mental health services act
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Mental Health Services Mental Health Services ActAct
Mental Health Provider Mental Health Provider MeetingMeeting
February 18, 2005February 18, 2005
Presented byPresented byNancy Peña, Ph.D., DirectorNancy Peña, Ph.D., Director
Santa Clara County Mental HealthSanta Clara County Mental Health
Meeting ObjectivesMeeting Objectives
To Review MHSATo Review MHSA
To Orient Providers to MHSA To Orient Providers to MHSA Planning ProcessPlanning Process
To Obtain Contract Provider Input To Obtain Contract Provider Input and Commitment to Client and and Commitment to Client and Family Engagement Strategies Family Engagement Strategies
The OpportunityThe Opportunity
Social Analysts have revealed Social Analysts have revealed flaws in the current system, flaws in the current system, providing objective evidence of providing objective evidence of the negative individual, social, the negative individual, social, and financial outcomes that are and financial outcomes that are resulting from neglect of the resulting from neglect of the mental health of our citizens mental health of our citizens
The OpportunityThe Opportunity
Local systems are stretched beyond Local systems are stretched beyond capacity and unable to meet demandcapacity and unable to meet demand
Administrators are distracted by the Administrators are distracted by the burdens of bureaucracy and financial burdens of bureaucracy and financial crisis and uncertainty crisis and uncertainty
Clinical leaders are preoccupied with Clinical leaders are preoccupied with operational demands and are unable operational demands and are unable to focus on effective quality to focus on effective quality improvement efforts that insure improvement efforts that insure excellence in practice and optimal excellence in practice and optimal client outcomes.client outcomes.
The OpportunityThe Opportunity
Consumers and family members are Consumers and family members are without adequate care and are demanding without adequate care and are demanding that mental health be addressed with the that mental health be addressed with the same urgency as health caresame urgency as health care
They are demanding freedom from They are demanding freedom from stigma, a path to recovery and wellness, stigma, a path to recovery and wellness, excellence in service, and inclusion as excellence in service, and inclusion as partners in their own care and in the partners in their own care and in the service delivery system service delivery system
The OpportunityThe Opportunity
Advocates and Stakeholders have Advocates and Stakeholders have presented the issues to Californians presented the issues to Californians and have offered a compelling set of and have offered a compelling set of strategies to correct the current strategies to correct the current system flaws.system flaws.
Citizens have affirmed the reality of Citizens have affirmed the reality of the current crisis, and have mandated the current crisis, and have mandated solutions to be financed and solutions to be financed and implemented.implemented.
Providing System Providing System Stakeholders a Stakeholders a Window of Opportunity Window of Opportunity to Maketo MakeFar-Reaching Change Far-Reaching Change
The ChallengeThe Challenge
Mental Health Directors and Mental Health Directors and Provider Leaders Need to step Up Provider Leaders Need to step Up and Provide Leadership in this and Provide Leadership in this Exciting New Era in Public Mental Exciting New Era in Public Mental Health History….Health History….
The VisionThe Vision
Is not created or facilitated by Is not created or facilitated by legislation or moneylegislation or money
Is created by LeadersIs created by Leaders
◆ in clarity and soundness of ideasin clarity and soundness of ideas◆ in effectiveness of in effectiveness of
communicationcommunication◆ in influence and engagementin influence and engagement◆ in sustained purpose and actionin sustained purpose and action
The VisionThe Vision
DMH: “To… expend funds made available through this initiative to transform the current mental health system in California …This will not be “business as usual”. Eventually access will be easier, services more effective and out-of-home and institutional care will be reduced.”
The VisionThe Vision
Outlines Transformation Outlines Transformation AreasAreas:: Consumer and Family Participation
and Involvement
Programs and Services
Community Partnerships
Cultural Competence
Outcomes and Accountability
The VisionThe Vision
Consumer and Family Involvement
Increased participation in all aspects of the system
Increased Consumer Operated Services
Full participation in Treatment Planning
The VisionThe Vision
Programs and ServicesPrograms and Services
Increased geographic access
Incorporation of best practices
Increased array and choice of service
The VisionThe Vision
Programs and Services Improved Services for
Transition Age Youth
Integrated screening, assessment and treatment
for co- occurring disorders
Improved services to 0-5
The VisionThe Vision
Community Partnerships
Increased participation and collaboration among a wide variety of agencies and services
The VisionThe Vision
Cultural CompetencyOutreach and expansion of services Outreach and expansion of services
to underserved ethnic communitiesto underserved ethnic communities
Implementation of more culturally Implementation of more culturally and linguistically competent and linguistically competent assessments and services aligned assessments and services aligned with culture, race, ethnicity, age, with culture, race, ethnicity, age, gender, sexual orientation and gender, sexual orientation and religious/spiritual beliefsreligious/spiritual beliefs
The VisionThe Vision
Outcomes and Accountability
Expanded commitment to monitoring of consumer and system outcomes
Incorporation of outcomes data into part of program planning
The ProcessThe Process
Santa Clara County -
Broad based stakeholder process
Stakeholder Leadership Committee to:
Review Development of PlanReview Development of Plan Facilitate Stakeholder InvolvementFacilitate Stakeholder Involvement Educate CommunityEducate Community Advise Board of SupervisorsAdvise Board of Supervisors
Board of Supervisors
State Dept. ofMental Health
BOS Committees(HHC, CSFC, PSJC)
County ExecutiveSCVHHS Exec. Dir
MHSA StakeholderLeadership Committee
Data, Technology,
Budget Work Group
Prevention & Early
InterventionWork Group
Children’s System of Care Work
Work Group
Adult/Older Adult
System of Care Work Group
Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups
Cultural Competency Readiness Forums Recovery/Self Help Readiness Forums
FocusGroup
FocusGroup
FocusGroup
FocusGroup
FocusGroup
Accountability Commission
Mental Health Board
Project Management
Team
Santa Clara CountyMHSA Planning
Structure
The ProcessThe Process
Monthly Stakeholder Leadership Monthly Stakeholder Leadership Meetings for:Meetings for:
Information and Status ReportsInformation and Status Reports Input from Broad CommunityInput from Broad Community Readiness ForumsReadiness Forums
Work Group Meetings:Work Group Meetings: Child, Adolescent, Young Adult SOCChild, Adolescent, Young Adult SOC Adult and Older Adult SOCAdult and Older Adult SOC Prevention and Early InterventionPrevention and Early Intervention Data, Infrastructure and Human ResourcesData, Infrastructure and Human Resources
Regular Reports Board and Board Regular Reports Board and Board Committees and Mental Health BoardCommittees and Mental Health Board
The Process - Santa Clara County The Process - Santa Clara County Partial List of StakeholdersPartial List of Stakeholders
Mental Health Department (chair)Mental Health Department (chair) County Executive’s Office (co-chair)County Executive’s Office (co-chair) Mental Health Board (co-chair)Mental Health Board (co-chair) Mental Health Self-Help Centers Mental Health Self-Help Centers MHD Office of Consumer MHD Office of Consumer
Empowerment Empowerment National Alliance for the Mentally Ill National Alliance for the Mentally Ill Association of Mental Health Association of Mental Health
Contractors Contractors Non-AMHCA mental health providersNon-AMHCA mental health providers Labor OrganizationsLabor Organizations Foster Care Association Foster Care Association Residential & Group Home ProvidersResidential & Group Home Providers Parents Helping Parents Parents Helping Parents Department of Alcohol and Drug Department of Alcohol and Drug
Services Services Public Health Department Public Health Department VMC Acute Psychiatric Services VMC Acute Psychiatric Services Custody Health ServicesCustody Health Services Valley Medical Center Valley Medical Center Office of the Public GuardianOffice of the Public Guardian
Police Chief Association Police Chief Association SCC Sheriff SCC Sheriff Department of Social Services Department of Social Services Probation Department Probation Department Superior Court Superior Court District Attorney’s Office District Attorney’s Office Public Defender’s Office Public Defender’s Office County Office of Education County Office of Education School District Superintendents School District Superintendents First Five Commission First Five Commission Council on Aging Council on Aging Office of Affordable Housing Office of Affordable Housing Domestic Violence Council Domestic Violence Council School Linked Services School Linked Services United Way United Way Interfaith Council Interfaith Council Silicon Valley Council of Non-Silicon Valley Council of Non-
profitsprofits San Andreas Regional CenterSan Andreas Regional Center
The Process – Phase IThe Process – Phase I
Engagement and CommitmentEngagement and Commitment Invite Stakeholder InvolvementInvite Stakeholder Involvement
Share Intent and VisionShare Intent and Vision
Set Tone of Inclusion Set Tone of Inclusion
Establish Collective Receptivity Establish Collective Receptivity
Align Expectations Without Align Expectations Without Losing Losing Optimism Optimism
Outline Planning LandscapeOutline Planning Landscape
The Process – Phase II The Process – Phase II
Learning and AssessmentLearning and Assessment Learn Current Service Delivery SystemLearn Current Service Delivery System
Learn Needs and Interests of Learn Needs and Interests of Consumers, Consumers, Family Members, Family Members, Providers, System Providers, System Partners, Partners, Community – (left and right Community – (left and right brain brain approaches)approaches)
Learn Best Practice Strategies to Meet Learn Best Practice Strategies to Meet NeedsNeeds
Learn Outcomes & Accountability Models
The Process – Phase IIIThe Process – Phase III
Prioritization and Planning Establish Local Mission, Values & Establish Local Mission, Values &
Transformation ObjectivesTransformation Objectives
Prioritize Local NeedsPrioritize Local Needs
Select Effective Strategies to Meet Local Select Effective Strategies to Meet Local NeedsNeeds
Complete Planning ComponentsComplete Planning Components
The Process – Phase IVThe Process – Phase IV
Implementation
Obtain State Approval & FundingObtain State Approval & Funding
Select Local ProvidersSelect Local Providers
Establish Local Accountability Establish Local Accountability StructureStructure
Initiate and Monitor ServicesInitiate and Monitor Services
Evaluate ServicesEvaluate Services
The Process – Lifespan The Process – Lifespan FrameworkFramework
Determine and Prioritize Local Determine and Prioritize Local Mental Health Needs Across Mental Health Needs Across LifespanLifespan
Prevention
Early Intervention
Intervention
All Citizens Across Lifespan
Citizens in need
Unmet Need
Current Public MH System
The Process – Lifespan The Process – Lifespan FrameworkFramework
Children, Youth Children, Youth and Young Adultsand Young Adults
0 - 5 years0 - 5 years
6 - 11 years6 - 11 years
12 – 17 years12 – 17 years
18 – 25 years18 – 25 years
Adults and Older Adults and Older AdultsAdults
26 – 35 years26 – 35 years
36 – 50 years36 – 50 years
51 – 65 years51 – 65 years
65 + years65 + years
• Population SizePopulation Size
• Geographic DistributionGeographic Distribution
• Ethnicity and ImmigrationEthnicity and Immigration
• Gender Gender
• AgeAge
• Service UtilizationService Utilization
• Prevalence InfoPrevalence Info
• Risk & Special PopulationsRisk & Special Populations
• Unmet NeedUnmet Need
• Stakeholder InputStakeholder Input
For Each Developmental Group Describe:Developmental Group Describe:
The Process – Lifespan The Process – Lifespan FrameworkFramework
For Each Developmental Group For Each Developmental Group Assess Each Transformation Area:
Consumer & Family Involvement
Community Partners
Programs & Services
Cultural Competency
Accountability and Outcomes
Where Are We?
Assess Strengths & Weaknesses in each area
Where Do We Want to Be?
Determine Transformation Objectives in each area
The Process – Lifespan The Process – Lifespan FrameworkFramework
Early Intervention
The Process – Lifespan The Process – Lifespan FrameworkFramework
Developmental Group
Strategies to Transform Current System
Strategies to Increase Services
Strategies forEarly Intervention & Prevention
Prevention
Intervention
For All Ages
The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:
Establish Formal Interagency Policy Establish Formal Interagency Policy ForumsForums
Establish System Goals for All AgesEstablish System Goals for All Ages
Assure Consumer & Family Influence Assure Consumer & Family Influence and Involvement at all levels and Involvement at all levels
Outline System Values and Outline System Values and PhilosophyPhilosophy
The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:
Determine and Prioritize Consumer Determine and Prioritize Consumer NeedsNeeds
Implement effective culturally Implement effective culturally competent prevention, early competent prevention, early intervention and treatment servicesintervention and treatment services
Demonstrate process quality and Demonstrate process quality and favorable outcomesfavorable outcomes
The Impact on County The Impact on County Service SystemsService Systems
Affirm System Values and Affirm System Values and PhilosophyPhilosophy Access and Choice
Cultural Proficiency
Early Identification
Family-Driven
Collaborative
Individualized Plans
Community Based
Strengths Based
The Impact on County The Impact on County Service SystemsService Systems
Local System – Establish Local System – Establish Common Goals for All AgesCommon Goals for All Ages
Health & Well
Being
Stability in Family & Social
Relations
Success in School/Wor
k Meaningful
Activity
Safe From Harming or
Being Harmed in Community
Examples of System Outcome ObjectivesHealth
Insurance
Health Visits
Health Status
Suicide
Stable Living
# Placements
DV Incidents
School Attendance
Graduations
Work stability
CJ Recidivism
Days incarcerated
Victims of Crime
CJS Diversions
The Impact on County The Impact on County Service SystemsService Systems
Establish System Structure Establish System Structure and Stakeholder Involvementand Stakeholder Involvement
Individual & Family
Provider Services
System Policy and
Management
Sta
keh
old
ers
System Performance: Expectations & Results
Provider Performance: Expectations & Results
Client Level Outcomes: Expectations & Results
The Impact on County The Impact on County Service SystemsService Systems
Demonstrate process quality Demonstrate process quality and favorable outcomesand favorable outcomes
Who Do We Serve?
What Are We Trying to Change?
What Practices Do We Employ and Why?
How Do We Insure Quality of Practices?
How Do We Measure Results?
What Results Do We Achieve?
The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to EngagePressure to Engage To Become Involved as StakeholdersTo Become Involved as Stakeholders
To Educate and Inform Your Boards, To Educate and Inform Your Boards, Staff and Families, and Business Staff and Families, and Business PartnersPartners
To Actively Involve Your Consumers To Actively Involve Your Consumers and Familiesand Families
To Actively Partner With System To Actively Partner With System Players in Your CountyPlayers in Your County
The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to Learn and AssessPressure to Learn and Assess Understand Stakeholder ViewsUnderstand Stakeholder Views
Know the System and CommunityKnow the System and Community
Understand Consumer Opinions and Understand Consumer Opinions and Needs Needs
Learn Most Effective Strategies and Learn Most Effective Strategies and Competencies that Meet NeedsCompetencies that Meet Needs
Assess Agency Strengths and Assess Agency Strengths and Weaknesses Relative to Weaknesses Relative to Transformation ExpectationsTransformation Expectations
The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to Prioritize and PlanPressure to Prioritize and Plan
Revisit Mission and Business Objectives Revisit Mission and Business Objectives
Affirm Practice Philosophy, Values and Affirm Practice Philosophy, Values and ProcessProcess
Outline Cultural Competency Objectives Outline Cultural Competency Objectives
Articulate Process Standards and Articulate Process Standards and Outcome Expectations and Track ResultsOutcome Expectations and Track Results
Determine Infrastructure Needs to Determine Infrastructure Needs to Maintain Process Standards and Achieve Maintain Process Standards and Achieve OutcomesOutcomes
The Impact on The Impact on Individual Service Individual Service ProvidersProviders
Pressure to Implement ChangesPressure to Implement Changes
Establish Consumer & Family Establish Consumer & Family PartnershipsPartnerships
Restructure care planning process Restructure care planning process
Implement Cultural Competency Implement Cultural Competency InitiativesInitiatives
Implement Process Improvement Implement Process Improvement StrategiesStrategies
Evaluate & Report Service OutcomesEvaluate & Report Service Outcomes
Consumer and Family Consumer and Family EngagementEngagement
Goal:Goal: To bring the voice of To bring the voice of 5,000 consumers and family 5,000 consumers and family members into the processmembers into the process
How: Focus Groups Meetings Surveys Other?
Community Community EngagementEngagement
Goal: To bring the voice of 5,000 To bring the voice of 5,000 community members, including community members, including unserved and underserved unserved and underserved communities to the process.communities to the process.
How: Focus Groups Meetings Surveys Other?
Provider Provider CommitmentCommitment
How Will You Involve How Will You Involve Consumers?Consumers?
What Resources Will What Resources Will it it Take?Take?
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