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MHSASteering Committee

April 6, 2009

1 p.m. – 4 p.m.

Health Care Agency/Behavioral Health Services

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Sharon Browning

Welcome

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Consumer Perspective

Report on the CNMHC Client Forum February 20-22 Theresa Boyd William Gonzalez

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Mark Refowitz

Local/State Updates

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Technology Update

Orange County Behavioral Health Service's path to an Electronic Health Record (EHR) has begun to be defined:

It is a two prong process:

1. Clinical Content Design and Definition of Methodology.

2. Upgrade Network and System Infrastructure to support an EHR application.

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Clinical Content Design

We are performing our due diligence to design the best and most efficient clinical content and execution methodology to reflect Recovery oriented services and support compliance with Medi-Cal and Medicare billing standards

An additional design consideration is to allow for outcome measures to be gathered from our clinical documentation

To assist us in this effort we have hired an EHR Project Coordinator

We are also part of a Statewide Coalition that is coming together to identify the best practices for treatment plans and other clinical documentation

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Upgrade Network and System Infrastructure to support an EHR application Existing systems and supporting applications

are old and past end-of-life, and need to be upgraded to better support current technologies and to sustain the development and deployment of an integrated EHR system.

MHSA funds will be needed to pay the Mental Health Plan’s proportional share of the servers and other hardware peripherals required for this upgrade.

We will be back before the end of this Fiscal Year with a specific infrastructure upgrade plan.

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Technology Stakeholder Process

We will be forming two Advisory Committees to assist us with our efforts:

EHR Design Advisory Committee Its purpose will be to ensure our content is recovery

oriented and that any IT expenditures support MHSA goals

Outcome Measures Advisory Committee Its purpose will be to assist us in identifying meaningful

outcome measures using the data currently available and data from the EHR in the future

If you would like to participate in either of these Advisory committees, please provide your contact information to Kate Pavich at the break or after today’s meeting

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Rochelle Pierre

MHSA Housing

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Jenny Qian

Prevention and Early Intervention (PEI) Update

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PEI Plan Update

PEI Plan approved unanimously by Oversight and Accountability Commission (OAC) on 3/26/09

Orange County will fund 8 projects which includes a total of 33 programs

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PEI Plan Update

Current Procurement Plan Provider Preparation for PEI

Principles and Trainings for PEI SIQ/RFP

Prevention vs. Treatment

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Kate Pavich

MHSA Updates

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MHSA Updates

Spirituality Initiative California Conference on Mental Health

and Spirituality - June 4, 2009 To increase awareness of spirituality as

a potential resource

To encourage collaboration among faith-based/mental health groups, consumer and families in combating stigma and reducing disparities in access

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California Strategic Plan on Reducing Mental Health Stigma & Discrimination - Public Workshop - March 19, 2009

Workshop was co-sponsored by the California Department of Mental Health and Orange County Health Care Agency

Total of 92 attendees

Solicited input on the draft: Vision, Core Principles, Strategic Directions, and Recommended Actions for the 10-year

California Strategic Plan on Reducing Mental Health Stigma and Discrimination

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Recovery Arts Program

April 16: MHSA Coordinators Regional Meeting

May 21: Art Fair and Calendar Contest

July 11 - August 23: Arts Festival

Such Great Heights by Theresa Boyd

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Innovation Component

Received notice of funding approval for $2,893,800

Funds will be used for community program planning.

Information regarding stakeholder meetings will be released in April.

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Capital FacilitiesProject Proposal The Capital Facilities Project Proposal

was approved on March 12, 2009 by the Department of Mental Health for $18,300,125.

These funds will be used for developing the Crisis Residential, Wellness/Peer Support Center, and the Education and Training Program at 401 S. Tustin St., Orange CA.

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401 S. Tustin Street

Maricela Loaeza

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401 S. Tustin St. (Front View)

Crisis ResidentialEducation and Training Center

Wellness/Peer Support Center

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401 S. Tustin St. (Rear View)

Crisis Residential

Education and Training Center

Wellness/Peer Support Center

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Crate and Barrel: Furniture

Crate and Barrel has been featuring renewable woods and sustainable materials for a number of years.

The majority of the upholstered sofas and chair frames are now certified sustainable by the Forest Stewardship Council (FSC).

Since 2005, Crate and Barrel has worked closely with the Tropical Forest Trust (TFT) to ensure that certain hardwoods selected for furniture are from plantations that are responsibly and socially managed.

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Crisis Residential Furniture

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Maureen Robles

Veteran Services

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BUILDING BRIDGESFOR OUR VETERANS

OC Health Care Agency

Behavioral Health Services:

Caring for Orange County Veterans

and their Families

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How Many Vets Are We Talking About? Total US veteran (all wars) population as

of September 2008:

Approx. 23.4 million

Total Orange County veteran (all wars) population September 2008:

Approx. 148,915

5% of OC’s population are veterans

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How Many Female VetsAre We Talking About? US female veterans (all wars) number

1,802,491

California has the highest number of female vets (all wars) at 166,984

Orange County has the second highest female veteran (all wars) population at 9,638 (Los Angeles has 30,590)

Total registered female vets at Long Beach Veteran’s Administration (including LA vets): 1,000

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Now That You Are Home…

POST COMBAT ISSUES Transition – combat stress PTSD Anger Depression Anxiety Self-medication with substances such as

alcohol, medications and illegal drugs

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Symptoms/Behaviors

Symptoms can lead to behaviors such as: Inability to concentrate at work/jobs Marital problems, domestic abuse, child

abuse Substance abuse Legal problems (DUI, tickets, etc.) Inability to sleep Reckless driving Civil disturbances (bar fights, etc.) Apathy, inability to keep appointments

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Symptoms/Behaviors

Multiple deployments equals more depression, PTSD, alcohol use, etc.

Army Reserve/National Guard and Marines have seen more combat in the current conflicts(OIF/OEF)* and have more behavioral health issues

*Operation Iraqi Freedom/Operation Enduring Freedom (Afghanistan)

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What’s the Problem?

In 2007, 300,000 vets self-disclosed moderate levels of depression and anxiety at the 90-day PDHRA (post deployment health readiness assessment)

Only 60% of those veterans registered at the Veterans Administration

(PDHRA started in 2005. There are no stats on previous combat veterans)

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Final Outcome

Broken marriages Job loss Incarceration Homelessness Repeated hospitalizations Reliance on county/state/federal social-

support programs Suicide Accidental death or severe medical issues

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Final Outcome

Veterans lose

Families lose

Society loses

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Proposed Veterans’ Plan for BHS: Primary Premise The Veterans Administration healthcare

system is “priority positioned” to provide superior mental health outcomes for veterans to seek and complete treatment

Orange County should not be the primary provider of mental health care to the American veteran

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Core Issues: Many Veterans do not seek services

for behavioral health issues

Many Veterans will not seek help at the VA

Veterans will show up in their community for symptoms related to their combat issues

Increasing number of veterans are involved in the legal system (domestic violence, drug related charges, etc.)

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Do You Knowthe Way to the VA?Why don’t vets seek care at the VA? Not eligible Don’t trust the VA or government Transportation issues Co-pays and wait times Unaware of benefits and VA capabilities Don’t know how to access Privacy concerns

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Barriers to SeekingBehavioral Health Care Warrior mentality

Stigma

Lack of insight (symptoms recognition vs. cognitive dysfunction from traumatic brain injury – TBI)

Lack of eligibility or lack of knowledge about benefits

Military career concerns

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Million Dollar Question

How to get the Veterans to intersect with Behavioral Health Care Provider?

And, how to overcome barriers for the Veteran to receive definitive mental health care preferably at the VA?

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Recommendation: Conceptual Framework For Veterans Behavioral Health Care VA has skilled, up-to-date, trained behavioral

health clinicians and integrated veterans’ programs

There are many effective community groups that wish to positively intervene to assist veterans

The OC Community wants veterans and families to be healthy

Case finding and overcoming reluctance to seek care at the VA is a primary barrier to positive outcomes

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Conceptual Framework ForVeterans Behavioral Health Care OC should primarily assist with case finding and

providing a

‘warm’ hand-off to the VA OC should provide follow-up to insure that veterans

continue to seek treatment at the VA Some situations may require OC intervention for short

term ‘bridging’ care OC will treat veterans who request treatment by OC BHS

rather than VA. Some veterans may complete entire course of care with OC BHS.

We will respect our client’s choice of provider There are many effective community groups that

wish to positively intervene to assist veterans

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Treatment Modality for Combat Stress and PTSD There is recent evidence from many sources

that early treatment results in better outcomes.

Ongoing research supports first line treatments such as:

Cognitive Behavioral Therapy

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Exposure Therapy

Pharmacological Therapy

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Cornerstones

All approaches should include:

Cultural competency

Evidence-based practices

Performance outcome measurements

Consumer involvement

Recovery philosophy

Integration of co-occurring treatment

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Successful Outcomes

Keys to successful outcomes are:

Early recognition and intervention

Evidence-based practice

Multi-agency, community and family collaboration

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Orange County: Veterans/Behavioral Health Services Plan

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Early Interceptors

Train early interceptors

Early interceptors are contacts at places where the veteran or family may first present with problems/issues

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Early Interceptors

Healthcare: Primary providers Emergency rooms/urgent care Emergency behavioral health teams

Colleges: Classroom instructors Guidance counselors Student health Student Veteran Associations

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Early Interceptors

Law enforcement: Public defenders Courts Emergency response Probation

Substance abuse: Primary provider Substance abuse clinics/groups

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Early Interceptors

Community organizations (NAMI, etc.)

Veteran’s organizations—non-government

Faith-based organizations

Social service agencies

Employment Development Department

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Early Interceptors

Community behavioral health providers: Governmental Private

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Veterans in LA/Orange Counties are recognized by DOD as the most underserved in the nation

One of the largest veteran communities and largest geographic area

OC does not have an active military post

OC does not have a VA Medical Center

OC VA & MilitaryCollaboration

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OC has vested interest in positive treatment outcomes for OC vets

Positive outcomes require active collaboration between VA, military and OC

Collaboration

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Work with VA, military bases (Los Alamitos, Camp Pendleton) to find solutions to veteran’s behavioral health problems and to support their families

Avoid duplication of effort

Evaluate performance

outcomes and alter programs as needed

Collaboration

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Many veterans distrust government and VA

Many vets are concerned about privacy and military career

Best clinical treatment will be provided at VA, as their clinicians are more familiar with treatment and are provided up-to-date research

Build a FortifiedBridge to VA

FACTS:

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1-3 sessions with OC case manager

“Warm handoff” to VA with follow-up

Build a FortifiedBridge to VA

Need for short-term intervention with vet to reduce barriers to seeking care at VA

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OC/BHS: Current ProgramsThat Serve Vets

“Another Kind of Valor” o Training days, using the videos (three)

to discuss issues that impact returning combat veterans and providing therapeutic approaches that maximize success for the veteran/family

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OC Behavioral Health Clinics provide direct clinical care for vets with serious mental illness who do not qualify or refuse care at VA

Program for Assertive Community Treatment – provides intensive care in the field

Direct care for veteran families with serious mental illness

Integrated Veterans/families into BHS Cultural Competency program and Stigma Task Force

OC/BHS: Current ProgramsThat Serve Vets

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OC/BHS: Current ProgramsThat Serve Vets

BHS Programs o Homeless Outreacho Older Adults Serviceso Alcohol Drug Serviceso Full Service Partnershipso Veterans Court o VA Jail Outreach

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Programs In Development

Early Interceptors

Fortified Bridges to VA

Collaboration with Military and VA

Peer to Peer (consumer) training and group facilitation

Veteran operated enterprises

Community/volunteer activities

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“Network of Care for Behavioral Health”

“Network of Care for Veterans”

BHS subject matter experts BHS Veterans’ Services

Coordinator Continuing educational

seminars, training workshops on issues related to vets: PTSD, TBI, etc.

Resources

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Community Involvement

NAMI “Frontline” – quarterly educational conference

Veteran service groups(AmVet, American Legion, VFW, Vietnamese Vets, DAV, etc.)

Veteran Service Office Veterans Centers Service organizations

Community groups:

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Veteran As Locus of Control

Recruit Veterans to Provide Consumer Input

Develop Peer to Peer Groups

Integrate Community Businesses to Support Veterans (Hire a Vet)

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Unique veteran population

Largest Vietnamese community outside of Vietnam

Third largest demographic in OC

Many of the same issues as other veterans

Not eligible for VA benefits

Unique Community

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Isolation due to poor acculturation and language barriers

High rate of trauma from re-education camp post 1975

Families impacted by veterans’ status and by cultural mores

Potential for major impact on OC resources

Unique Community

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Community stakeholders

Needs assessment that is culturally competent

Outreach program that is designed to mitigate cultural reluctance

Unique Bridges for Unique Populations

Develop programs to include:

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Intervention program based on evidence-based practice

Integrate approach into BHS clinical practice framework as much as practical

Reach out to other counties with Vietnamese communities

Unique Bridges for Unique Populations

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Performance Outcomes

The key to success is to continually evaluate outcomes as they impact

o Veterans

o Families

o Communities

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Next Steering Committee Meeting

May 11, 20091 p.m. – 4 p.m.

Delhi Community Center505 East CentralSanta Ana, CA 92707