Supporting individuals by promoting recovery, self-determination, and wellness in all aspects of life

A life of possibilities for all Virginians

Focus First on Individuals Receiving Services

Our decisions and actions consider first the best interests of individuals who receive services and their families. We respect the potential and capacity of each individual who receives services. We value and support the healing and recovery process.

Accountability and Oversight

We take seriously our responsibility to provide oversight and accountability throughout Virginia’s public behavioral health and developmental system to ensure individuals receive timely access to quality, consistent services.

Responsiveness to External and Internal Customers

We seek input and involvement from our customers. We share ideas and remain open to different opinions. We listen to and respect what our customers say and respond promptly to their requests.

Partnership and Collaboration

We create opportunities for partnerships, encourage teamwork, and support each other to succeed. We accept shared ownership and seek win-win (mutually acceptable) solutions. We communicate openly and clearly. We are willing to take risks as we look for creative solutions and new ways of solving problems. We make decisions and resolve problems at the level closest to the issue.

Professionalism, Integrity, and Trust

We recognize and celebrate individual and team successes. We use valid data that reflect best practices and positive results and outcomes. We take responsibility for ourselves, for our actions, and for how these actions affect others. We develop a supportive and learning environment and work continuously to improve the quality of the services we provide. We keep our word and deliver what we promise. We incorporate our values into everyday decisions.

Stewardship

We protect the assets and interests of the entire services system. We value and take care of staff. We use the Commonwealth’s resources in the most effective and efficient manner.

The Department of Behavioral Health and Developmental Services (DBHDS) operates the Virginia Center for Behavioral Rehabilitation (VCBR), which is located in Burkeville. VCBR is a secure facility that provides evaluation and rehabilitation services to individuals found by the court to meet the statutory criterion of being a Sexually Violent Predator (SVP) and committed to DBHDS for secure residential treatment. Although the facility is a high security institution that requires some visible security features such as perimeter fencing, VCBR is operated as a rehabilitation facility similar to the state hospitals. Virginia is one of 20 states that operate inpatient SVP programs. All are similar except Arizona, and Pennsylvania, which use different commitment program models.

The current VCBR facility was designed reflecting the 1999 SVP commitment laws. Under the then prevailing SVP laws, admissions ran about one per month. At that rate a 300-bed capacity facility would have sufficed for about 20 years. This changed in 2006 when the Virginia General Assembly expanded the number of qualifying crimes from four offenses to 28 offenses and shifted the screening tool from the RRASOR (Rapid Risk Assessment of Sex offender Recidivism) to the Static-99 actuarial instrument. Combined, these changes increased the admission rate at VCBR by more than 300 percent. This increased pressure on the SVP system for services at all levels. Whereas, the facility had been experiencing about one admission per month, over the past four fiscal years, VCBR has averaged five admissions per month.  Despite the increased number of discharges, VCBR experiences (and is expected to continue to experience) some net gain in its census each year.

The first phase of expansion of VCBR was completed in FY 2021 and provides living and treatment space for a total of 632 individuals. Based on most recent census projections we are projecting that VCBR will reach 632 residents by the end of FY 2022.  The completed expansion (Phase I and II) will result in an expanded facility capable of housing 708 individuals. It should be noted that recruiting and retaining a sufficient work force for this large of a facility will be exceedingly challenging and at some point the decision may need to be made to expand to a different region of the state. While there are some definite challenges of operating two distinct facilities, having distinct facilities will provide the Commonwealth with more flexibility to address resident management, staffing, and discharge planning challenges.

With the possibility of continued census growth into the future, DBHDS developed options to reduce the census growth and the need for additional bed capacity at VCBR. These options included:

1. Repealing the changes made to the Code of Virginia in 2006 and/or eliminate some of the included predicate offenses to decrease the pool of SVP eligible individuals.


2. Create a pilot treatment program dually run by VADOC and DBHDS that would target individuals at high risk of being civilly committed at the end of their sentence in VADOC but who are identified as benefitting from pre-committed SVP treatment with the goal of either avoiding civil commitment (when safe to do so) or shortening their eventual length of stay should they be civilly committed.


3. Increase treatment staffing at VCBR (thus presumable facilitating the more timely movement of residents through the treatment program).


4. Develop transitional housing options, creating capacity in the community to manage SVPs on conditional release.


5. Create programs for individuals with psychiatric instability or developmental disability for individuals that are mentally unable to fully benefit from SVP treatment.

Acting on one or more of the above options as needed would prolong the period until a new/expanded facility. Obviously, each option comes with its own unique risks and benefits and has public policy implications.

VCBR maintains a small information technology staff to support locally developed applications systems and their local information technology infrastructure environment. The DBHDS central office Information Services and Technology (IT) office provides coordination, guidance, oversight, and support to ensure that these local systems comport to Commonwealth of Virginia (COV) security requirements and to enable required data integration with central office-provided systems. 

Although many of the central office (720) IT goals are intended to support VCBR, two are of particular importance. First, the reduction of the Facility Application Inventory will have the most significant impact on VCBR technology operations. A reduced facility application inventory and increased central office support for agency-wide applications will allow facility IT staff to focus on the specific needs of their facility’s clinical staff. 

The continued enhancement of the Electronic Health Record to help improve the quality of services, decrease the frequency of treatment errors, will improve communication and will facilitate treatment planning. Using an EHR will also aid DBHDS in attracting and retaining qualified clinical staff as most new graduates are only familiar with using an EHR and are unfamiliar with our antiquated and time-consuming paper records.

VCBR operates 24 hours a day, seven days a week and depend on a cadre of skilled and dedicated employees in a wide variety of classifications. Most provide direct care, security, or infrastructure support services. The workforce average age is 40 years old and work tenure is 6 years. The turnover rate is 3% (although historically this has been higher).  VCBR has implemented aggressive recruitment and retention strategies which have resulted in a more stable workforce.  In the next five years, 9 percent will be eligible to retire with unreduced benefits.

VCBR is building relationships with the local technical center, community colleges and other regional technical centers to help with acquiring employees. In addition, VCBR is working with managers to develop succession planning and create training for employees and future employees to meet the knowledge, skills and abilities of the positions needed to support the mission of VCBR. VCBR, along with next-door Piedmont Geriatric Center, have developed very strong social media promotional efforts to position them as an employer of choice in their area. 

The hiring of qualified staff will need to match the pace in which the census of the facility grows. While VCBR’s treatment program performs exceptionally well when compared to the nation’s other SVP commitment programs, the treatment staff to resident ratio in the Virginia system is lacking when compared to other programs. In order to maintain the constitutionality of the commitment program, VCBR must provide adequate evidenced based treatment. In order to achieve this, the number of qualified treatment providers at the facility will need to increase.

VCBR is a 174,500 square-foot facility in two buildings constructed in 2008. The existing facility was designed with 300 single occupancy bedrooms.  VCBR is using double bunking in half of the bedrooms to achieve a maximum census of 450. For staff safety and to accommodate both the behavioral and medical challenges of the residents, VCBR has maximized the number of rooms it can double bunk. VCBR is currently undergoing an expansion which will help meet current census pressures and address some existing design limitations of the current facility.

Because of double-bunking, the facility is currently operating above its original design capacity. However, treatment and therapy space has not yet been increased. Forecasts continue to show a growth in the facility's census for the foreseeable future.

Note:  This is one of five DBHDS Executive Progress Reports. See Department of Behavioral Health and Developmental Services (720); Grants to Localities (790); Mental Health Treatment Centers (792); and Intellectual Disabilities Training Centers (793).

Several factors will have a significant effect on VCBR over the next four years:

Expansion of Current Facility: VCBR is currently the only facility designated for the treatment of individuals committed as Sexually Violent Predators (SVP) in Virginia. The facility was originally designed to house 300 individuals. In 2012, in response to a directive from the General Assembly, an additional bed was added in 150 rooms (“double-bunking”), making the census capacity of the current facility 450 residents. The current census is 443 thus the facility is essentially full at this time.  The 2013 Appropriation Act authorized DBHDS to conduct a pre-planning study for a new facility to be located in Nottoway County. Chapter 2, 2014 Special Session I of the General Assembly provided funding for the detailed planning of the expansion. Construction has just recently started.  This project proposes the phased construction and renovation of the existing facility with the addition of up to 258 new beds and additional treatment and support services spaces. Phase 1 proposes 182 beds with shelled space for 76 additional beds, which could be completed quickly if the need arises sooner than forecast. Phase 2 proposes the fit-out of the additional 76 shelled-space beds. Construction just recently began.  To address the growing census while the facility is under expansion, DBHDS has taken over a unit at Piedmont Geriatric Hospital (which is located on the same campus) and is renovating that unit to house medically fragile SVPs.  VCBR will operate the unit and the individuals will receive programming at VCBR/ from VCBR staff.  This is a stop gap measure.  Additionally, DBHDS has worked with the construction company to build the expansion in phases.  Living quarters will be completed first in order to address the growing census.  Construction of the expansion will take approximately three years.

Medical Needs of Residents Committed: Many residents are admitted to VCBR with complex medical needs that require increased medical intervention. Of individuals committed, there are approximately 280 diagnoses of a significant medical condition that require regular medical interventions, including Hepatitis, HIV, Diabetes, and Cancer. Many of these complex medical needs impact a resident’s participation in treatment. The cost of providing medical care to residents is a significant portion of the facility’s budget. In addition, medical costs fluctuate greatly as one hospitalization in response to an acute need (e.g., heart attack, injury, stroke, etc.) may result in a long term hospitalization. The complexity of medical needs of residents also requires an increased number of staff members that have the knowledge to provide necessary care at the facility (e.g., RN, LPN, MD, NP, and PA).

Providing necessary medical care also requires consultation with external medical providers, resulting in staffing for security officers to provide secure/safe transportation into the community.

Recruiting and Maintaining Qualified Staff:  VCBR is one of only 20 facilities in the nation that provides services to individuals civilly committed as SVP. Treatment for SVPs is a specialized field that requires specialized knowledge, skills, and abilities. Individuals who do not qualify for conditional release directly to the community are involuntary committed to VCBR after completing their sentence in VADOC. The majority of the individuals at VCBR are diagnosed with a personality disorder. These factors result in staff serving a population that may be hostile, manipulative and likely to complain about services. Residents sometimes file frivolous complaints with licensing agencies against professional staff (Therapist, RN, MD, Ph.D., etc.); though these complaints are typically not founded, this has a negative impact on retention. While VCBR residents are received from VADOC, direct care staff members at VCBR are not reimbursed at the same rate as correctional officers. Frequently, qualified staff members leave VCBR to go to VADOC where pay is greater. At times, residents exploit low wages and minimum education of direct care staff as a means to manipulate treatment or circumvent security measures, resulting in termination.

VCBR is funded with 100 percent general fund dollars.

Revenue collections are a result of insurance reimbursements from loss coverage and sale of surplus materials.

The following statistics provide a snapshot of VCBR operations during FY 2022:

No data

VCBR provides a variety of intensive residential sex offender evaluation, rehabilitation, and other clinical services within a maximum-security perimeter. International experience with the SVP population supports the use of a rehabilitation approach based on cognitive-behavioral principles and focused on relapse prevention. Rehabilitation involves multiple daily group sessions, individual behavioral therapy, vocational training, and work therapy and programs, as appropriate.

VCBR assures that intensive inpatient sex offender evaluation, rehabilitation, and other clinical services are provided in a secure confinement setting. Security staff members work with direct care staff and clinicians to create a safe environment that challenges deviant and criminal thinking and behavior while reinforcing appropriate behavior.

VCBR prepares residents for eventual return to the community, working with community providers to develop realistic and appropriate conditional release and monitoring safety plans. These plans are presented to the court that ultimately must authorize the individual’s release.  Once released, individuals are closely monitored for their compliance with the court approved plan.  If individuals fail to follow their plans or are deemed to pose too great a risk to the community their releases can be revoked.  DBHDS is charged with monitoring individuals on release and accomplishes this mandate via a contract with VADOC who provides the monitoring services.

Twenty states and the federal system allow for the civil commitment of individuals determined to be Sexually Violent Predators (SVP). 99 percent of individuals committed to VCBR have consented to participate in the treatment program. VCBR residents participate at a higher rate than most other sexual offender civil commitment treatment programs.  Progress of individuals at VCBR to meet clinical requirements for conditional release is measured by their progress in evidence-based sex offender treatment. This treatment includes three phases that are focused on reducing an individual's risk of reoffending, thus preparing individuals to be safely managed in the community once conditionally released. Most recently, 12 percent of individuals committed to VCBR are in Phase III of treatment, meaning that they are preparing for conditional release into the community.

Compared to commitment programs in other states, VCBR is performing exceptionally well at providing necessary treatment to support individuals in obtaining conditional release. VCBR is a leader in terms of the number of individuals released from secure confinement to Conditional Release. In addition, VCBR was a leader in the proportion of individuals released compared to the total number committed. Finally, the sexual re-offense rate for individuals released from VCBR is well below national re-offense rates for high risk sex offenders, thus suggesting that the treatment being provided at VCBR and the services/oversight being provided to individuals on conditional release in fact is mitigating the risk for future sexual re-offense.

Chapter 3 of Title 37.2 of the Code of Virginia establishes DBHDS and Chapter 7 of Title 37.2 authorizes DBHDS to perform certain functions related to the operation of state facilities. Additionally, Chapter 9 of Title 37.2 authorizes the civil commitment of sexually violent predators (SVPs) and authorizes DBHDS to operate or contract for a secure confinement facility to provide behavioral rehabilitation services to them. DBHDS operates VCBR to provide treatment of SVPs in a secure facility. VCBR provides treatment to residents to address their risk factors for future sexual re-offending. VCBR prepares residents, when appropriate and approved by the court, for the eventual return to their home communities and works with community providers to develop realistic and appropriate conditional release plans which adequately mitigates the individual’s risks. This goal envisions the implementation of evidence­based sex offender rehabilitation services that are intended to reduce the risk that SVPs will reoffend so they can safely and successfully transition to the community once approved for conditional release by the court.

The objective supports the realization at VCBR of a more person ­focused and needs ­based system of rehabilitation services and supports. Services provided at VCBR are person ­centered and individualized to meet each individual’s goals for recovery. Key components of these services focus on developing insight into risk factors and introducing positive goals for lifestyle change and on skills acquisition to transition back to the community to a healthy, productive, non-offending lifestyle.

• Incorporate recovery principles in VCBR operations to the extent possible, including provision of educational, career development and job training opportunities.

• Provide intensive treatment aimed at reinforcing positive behaviors, reducing risk, and preparing individuals for safe and successful adjustment to the community.

• Increase vocational development opportunities and work experiences that increase the recovery experience for individuals receiving services at VCBR.

• Assist VCBR residents to acquire the supports and resources needed to develop a viable conditional release plan

VCBR provides behavioral rehabilitation services within a secure facility to sex offenders who are civilly committed to DBHDS at the end of their confinement in the Department of Corrections because of their histories of habitual sexually violent behavior and because their ability to control their violent tendencies is compromised by the presence of a mental abnormality or personality disorder. International experience with the SVP population supports the use of a rehabilitation approach based on cognitive ­behavioral principles and focused on relapse prevention. This goal envisions the provision of a sufficient array of behavioral rehabilitation services that are appropriately tailored to the needs of individuals committed to VCBR and which have been found to potentially mitigate risk factors for future aggression.

This objective implements highly structured intensive residential sex offender evaluation, rehabilitation, and other clinical services. This includes multiple daily group sessions, individual behavioral therapy, vocational training, medical services, and other rehabilitative services, as appropriate

• Offer a comprehensive array of behavioral rehabilitation services including a three­phased program of evidence­based sex offender treatment to individuals who have been civilly committed as sexually violent predators.

• Provide vocational training and other clinical services to meet the needs of residents at VCBR.

• Assess each individual’s ability to manage himself sexually, behaviorally, and emotionally throughout his treatment and implement strategies that reinforce positive behaviors that increase the recovery experience for individuals receiving services.

• Provide adult basic education, adult secondary education, and educational skill building classes that allow individuals to increase their academic skills and support success when/if released to the community.

• Provide on­site work experience in food services, housekeeping, grounds maintenance, and as recreation and education aides.

• Continue partnerships with the Office of the Attorney General and with Probation and Parole offices to support and expand the safe and appropriate use of SVP conditional release.

• Provide security services required to safely operate the VCBR to assure the safety of individuals receiving services at the Virginia Center for Behavioral Rehabilitation (VCBR), staff, and the public.

• Maintain sufficient numbers of trained professional and direct care staff necessary to deliver quality forensic treatment and behavioral rehabilitation services.

• Maintain sufficient numbers of trained professional and direct care staff necessary to deliver quality forensic treatment and behavioral rehabilitation services.

• Plan for the future needs of the Commonwealth giving the increasing numbers of individuals committed as SVP and explore possible alternatives to secure confinement (without jeopardizing community safety).

This goal envisions consistent implementation of administrative and support services that support and sustain VCBR service quality and appropriateness, ensure compliance with federal and state requirements, and promote efficiency and cost­ effectiveness.

Efficient and effective administration and support services must be in place if VCBR is to provide quality services in a safe, secure, and healthy environment. This objective implements general management, computer services, food services, housekeeping, linen and laundry services, and physical plant services that support the effective and efficient operation of the VCBR.

• Adhere to all safety regulations as prescribed by the Department of Environmental Quality pertaining to boiler inspections.

• Adhere to all safety regulations as prescribed by the local Fire Marshall pertaining to building safety.

• Adhere to Virginia Department of Health regulations pertaining to state facility food services operations, overall sanitation, and cleanliness.

• Comply with Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rule requirements.

• Continue to adhere to Prompt Payment Act, small purchase charge card usage, Payline participation, direct deposit participation, and other regulatory compliance requirements.

• Continue to assess opportunities to improve the effectiveness and efficiency of facility administrative services.

Facility-Based Education and Skills Training Services consist of educational and vocational and employment services provided at the Virginia Center for Behavioral Rehabilitation to individuals found by the court to meet the statutory criterion of sexually violent predator.

Facility-Based Education and Skills Training Services improve individuals’ person-centered work skills.

Facility education and skills training include educational services and vocational, pre-vocational, and work training activities.

This service area is funded with 100 percent general funds.

Forensic and Behavioral Rehabilitation Security Services assure that intensive inpatient sex offender evaluation, rehabilitation, and other clinical services are provided at Virginia Center for Behavioral Rehabilitation in a secure confinement setting.  Security staff members work with direct care staff and clinicians to create an environment that challenges deviant and criminal thinking and behavior while reinforcing appropriate behavior.

DBHDS  must, by statute, operate or contract for a secure confinement facility to provide behavioral rehabilitation services to individuals found by the courts to be sexually violent predators.

Forensic behavioral rehabilitation security services include a cadre of trained security staff required to maintain the Virginia Center for Behavioral Rehabilitation maximum-security perimeter.

This service area is funded with 100 percent general funds.

Inpatient Pharmacy Services consist of medication selection and procurement, storage, ordering and prescribing, preparation and dispensing, administration, and monitoring.  Medication orders are prepared, packaged, compounded (if needed), labeled and then sent directly to the individual's unit for administration by nursing staff.

VCBR provides medications that appropriately alleviate the symptoms of and distress associated with an individual’s illness or medical condition, or both.

Inpatient pharmacy services include medication selection, procurement, preparation, dispensing; management, and education, and pharmacy service oversight and cost containment.

This service area is funded with 100 percent general funds.

State Mental Health Facility Services include a variety of intensive inpatient sex offender evaluation, rehabilitation, and other clinical services provided to individuals receiving services at the Virginia Center for Behavioral Rehabilitation.  International experience with the sexually violent predator population supports the use of a rehabilitation approach based on cognitive-behavioral principles and focused on relapse prevention.  Rehabilitation involves multiple daily group sessions, individual behavioral therapy, vocational training, and work therapy and programs, as appropriate.  Direct care staff work with clinicians to create an environment that challenges deviant and criminal thinking and behavior while reinforcing appropriate behavior.

DBHDS must, by statute, operate or contract for a secure confinement facility to provide behavioral rehabilitation services to individuals found by the courts to be sexually violent predators. State hospital services provided at the Virginia Center for Behavioral Rehabilitation (VCBR) are person-centered and individualized to meet each individual’s goals for recovery.

Behavioral rehabilitation services include inpatient sex offender rehabilitation services within a maximum-security perimeter, sex offender evaluation and treatment training, quality management feedback to Commitment Review Committee evaluators, and annual SVP commitment reviews for the courts.

This service area is funded with 100 percent general funds.

Facility Administrative and Support Services consist of administrative leadership and general management, computer services, food services, housekeeping, linen and laundry services, and physical plant services that support the effective and efficient operation of the Virginia Center for Behavioral Rehabilitation.

Facility Administrative and Support Services provide the administrative framework that enables the VCBR to provide quality care in a safe and clean environment and comply with administrative and financial requirements.

Facility administrative and support services include general management and direction; information technology support; food and dietary services, housekeeping, linen and laundry, and physical plant services.

This service area is funded with 100 percent general funds.

Efforts to provide administrative management and direction.

Efforts to provide information technology services including VITA costs, software, hardware and IT support personnel.

Efforts to provide food and dietary services to patients, costs include personnel, food products and food preparation equipment and supplies.

Efforts to provide housekeeping services for patients. Costs include personnel, and cleaning supplies.

Efforts to operate and maintain physical plant facilities including buildings and grounds.

Efforts to provide training and education to state employees. Facilities have high numbers of direct care turnover. As a result training departments are needed to ensure proper training of staff.