The Joint Committee on Health met this afternoon.
The Committee received an update from the Bureau for Behavioral Health and recommendations on IDD and ICF. The agency has had routine and ongoing meetings with patients and staff at state hospitals, as well as bi-weekly meetings with Disability Rights of WV.
Three barriers/challenges were identified by the Bureau: (1) workforce, (2) discharge planning, and (3) crisis services. Currently, there is no central point of coordination to oversee training, monitoring, and coordination across state health agencies. Staffing positions in professional and direct services are difficult to address, as there is a lack of professionals trained in applied behavioral analysis and positive behavior support. Resources are currently being directed to children with IDD and not adults.
Community providers are less involved in the discharge process now. They frequently refuse to serve people wones they have been committed through the state mental hygiene process. Individuals who do not qualify for waiver are more difficult to discharge to the community without proper funding. DHHR has no power to relocate or reallocate beds, even though about 10 percent of licensed ICF beds are unavailable due to workforce availability. There has been an increase in young adults aging out of care in out-of-state placements and then being committed to state hospitals. Providers already see the current regulatory oversight as overbearing and punitive.
The current crisis response structure makes it difficult to access the level of care that is needed in real-time. The current mobile crisis teams are not trained to manage the special needs of individuals with IDD. Community-based crisis stabilization units are reluctant to serve individuals with IDD. Existing crisis units designed to serve individuals with IDD do not have the capacity to serve in crisis. Currently, one of the two units is temporarily closed due to lack of workforce.
The Bureau had several recommendations relating to the workforce. First, it recommends hiring and training a qualified individual to serve as the director for IDD services to implement the recommendations identified and to develop a strategic plan. An existing position and funding are available for this. Another recommendation is developing a pilot project for community engagement specific to IDD to facility community discharge placement. The Bureau will continue working on the full implementation of ECHO and continue to offer specialized training to first responders. It was recommended that training be increased at all staffing levels and include coaching and mentor training. Funding needs to be re-established for PBS to adults. Another recommendation is to develop a technical assistance center that can be used to help providers stay current on best practices and policy development.
It was recommended to use comprehensive centers to continue to improve participation in discharge planning. Responsibilities relating to discharge planning need to be clarified. Training needs to be provided to hospital staff and community-based providers for discharge planning and trauma-informed care. The Bureau wants to explore housing options for permanent housing support or HUF 811 projects for individuals not eligible for the IDD waiver. The Bureau needs to determine if there is an additional need for group homes to serve individuals with IDD. Another recommendation was to develop a three-year strategic plan for the re-entry of out-of-state youth preparing to age out of foster care and have an IDD diagnosis. A resource manual for providers that includes community-based responses that will complement, and augment clients’ treatment plans was also recommended.
In order to address crisis service needs, it was recommended to establish a three-region crisis response team with specialized training in IDD. Additionally, it was recommended to replicate other states’ promising practices such as establishing three to four four-bed short-term stabilization homes to help avoid hospitalization or shorten the length of state in-state hospitals.
The Bureau also had policy recommendations: a peer review of the civil commitment process, exploring the possibility of modifying Chapter 27 of the WV code to allow community providers to service people with challenging behaviors where state hospitals can still be the backup for crisis services, and assure unused intermediate care facility beds are available to clients.
The Committee also heard updates on the proposed state labs as well as the Center for Local Heath and Tobacco Cessation.
The Committee received an update on the controlled substance monitoring database. Controlled substances dispensed are declining across the state in most drug types, buprenorphine and some stimulants are increasing. All opioid dispensing has declined. The utilization of the CSMP remains high; 15 million queries or more a month.
Finally, the committee discussed the 2024 draft legislation relating to CON mobile exemption, drug test strips, and psychiatrist residency program. All motions were adopted to introduce the legislation in the 2024 session.