Report cites 'persistent' issues as basis to close Commonwealth Center for Children and Adolescents

RICHMOND – Citing “persistent operational and performance problems,” a state legislative study is suggesting the closure of the Commonwealth Center for Children and Adolescents in Staunton and possible reassignment of its workers to nearby Western State Hospital.

Virginia is one of a handful of states with a facility that specializes in treatment of kids and teenagers, and CCCA is the smallest of all the nine state-run psychiatric hospitals. It also seems to have created the most headaches for the state Department of Behavioral Health and Developmental Services, according to a report by the staff of the Joint Legislative Audit Review Commission made public Monday afternoon.

The report said that CCCA "stands out as the worst or among the worst performers compared with other state hospitals.” It has the highest rate of:

• patient-on-patient and patient-on-staff physical safety incidents;

• patient self-harm;

• substantiated human rights complaints; and

• physical restraint against patients.

The report found that CCCA had “nearly the highest staff vacancy rate, and the greatest dependence on expensive contract staff.”

The report says CCCA restrains patients “at a higher rate than any other state hospital and over 20 times higher than the reported national average.” Patients at CCCA also spend longer amounts of time in restraints compared with other hospitals.

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Inspections found major issues

An unannounced visit to CCCA last June by healthcare accrediting agency The Joint Commission uncovered 28 violations “and was determined to be an immediate threat to the health and safety of patients,” the report said.

In addition to the violations, roughly half of CCCA’s 48 beds are not filled due to problems with adequate staffing.

Even though its mission is to offer services to children and teenagers, the report found that 82% of the patients admitted between 2020 and 2022 were 12-17 years old, with the average age being 14. The average length of stay for patients has also dropped from 10 days in 2013 to seven days last year, and more patients are likely to be readmitted now than a decade ago.

Despite the increased spending, children admitted to CCCA are more likely to be readmitted than a decade ago, from 9% in 2013 to 18% in 2020. The readmission rates dipped in 2021 and 2022, but JLARC staff attributed that to DBHDS closing bedspace by half due to staffing shortages.

Costs to run the facility have jumped 77%, from $10.3 million in 2013 to $18.2 million this year. The per-bed costs went from $890 per day in 2013 to $2,463 this year – a 177% jump.

Despite DBHDS’ efforts to correct the problems – it replaced the hospital’s director in 2016 – the report indicated that issues continue to persist.

The report suggested that the $18.2 million used to operate CCCA annually could be best spent elsewhere, such as contracting with private services to offer adolescents’ and children’s mental-health treatments, and essentially get out of the under-18 mental-health business. Georgia, Louisiana and Tennessee are the only other states that offer government-run mental services for kids.

“CCCA has become more costly to operate, neither patient outcomes nor staffing challenges have improved, and additional investment in the facility is unlikely to result in further improvements,” the report read.

As far as CCCA’s current payroll, the JLARC study suggested those workers could transfer to Western State Hospital. WHS is two and a half miles away from CCCA “and experiencing [its own] staffing difficulties,” the report said.

Recommendation and response

JLARC staff recommends the Virginia General Assembly direct DBHDS to develop a plan to close CCCA by July 2025 and develop “alternative effective, safe, and therapeutic placements for children and youth who would otherwise be admitted to CCCA.” That plan would be submitted to the key Assembly budget-writing committees House Appropriations, and Senate Finance & Appropriations.

In a written response accompanying the report, DBHDS commissioner Nelson Smith seemed to think that the brakes need to be tapped on closing CCCA.

Smith said his department worked with The Joint Commission to immediately remediate all but two of the violations. He cited what he called “look-behinds” by both the Virginia Department of Health and the Centers for Medicare and Medicaid Services, plus a return visit by The Joint Commission, that yielded no new violations.

“Today, CCCA continues to sustain compliance,” Smith wrote in the letter. The most recent scores were 100% for safety and environment of care, 92% for treatment planning and 86% for clinical documentation.

The report said that CCCA has the highest rate of patient restraint of any state-run mental facility — 17.1 hours per 1,000 patient hours.

Smith said restraint use has dropped 116% from 2013 until now, even though the rate has remained consistent for the past four years. He said the goal is to make CCCA a restraint-free environment.

He told the commission that while CCCA was "clearly struggling," there have been improvements since Gov. Glenn Youngkin took office in 2021. It will take more time for CCCA to be completely out of the woods, but Smith said upcoming budget proposals by the Youngkin administration will address not just CCCA but shortcomings at all state-run hospitals.

"It will take time," Smith said at the meeting.

Commission members listened intently to the findings and to Smith’s responses but did not appear fazed by what the commissioner said. Sen. Jeremy McPike, D-Prince William County, said the thought of restraints being used on kids and teenagers “turns my stomach.”

The Virginia General Assembly convenes Jan. 10 in Richmond and is expected to begin addressing the issues brought up in the JLARC study. JLARC staff said it was recommending the closure take place in July 2025 to give DBHDS and others enough time to have alternatives in place.

Bill Atkinson (he/him/his) is an award-winning journalist who covers breaking news, government and politics. Reach him at batkinson@progress-index.com or on X (formerly known as Twitter) at @BAtkinson_PI.

This article originally appeared on The Progress-Index: State report recommends closing mental hospital for youth