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Community Crisis Stabilization Services

Permanent Injunction

  • 35. The Commonwealth will work to achieve a goal of 86% of individuals with a DD waiver and known to the REACH system who are admitted to a CTH or a psychiatric hospital have a community residence identified within 30 days of admission. To achieve that goal, the Commonwealth will take the following actions:
    1. DBHDS will enter into contracts with providers to develop homes for individuals with intense behavioral support needs that will be operational (i.e., that an individual can move into the home) in accordance with the following schedule:
      1. Region 1: one home operational by August 2024 and one additional home operational by February 2025;
      2. Region 2: two homes operational by August 2024 and one additional home operational by February 2025;
      3. Region 3: one home operational by November 2024 and one additional home operational by February 2025;
      4. Region 5: one home operational by November 2024 and two additional homes operational by February 2025.
    2. If the Commonwealth has not achieved the goal after taking the actions in Paragraph 35(a) by June 30, 2025, DBHDS will conduct a root cause analysis and implement a QII as determined appropriate by DBHDS. DBHDS will continue this quality improvement process until the goal is achieved and sustained for one year.

  • 36. To prevent institutionalization of children due to behavioral or mental health crises, the Commonwealth will implement out-of-home crisis therapeutic prevention host-home-like services for children connected to the REACH system who are experiencing a behavioral or mental health crisis and would benefit from this service by:
    1. Within one month of the date of this Order, DBHDS will send out a communication through the list serv for individuals and families on the waiver waiting list, and to the provider list serv communicating that the two CTHs existing in Regions 1 and 4 as of the date of this Order can be utilized for preventive stays by children across the Commonwealth.
    2. DBHDS will continue to track and report quarterly on the number of crisis prevention stays being utilized by children in each of the five regions.
    3. Providing funding in Fiscal Year 2025 to establish three additional CTH’s in the regions where they do not exist as of the date of this Order (Regions 2, 3, and 5) that will be operational between May 2025 and January 2026.
    4. From the date of this Order and continuing until all three additional CTHs referenced in Paragraph 36(c) are operational, DBHDS will support up to a total of 1,000 days per year of respite for children connected to REACH, who have previously experienced or are at risk of experiencing a crisis, reside in regions without an operational CTH, and who do not otherwise have funding to access respite services at a rate of up to $500 per 24-hour period.
    5. If the Commonwealth has not achieved the goal after taking the actions in Paragraphs 36(a) through 36(d) by June 30, 2026, DBHDS will conduct a root cause analysis and implement a QII as determined appropriate by DBHDS. DBHDS will continue this quality improvement process until the goal is achieved and sustained for one year.

Settlement Agreement

iii.  Crisis stabilization programs

A.   Crisis stabilization programs offer a short-term alternative to institutionalization or hospitalization for individuals who need inpatient stabilization services.

B.   Crisis stabilization programs shall be used as a last resort. The State shall ensure that, prior to transferring an individual to a crisis stabilization program, the mobile crisis team, in collaboration with the provider, has first attempted to resolve the crisis to avoid an out-of-home placement and if that is not possible, has then attempted to locate another community based placement that could serve as a short-term placement.

C.   If an individual receives crisis stabilization services in a community-based placement instead of a crisis stabilization unit, the individual may be given the option of remaining in the placement if the provider is willing and has capacity to serve the individual and the provider can meet the needs of the individual as determined by the provider and the individual’s case manager.

D.   Crisis stabilization programs shall have no more than six beds and lengths of stay shall not exceed 30 days.

E.   With the exception of the Pathways Program operated at Southwestern Virginia Training Center (“SWVTC”), crisis stabilization programs shall not be located on the grounds of the Training Centers or hospitals with inpatient psychiatric beds. By July 1, 2015, the Pathways Program at SWVTC will cease providing crisis stabilization services and shall be replaced by off-site crisis stabilization programs with sufficient capacity to meet the needs of the target population in that Region.

F.    By June 30, 2012, the Commonwealth shall develop one crisis stabilization program in each Region

G.   By June 30,2013, the Commonwealth shall develop an additional crisis stabilization program in each Region as determined necessary by the Commonwealth to meet the needs of the target population in that Region.

About Community Crisis Stabilization Services

Community stabilization services are offered to the individual in a community setting (non-residential) or in a designated short term residential crisis program. Community Stabilization services are available 24 hours a day, seven days a week, to provide for short-term assessment, crisis intervention, and care coordination to individuals experiencing a behavioral health crisis.  Services may include brief therapeutic and skill building interventions, engagement of natural supports, interventions to integrate natural supports in the de-escalation and stabilization of the crisis, and coordination of follow-up services.  Services involve advocacy and networking to provide linkages and referrals to appropriate community-based services and assisting the individual and their natural support system in accessing other benefits or assistance programs for which they may be eligible.   

The goal of Community Stabilization services is to stabilize the individual within their community and support the individual and natural support system during the following: 1) between an initial Mobile Crisis Response and entry in to an established follow-up service at the appropriate level of care if the appropriate level of care is identified but not immediately available for access 2) as a transitional step-down from a higher level of care if the next level of care is identified but not immediately available or 3) as a diversion from a higher level of care.  

The Crisis Therapeutic Home (CTH) is the residential component of REACH and shall be used when community-based crisis services or supports are not effective or clinically inappropriate. The Crisis Therapeutic Home (CTH) is not intended to be a long-term residence or respite. REACH programs admit persons to the CTH for stabilization of a crisis, a planned prevention, or as a step-down from a state hospital/ training center/jail. The therapeutic techniques utilized at the CTH are designed to support individuals in crisis or post crisis (prevention and step-down) and thus the CTH environment is designed around these supports rather than an environment associated with a long-term residence. The CTH can provide in depth assessments, a change in setting to allow for stabilization, and a highly structured and supportive environment to improve coping skills and work on other goals that aide in stabilizing the current crisis or prevent future occurrence.  REACH crisis therapeutic homes are coeducational and have a capacity for 6 individuals. The CTHs supporting adults 18 years of age and older are in each of the five DBHDS Service Regions of the state. There are two CTHs that support youth up until their 18th birthday. One home operated by the Region II REACH Program supports the Region II (Northern) and Region I (Western) Regions while the second home operated by the Region IV (Central) REACH Program, supports Region IV (Central), Region V (Eastern), and RIII (Southwestern) Regions.  

Trend Data

Compliance Indicator 10.4 Language:

86% of individuals with a DD waiver and known to the REACH system who are admitted to CTH facilities and psychiatric hospitals will have a community residence identified within 30 days of admission.

Compliance Indicator 11.1 Language:

86% of individuals with a DD waiver and known to the REACH system admitted to CTH facilities will have a community residence identified within 30 days of admission.

Authorizing Authority

CSB Performance Contract

Delegation

Processes, Protocols and Standards

Guidelines, Charters, Plans, Other

Instruments and Tools

For more information link: DBHDS Crisis Page

Training Materials