September 17, 2021
Ruth Ann Walker, Director of Regulatory Affairs
Virginia Department of Behavioral Health and Developmental Services
Jefferson Building
1220 Bank Street, 4th Floor
Richmond, VA 23219
RE: disAbility Law Center of Virginia Public Comment on Periodic Review of § 12VAC35-190 and § 12VAC35-200
Dear Ms. Walker:
On behalf of the disAbility Law Center of Virginia (dLCV) and the people we serve, I write to comment on the periodic review of § 12VAC-35-190, “Regulations for Voluntary Admissions to State Training Centers” and § 12VAC-35-200, “Emergency and Respite Care Admission to State Training Centers.” As the designated Protection and Advocacy system for individuals with disabilities in Virginia, dLCV appreciates the opportunity to provide feedback on this review.
Since the DOJ settlement, the role of State Training Centers has shifted. State Training Centers are really only appropriate for individuals who cannot otherwise be served successfully in the community. In addition, Virginia law requires that all voluntary admissions be admitted with a discharge plan. Consequently, we can assume that training centers will become a short-term service provider, rather than housing people for their entire lives. With that in mind, the Commonwealth may wish to consider combining this section of the regulations with § 12VAC35-200: Emergency and Respite Care Admission to State Training Centers, to reflect a single admission process that promotes short-term admissions.
The definition for “Training center” under both sections (a “facility operated by the department that provides training, habilitation, or other individually focused supports to persons with intellectual disabilities”) appears too broad. With the current language, the definition clearly encompasses Hiram Davis Medical Center and also any State Hospital that provides services to individuals with intellectual disabilities (which is all or most of them). We recommend an updated definition to clarify the separate roles of other state facilities.
We also recommend updating the definition in these sections to include individuals with Developmental Disabilities, as this is the language that best fits the population and is used by most state agencies at this time. Additionally, § 12VAC35-190-30 (Criteria for Admission) and § 12VAC35-200-30 (Emergency Admission) refer to intellectual disability as the sole qualifying diagnosis. We also recommend updating this to reflect Developmental Disabilities.
Section 12VAC35-200-20 (Respite Care Admission) requires a training center providing respite services to provide “adequate staff coverage” and an “appropriate peer group” but these terms are never defined. We recommend creating definitions that operationalize these terms if at all possible.
Sections 12VAC35-190-21 (Application for Admission), 12VAC35-190-51 (Judicial Certification), and 12VAC35-200-30 (Emergency Admission) appear to be limited to the actions of parents, guardians and authorized representatives seeking admission to State Training Centers. However, not all individuals with intellectual or developmental disabilities have or need these supports. Indeed, they may be their own decision makers. We recommend that these sections be changed to reflect this.
Section 12-VAC35-200-30 (Emergency Admission) further sets out admission procedures for minors. As minors are not included in the respite or voluntary admission processes, it is unclear why they are included in the emergency process. Serving juveniles requires specific skills and expertise that training centers may not have. We would urge the Commonwealth to consider whether continuing to admit juveniles to State Training Centers is appropriate.
In addition, the application materials listed in § 12VAC35-190-21 (Application for Admission) are minimal and may be better reflected by simply adopting or referring to the application materials listed in § 12VAC35-200-20 (Respite Care Admission).
Finally, § 12VAC35-190-30 (Criteria for Admission) states that a decision on admission will be made within 10 working days. As we have seen in recent years, individuals being newly admitted to State Training Centers are often experiencing crises and instability in the community. For many of these individuals, 10 working days may be too long a review period, and could result in individuals being unnecessarily hospitalized in facilities that cannot adequately treat them. If it is, in fact, the State’s intention that State Training Centers become short-term facilities for individuals with ID/DD, then the admission process should be similarly crisis-focused with a shorter decision-making time.
Sincerely,
Colleen Miller
Executive Director