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

Public Hearing Public Hearing CSS Three-Year PlanCSS Three-Year Plan November 28, 29, 30, 2005November 28, 29, 30, 2005

Department of Mental Health SCVHHS

Plan OverviewPlan Overview

MHSA Planning Context

CSS State Required Process

Recommended Strategies

(MHSA (aka Proposition (MHSA (aka Proposition 63)63)

1% tax on taxable personal income over $1 million to 1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund be deposited into a Mental Health Services Fund (MHSF) in State Treasury(MHSF) in State Treasury

Administered by State Department of Mental HealthAdministered by State Department of Mental Health

Oversight by 16-Member Accountability CommissionOversight by 16-Member Accountability Commission

Distributed to Counties Via Current State-County Distributed to Counties Via Current State-County ContractContract

$300 Est. Million in FY05; $700 Million Est. in FY06$300 Est. Million in FY05; $700 Million Est. in FY06

Is used to expand, not supplant services; can Is used to expand, not supplant services; can ““not be not be used to supplant existing state or county funds utilized used to supplant existing state or county funds utilized to provide mental health services.”to provide mental health services.”

Phased in approach to implementation, beginning with Phased in approach to implementation, beginning with Planning and Expanded Service componentsPlanning and Expanded Service components

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%)

State UpdatesState Updates

Accountability Commission ConvenedAccountability Commission Convened

CSS Component Funding Posted:CSS Component Funding Posted:

Santa Clara = $13.4 Million x 3 yrs.Santa Clara = $13.4 Million x 3 yrs.

Majority of Counties Posted CSS PlansMajority of Counties Posted CSS Plans

Three Plans reviewed by State Three Plans reviewed by State

Components Pending State Components Pending State Requirements:Requirements: Training & EducationTraining & Education Capital and Information TechnologyCapital and Information Technology Prevention and Early Intervention Prevention and Early Intervention

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

Work Group & Strategy Teams

Older Adults60+ Years

Work Group & Strategy Teams Transition Age

Youth16-25 Years

Work Group & Strategy Teams

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

CSS –Funding for Three CSS –Funding for Three Types of ServiceTypes of Service

1. Full Service Partnership Funds (51+% ) – to provide “whatever it takes” in necessary services and supports for new clients of focal populations (treatment, housing, self-help, vocational support)

2. General “Capacity Building” Funds – to improve services and infrastructure; can be system-wide strategies

3. Outreach and Engagement Funds – to engage those underserved populations that are currently receiving little or no service

Essential Elements of all County plans:

Community collaboration with system partners, general community, consumers and families

Cultural competence throughout system

Client/family driven mental health system for older adults, adults and transition age youth and family driven system of care for children and youth

Wellness focus, which includes the concepts of recovery and resilience, self-help, consumer-directed service

Integrated service experiences for clients and their families throughout their interactions with the mental health system

Local MHSA Planning Local MHSA Planning Work to DateWork to Date 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

Focal PopulationsFocal PopulationsDefined Per Defined Per RequirementsRequirements

ChildrenChildren Zero to Five Years High RiskZero to Five Years High Risk Foster Care YouthFoster Care Youth Juvenile Justice Involved YouthJuvenile Justice Involved Youth Underserved Seriously Emotionally Underserved Seriously Emotionally

DisturbedDisturbed

Transition Age YouthTransition Age Youth Sixteen to 25 Years Aging Out of Sixteen to 25 Years Aging Out of

SystemsSystems First Time PsychosisFirst Time Psychosis

Focal PopulationsFocal PopulationsDefined Per Defined Per RequirementsRequirements AdultsAdults

Homeless, Dual Diagnosed, JailedHomeless, Dual Diagnosed, Jailed Frequent ER User Seriously Mentally Frequent ER User Seriously Mentally

IllIll Underserved/Unserved SMIUnderserved/Unserved SMI Jail Involved Dual Diagnosis Non SMIJail Involved Dual Diagnosis Non SMI

Older AdultsOlder Adults High Risk Seriously Mentally IllHigh Risk Seriously Mentally Ill Isolated/Homebound Mentally IllIsolated/Homebound Mentally Ill

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 50% ($10K) est. $20K per year per child, with up to 50% ($10K) to support stable living/housing; emphasis on to support stable living/housing; emphasis on Latino, African American, and American Indian Latino, African American, and American Indian juvenile justice involved and youth without juvenile justice involved and youth without insurance. 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, Native American Asian, African American, Native American 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 50% ($10K) est. $20K per year per youth, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, to 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 50% est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis ($10K) to support stable living/housing; emphasis on Latino, African American, Asian and American on Latino, African American, Asian and American Indian, homeless, institutionalized, and frequent Indian, homeless, institutionalized, and frequent ER users with severe mental illness. ER users 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.

Adults 26-59Adults 26-59

A-03 Jail Aftercare and Recovery ServicesA-03 Jail Aftercare and Recovery Services – – 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 50% ($10K) to per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on support stable living/housing; emphasis on Latino, African American, and American Indian;Latino, African 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 slots – 125 slots for medication and case management services;for medication and case management services;

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

Adults 26-59Adults 26-59

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 50% est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis ($10K) to support stable living/housing; emphasis on those in or at risk of homelessness, on those in or at risk of homelessness, institutionalization, incarceration; physical and institutionalization, incarceration; physical and emotional harm.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 treatment; assessment and best practice models of treatment; specialized access and care management of older specialized access and care management of older adults; expanded service to senior day programs.adults; expanded service to 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 State requirements allow up to 6 months ($6.7 million) of FY06 6 months ($6.7 million) of FY06 funds to be used for one-time funds to be used for one-time expenses over three years. expenses over three years. These funds are proposed to These funds are proposed to support several age-based plans support several age-based plans in addition several cross-cutting in addition several cross-cutting initiatives.initiatives.

Crosscutting Crosscutting Strategies Strategies

HO-01 – Housing Options - HO-01 – Housing Options - establishes establishes $2 million fund to develop housing options in $2 million fund to develop housing options in collaboration with key leaders in housing collaboration with key leaders in housing support and resource development. These support and resource development. These resources, combined with housing support resources, combined with housing support resources in FSP, and other housing options, resources in FSP, and other housing options, will insure that 25-30% of available CSS funds will insure that 25-30% of available CSS funds during initial 3-years is committed to during initial 3-years is committed to facilitate permanent stable living for those facilitate permanent stable living for those served. Further capital housing resource is served. Further capital housing resource is anticipated through Capital and Technology.anticipated through Capital and Technology.

Crosscutting Crosscutting Strategies Strategies

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.

Crosscutting Crosscutting Strategies Strategies

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.

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

Next StepsNext Steps

December 5December 5thth –– Proposed Plan to MHBProposed Plan to MHB

December 7December 7thth - - Proposed Plan to HHCProposed 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 – Implementation ReadinessImplementation Readiness

April - JuneApril - June – – Implementation of Implementation of ProgramsPrograms

Contact InfoContact Info

Nancy Pena, Ph.D., Director, MHD, 408-885-5783

Bruce Copley, Deputy Director, MHD 408-885-5773

Tiffany Ho, M.D., Medical Director, MHD, 408-885-5781

Sheila Yuter, MHSA Coordinator, 408-885-3885

Maria Fuentes, Ethnic Services Manager, 408-885-5775

Santa Clara County MHD Website www.sccmhd.org

State Dept. Mental Health website www.dmh.ca.gov