Therapeutic Behavioral Services (TBS)

Mental Health Board

System Planning and Fiscal Committee January 5, 2012

Santa Clara County Mental Health Department

Emily Q vs. State DMH • As a result of a lawsuit (Emily Q) initiated by

advocates in 1998, state began offering TBS as a Medi-Cal Mental Health supplemental service

• Goal of lawsuit was to provide services to help prevent higher levels of care or assist with transitions to lower levels of care

• Court has had continued oversight of TBS implementation and there has been concern that there has not been sufficient utilization of TBS

• Nine-Point Settlement Plan was adopted in November 2008 to resolve continued concerns. One requirement of the plan is for counties to increase TBS access and utilization.

Emily Q vs. State DMH As of April 28, 2011, 18 county Mental Health Plans (MHP)

(includes Santa Clara County) were certified by Special Court Master as having satisfied 4% benchmark.

On May 6, 2011, Special Court Master submitted final report to the United States District Court recommending the Court exit Emily Q matter and DMH take over TBS as per post-exit requirements described in the nine point plan.

On September 14, 2011, an order was filed by the United States District Court, Central District of California, adopting the Special Master’s findings and recommendations and terminating jurisdiction by the Honorable Judge A. Howard Matz.

Emily Q – Recommendation for Terminating Jurisdiction

As stated in the orders: “The Court adopts the findings and recommendationsof the Special Master in his Final Report. Defendant Director of the Department of Health Care Services, and the director or directors of any successor entity or entities, shall continue to comply with the post-termination terms of the Nine Point Plan and transition plan. Nothing in this order shall preclude subsequent litigation regarding the obligation of counties and county mental health plans to provide TBS. Monies remaining in the Special Services Fund in the approximate amount of $198,394.63 shall remain on deposit with the California Institute for Mental Health or any successor entity, to support TBS trainings, quality improvement activities, data review, and continued maintenance of public TBS data dashboards.”

What is TBS?• Supplemental program to an ongoing

Specialty Mental Health Service

• Intensive, short-term, home or placement-based, 1:1 behavioral interventions

• Trained behavioral coaches teach child or youth and caregivers or TAY effective coping skills, anger management skills and mood regulation

• Interventions are strength-based, individualized and culturally sensitive

Who is eligible?Insurance Eligibility • Medi-Cal beneficiaries up to age 21

Class Criteria Requirements • Is currently placed in a group home• “Being considered” for a group home (level 12 or above)

• “Being considered” for psychiatric hospitalization or has had a previous hospitalization (within last 2 years)

(Is one option, though not necessarily the only option, that is being considered as part of a set of possible solutions to address the child/youth’s needs)

Service Need Criteria • Participating in Specialty Mental Health Services• Prevent higher level of care• Transition successfully to lower level of care

Agencies Providing TBS

TBS Client Count FY10 & FY11

Agency FY10 FY11

Bill Wilson Center 18 30

Community Solutions 4 7

EMQ (Families First) 109 113

Gardner 28 19

Hope Services 9 11

Rebekah's Children Services 55 51

Starlight 90 91

Unity Care 45 55

Total 358 377

Client Gender

Gender FY10 FY11

Female 130 142

Male 228 235

Total 358 377

Client Ethnicity

Diagnosis Acuity

Diagnosis Acuity FY10 FY11

1 Diagnosis 64 96

2 or more Diagnoses 285 270

Unknown 9 11

Total 358 377

Most Common DiagnosesFY10 FY11

Diagnosis Frequency FrequencyAdjustment Disorder With Mixed Disturbance of Emotions and Conduct

13 12

Anxiety Disorder NOS 9 12

Attention-Deficit/Hyperactivity Disorder NOS 9 12

Attention-Deficit/Hyperactivity Disorder, Combined or Predominantly Hyperactive Type

32 37

Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

8 9

Depressive Disorder NOS 24 24

Disruptive Behavior Disorder NOS 29 45

Mood Disorder NOS 24 18

Oppositional Defiant Disorder 39 42

Parent-Child Relational Problem 16 11

Posttraumatic Stress Disorder 33 36

County TBS Office: (408)793.5894 fax: (408)288.6113 

QI Authorization: Mary Harnish, MFT, QI Coordinator at (408) 793-5892

Family & Children’s Division Contact:Sherri Terao, Ed.D. (408) 885-5776

DMH TBS Website:

www.dmh.ca.gov/Services_and_Programs/Children_and_Youth/EPSDT.asp

TBS Contact Information