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

Stakeholder Leadership CommitteeStakeholder Leadership CommitteeMay 20, 2005May 20, 2005

Department of Mental Health

ObjectivesObjectives

Launch the SCC Stakeholder Leadership Committee

Provide brief overview of MHSA & planning process

Provide overview of Community Services & Supports (CSS) Plan requirements & work to date

Obtain SLC input on “Critical Issues” selection criteria

MHSA FundingMHSA Funding 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

MHSA is IntendedMHSA is Intended toto

Introduce effective new service models that promote well-being, recovery and self-help

Introduce prevention and early intervention to prevent negative impact of serious mental illness

Enhance human resource, technology and capital infrastructure of current system

Reduce stigma and change negative social perceptions of mental illness

Correct fragmentation and inadequate funding

MHSA ComponentsMHSA Components

The MHSA addresses six components of building a better mental health system involving an extensive stakeholder process to guide policies and programs:

1. Community Program Planning

2. Services and Supports

3. Capital (buildings) and Information Technology

4. Education and Training (human resources)

5. Prevention and Early Intervention

6. Innovation

Initial Funding FY04-08Initial Funding FY04-08

FY04-05 funds (est. $300 Million)FY04-05 funds (est. $300 Million)

45% - Education and Training (DMH fund)45% - Education and Training (DMH fund)

45% - Capital Facilities Technology (DMH fund)45% - Capital Facilities Technology (DMH fund)

5% - Local Planning (to counties)5% - Local Planning (to counties)

5% - State Implementation (to DMH Admin)5% - State Implementation (to DMH Admin)..

FY06, FY07 and FY08 (est. $600 – 800 FY06, FY07 and FY08 (est. $600 – 800 Million)Million)

10% - Education & Training10% - Education & Training10% - Capital and Technology 10% - Capital and Technology 50% - Children, Adult, Senior Services50% - Children, Adult, Senior Services 5% - Innovative Programs5% - Innovative Programs20% - Prevention and Early Intervention20% - Prevention and Early Intervention 5% - State Administration5% - State Administration

MHSA in PerspectiveMHSA in Perspective Research indicates the prevalence of mental Research indicates the prevalence of mental

illness in US is 8.55%, which equalsillness in US is 8.55%, which equals 145,000 145,000 Santa Clara County residentsSanta Clara County residents

MHSA is projected to provide $700 Million in MHSA is projected to provide $700 Million in new revenue in FY 2005/06 with est. new revenue in FY 2005/06 with est. 55% 55% going to direct service expansion, which will going to direct service expansion, which will increase direct services by 15%increase direct services by 15%

SCC share for first phase expansion of SCC share for first phase expansion of direct services is projected to be between direct services is projected to be between $10 - $18 Million, depending on allocation $10 - $18 Million, depending on allocation method (2.5% - 5% of funds; MHD lost $58 method (2.5% - 5% of funds; MHD lost $58 Million since FY02)Million since FY02)

The ProcessThe Process

Broad based stakeholder involvement process: Open monthly forums to engage, inform,

gather input, educate

Delayed establishment of Leadership Committee

Four clear phases of planning

Extensive “inreach” to consumers, families, providers; outreach to system partners, underserved, community

The ProcessThe Process

Work Groups for specific topic areas

Child, Adolescent, Young Adult SOC Adult and Older Adult SOC Prevention and Early Intervention Data, Infrastructure and Human Resources

Strategy Teams for detailed research and design

The ProcessThe Process

Stakeholder Leadership Committee to:

Review & Input to Development of

Plan

Facilitate Stakeholder Involvement

Educate Community

Advise 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 Process - Santa Clara The Process - Santa Clara County County Partial List of StakeholdersPartial List of Stakeholders

Mental Health Department (chair) County Executive’s Office (co-chair) Mental Health Board (co-chair) Mental Health Self-Help Centers MHD Office of Consumer

Empowerment National Alliance for the Mentally Ill Association of Mental Health

Contractors Non-AMHCA mental health providers Labor Organizations Foster Care Association Residential & Group Home Providers Parents Helping Parents Department of Alcohol and Drug

Services Public Health Department VMC Acute Psychiatric Services Custody Health Services Valley Medical Center Office of the Public Guardian

Police Chief Association SCC Sheriff Department of Social Services Probation Department Superior Court District Attorney’s Office Public Defender’s Office County Office of Education School District Superintendents First Five Commission Council on Aging Office of Affordable Housing Domestic Violence Council School Linked Services United Way Interfaith Council Silicon Valley Council of Non-

profits San Andreas Regional Center

The OpportunityThe Opportunity Will not achieve transformation without

strong leadership and vision at the local level. That leadership must: Engage local consumers and families, system

partners, providers, and advocates

Establish a collective purpose and system-wide enthusiasm and desire for change

Provide a clear and understandable framework for the planning process

Provide opportunities for subjective and deep dialog as well as access to objective data and information

Planning PhasesPlanning Phases Engagement and CommitmentEngagement and Commitment

Invite Stakeholder Involvement Share Intent and Vision Lay Out Planning Landscape

Learning and AssessmentLearning and Assessment Learn Current System Learn Needs of Consumers, Stakeholders, Community Learn Best Practice Strategies to Meet Needs

Prioritization and PlanningPrioritization and Planning Establish Local Mission, Values & Transformation

Objectives Prioritize Local Needs Select Most Effective Strategies to Meet Local Needs

ImplementationImplementation Obtain State Approval Select Local Providers Initiate, Monitor and Evaluate Services

The Approach– The Approach– Lifespan FrameworkLifespan Framework

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

Work Groups Age Work Groups Age GroupsGroups

1.1. Early Childhood 0-5 yearsEarly Childhood 0-5 years

2.2. School Age 6-15 yearsSchool Age 6-15 years

3.3. Transition Age 16-25Transition Age 16-25

4.4. Adults 26-59Adults 26-59

5.5. Older Adults 60+Older Adults 60+

The ApproachThe Approach

Establish System Structure and Establish System Structure and Stakeholder InvolvementStakeholder 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 ApproachThe Approach

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?

MHSA Planning Work to MHSA Planning Work to DateDate

Major Inreach and Outreach Campaign Major Inreach and Outreach Campaign regarding Critical Concerns and needs regarding Critical Concerns and needs through end of Maythrough end of May

Four Large Forums to address:Four Large Forums to address:– MHSA OrientationMHSA Orientation– Engagement and CommitmentEngagement and Commitment– Cultural Competency ReadinessCultural Competency Readiness– Wellness, Recovery & Resiliency ReadinessWellness, Recovery & Resiliency Readiness

Work Groups to addres critical concerns of Work Groups to addres critical concerns of five age groupsfive age groups

Determining Critical ConcernsDetermining Critical Concerns

Health & Well

Being

Stable Home, Family, Social

Relations

Meaningful School, Work

Activity

Safe From Harm or

Harming in Community

Emotional Suffering SA Abuse Poor Health

Thriving With Mental Illness

Failing With Untreated and Under-treated Mental Illness

Homeless Adult Isolated Senior Removed Child

Housed Adult Connected Senior

Child at Home

Emotional Well Being SA Remission

Good Health

Jobless Adult Inactive Senior

School Failing Child

Jailed Adult Victimized Senior Delinquent Child

Employed Adult Active Senior

Child in School

Adult out of Jail Safe Senior

Child out of Trouble

Low Need

Hi Need

MHSA PlanningMHSA PlanningIndividual and System Individual and System Strengths & WeaknessesStrengths & Weaknesses

Consumer Strengths

•Individual

• Family

•Community & Cultural

System Strengths

System Weaknesses

Pre-Referral Admission Services

Discharge

Initial MHSA Initial MHSA Component –Component –Community Services Community Services and Supports (CSS) and Supports (CSS) PlanPlan Expands Services to New Expands Services to New ClientsClientsTransform Current SystemTransform Current SystemFunds Outreach & Funds Outreach & EngagementEngagement

CSS Objectives & Desired CSS Objectives & Desired Outcomes For Mental Health Outcomes For Mental Health

ClientsClients Meaningful use of time and capabilities

(employment, vocational training, education, and social and community activities)

Safe and adequate housing (safe living environments with family for children and youth; reduction in homelessness)

A network of supportive relationships

Timely access to needed help, including times of crisis

Reduction in incarceration in jails and juvenile halls

Reduction in involuntary services including reduction in institutionalization and out-of-home placements.

Significant Changes Significant Changes IntendedIntendedThese requirements are intended to initiate significant changes including:

Increases in the level of participation and involvement of clients and families in all aspects of the public mental health system

Increases in client and family operated services

Outreach to and expansion of services to client populations in order to eliminate ethnic disparities in accessibility, availability and appropriateness of mental health services and to more adequately reflect mental health needs

Increases in the array of service choices for individuals diagnosed with serious mental illness and children/youth diagnosed with serious emotional disorders, and their families

Essential ConceptsEssential Concepts

DMH considers it essential that all DMH considers it essential that all county plans address and incorporate county plans address and incorporate five essential concepts. They are:five essential concepts. They are:

1. Community collaboration2. Cultural competence3. Client/family-driven mental health system for

older adults, adults and transition age youth and family-driven system of care for children and youth

4. Wellness focus, which includes the concepts of recovery and resilience

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

CSS - Three Types of CSS - Three Types of FundingFundingDMH is making three types of funding DMH is making three types of funding available to counties. The three types are:available to counties. The three types are:

1. Full Service Partnership Funds – funds to provide necessary services and supports for initial populations

2. General System Development Funds – funds to improve services and infrastructure

3. Outreach and Engagement Funding – funds for those populations that are currently receiving little or no service

CSS Plan – Logic ModelCSS Plan – Logic Model

The MHSA Plan Requirements are based The MHSA Plan Requirements are based on a logic model that links:on a logic model that links:

1.1. Community issuesCommunity issues resulting from untreated mental resulting from untreated mental illness and a lack of services and supportsillness and a lack of services and supports

2.2. Mental health Mental health needsneeds within the community, within the community,

3.3. The identification of specific The identification of specific initial populationsinitial populations to be to be served based upon the issues and needs identified, served based upon the issues and needs identified,

4.4. The The strategies and activitiesstrategies and activities to be implemented, to be implemented, andand

5.5. The The desired outcomesdesired outcomes to be achieved. to be achieved.

Inability to be in a mainstream school environment

School failure

Hospitalization

Peer and family problems

Out-of home placement

Involvement in the child welfare and juvenile justice systems

Community Concerns – For Community Concerns – For Children, Youth and Some Children, Youth and Some TAYTAY

Community Concerns – Community Concerns – Some TAY, Adults and Some TAY, Adults and Older AdultsOlder Adults

Homelessness

Frequent hospitalizationsFrequent hospitalizations

Frequent emergency medical careFrequent emergency medical care

Inability to workInability to work

Inability to manage independenceInability to manage independence

IsolationIsolation

Involuntary careInvoluntary care

Institutionalization Institutionalization

IncarcerationIncarceration

Determining Critical Determining Critical Community ConcernsCommunity Concerns

““Working with clients, families and Working with clients, families and other community stakeholders, counties other community stakeholders, counties should examine these issues and others should examine these issues and others in the context of their communities and in the context of their communities and identify which of these community identify which of these community issues and concerns they will focus issues and concerns they will focus on in their initial three-year on in their initial three-year program and expenditure planprogram and expenditure plan””

Critical Concerns Lead Critical Concerns Lead to Initial Plan to Initial Plan PopulationsPopulations““The selection of community The selection of community issues to be addressed should issues to be addressed should inform a county’s choices about inform a county’s choices about which populations or groups which populations or groups of individuals will be of individuals will be identified for full service identified for full service partnership funding in this partnership funding in this first three-year planfirst three-year plan.”.”

Community Issues/Concerns Community Issues/Concerns Identified in the Public Planning Identified in the Public Planning ProcessProcess

Children/Children/

YouthYouthTAYTAY AdultsAdults Older Older

AdultsAdults

1.1. 1.1. 1.1. 1.1.

2.2. 2.2. 2.2. 2.2.

3.3. 3.3. 3.3. 3.3.

4.4. 4.4. 4.4. 4.4.

5.5. 5.5. 5.5. 5.5.

Selection of County Selection of County Issues/ConcernsIssues/Concerns

Counties must describe:Counties must describe:

What factors or criteria led to the selection of the issues to be the focus of MHSA services over the next three years.

How were issues prioritized for selection?

Selection of County Selection of County Issues/ConcernsIssues/Concerns

Counties must describe specific racial ethnic, and gender disparities within selected community issues for each age group, such as:

Access disparities Disproportionate representation in the homeless

population and in county juvenile or criminal justice systems

Foster care disparities Access disparities on American Indian reservations School achievement drop-out rates Other significant issues

Steps to Complete CSS Steps to Complete CSS Three-Year Plan – Three-Year Plan – Full Full ServiceService

1.1. Prioritize concerns by age groupPrioritize concerns by age group

2.2. Identify related needs & disparities Identify related needs & disparities

3.3. Identify populations most impactedIdentify populations most impacted

4.4. Determine strategies & activities to Determine strategies & activities to meet needsmeet needs

5.5. Determine expected outcomes to be Determine expected outcomes to be achievedachieved

CSS Three-Year Plan – CSS Three-Year Plan – System Development System Development FundsFunds

The funds will be available to improve services and infrastructure for the identified initial full service populations and for other clients with emphasis on reducing ethnic disparities. Examples: client and family services such as peer support,

education and advocacy services

mobile crisis teams

funds to promote interagency and community collaboration and services

funds to develop the capacity to provide values-driven, evidence-based and promising clinical practices.

CSS Three-Year Plan – CSS Three-Year Plan – Outreach and Outreach and EngagementEngagementRecognizes special activities needed to reach unserved populations with a priority on eliminating racial ethnic disparities. Examples: funding for racial ethnic community-based organizations

mental health and primary care partnerships

faith-based agencies

tribal organizations

health clinics

organizations that help individuals who are homeless or incarcerated and link potential clients to services

funds for clients and families to reach out to those that may be reluctant to enter the system

funds for screening of children and youth

school and primary care based outreach to children and youth who may have serious emotional disorders.

Stakeholder Stakeholder Leadership Leadership CommitteeCommittee

Review input on Critical ConcernsReview input on Critical ConcernsShare views on Critical ConcernsShare views on Critical ConcernsShare views on Prioritizing Critical Share views on Prioritizing Critical ConcernsConcerns

Next StepsNext Steps

June 17, 2005 – Work Groups:June 17, 2005 – Work Groups: Complete initial summary of critical concerns,

individual strengths, system strengths and weaknesses, focal populations

Input to draft priority critical concerns Input to needs and disparities

June 24, 2005 – Leadership Committee June 24, 2005 – Leadership Committee Reviews community input to critical concerns

(inreach/outreach results); Reviews WG Summary Reviews draft of priority concerns by age group; Reviews initial needs and disparities data

Evaluation & ClosureEvaluation & Closure

What worked?What worked? What should be changed?What should be changed? RequestsRequests Next Time and PlaceNext Time and Place Contact InfoContact Info

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

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

Sheila Yuter, MHSA Coordinator, 408-885-3885

Santa Clara County MHD Website www.sccmhd.org

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