the vacsb community roi model...the roi audience should know that these outcomes in health,...

The VACSB Community ROI Model

The VACSB Community ROI Model User Guide


Table of Contents

Introduction

1

Overview and Getting Prepared

2

Ten Steps to Community ROI

4

Step 1. Identify the Audience

5

Step 2. Estimate Community Need

6

Step 3. Calculate Community Investment

7

Step 4. Describe Community Services

8

Step 5. Describe Community Outcomes

9

Step 6. Describe Community Innovations

10

Step 7. Describe Community Stewardship

11

Step 8. Estimate Community Economic Impact

12

Step 9. Report Results

13

Step 10. Improve and Systemize the Process

13

Appendix A. Example Community ROI Report for Dominion CSB

14

Appendix B. Notes on Economic Impact Analysis

17

Appendix C. Overview of the Virginia Atlas of Behavioral Health

19


1

Introduction Virginia Community Services Boards (CSBs) provide vital services to more than 200,000 Virginians each year. The CSBs and facilities serve children and adults who have or who are at risk of mental illness, serious emotional disturbance, intellectual disabilities, or substance use disorders. All of these organizations function as:

Single points of entry into publicly funded behavioral health and developmental services, including access to state hospital and training center (state facility) services;

Service providers, directly and through contracts with other providers;

Advocates for individuals receiving services or in need of services;

Community educators, organizers, and planners;

Advisors to the local governments that established them; and

Local focal points for programmatic and financial responsibility and accountability. Anyone who has experienced a need for community behavioral health or developmental services, either personally or through a family member or friend, knows that CSB services are absolutely critical for the many thousands of individuals who need them. But today, funders are demanding a new kind of accountability at the community level. Like many other health and human service organizations, Virginia CSBs are being pressed to demonstrate the value they deliver. Funders are asking: Who do you serve? What services do you provide? How do these services make a difference? Are your services worth the investment? Clearly, Virginia CSBs have been answering these questions in one form or another for many years. Although the typical CSB might not use the exact terminology of „value‟ or „return on investment,‟ available reports provide a wealth of information on the work and the impact of Virginia CSBs. Building upon these existing capabilities, the Virginia Association of Community Services Boards decided to develop a more refined and systematic approach to defining, measuring, and communicating the community value of each CSB. This User Guide provides a framework and set of instructions for utilizing the Community ROI Model. The model was developed by Community Health Solutions (CHS) under a contract with the VACSB. Key steps in the development process included:

1. A VACSB Product Review Panel was formed to provide oversight and advice for the work completed by CHS.

2. CHS conducted a comprehensive literature review to identify existing studies of cost-benefit analysis or return on investment analysis related to the community value of behavioral health services. This search yielded numerous studies of the costs and benefits of particular categories of behavioral health services. The search did not identify any models for evaluating the community return on investment in behavioral health services.

3. Given the absence of an established model which might be adapted, CHS proceeded to develop an original model for pilot testing. The model was reviewed by the Product Review Panel and pilot tested by four CSBs. Pilot test feedback was used to refine multiple elements of the model.

The model presented in this User Guide is a flexible model designed to accommodate the significant diversity present in the services and systems of Virginia CSBs. The model can be – and should be – adapted and refined to meet the requirements of your particular CSB. The rest of this User Guide describes the framework and instructions for the using the model. Additional user support will be made available online and by telephone.


2

Overview and Getting Prepared The purpose of the Community ROI Model is to help Virginia CSBs define and communicate the value they deliver to the communities they serve. The basic concepts of the model are outlined below. Community ROI The Community ROI Model begins with a conceptual definition of community ROI. The community ROI for a program or organization can be generally defined as the value delivered to the community in relation to the community investment in the program or organization.

Community ROI = Community Value Delivered Community Investment

Applying this definition to CSBs, the community ROI for a CSB can be defined conceptually as the value delivered to the community per unit of community investment. Taking this definition from concept to practice poses practical challenges. Although we can quantify the direct community investment in the CSB, we cannot fully quantify the value returned to the community by the CSB. There is no simple solution to this challenge, which is present in virtually any attempt to measure the return on investment in public goods and services. Rather than exclude legitimate but unquantifiable benefits from the analysis, we adjust by analyzing return on community investment in quantitative terms when possible, and in qualitative terms when necessary. Community Value Community value is defined as the benefits delivered to the community by the CSB. The model captures community value in six dimensions including:

Community Need

Community Service

Community Outcomes

Community Innovations

Community Stewardship

Community Economic Impact Community Investment Community investment is defined in terms of total operating revenues generated by the CSB as an organization, including:

State Funds

Local Funds

Federal Funds

Medicaid Fees

Other Fees

Other Funds


3

Telling Your ROI Story The Community ROI Model is intended to equip you to tell a story about the community return on investment in your CSB. The details of the story will vary according to the particular characteristics of your CSB, and your audiences. The potential audiences for community ROI reporting include those people and organizations that either benefit from CSB services or provide support (monetary or other) for CSB services. But every story can have the same general outline, as follows:

In return for the community’s investment in our CSB, we deliver value by: Responding to significant community needs; Delivering or facilitating an array of vital services to the most vulnerable people in our

community; Producing outcomes that benefit individual consumers and the community at large; Continuously innovating to optimize access, quality, and cost efficiency; Demonstrating stewardship of resources through sound financial management and performance

monitoring; and Contributing to the sustainability of the local economy.

Getting Prepared As preparation for using the Model, it will be helpful to think about and gather the following:

Financial Data. Operating revenues by source; total operating expenditures; and operating expenditures for

wages/employee compensation (including benefits) and other major categories for the most recent fiscal year.

Employment Data. An estimate of FTE employees as of the end of the most recent fiscal year.

Consumer Data. The number of consumers served during the most recent fiscal year, by age and other characteristics if possible.

Consumer Outcomes. A list of three to five important consumer outcomes tracked by your CSB.

Innovations. A list of three to five recent innovations implemented by your CSB. An innovation may be defined as any change to a policy, program, practice, or system that resulted in an improvement in access, quality, or cost efficiency. Innovations achieved in collaboration with community partners are of special interest.

Strategic Performance Objectives. A list of three to five strategic performance objectives or benchmarks which your CSB is pursuing as an organization. As just one of many possible examples, if your CSB has developed a set of 'Balanced Scorecard' objectives, those objectives could be on your list of strategic performance objectives or benchmarks.


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Ten Steps to Community ROI The Community ROI Model will allow you to develop a community ROI report by following ten basic steps.

Step 1. Identify the Audience. The audience for a community ROI report should logically include those people and organizations that either benefit from CSB services or provide support (monetary or other) for CSB services.

Step 2. Estimate Community Need. CSBs deliver value by addressing serious community needs. The ROI audience should know something about the scope of community need as context for understanding the vital role of the CSB in promoting community health.

Step 3. Calculate Community Investment. The community investment in the CSB can be defined in terms of total revenue from all public and private sources. The community investment may also include the value of voluntary or discounted services provided to the CSB. This will vary by CSB, and can be measured as feasible.

Step 4. Describe Community Services. CSBs deliver value by providing multiple services to a diverse group of people. The ROI audience should know about the scope and diversity of services so they can appreciate the number of people who benefit, and appreciate the consequences that could result if CSB resources are reduced.

Step 5. Define Community Outcomes. CSBs deliver value by improving individual and community outcomes. The ROI audience should know that these outcomes in health, wellness, recovery, productivity, and independence benefit not only consumers and their families, but also the community at large.

Step 6. Describe Community Innovations. CSBs deliver value by working with consumers and community partners to generate innovative, evidence-based programs and services. The ROI audience should know that CSBs are some of the most innovative organizations in Virginia, and many of their innovations have resulted in significant improvements in outcomes as well as substantial cost savings.

Step 7. Describe Community Stewardship. CSBs deliver value by demonstrating excellent stewardship of community resources. The ROI audience should know that the CSB demonstrates accountability for resources by adhering to high standards of accounting, auditing, and reporting. The ROI audience should also know if the CSB has adopted strategic performance benchmarks such as a „balanced scorecard‟ or some other strategic performance framework.

Step 8. Estimate Community Economic Impact. In addition to its role as a service provider, every CSB contributes to the local economy. The ROI audience should know that the CSB contributes to the local economy by providing jobs, attracting revenue, and purchasing goods and services.

Step 9. Report Results. The results of Steps 1-8 can now be used to produce a community ROI reporting template. This flexible template can be customized to optimize reporting to particular audiences.

Step 10. Improve and Systemize the Process. Having developed the information needed to complete Steps 1-8 for the first time, the next step is to systemize the process. Consider creating a set of systematic data development procedures and reporting templates that can be used repeatedly to produce ROI information and reports for your CSB.

The remainder of this User Guide provides instructions for completing each of the steps outlined above. As you follow the steps, please remember that this is intended to be a flexible model. Please think creatively about how to optimize each step for your organization. Also consider sharing your insights and ideas for improving the model with your peers in other CSBs.


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Step 1. Identify the Audience (Open Workbook Sheet 1) The audience for a community ROI report should logically include those people and organizations that either benefit from CSB services or provide support (monetary or other) for CSB services. For example:

Consumers and their families who benefit from CSB services;

Community service providers (public and private) who also serve CSB consumers and their families;

Third-party payers who provide reimbursement for CSB services on behalf of consumers and families;

Lawmakers and public officials at the local, state, and federal level who authorize public funding for CSB services;

Private grant makers that provide funding for CSB services;

Community employers who benefit from healthier employees; and

Community school systems that benefit from healthier children and families. Convene your team to discuss and identify key audience members. To identify the audiences who may be interested in your community ROI reports:

Open Worksheet 1 of the accompanying Community ROI Model Workbook.

In the space provided in the Worksheet, make a list of particular people and organizations that are likely to be interested in your ROI information.

As each is identified, briefly discuss why they would be interested, and the particular types of information they might value. If you are not sure what key audience members would appreciate, consider asking them what kinds of ROI information they would like to receive.

Keep key audience members in mind as you proceed with Steps 2-10.


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Step 2. Estimate Community Need (Open Workbook Sheet 2) CSBs deliver value by addressing serious community needs. The ROI audience should know something about the scope of community need as context for understanding the vital role of the CSB in promoting community health. To estimate community need in the service region of your CSB:


In the upper part of the worksheet, enter the prevalence estimates1 for your CSB from the table provided.

At your option:

In the optional part of the worksheet, you might want to include additional or more specific estimates of community need. To do so:

o Open the Virginia Atlas of Behavioral Health which is provided in a separate Microsoft Excel

workbook.

o Browse the list of community indicators for your CSB region.

o Enter the indicators of interest in Worksheet 2 of the Community ROI Model Workbook.

Using the results:

The results of Worksheet 2 will be used to produce the Community Need module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A.

Example of Community Need for Dominion CSB

The Dominion CSB service region includes more than 71,000 people residing in Piedmont City and Dominion County. Within this population, an estimated 1,400 individuals age 6 and older may have an Intellectual Disability. An estimated 5,200 persons age 12 and older may have experienced dependence or abuse involving illicit drugs or alcohol in the past year. An estimated 11,400 persons (ages 18 and older) may have a serious mental illness and 900 persons (ages 9 to 17) may have experienced serious emotional disturbances. Any of these individuals may seek help from Dominion CSB.

Estimated Local Population with

Behavioral Health Conditions, 2010

Condition Estimate

Intellectual Disability Age 6+ 1,400

Alcohol or Drug Problem in Past Year, Age 12+

5,200

Serious Mental Illness Age 18+ 11,400

Serious Emotional Disturbance Age 9-17

900

1 Community Health Solutions analysis of 2010 data from SRC Corporation.


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Step 3. Calculate Community Investment (Open Workbook Sheet 3) The community investment in the CSB should logically include the total funding of the CSB. This can be defined in terms of total revenue from all public and private sources. At your option, the community investment may also include the value of voluntary or discounted services provided to the CSB or CSB consumers. This will vary by CSB, and can be measured as feasible. To calculate the community investment in your CSB:


In the upper part of the worksheet, enter the revenues received from each of the sources listed for the most recent 12-month period for which both financial data and community service data are available. (The community service data will be needed for Step 4.)

At your option:

In the optional part of the worksheet, include the economic value of voluntary or discounted services provided to the CSB or CSB consumers. Examples might include: o The economic value of volunteer services provided to the CSB or CSB consumers;

o The economic value of prescription drugs or other health products and services provided at no cost or

discounted cost for CSB consumers. When deciding whether to include these optional factors in your community investment calculation, consider both the magnitude of the investment and the feasibility of producing an authentic estimate of the economic value. If you need help calculating the economic value of volunteer time or free or discounted services, technical assistance is available.

Using the results: The results of Worksheet 3 will be used to produce the Community Support module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A. Example of Community Investment for Dominion CSB Dominion CSB finances its work through a combination of public and private sector funding. In 2009, Dominion CSB generated revenues of $15.9 million from the multiple sources shown in the chart. It is worth noting that for every $1 of direct local funding to Dominion CSB, almost $22 was generated from other sources. Fee revenue came primarily from Medicaid but also from other sources.

Dominion CSB Sources of Support, 2009

Source Investment

Total $15,922,382

State $2,808,003

Local $693,621

Federal $885,236

Medicaid Fees $8,989,910

Other Fees $1,802,524

Other Funds $743,089


8

Step 4. Describe Community Services (Open Workbook Excel Sheet 4) CSBs deliver value by providing multiple services to a diverse group of people. The ROI audience should know about the scope and diversity of services so they can appreciate the number of people who benefit, and appreciate the harm that could result if CSB resources are reduced. To describe community services provided by your CSB:


In the upper part of the worksheet, follow instructions to enter the number of consumers your CSB serves by age group.

At your option:

In the optional part of the worksheet, you might want to include more specific descriptors* of community services provided by your CSB. The options provided include:

o Consumers served by service type

o Consumers served by source of payment

o Consumers served by income level.

* The feasibility of producing these descriptors will depend on the data and reporting systems available at your CSB. If you need help developing these indicators, technical assistance is available.

Using the results:

The results of Worksheet 4 will be used to produce the Community Service module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A.

Example of Community Service for Dominion CSB Dominion CSB offers mental health services, intellectual disability services, and substance use services. We also offer emergency services for people in crisis, early intervention services for young children, and prevention services to reduce risk and promote wellness. In 2009 we provided direct services to 3,900 individuals including 780 consumers age 0-17, 2,535 consumers age 18-64, and 585 consumers age 65+.

Dominion CSB Consumers, 2009

Consumers Count

Total Consumers Served (unduplicated) 3,900

Consumers Age 0-17 780

Consumers Age 18-64 2,535

Consumers Age 65+ 585


9

Step 5. Describe Community Outcomes (Open Workbook Sheet 5) CSBs deliver value by improving individual and community outcomes. The ROI audience should know that individual outcomes - in terms of improved health, wellness, recovery, productivity, and independence - benefit not only consumers and their families, but also the community at large. To describe community outcomes achieved by your CSB:

Convene your team to identify a set of individual consumer outcomes your CSB achieves. Also discuss how these individual outcomes benefit the community at large. You can use the Dominion CSB example below (and in Worksheet 5) as a source of ideas for describing individual outcomes in terms of community impact.

When your team has identified a solid set of outcomes to describe, open Worksheet 5 of the accompanying Community ROI Model Workbook. Follow instructions to enter a set of outcomes for your CSB.

Using the results:

The results of Worksheet 5 will be used to produce the Community Outcomes module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A.

Example of Community Outcomes for Dominion CSB

The individual value of Dominion CSB services can be defined in terms of consumers‟ improvements in health, wellness, recovery, productivity, and independence. This value accrues to the community in the form of increased productivity in school and work, reduced community costs for other services, and enhanced quality of life.

Dominion CSB helps… …accomplish these individual and community outcomes…

Infants and toddlers with disabilities and their families…

Require fewer special education services and some types of medical services, resulting in long-term cost savings in decreased grade repetition, reduced special education spending, lower healthcare costs, increased tax revenues, and lower juvenile justice costs.

Children, youth, and families…

Prevent risky behavior, including substance and alcohol use and the associated costs of treatment.

Adults and youth in crisis… Stabilize their situation and mitigate the need for costly inpatient hospitalization and encounters with the criminal justice system.

Adults and youth with serious mental illness…

Manage their condition and live in community settings at far less cost than hospitals, jails, or homeless shelters.

Adults and youth with severe substance use disorders…

Recover to clean and sober lives, employment, supporting their families, and mentoring others out of the addiction cycle.

Individuals with intellectual disabilities…

Gain independence, hold jobs, and live in community settings at far less cost than nursing homes and state institutions.

Veterans and their Families Overcome the traumas of stress-related and traumatic brain injuries, and fully rejoin their community.


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Step 6. Describe Community Innovations (Open Workbook Sheet 6) CSBs deliver value by working with consumers and community partners to generate innovative, evidence-based programs and services. The ROI audience should know that CSBs are some of the most innovative organizations in Virginia, and many of their innovations have resulted in significant improvements in outcomes as well as substantial cost savings. To describe community innovations achieved by your CSB:

Convene your team to identify a set of innovations your CSB has implemented with positive impact. As applicable, also discuss how these innovations were achieved in collaboration with consumers and community partners. You can use the Dominion CSB example below (and in Worksheet 6) as a source of ideas for describing your innovations.

When your team has identified a solid set of innovations to describe, open Worksheet 6 of the accompanying Community ROI Model Workbook. Follow instructions to enter a set of innovations for your CSB.

Using the results:

The results of Worksheet 6 will be used to produce the Community Innovation module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A. Example of Community Innovation for Dominion CSB

Dominion CSB works in partnership with consumers and community partners to generate innovative and evidence-based programs and services. All of these programs and services are designed to maximize value for the individual consumer and the community.

Program Innovation

School-Based Therapy Program

Partners with school divisions to identify students in need of counseling services. The program promotes increased academic performance, decreased disciplinary problems at school and home, and healthy interpersonal relationships by identifying mental health or substance use disorders that create behavioral problems.

Targeted Case Management

Offers personal and individualized support for addressing immediate and long-term needs of children and adults with serious mental illness and serious emotional disturbance. The Case Manager provides active linking to services, monitors progress toward goal achievement, and helps the individual maintain adherence to the treatment plan.

Money Follows the Person

Helps individuals with intellectual disabilities return to their communities from institutional living with the help of a case manager who provides assistance with waivers, employment, housing, and services.

Crisis Stabilization Help adults in crisis recover through a coordinated package of evidence-based services, resulting in reduced hospital days and positive outcomes.

Walk-in Hours for Substance Use Treatment

Provides walk-in hours for adults in need of substance use treatment, resulting in more consumers treated and no waiting lists for treatment.

Jail Diversion Provides a team approach to divert, coordinate, and clinically manage the needs of individuals who are mentally ill and involved in the criminal justice system, resulting in positive outcomes and reduced incarceration costs.


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Step 7. Describe Community Stewardship (Open Workbook Sheet 7) CSBs deliver value by demonstrating excellent stewardship of community resources. The ROI audience should know that the CSB demonstrates accountability for resources by adhering to high standards of accounting, auditing, and reporting. The ROI audience should also know if the CSB has adopted strategic performance standards and benchmarks such as a „balanced scorecard‟ or some other strategic performance framework. To describe community stewardship practiced by your CSB:

Convene your team to identify the ways in which your CSB demonstrates accountability for resource utilization. Also identify any strategic performance standards and benchmarks you may be using to assure efficient and effective utilization of resources. You can use the Dominion CSB example below (and in Worksheet 7) as a source of ideas for strategic performance benchmarks.

When your team has identified a solid set of stewardship practices to describe, open Worksheet 7 of the accompanying Community ROI Model Workbook. Follow instructions to enter a set of stewardship practices and strategic performance benchmarks for your CSB.

Using the results:

The results of Worksheet 7 will be used to produce the Community Stewardship module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A.

Example of Community Stewardship for Dominion CSB

Dominion CSB views stewardship of community resources as an absolute priority. We demonstrate accountability for the resources we receive through strict adherence to established standards of accounting, auditing, and reporting. We also pursue a set of strategic performance standards and benchmarks to assure that we continuously improve our capacity to deliver value to the community. To generate these benchmarks we use a „Balanced Scorecard‟ approach. This approach is widely used in many industries to promote performance and demonstrate accountability. Our current Balanced Scorecard objectives are shown at right.

Dominion CSB Balanced Scorecard Objectives

Perspective Objective

Customers 1. Ensure that services are available, timely and efficient

Service Quality

2. Ensure that services are effective and meet individual needs

Risk Management

3. Maintain performance in key risk management indicators

Finance 4. Ensure that the CSB is operationally sound

Employees 5. Maintain a high quality workforce


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Step 8. Estimate Community Economic Impact (Open Workbook Sheet 8) In addition to its role as a service provider, every CSB contributes to the local economy. The ROI audience should know that the CSB contributes to the local economy by providing jobs, attracting revenue, and purchasing goods and services. To describe the community economic impact of your CSB:

Start by reading the overview of economic impact analysis in Appendix B.

Open Worksheet 8 of the accompanying Community ROI Model Workbook. Browse the worksheet to see what kinds of inputs and outputs are produced by the economic impact module.

Enter the input data for your CSB according to the instructions provided in Worksheet 8. Watch as the spreadsheet automatically calculates the economic impact of your CSB.

Review the results of the economic impact analysis with your team. Discuss the options for communicating the results to your key audiences. Which key audiences would value information on the economic impact of the CSB? How receptive would they be to the methodology? Which elements of the methodology might require more explanation and clarification? To inform this discussion, it might be helpful to review the example of Community Economic Impact reporting from the fictional Dominion CSB provided below.

Using the results:

The results of Worksheet 8 will be used to produce the Community Economic Impact module of your community ROI report, as illustrated in the following excerpt from the fictional Dominion CSB report in Appendix A.

Example of Community Economic Impact for Dominion CSB

In addition to its role as a community service provider, Dominion CSB is a contributor to the local economy. In 2009 Dominion CSB directly provided 316 jobs, paid $11.4 million in employee compensation, and spent $15.9 million in total output/expenditures. Using standard methods of economic impact analysis, it is estimated that these direct outputs may have supported 130 additional jobs, $6.6 million in additional labor income, and $8.4 million in additional economic output.

Dominion CSB Economic Impact,

2 2009

Direct Impact

Ripple Effect

Total Impact

Total Jobs 316 130 446

Direct Impact

Ripple Effect

Total Impact

Total Labor Income

$11.4 m $6.6 m $18.0 m

Direct Impact

Ripple Effect

Total Impact

Total Output

$15.9 m $8.4 m $24.3 m

2 Community Health Solutions estimation and analysis of economic impact using IMPLAN® economic modeling system.


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Step 9. Report Results (Download Template) The results of Steps 1-8 can now be used to produce a community ROI reporting template as shown in the Dominion CSB example in Appendix A. An electronic version of this template is provided in Microsoft Word format at the VACSB ROI website at http://vacsbroi.webexone.com. As you begin to craft your reports, please keep the following guidelines in mind: Download the reporting template.

The reporting template, like the Community ROI Model itself, is intended to be a flexible template. You can and should adapt the template to meet the needs of particular audiences.

The reporting template has an Introduction and seven reporting modules (Community Need, Community Investment, Community Service, Community Outcomes, Community Innovation, Community Stewardship, and Community Economic Impact). You should feel free to edit, reorder, or eliminate any of these modules from a particular report.

Technical assistance is available if you have any questions or concerns about particular aspects of reporting.

Step 10. Improve and Systemize the Process As you work through the Community ROI Model with your team, you will undoubtedly identify opportunities for improving the model in general or as it applies to your particular situation.

We encourage you to share your insights and ideas for improving the model with VACSB and CHS so that we can continuously improve the product.

We also encourage you to systemize the process of executing the model. Consider creating a set of systematic data development procedures and reporting templates that can be used repeatedly to produce ROI information and reports for your CSB.


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Appendix A. Example Community ROI Report for Dominion CSB This appendix presents an example report for the fictional Dominion CSB. The template for the report includes an introduction and seven modules (Community Need, Community Investment, Community Service, Community Outcomes, Community Innovation, Community Stewardship, and Community Economic Impact.) Please view this template as a starting point and not a strict script. You can modify the template for your CSB by:

Editing the narrative

Reordering the modules

Expanding modules

Eliminating modules

Adding modules of your own Introduction

Dominion CSB is the behavioral health agency serving Piedmont City and Dominion County. Every day, we strive to help our consumers achieve the best possible outcomes in health, wellness, recovery, and independence. We view ourselves as community partners with an obligation to deliver the best possible value in return for the community support we receive. This value begins with the consumers we serve, and extends to the broader community. In this brief document we present a profile of the community impact of Dominion CSB. Please contact us to learn more about our work.

Mission of Dominion CSB

Dominion CSB is committed to improving the quality of life for people with, or at risk of developing, mental disabilities and substance abuse problems and to preventing the occurrence of these conditions. We do this through a system of caring that respects and promotes the dignity, rights, and full participation of families. To the maximum extent possible, these services are provided within the community.

Community Need

The Dominion CSB service region includes more than 71,000 people residing in Piedmont City and Dominion County. Within this population, an estimated 1,400 individuals age 6 and older may have an Intellectual Disability. An estimated 5,200 persons age 12 and older may have experienced dependence or abuse involving illicit drugs or alcohol in the past year. An estimated 11,400 persons (ages 18 and older) may have a serious mental illness and 900 persons (ages 9 to 17) may have experienced serious emotional disturbances. Any of these individuals may seek help from Dominion CSB.

Estimated Local Population with Behavioral Health Conditions,

3 2010

Condition Estimate

Intellectual Disability Age 6+ 1,400

Alcohol or Drug Problem in Past Year, Age 12+

5,200

Serious Mental Illness Age 18+ 11,400

Serious Emotional Disturbance Age 9-17

900

Community Investment

Dominion CSB finances its work through a combination of public and private sector funding. In 2009, Dominion CSB generated revenues of $15.9 million from the multiple sources shown in the chart. It is worth noting that for every $1 of direct local funding to Dominion CSB, almost $22 was generated from other sources. Fee revenue came primarily from Medicaid but also from other sources.

Dominion CSB Sources of Support, 2009

Source Investment

Total $15,922,382

State $2,808,003

Local $693,621

Federal $885,236

Medicaid Fees $8,989,910

Other Fees $1,802,524

Other Funds $743,089

Community Service

Dominion CSB offers mental health services, intellectual disability services, and substance use services. We also offer emergency services for people in crisis, early intervention services for young children, and prevention services to reduce risk and promote wellness. In 2009 we provided direct services to 3,900 individuals including 780 consumers age 0-17, 2,535 consumers age 18-64, and 585 consumers age 65+.

Dominion CSB Consumers, 2009

Consumers Count

Total Consumers Served (unduplicated) 3,900

Consumers Age 0-17 780

Consumers Age 18-64 2,535

Consumers Age 65+ 585

3 Community Health Solutions analysis of 2010 data from SRC Corporation.


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Community Outcomes

The individual value of Dominion CSB services can be defined in terms of consumers‟ improvements in health, wellness, recovery, productivity, and independence. This value accrues to the community in the form of increased productivity in school and work, reduced community costs for other services, and enhanced quality of life.

Dominion CSB helps… …accomplish these individual and community outcomes…

Infants and toddlers with disabilities and their families…

Require fewer special education services and some types of medical services, resulting in long-term cost savings in decreased grade repetition, reduced special education spending, lower healthcare costs, increased tax revenues, and lower juvenile justice costs.

Children, youth, and families… Prevent risky behavior, including substance and alcohol use and the associated costs of treatment.

Adults and youth in crisis… Stabilize their situation and mitigate the need for costly inpatient hospitalization and encounters with the criminal justice system.

Adults and youth with serious mental illness…

Manage their condition and live in community settings at far less cost than hospitals, jails, or homeless shelters.

Adults and youth with severe substance use disorders…

Recover to clean and sober lives, employment, supporting their families, and mentoring others out of the addiction cycle.

Individuals with intellectual disabilities…

Gain independence, hold jobs, and live in community settings at far less cost than nursing homes and state institutions.

Veterans and their Families Overcome the traumas of stress-related and traumatic brain injuries, and fully rejoin their community.

Community Innovation

Dominion CSB works in partnership with community partners to generate innovative and evidence-based programs and services. All programs and services are designed to maximize value for the individual consumer and the community.

Initiative Innovation

School-Based Therapy Program

Partners with school divisions to identify students in need of counseling services. The program promotes increased academic performance, decreased disciplinary problems at school and home, and healthy interpersonal relationships by identifying mental health or substance use disorders that create behavioral problems.

Targeted Case Management

Offers personal and individualized support for addressing immediate and long-term needs of children and adults with serious mental illness and serious emotional disturbance. The Case Manager provides active linking to services, monitors progress toward goal achievement, and helps the individual maintain adherence to the treatment plan.

Money Follows the Person Helps individuals with intellectual disabilities return to their communities from institutional living with the help of a Case Manager who provides assistance with waivers, employment, housing, and services.

Crisis Stabilization Help adults in crisis recover through a coordinated package of evidence-based services, resulting in reduced hospital days and positive outcomes.

Walk-in Hours for Substance Use Treatment

Provides walk-in hours for adults in need of substance use treatment, resulting in more consumers treated and no waiting lists for treatment.

Jail Diversion Provides a team approach to divert, coordinate, and clinically manage the needs of individuals who are mentally ill and involved in the criminal justice system, resulting in positive outcomes and reduced incarceration costs.


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Community Stewardship

Dominion CSB views stewardship of community resources as an absolute priority. We demonstrate accountability for the resources we receive through strict adherence to established standards of accounting, auditing, and reporting. We also pursue a set of strategic performance standards and benchmarks to assure that we continuously improve our capacity to deliver value to the community. To generate these benchmarks we use a „Balanced Scorecard‟ approach. This approach is widely used in many industries to promote performance and demonstrate accountability. Our current Balanced Scorecard objectives are shown at right.

Dominion CSB Balanced Scorecard Objectives

Perspective Objective

Customers 1. Ensure that services are available, timely and efficient

Service Quality

2. Ensure that services are effective and meet individual needs

Risk Management

3. Maintain performance in key risk management indicators

Finance 4. Ensure that the CSB is operationally sound

Employees 5. Maintain a high quality workforce

Community Economic Impact

In addition to its role as a community service provider, Dominion CSB is a contributor to the local economy. In 2009 Dominion CSB directly provided 316 jobs, paid $11.4 million in employee compensation, and spent $15.9 million in total output/expenditures. Using standard methods of economic impact analysis, it is estimated that these direct outputs may have supported 130 additional jobs, $6.6 million in additional labor income, and $8.4 million in additional economic output.

Dominion CSB Economic Impact,

4 2009

Direct Impact

Ripple Effect

Total Impact

Total Jobs 316 130 446

Direct Impact

Ripple Effect

Total Impact

Total Labor Income

$11.4 m $6.6 m $18.0 m

Direct Impact

Ripple Effect

Total Impact

Total Output

$15.9 m $8.4 m $24.3 m

4 Community Health Solutions estimation and analysis of economic impact using IMPLAN® economic modeling system.


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Appendix B. Notes on Economic Impact Analysis The purpose of economic impact analysis is to estimate how a particular organization or initiative impacts the local economy. In this Appendix we describe how economic impact analysis is applied in the Community ROI Model. The IMPLAN Model Economic impact analysis involves quantitative modeling to estimate the impact of a particular organization or initiative on the local economy. IMPLAN® economic impact modeling system provided by MIG, Inc (formerly Minnesota IMPLAN Group, Inc.) is used in this case to quantify the impact of your CSB on the economy of your service region. IMPLAN was developed from work with the U.S. Department of Agriculture Forest Service. IMPLAN is widely used across professions and industries including economics, academia, and government. The microcomputer-based system generates input-output multipliers by locality (city/county) and across industries. These economic multipliers can then be applied to organizational expenditures to produce the total economic impact of compensation, jobs, and output (sales/dollars). Economic Multipliers and the Ripple Effect Economic impact analysis for an organization (such as a CSB) begins with an analysis of the direct impact of the organization on the local economy. The direct impact is measured in terms of jobs supported, wages paid, and other organizational expenditures. The direct impact creates an additional economic impact which we might call the „ripple effect.‟ The ripple effect

5 occurs as employees spend their wages on goods and services provided by other businesses,

and as the organization spends its money on purchasing inputs (e.g. goods and services) from other businesses for the organization. The total economic impact of the organization can then be estimated as the direct impact plus the ripple effect. The IMPLAN Model uses standard economic analysis techniques to estimate the ripple effect of the direct jobs, wages, and expenditures of the organization. This is accomplished by applying a set of multipliers to the direct impacts.

The Employment Multiplier measures the change in employment (i.e. job creation) in the CSB service region generated by a change in CSB-provided jobs.

The Labor Income Multiplier measures the change in earnings in the CSB service region generated by a change in the CSB employee compensation.

The Output Multiplier measures the change in spending in the CSB service region generated by a change in dollars spent by that CSB.

Applying Economic Impact Analysis to a CSB Applying the general concepts above to a CSB, we can estimate the CSB‟s direct impact, ripple effect, and total impact on the local economy. To illustrate:

The CSB directly creates jobs and spends money on employee compensation, infrastructure, and other goods and services. We call these expenditures the direct impact.

The direct impact creates a ripple effect when CSB dollars are spent and then re-circulated in the economy.

The ripple effect is estimated by applying the three multipliers outlined above to project the additional jobs, labor earnings, and total spending created by the direct economic impact of the CSB.

Using the Dominion CSB example in Appendix A to illustrate the above:

In 2009 Dominion CSB directly provided 316 jobs, paid $11.4 million in employee compensation, and spent an additional $4.5 million on facilities, goods, and services.

5 The ripple effect is composed of two separate pieces: indirect and induced effects. The indirect effect measures the industry

response, whereas the induced effect measures the change in employee spending of earnings. In other words, the indirect effect quantifies the economic activity and response by other industries to the CSB inter-industry spending. The induced effect quantifies the portion of the increase in earnings (resulting from the indirect effect of CSB spending) that is re-spent in the economy on final goods and services. For more detailed explanation and methodology, contact Community Health Solutions.


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Using standard methods of economic impact analysis, it is estimated that these direct outputs supported 130 additional jobs, an additional $6.6 million in labor income, and an additional $8.4 million in economic output.

The total economic impact of Dominion CSB was estimated to be 446 jobs, $18 million in labor income, and $24.3 million in total spending.

Keeping Economic Impact Analysis in Perspective Economic impact analysis is a legitimate, widely used technique for measuring the economic impact of organizations on their local economy. The IMPLAN Model in particular is one of the most comprehensive tools for conducting economic impact analysis. This being said, it is important to remember that economic impact analysis is an estimation technique. In particular:

No one can guarantee that the estimates of ripple effects and total impacts are completely accurate. The actual economic impact of your CSB may be greater or lesser than the estimate produced in by the Model.

The economic impact analysis does not assume that if a particular CSB closed down tomorrow, all of its economic impact would be lost to the community forever. Hopefully another organization of some type would be started or expanded and begin to replace the jobs and expenditures previously provided by the CSB. The important point is that the economic impact of the CSB would have to be replaced in some fashion, or the community would suffer an economic deficit.


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Appendix C. Overview of the Virginia Atlas of Behavioral Health The Virginia Atlas of Behavioral Health contains 105 indicators, split into 11 sections, and categorized by CSB service region, locality, and health planning district. Those 11 sections of data are detailed below, including sources and methodology. The lines listed in the left-hand column correspond to lines in the Virginia Atlas of Behavioral Health workbook. Please refer to the workbook for CSB-relevant community health and community need data.

Lines Source

Lines 3-8

Total 2010 Population: Community Health Solutions analysis of 2010 data from SRC Corporation.

Lines 9-14

Children Covered under Comprehensive Services Act (CSA), 2010: Community Health Solutions analysis of

2010 Comprehensive Services Act locality data from http://www.csa.virginia.gov/publicstats/index.cfm. The Comprehensive Services Act is a 1993 Virginia Law that provided for the pooling of eight specific funding streams used to purchase services for high-risk youth. The purpose of the act is to provide high quality, child centered, family focused, cost effective, community-based services to high-risk youth and their families.

Lines 15-44

Children age 0-22+ in Special Education in Virginia Schools, 2010: Community Health Solutions analysis of

2010 Virginia Department of Education, Special Education Child Count data. School divisions are required to report an unduplicated count of students with disabilities receiving special education on December 1 or the closest school day to December 1 for state funding and federal reporting under provisions of the Individuals with Disabilities Education Act (IDEA) Part B. Data source: Virginia Department of Education, Special Education Child Count 2010. “Totals for Students with Disabilities by Disability and Age, Ages 0-22+.”

Lines 45-50

Number of Persons with SUDS, age 12+, 2010: Community Health Solutions produced synthetic estimates

based on Substate Estimates from the 2006-2008 National Surveys on Drug Use and Health (NSDUH) and 2010 population data from SRC Corporation. NSDUH defines 5 substate regions in Virginia, provided by the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services and are defined in terms of the State's 135 counties/independent cities.

Lines 51-52

Number of Adults with SMI, age 18 and older, 2010: Community Health Solutions produced synthetic estimates

based on the State Data Infrastructure Coordinating Center, Uniform Reporting System (URS) Table 1: Number of Persons with Serious Mental Illness, age 18 and older, by State, 2009.

Lines 53-55

Number of Youth/Adolescents with SED, age 9 to 17, 2010: Community Health Solutions produced synthetic

estimates based on the State Data Infrastructure Coordinating Center, Uniform Reporting System (URS) Table 1: Number of Children with Serious Emotional Disturbances, age 9 to 17, by State, 2009.

Lines 56-59

Number of Persons with ID, age 6+, 2010: Community Health Solutions produced synthetic estimates based on

the Virginia Department of Behavioral Health and Developmental Services (VDBHDS) - Comprehensive State Plan 2010-2016. "National research on the prevalence of intellectual disability range from 1 and 3 percent of the population over age 6 (Arc of the United States, October 2004). A conservative approximation (using the 1 percent rate)..."

Lines 60-62

Number of Persons with DD, all ages, 2010: Community Health Solutions produced synthetic estimates based

on the Virginia Department of Behavioral Health and Developmental Services (VDBHDS) - Comprehensive State Plan 2010-2016. "The U.S. Centers for Disease Control (CDC) and the U.S. Administration on Developmental Disabilities (ADD) and its parent organization, the U.S. Administration on Children and Families (ACF), estimate that the prevalence of developmental disabilities is from 1.2 percent to 1.8 percent of the general population. The ADD asks state DD Councils to use the 1.8 percent prevalence rate."

Lines 63-112

Behavioral Health Hospital Discharges (Primary or Secondary diagnosis), 2009: Community Health

Solutions analysis of hospital discharge data from Virginia Health Information's 2009 dataset. The data reported are hospital discharges, with a primary or secondary behavioral health diagnosis (top 20 behavioral health diagnoses reported). Note that VHI data by locality may include patients outside Virginia residence. VHI requires the following statement to be included in all reports utilizing its data: Virginia Health Information (VHI) has provided non-confidential patient level information used in this report which was compiled in accordance with Virginia law. VHI has no authority to independently verify this data. By accepting this report the requester agrees to assume all risks that may be associated with or arise from the use of inaccurately submitted data. VHI edits data received and is responsible for the accuracy of assembling this information, but does not represent that the subsequent use of this data was appropriate or endorse or support any conclusions or inferences that may be drawn from the use of this data.

Lines 113-115

Health Measures, from County Health Rankings 2010: Community Health Solutions analysis of 2010 County

Health Rankings.

Lines 116-118

Virginia Crime Rates, 2009: Community Health Solutions analysis of 2009 violent crime and drug arrest rates

from Virginia Department of Criminal Justice Services (DCJS) Criminal Justice Research Center - Virginia Crime Trends 2000-2009.

the vacsb community roi model...the roi audience should know that these outcomes in health,...

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