Santa Clara County Mental Health Services Act Planning A Presentation to the Board of Supervisors December 13, 2005 Santa Clara County Mental Health Services

Santa Clara CountySanta Clara CountyMental Health Services Act PlanningMental Health Services Act Planning

CSS Three-Year Plan

A Presentation to theA Presentation to the

Board of SupervisorsBoard of Supervisors December 13, 2005December 13, 2005

Department of Mental Health SCVHHS

Overview of Overview of MHSA ComponentsMHSA Components

SSix phased-in components completed through a state and local stakeholder involved process:

1. Community Program Planning (5%)

2. Community Services and Supports (50%)

3. Capital and Information Technology (10%)*

4. Education and Training (10%)*

5. Prevention and Early Intervention (20%)*

6. Innovation (5%)*

*requirements and allocation method undetermined

Current Plan Current Plan Before the BoardBefore the Board

Community Services & Supports Community Services & Supports PlanPlan

Santa Clara: $13.4 Million x 3 yrs Santa Clara: $13.4 Million x 3 yrs Broad stakeholder process requiredBroad stakeholder process required 51%+ in Full Service Partnerships51%+ in Full Service Partnerships 49% System Development/Outreach49% System Development/Outreach Public Hearing hosted by Mental Health BoardPublic Hearing hosted by Mental Health Board Subject to DMH approval Subject to DMH approval Each distinct program must be approved/deniedEach distinct program must be approved/denied

Board of Supervisors

State Dept. ofMental Health

BOS Committees(HHC, CSFC, PSJC)

County ExecutiveSCVHHS Exec. Dir

MHSA StakeholderLeadership Committee

Work Group & Strategy Teams

Children & Youth

0-15 Years


Older Adults60+ Years

Work Group & Strategy Teams Transition Age

Youth16-25 Years


Adults26-59 Years

Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups

Cultural Competency

Wellness and Recovery

Evidenced Based Practices

MHSA Vision & Requirements

FocusGroup

FocusGroup

FocusGroup

FocusGroup

FocusGroup

Accountability Commission

Mental Health Board

Project Management

Team

Santa Clara CountyMHSA Planning

Structure

Ethnic Community Advisory

Committees

Ethnic Community Advisory

Committees

Plan RequirementsPlan Requirements

The Three-Year CSS The Three-Year CSS PlanPlan

Identify Community

Concerns for All Ages

Determine Unmet

Need

Identify Specific

Populations for Focus

Identify strategies to Meet

Need

1 2 3 4

Stakeholder ProcessStakeholder Process

Major Inreach and Outreach Campaign Major Inreach and Outreach Campaign regarding Critical Concerns and needs regarding Critical Concerns and needs from March through June –from March through June – 10,000 10,000 voices have been heard through voices have been heard through meetings and surveys!meetings and surveys!

Stakeholder Leadership Committee -Stakeholder Leadership Committee -convened andconvened and endorsed critical endorsed critical concerns, focal populations & draft plan concerns, focal populations & draft plan recommendations from Work Groups, recommendations from Work Groups, Strategy Teams, and Ethnic Community Strategy Teams, and Ethnic Community Advisory TeamsAdvisory Teams

Most Frequently Most Frequently Noted ConcernsNoted Concerns

Across all Age GroupsAcross all Age Groups– In trouble with the law, incarcerationIn trouble with the law, incarceration– Concurrent substance abuseConcurrent substance abuse– Abuse, neglect, violence, traumaAbuse, neglect, violence, trauma– Sadness, depression, loneliness, isolationSadness, depression, loneliness, isolation– Poverty, homelessness, inadequate housingPoverty, homelessness, inadequate housing– Failing school & jobs, meaningless activitiesFailing school & jobs, meaningless activities– Concurrent medical problemsConcurrent medical problems– Institutionalization, hospitalizationInstitutionalization, hospitalization– Problems with family and peersProblems with family and peers

Focal PopulationsFocal PopulationsDefined Per Defined Per RequirementsRequirements

ChildrenChildren1.1. Zero to Five Years High RiskZero to Five Years High Risk2.2. Foster Care YouthFoster Care Youth3.3. Juvenile Justice Involved YouthJuvenile Justice Involved Youth4.4. Underserved Seriously Emotionally DisturbedUnderserved Seriously Emotionally Disturbed

Transition Age YouthTransition Age Youth5.5. First Time PsychosisFirst Time Psychosis6.6. Sixteen to 25 Years Aging Out of Child SystemsSixteen to 25 Years Aging Out of Child Systems

AdultsAdults7.7. Jail Involved/Homeless/Dual Diagnosed SMIJail Involved/Homeless/Dual Diagnosed SMI8.8. Underserved/Un-served SMIUnderserved/Un-served SMI

Older AdultsOlder Adults9.9. High Risk/Homebound SMI SeniorsHigh Risk/Homebound SMI Seniors

Estimates of Estimates of Unmet NeedUnmet Need

Based on 200% of poverty population by Based on 200% of poverty population by prevalence estimates (FY03 service data)prevalence estimates (FY03 service data)

AGEAGE Fully Fully ServedServed

ServedServed Under-Under-servedserved

Un-Un-served*served*

0-150-15 250250 4,1474,147 751751 3,1593,159

16-2516-25 137137 3,8913,891 1,3021,302 1,1721,172

26-5926-59 5252 11,60811,608 2,5172,517 3,9773,977

60+60+ 22 2,4102,410 285285 622622

TotalTotal 441441(2%)(2%)

22,05622,056(100%)(100%)

4,8554,855(22%)(22%)

8,9308,930

* Understated estimate of public need (closer to 300% of poverty) and prevalence among certain populations (e.g. 8.5% general population vs. 50+% in jail, foster care, juvenile justice)

Disparities in Disparities in Unmet NeedUnmet Need

Latino, Asian and American Indian underserved Latino, Asian and American Indian underserved among all agesamong all ages

Latino, African American and American Indian Latino, African American and American Indian over-represented in CJS, un-housed, and foster over-represented in CJS, un-housed, and foster care with greater need (prevalence) and less care with greater need (prevalence) and less servedserved

Refugee, immigrant and monolingual greater need Refugee, immigrant and monolingual greater need and less servedand less served

LGBTQ greater need and less servedLGBTQ greater need and less served

Developmentally disabled greater need and less Developmentally disabled greater need and less servedserved

Overview of Overview of RecommendationsRecommendations

Children 0-15Children 0-15

C-01 Full Service PartnershipsC-01 Full Service Partnerships – 30 slots; – 30 slots; est. $20K per year per child, with up to 30% to est. $20K per year per child, with up to 30% to support stable living/housing; emphasis on Latino, support stable living/housing; emphasis on Latino, African American, and American Indian juvenile African American, and American Indian juvenile justice involved and youth without insurance. justice involved and youth without insurance.

C-02 Zero to Five System C-02 Zero to Five System DevelopmentDevelopment -to develop inter-agency -to develop inter-agency infrastructure to support 0-5 year olds, includes infrastructure to support 0-5 year olds, includes planning; screening/assessment design; training of planning; screening/assessment design; training of specialists; family support and system navigation specialists; family support and system navigation for monolingual Latino and Vietnamese families.for monolingual Latino and Vietnamese families.

Children 0-15Children 0-15

C-03 Behavioral Health System C-03 Behavioral Health System DevelopmentDevelopment – System-wide – System-wide implementation of improved screening, implementation of improved screening, assessment and best practice models of assessment and best practice models of treatment; specialized access and care treatment; specialized access and care management of juvenile justice and foster care management of juvenile justice and foster care populations. Emphasis on underserved Latino, populations. Emphasis on underserved Latino, Asian, African American, American Indian Asian, African American, American Indian youth and families.youth and families.

Transition Age Youth Transition Age Youth 15 – 25 Years 15 – 25 Years

T-01 Full Service PartnershipsT-01 Full Service Partnerships – 30 slots; – 30 slots; est. $20K per year per youth, with up to 30% to est. $20K per year per youth, with up to 30% to support stable living/housing; emphasis on Latino, support stable living/housing; emphasis on Latino, African American, and American Indian exiting African American, and American Indian exiting juvenile justice and foster care systems. juvenile justice and foster care systems.

T-02 Behavioral Health System T-02 Behavioral Health System DevelopmentDevelopment System-wide implementation of System-wide implementation of improved screening, assessment and best practice improved screening, assessment and best practice models of treatment; specialized access and care models of treatment; specialized access and care management of youth child-serving systems. management of youth child-serving systems. Emphasis on underserved Latino, Asian, African Emphasis on underserved Latino, Asian, African American, Native American youth and families.American, Native American youth and families.

Transition Age Youth Transition Age Youth 15 – 25 Years 15 – 25 Years

T-03 Crisis & Drop-In Services and T-03 Crisis & Drop-In Services and

SupportsSupports safe, non-stigmatizing access to safe, non-stigmatizing access to mental health and basic services.mental health and basic services.

T-04 Education PartnershipT-04 Education Partnership – Integrated – Integrated “middle college” and community college support to “middle college” and community college support to improve “school success” of youth with mental improve “school success” of youth with mental health concerns.health concerns.

Adults 26-59Adults 26-59

A-01 Full Service PartnershipsA-01 Full Service Partnerships – 75 slots; – 75 slots; est. $20K per year per client, with up to 30% to est. $20K per year per client, with up to 30% to support stable living/housing; emphasis on Latino, support stable living/housing; emphasis on Latino, African American, Asian and American Indian, African American, Asian and American Indian, homeless, institutionalized, and frequent ER users homeless, institutionalized, and frequent ER users with severe mental illness. with severe mental illness.

A-02 Behavioral Health Recovery A-02 Behavioral Health Recovery ServicesServices – to redesign county adult outpatient – to redesign county adult outpatient services to include consumer and family support services to include consumer and family support staff; add support and case management staff; staff; add support and case management staff; and to introduce best practice strategies and align and to introduce best practice strategies and align and establish therapeutic caseload size. and establish therapeutic caseload size.


A-03 Jail Aftercare and Recovery ServicesA-03 Jail Aftercare and Recovery Services – – (($2.5 M$2.5 M proposed to satisfy Jail Task Force solution proposed to satisfy Jail Task Force solution #15)#15) for criminal justice involved mentally ill:for criminal justice involved mentally ill:

Full Service PartnershipsFull Service Partnerships - 75 slots; est. $20K - 75 slots; est. $20K per year per client, with up to 30% to support per year per client, with up to 30% to support stable living/housing; emphasis on Latino, African stable living/housing; emphasis on Latino, African American, and American Indian;American, and American Indian;

Enhanced Treatment CourtEnhanced Treatment Court – 60 slots for case – 60 slots for case management and service linkage;management and service linkage;

Dual-Diagnosis After Care TreatmentDual-Diagnosis After Care Treatment – 125 – 125 slots for medication and case management slots for medication and case management services;services;

Expanded Housing OptionsExpanded Housing Options – 75 beds; – 75 beds; Transitional Housing Units (THU) Transitional Housing Units (THU)


A-04 Adult Urgent Care and Crisis A-04 Adult Urgent Care and Crisis SupportSupport – Establishes urgent care and mobile – Establishes urgent care and mobile crisis response in north, central and south crisis response in north, central and south county regions.county regions.

A-05 Consumer and Family Self-Help A-05 Consumer and Family Self-Help SupportSupport- Establishes Director of Consumer - Establishes Director of Consumer Affairs and Director of Family Support and Affairs and Director of Family Support and Education, in addition to expanded consumer Education, in addition to expanded consumer and family self-help with focus on unserved and and family self-help with focus on unserved and underserved ethnic and cultural communities. underserved ethnic and cultural communities.

Older Adults Older Adults 60+60+

OA-01 Full Service PartnershipsOA-01 Full Service Partnerships – 25 slots; – 25 slots; est. $20K per year per client, with up to 30% to est. $20K per year per client, with up to 30% to support stable living/housing; emphasis on those support stable living/housing; emphasis on those in or at risk of homelessness, institutionalization, in or at risk of homelessness, institutionalization, incarceration; physical and emotional harm.incarceration; physical and emotional harm.

OA-02 Behavioral Health ServicesOA-02 Behavioral Health Services – – System-System-wide implementation of improved screening, wide implementation of improved screening, assessment and best practice models of assessment and best practice models of treatment; specialized access and care treatment; specialized access and care management of older adults; expanded service to management of older adults; expanded service to senior day programs.senior day programs.

Older Adults Older Adults 60+60+

OA-03 Senior Mobile Assessment & OA-03 Senior Mobile Assessment & OutreachOutreach-- Provides specialized mobile Provides specialized mobile assessment and outreach services to shut-in and assessment and outreach services to shut-in and homebound mentally ill seniors, many of whom homebound mentally ill seniors, many of whom are experiencing concurrent medical and are experiencing concurrent medical and substance abuse problems; focus on monolingual substance abuse problems; focus on monolingual seniors.seniors.

OA-04 Senior Family and Caregiver SupportOA-04 Senior Family and Caregiver Support – Provides culturally appropriate family and – Provides culturally appropriate family and caregiver support and education to those caring caregiver support and education to those caring for mentally ill seniors.for mentally ill seniors.

Support StaffSupport Staff

2.0 Full Service Coordinators2.0 Full Service Coordinators

1.0 Training Director1.0 Training Director

2.0 Q.I./U.M. Coordinators2.0 Q.I./U.M. Coordinators

1.0 Utilization Management Analyst1.0 Utilization Management Analyst

1.0 Cultural Competency Coordinator1.0 Cultural Competency Coordinator

Crosscutting Crosscutting Strategies Strategies

State requirements allow up to 6 State requirements allow up to 6 months ($6.7 million) of FY06 months ($6.7 million) of FY06 funds to be used for one-time funds to be used for one-time expenses over three years. These expenses over three years. These funds are proposed to support funds are proposed to support several age-based plans in addition several age-based plans in addition to several cross-cutting initiatives.to several cross-cutting initiatives.


HO-01 – Housing Options – HO-01 – Housing Options – Establishes $2 million fund to develop

housing options in collaboration with Office of Affordable Housing. Upon State approval of this proposal, MHD and OAH will jointly design expenditure plan with assistance of housing experts, and will bring back to BOS for approval. Objective will be to leverage these funds in order to maximize the establishment of ongoing permanent housing for the mentally ill in Santa Clara County.

Crosscutting Crosscutting StrategiesStrategiesHousing Component SummaryHousing Component Summary Full Service Partnerships (C-01, T-01, A-01, Full Service Partnerships (C-01, T-01, A-01,

A-03 and OA-01)A-03 and OA-01). . Est. $2-3 MillionEst. $2-3 Million (30% of annual (30% of annual resources) will go to securing and maintaining stable resources) will go to securing and maintaining stable permanent living for clients. permanent living for clients.

MHSA Housing Fund (HO-01) - MHSA Housing Fund (HO-01) - $2 Million$2 Million to to

develop permanent housing resources.develop permanent housing resources.

Jail Aftercare & Recovery (A-03) - Jail Aftercare & Recovery (A-03) - $625,000$625,000 for for 75 Transition Housing Units dedicated to jail 75 Transition Housing Units dedicated to jail aftercare. Length of stay and provider requirements aftercare. Length of stay and provider requirements will be determined through collaboration with Jail will be determined through collaboration with Jail Task Force members.Task Force members.


FH-01 – Community & Family FH-01 – Community & Family Outreach and Engagement Initiative Outreach and Engagement Initiative –– to develop culturally competent to develop culturally competent outreach and engagement strategies to outreach and engagement strategies to underserved populations.underserved populations.

HC-01 – Behavioral & Primary Health HC-01 – Behavioral & Primary Health Care PartnershipCare Partnership – to establish – to establish integrated pilot primary care services for integrated pilot primary care services for clients of the mental health system.clients of the mental health system.


EE-01 – Education, Employment, and EE-01 – Education, Employment, and Self-Sufficiency Services - Self-Sufficiency Services - to develop to develop comprehensive education, employment comprehensive education, employment and benefit assistance system for all and benefit assistance system for all clients of the system.clients of the system.

ST-01 – Regional Survivors of Torture ST-01 – Regional Survivors of Torture Treatment ServicesTreatment Services – to establish – to establish regionally available specialty treatment regionally available specialty treatment services for Bay Area refugee survivors of services for Bay Area refugee survivors of torture. torture.

Total CSS Funding Allocations FY06 – FY08

Age 26-59 $17.4m 46%

Age 60+ $3.8m 10%

Cross Cutting $4.6m

Admin $3.4m 9%

Age 0-15 $3.8m 10%

Age 16-25 $4.9m 13%

12%

Following initial Three-Year Plan Following initial Three-Year Plan County will submit renewal planCounty will submit renewal plan

Increased revenues expected in Increased revenues expected in future years to finance one-time future years to finance one-time initiatives and expand strategies to initiatives and expand strategies to further populationsfurther populations

MHD may revise strategies MHD may revise strategies depending on outcomes achieved depending on outcomes achieved with DMH approvalwith DMH approval

FY09 and BeyondFY09 and Beyond

TimelineTimeline

October 28October 28thth - - Leadership CommitteeLeadership Committee Endorsed Endorsed

PlanPlan

November 29-30November 29-30thth -- Public Hearings Public Hearings

December 5December 5thth - - Mental Health Board Endorsed PlanMental Health Board Endorsed Plan

December 7December 7thth - - Proposed Plan to HHC Proposed Plan to HHC

December 13December 13thth – – Proposed Plan to BOSProposed Plan to BOS

December 30December 30thth –– Final Plan to State DMHFinal Plan to State DMH

January – April –January – April – RFP Process, Training, Start-UpRFP Process, Training, Start-Up

April – Jan 07April – Jan 07 – – Implementation of ProgramsImplementation of Programs

Documents

Santa Clara County Mental Health Services Act Planning A Presentation to the Board of Supervisors December 13, 2005 Santa Clara County Mental Health Services