Crisis Services Division of Developmental Services Heather Norton, Director DBHDS Vision: A life of possibilities for all Virginians
…both children and adults …persons with a developmental disability, including an intellectual disability …who have a co-occurring mental health illness or behavioral disorder ...who are at risk for a crisis event or are in the midst of a crisis …the support system surrounding individuals receiving services from REACH
To Provide Crisis To Educate To Assess To Habilitate Services • Providers • Crisis • 24/7 crisis • Teach effective situations response coping skills • Family • Mental health • Stabilization • To develop • Health Care symptoms services stress staff tolerance skills • Behavioral • Coaching and • Schools function mentoring for • To teach • Mental Health the person’s functional skills • Environment Professionals system of for increased • The support • Law support independence system enforcement • Making • To identify surrounding • Members of environmental individual the Individual the person’s changes that interests and • Medical issues natural circle support the learn to access impacting of support person these behavior
Adult Crisis Total Number of Referrals by Fiscal Year 1600 1369 1400 1200 Total # of Referrals 1000 854 800 592 600 584 472 400 200 54 0 FY12 FY13 FY14 FY15 FY16 FY17 Fiscal Year Slide 4
Child Crisis Total Number of Referrals by Fiscal Year 1200 999 1000 800 Total # of Referrals 600 384 400 200 0 FY16 FY17 Slide 5
Outcome of Crisis Assessments (Adult) Outcome of Crisis Assessment by Fiscal Year 800 FY15 710 700 FY16 580 FY17 Total Number of Outcomes per Fiscal Year 600 501 480 500 400 300 260 255 256 193 200 130 100 100 116 36 29 28 11 17 13 10 7 4 3 0 0 0 Retain Setting Retain Setting Psychiatric Medical CTH Admission Alternative CSU New Placement Jail Other w/REACH Hosp. Slide 6
Outcome of Crisis Assessment (Child) Outcome of Crisis Assessment by Fiscal Year 350 304 300 FY16 Total Number of Outcomes per Fiscal Year FY17 250 229 213 182 200 150 100 41 50 11 6 6 6 2 1 0 0 0 0 Slide 7
Mobile Support Outcome (Adult) Disposition at Conclusion of Mobile Supports by Fiscal Year 600 Fiscal Year 502 500 FY15 FY16 419 Total Number of Dispositions per Setting 398 FY17 400 300 200 100 46 45 42 39 30 23 15 10 7 7 6 6 4 1 1 0 0 0 0 Psychiatric Medical Retained Setting New Residential Jail Other CTH Hospitalization Hospitalization Setting Slide 8
Mobile Support Outcomes (Child) Disposition at Conclusion of Mobile Crisis by Fiscal Year 600 550 FY16 500 Total Number of Dispositions per Setting FY17 400 300 200 148 100 66 18 6 5 6 3 1 0 0 0 0 Psychiatric Medical Retained Setting New Residential Mobile Supports Other Hospitalization Hospitalization Setting Active Slide 9
CTH Outcomes (Adults) Disposition from CTH by Fiscal Year 500 461 450 400 FY15 338 338 FY16 350 FY17 300 Total Number per Setting 250 200 150 100 79 67 45 40 38 50 27 28 27 12 13 8 1 1 0 0 Psychiatric Medical Hospitalization Retained Setting New Residential Setting Jail Other CTH Hospitalization Slide 10
Independent Reviewer Concerns “The Commonwealth should study and determine the root causes of the significant increase in admissions of individuals with IDD to state operated psychiatric facilities. Studies found two related factors: an unexpected high rate of families refusing REACH services and not all CSB ES Teams informed REACH of individuals with IDD being screened for psychiatric admission.” • Emergency Services System • Psychiatric Hospitalizations – Adult – Children • Refusal of services Slide 11
Next Steps Children’s Crisis Hospital Data Review • – Reasons for increased admissions • Age of parent caregiver • Size of child (obesity and GMO) • Increase in survival rate of preemies • Fetal Alcohol/Drug impact • DSS/Foster Care • Single natural parent households • Abuse /Neglect and trauma • Bullying • Looking at CSA data – are more kids remaining in state in comparison Children’s Therapeutic Homes • Increase consistency • – Training – Documentation – Processes Slide 12
Next Steps Adult Crisis • Hospital Data Review – Vet data and theories • Adult Transitional Homes • Increase consistency – Training – Documentation – Processes • Partnership with BH Acute Care Team – Hospitalizations • Behavioral Provider Development Slide 13
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