Region IV Reinvestment

Enhancing public mental health in Central Virginia
horse in Powhatan

Acute Care Project (LIPOS)

Started in 1999.  Regional Authorization Committee (RAC) reviews all admissions after 15 days. 

Since 7/05, 3009 uninsured admissions to community hospitals.  80% of funded consumers are admitted through emergency services and do not have an open case with the CSB.

For last three fiscal years, 30 or less admissions to Central State Hospital (civil side) per year for long term care.

Average Length of Stay: 6.4 days

Outcome data (as of 6/30/08)

In April 2006, Region IV hired a Utilization Review and Continuous Quality Improvement manager in order to begin measuring and analyzing data from the numerous Region IV Reinvestment programs.

Rubicon Crisis Stabilization Unit

In operation since October 2003.  Staff include nurses, case managers, psychiatrist on call.

Since 7/05, 865 admissions diverted from community hospitals, including 74 TDO admissions.  39% of admissions are step-down from inpatient hospitalization.

Average Length of Stay: 9.2 days

Utilized primarily by RBHA and Henrico MH (77% of admissions).

Regional Jail Team

In operation since June 2004. Team of 6 includes psychologist, psychiatrist, 2 case managers, discharge planner, and an administrative assistant.

193 admissions to Central State’s forensic unit diverted.

63 days for restoration in jail as opposed to 180 at CSH.

800 inmates served.

Regional Behavioral Team

Began in September 2004.  Team consists of a Licensed Applied Psychologist and an LCSW.

298 total clients served. Team works with CSB case managers to develop behavior plans for consumers to maintain them in current residential or occupational placement.

Along with staff from CSBs and regional training center, team helped develop guidelines for emergency admissions to the training center or state hospital for MH/MR consumers.

Regional Utilization Management

Began in May 2005.  Experienced psychiatric nurse travels to community hospitals to review admissions appropriate for discharge or transfer to state hospital.

1059 hospitalizations reviewed.

Average LOS has decreased from 7.17 days in FY 05 to 6.4 in FY 08 due to decrease in long admissions (over 2 weeks).

New Directions Short Term Residential Treatment

Took over existing inpatient MH/SA treatment program in November 2005.

639 admissions with median LOS of 27 days.

Only 2% recidivism rate during FY 08.

Regional Utilization Review/Continuous Quality Improvement

Started in April 2006. Responsible for auditing LIPOS admissions and payments.

Started quarterly regional newsletter in August 2006, redesigned regional website in April 2007.

Provides ad-hoc data reporting to stakeholders as needed.

Created and distributed 200 manuals to case managers at 7 CSBs explaining regional programs and providing intake forms.

New Directions Crisis Stabilization Unit

 In operation from May 2006 until July 2008.  Set up similar to Rubicon CSU, but located in a different area of the region, and primarily utilized by District 19 and Chesterfield CSBs (73% of admissions).

266 admissions diverted from community hospitalization, including 54 TDO admissions. 

12% of admissions transition into Short Term Residential tx program in the same building.

Average LOS is 11 days.

Regional Discharge Assistance Project Funding

Several funding streams: “old” DAP, civil DAP, NGRI DAP.

All new uses of DAP funds approved through RAC.

Almost 120  consumers served with DAP funding in FY 08.

Discharge Challenge Project designed by Mental Health directors to address concerns of “discharge-resistant” population at CSH in progress.