2.1 Overview And Background

 

The ASH Redesign began March 2018 with an initial $2.5M investment from the Texas Legislature’s 85th special session to pre-plan the ASH campus, with a goal to become a national leader in brain health care. Planning commenced using a “person first” approach to set the stage for work groups comprised of dedicated stakeholders and community members. Across the three planning phases, the steering committee and work group members have established recommendations to create a world-class brain health system for Central Texas’ most vulnerable population, to optimize the investment in the new hospital. 

The project received strong legislative support throughout the 85th, 86th and 87th legislative sessions totaling $304.6M. 

“…a ‘person first’ approach to set the stage for work groups comprised of dedicated stakeholders and community members.”

*The timeline of the hospital build aligned with splitting the construction funding through two legislative sessions. This split created a warm shell package to complete the exterior and a dry, secure building, and a hospital completion to finish the interior of the hospital. The schedule was not impacted by the funding split; however, doing so did increase the final cost by $6M due to cost escalation and delay of the construction buyout process. 

While design and construction progressed, the steering committee and work group members continued to develop solutions for the regional continuum of care. Here we summarize Phases I and II, with more details at ashredesign.org.

Phase I Ash Redesign | CY2018 

The need to invest in state psychiatric hospitals initiated from the Cannon Report (2014) (Appendix 1). This report raised concerns of the condition of all the state facilities, in particular noting ASH was in “poor” and “critical” condition. HHSC’s A Comprehensive Plan for State-Funded Inpatient Mental Health Services (Appendix 2) also supported the need for new builds or renovations to enhance hospital facilities. These two documents created the momentum for the first investment of the new ASH, as previously mentioned. 

Phase I planning established a Steering Committee, 7 subcommittees, and 8 work groups (detailed lists can be found at ashredesign.org). Altogether, the members of these groups comprised a total of 116 volunteer stakeholders to develop the first set of recommendations for the ASH Redesign. Along with convening stakeholders for solution driven recommendations, and following the procurement processes of the University of Texas, Page Southerland Page, Inc. (Page/) in partnership with architecture+ were contracted to complete the master plan for the campus and design of the hospital (Appendix 3). Notably, in August 2022, the master plan that was developed was awarded the Next Best Idea from Urban Land Institute’s Impact Awards. Along with a master plan, Phase I produced a qualitative report to best understand a person’s experience through the system and inform the Steering Committee of opportunities for a more person-centered approach in the care provided in the hospital and continuum of care (Appendix 4). The Phase I report recommended the following: 

Transform the Austin State Hospital Campus 

  1. Replace the existing outmoded adult hospital with a new state-of-the-art facility. 

  2. Improve ASH operations. 

  3. Change the ASH reporting structure. 

  4. Initiate a brain health platform on the ASH campus and beyond. 

Optimize the Use of Community Psychiatric Beds in the Region 

  1. Expand the community psychiatric bed-purchasing program (CPB). 

  2. Expand CPB to provide short-term competency restorations.

Redesign Competency Restoration Programs and Processes 

  1. Establish consistent competency standards and assessments across all courts. 

  2. Establish a formal 60-day inpatient competency restoration limit. 

  3. Create a regional competency restoration team to work across venues. 

Increase Residential Care and Supported Housing Capacity 

  1. Foster better use of the HCBS-AMH 1915(i) State Plan Amendment program. 

  2. Finance expansion of evidence-based residential care and supported housing. 

Phase II ASH Redesign | CY2019-2020 

Phase II planning initiated preparation of the ASH campus for construction, beginning with the legislature appropriating $165M to this end in the 86th legislative session. This funding initiated construction but did not fund the complete project; final funding was secured in the next session (87th). Following the procurement processes of the University of Texas, Turner Construction Company (TCCO) was contracted as the construction manager at risk to build the new hospital. 

While the construction started on the ASH Campus, Dell Medical School convened 69 volunteer stakeholders, community members, people with lived experience, experts in medical, judicial, and forensic mental health to develop recommendations. Along with the Steering Committee, there were 6 work groups to help lead to potential solutions for an efficient new ASH (details can be found at ashredesign.org). 

The Phase II report recommended the following to HHSC: 

Complete the new Austin State Hospital construction 

Increase Functional Bed Capacity – i.e., optimize the use of the new hospital 

Strategy 1: Increase opportunities for hospital discharge by rapidly creating alternative residential care and housing options. 

Strategy 2: Reduce forensic hospitalizations by creating a roadmap that provides alternatives to ASH for competency restoration. 

Strategy 3: Engage academic and service area experts to optimize efficient, evidence-based treatment in ASH that facilitates recovery in order to support smooth transitions to care in the least restrictive environment. 

Expand Peer Engagement 

Strategy 1: Continue to enhance engagement into the ASH Redesign process of people from diverse ethnic, racial, sexual orientation, gender identity, and disabilities backgrounds. 

Strategy 2: Work to ensure ASH has a robust financially sustainable peer support program. 

Sharing the History of ASH 

Strategy 1: Share the history of ASH with the community. 

Strategy 2: Create a space for collection management and interpretation. 

Strategy 3: Preserve environmental aspects of the campus. 

The COVID-19 pandemic began halfway through the work groups’ meeting efforts. This changed our meeting setting to virtual, but did not hinder participation or strategic planning for recommendations. The pandemic has created delays in construction planning and process, that the team has consistently worked through to get to a new targeted opening in 2024. 

“…the identified priority from all groups is the need for an Austin market competitive salary for all hospital staff.”

Phase III ASH Redesign | CY2021 - 2022 

The third Phase of the ASH Redesign marked the 87th legislative appropriations for the investment to complete the new ASH construction for $124.1M. With the funding secured for the construction, Phase III Steering Committee and Work Groups convened to determine what enhancements to the continuum of care can be recommended to create the most efficient ASH. The Steering Committee membership shifted with a few changes and the latest member list is provided in Table 2. 

The five work groups established continued to build on previous work groups’ efforts and were: 

  1. Housing 

  2. Competency Restoration 

  3. Academic and Area Expert Engagement 

  4. History of ASH 

  5. Peer and Family 

The focus of this Phase III report details the dedicated work from the members and recommended solutions to enhance the continuum of care. As mentioned in the Executive Summary, the identified priority from all groups is the need for an Austin market competitive salary for all hospital staff. Without securing these operation funds, the new ASH will not open at full capacity. 

Key Points – Overview and Background:

• Texas Law Makers invested $304.6M in the ASH Redesign.

• ASH Redesign Phases I and II established recommendations to build a new ASH and focus on an efficient continuum of care.

• ASH Redesign Phase III urges the need for livable and competitive salaries for the ASH staff to ensure operating at capacity, while continuing work on the care continuum.