that local governments not be financially liable for regional reinvestment projects, nor required to provide matching funds for the project; and that the State remains responsible for provision of inpatient psychiatric services and any future funding levels for reinvestment. The initial HPR IV plan had two phases. Phase I focused on project management; contracting for crisis stabilization, specialized nursing home beds, and dual disorder (mental illness and substance abuse) detoxification services; and a regional census management effort. Phase II focused on building capacity within the community through such services as specialized adult living options, additional PACT services, intensive case management and psychosocial programs. The goal of Phase I was to close one civil ward at Central State Hospital. HPR IV developed a Consortium of CSB/BHA and state facility directors as the entity to plan, implement and manage the Reinvestment Project. Joe Hubbard, Executive Director, District 19 Community Services Board, is the Chair of the Consortium. The Consortium provides ongoing oversight of the regional partnership planning steering committee, which is composed of multiple stakeholders. The Consortium negotiated a model reinvestment memorandum of agreement with DMHMRSAS. The Consortium also created a Reinvestment Project Manager position, which is directed and evaluated by the Consortium, with day-to-day supervision provided through RBHA as fiscal agent. Arnold Woodruff, M.S. serves as the HPR IV Reinvestment Project Manager. The project agreed to strengthen Regional Authorization Committee (RAC) with representatives from CSB/BHA, DMHMRSAS, and Central State Hospital (CSH) providing for a model of intensive and ongoing utilization management of the CSH census. The Project Manager is added to the RAC team to assure coordination and authorization of regional resources when needed. HPR IV Reinvestment Goals: · Provide quality community-based services for consumers who do not need institutional care; · Maintain high quality care at CSH for consumers who still need this care; · Increase state ownership for system success; · More effectively utilize available state funds and leverage more Medicaid funds for services; · Serve more consumers; · Increase individual CSB/BHA ownership for their catchment area consumers; · Reduce/eliminate out-of-region referrals of consumers directly and/or through state institutions: · Measure and report outcomes and successes; · Exercise sensitivity to regional and local needs for service dispersion; · Establish services that will reduce historical reliance on limited local or regional inpatient beds; · Focus services as needed on consumers with co-occurring disorders (MH/SA; MH/MR); and · Coordinate effectively with HPR IV acute care project. HPR IV Reinvestment Project Phases Phase I of HPR IV Reinvestment Project was implemented June 2003 with reduction of 20 civil beds and reinvestment of $1.4 million in community-based regional and local services. Phase II was implemented August 2003 with reduction of another 20 civil beds and reinvestment of another $1.4 million in community-based regional and local services. Phase III continues in planning status with focus on CSH forensic beds. Since August 2003, CSH civil bed capacity remains at 100. Early Outcomes of the Reinvestment Project: · Utilization of 100 CSH civil bed capacity effectively managed by RAC · 233 consumers served in crisis stabilization 10/03-11/04 with only 6% needing CSH or local hospitalization following discharge · Behavioral team began services September 2004 with 17 consumers seen and 135.25 service hours provided (Note: team is ½ time direct service, ½ time training and consultation) · Jail/Forensic team served 127 consumers with 528 consumer contacts; 16 diverted from need for admission to CSH; several with reduced level of services at CSH · 7 consumers effectively served with on-going individualized support services- none needing re-hospitalization · Held September 2004 Consensus Forum on MR/MI needs (82 professionals attended including CSB/BHA's, consumers, private providers, hospitals- presentations by Commissioner, DMAS, state of Ohio and National Association on Dual Diagnosis (NADD) · Formed three work groups to: * Develop regional protocol for management of MR/MH * Develop regional competencies and training curriculum * Enhance staff support/relationships (professional ground rules)
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