Santa Clara County Mental Health Services Act Planning Public Hearing CSS Three-Year Plan November 28, 29, 30, 2005 Department of Mental Health SCVHHS

Plan Overview   MHSA Planning Context   CSS State Required Process   Recommended Strategies

(MHSA (aka Proposition 63)  1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury  Administered by State Department of Mental Health  Oversight by 16-Member Accountability Commission  Distributed to Counties Via Current State-County Contract  $300 Est. Million in FY05; $700 Million Est. in FY06  Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”  Phased in approach to implementation, beginning with Planning and Expanded Service components

Overview of MHSA Components S Six phased-in components completed through a state and local stakeholder involved process: Community Program Planning (5%) Community Services and Supports (50%) Capital and Information Technology (10%) Education and Training (10%) Prevention and Early Intervention (20%) Innovation (5%)

State Updates Accountability Commission Convened Accountability Commission Convened CSS Component Funding Posted: CSS Component Funding Posted:  Santa Clara = $13.4 Million x 3 yrs. Majority of Counties Posted CSS Plans Majority of Counties Posted CSS Plans Three Plans reviewed by State Three Plans reviewed by State Components Pending State Requirements: Components Pending State Requirements: Training & Education Training & Education Capital and Information Technology Capital and Information Technology Prevention and Early Intervention Prevention and Early Intervention

Board of Supervisors State Dept. of Mental Health BOS Committees (HHC, CSFC, PSJC) County Executive SCVHHS Exec. Dir MHSA Stakeholder Leadership Committee Work Group & Strategy Teams Children & Youth 0-15 Years Work Group & Strategy Teams Older Adults 60+ Years Work Group & Strategy Teams Transition Age Youth Years Work Group & Strategy Teams Adults Years Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups Cultural Competency Wellness and Recovery Evidenced Based Practices MHSA Vision & Requirements Focus Group Focus Group Focus Group Focus Group Focus Group Accountability Commission Mental Health Board Project Management Team Santa Clara County MHSA Planning Structure Ethnic Community Advisory Committees

Plan Requirements The Three-Year CSS Plan Identify Community Concerns for All Ages Determine Unmet Need Identify Specific Populations for Focus Identify strategies to Meet Need 1234

CSS –Funding for Three Types of Service 1. 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. 2.General “Capacity Building” Funds – to improve services and infrastructure; can be system-wide strategies 3. 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 Work to Date Major Inreach and Outreach Campaign regarding Critical Concerns and needs from March through June – 10,000 voices have been heard through meetings and surveys! Major Inreach and Outreach Campaign regarding Critical Concerns and needs from March through June – 10,000 voices have been heard through meetings and surveys! Stakeholder Leadership Committee convened and endorsed critical concerns, focal populations & draft plan recommendations from Work Groups, Strategy Teams, and Ethnic Community Advisory Teams Stakeholder Leadership Committee convened and endorsed critical concerns, focal populations & draft plan recommendations from Work Groups, Strategy Teams, and Ethnic Community Advisory Teams

Focal Populations Defined Per Requirements Children Children  Zero to Five Years High Risk  Foster Care Youth  Juvenile Justice Involved Youth  Underserved Seriously Emotionally Disturbed Transition Age Youth Transition Age Youth  Sixteen to 25 Years Aging Out of Systems  First Time Psychosis

Focal Populations Defined Per Requirements Adults Adults  Homeless, Dual Diagnosed, Jailed  Frequent ER User Seriously Mentally Ill  Underserved/Unserved SMI  Jail Involved Dual Diagnosis Non SMI Older Adults Older Adults  High Risk Seriously Mentally Ill  Isolated/Homebound Mentally Ill

Overview of Recommendations

Children 0-15 C-01 Full Service Partnerships – 30 slots; est. $20K per year per child, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian juvenile justice involved and youth without insurance. C-01 Full Service Partnerships – 30 slots; est. $20K per year per child, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian juvenile justice involved and youth without insurance. C-02 Zero to Five System Development – to develop inter-agency infrastructure to support 0- 5 year olds, includes planning; screening/assessment design; training of specialists; family support and system navigation for monolingual Latino and Vietnamese families. C-02 Zero to Five System Development – to develop inter-agency infrastructure to support 0- 5 year olds, includes planning; screening/assessment design; training of specialists; family support and system navigation for monolingual Latino and Vietnamese families.

Children 0-15 C-03 Behavioral Health System Development – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of juvenile justice and foster care populations. Emphasis on underserved Latino, Asian, African American, Native American youth and families. C-03 Behavioral Health System Development – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of juvenile justice and foster care populations. Emphasis on underserved Latino, Asian, African American, Native American youth and families.

Transition Age Youth 15 – 25 Years T-01 Full Service Partnerships – 30 slots; est. $20K per year per youth, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian exiting juvenile justice and foster care systems. T-01 Full Service Partnerships – 30 slots; est. $20K per year per youth, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian exiting juvenile justice and foster care systems. T-02 Behavioral Health System Development – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of youth child- serving systems. Emphasis on underserved Latino, Asian, African American, Native American youth and families. T-02 Behavioral Health System Development – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of youth child- serving systems. Emphasis on underserved Latino, Asian, African American, Native American youth and families.

Transition Age Youth 15 – 25 Years T-03 Crisis & Drop-In Services and Supports – safe, non-stigmatizing access to mental health and basic services. T-03 Crisis & Drop-In Services and Supports – safe, non-stigmatizing access to mental health and basic services. T-04 Education Partnership – Integrated “middle college” and community college support to improve “school success” of youth with mental health concerns. T-04 Education Partnership – Integrated “middle college” and community college support to improve “school success” of youth with mental health concerns.

Adults A-01 Full Service Partnerships – 75 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, Asian and American Indian, homeless, institutionalized, and frequent ER users with severe mental illness. A-01 Full Service Partnerships – 75 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, Asian and American Indian, homeless, institutionalized, and frequent ER users with severe mental illness. A-02 Behavioral Health Recovery Services – to redesign county adult outpatient services to include consumer and family support staff; add support and case management staff; and to introduce best practice strategies and align and establish therapeutic caseload size. A-02 Behavioral Health Recovery Services – to redesign county adult outpatient services to include consumer and family support staff; add support and case management staff; and to introduce best practice strategies and align and establish therapeutic caseload size.

Adults A-03 Jail Aftercare and Recovery Services – for criminal justice involved mentally ill: A-03 Jail Aftercare and Recovery Services – for criminal justice involved mentally ill:  Full Service Partnerships - 75 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on Latino, African American, and American Indian;  Enhanced Treatment Court – 60 slots for case management and service linkage;  Dual-Diagnosis After Care Treatment – 125 slots for medication and case management services;  Expanded Housing Options – 75 beds; Transitional Housing Units (THU)

Adults A-04 Adult Urgent Care and Crisis Support – Establishes urgent care and mobile crisis response in north, central and south county regions. A-04 Adult Urgent Care and Crisis Support – Establishes urgent care and mobile crisis response in north, central and south county regions. A-05 Consumer and Family Self-Help Support – Establishes Director of Consumer Affairs and Director of Family Support and Education, in addition to expanded consumer and family self-help with focus on unserved and underserved ethnic and cultural communities. A-05 Consumer and Family Self-Help Support – Establishes Director of Consumer Affairs and Director of Family Support and Education, in addition to expanded consumer and family self-help with focus on unserved and underserved ethnic and cultural communities.

Older Adults 60+ OA-01 Full Service Partnerships – 25 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on those in or at risk of homelessness, institutionalization, incarceration; physical and emotional harm. OA-01 Full Service Partnerships – 25 slots; est. $20K per year per client, with up to 50% ($10K) to support stable living/housing; emphasis on those in or at risk of homelessness, institutionalization, incarceration; physical and emotional harm. OA-02 Behavioral Health Services – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of older adults; expanded service to senior day programs. OA-02 Behavioral Health Services – System-wide implementation of improved screening, assessment and best practice models of treatment; specialized access and care management of older adults; expanded service to senior day programs.

Older Adults 60+ OA-03 Senior Mobile Assessment & Outreach – Provides specialized mobile assessment and outreach services to shut-in and homebound mentally ill seniors, many of whom are experiencing concurrent medical and substance abuse problems; focus on monolingual seniors. OA-03 Senior Mobile Assessment & Outreach – Provides specialized mobile assessment and outreach services to shut-in and homebound mentally ill seniors, many of whom are experiencing concurrent medical and substance abuse problems; focus on monolingual seniors. OA-04 Senior Family and Caregiver Support – Provides culturally appropriate family and caregiver support and education to those caring for mentally ill seniors. OA-04 Senior Family and Caregiver Support – Provides culturally appropriate family and caregiver support and education to those caring for mentally ill seniors.

Support Staff 2.0 Full Service Coordinators 2.0 Full Service Coordinators 1.0 Training Director 1.0 Training Director 2.0 Q.I./U.M. Coordinators 2.0 Q.I./U.M. Coordinators 1.0 Utilization Management Analyst 1.0 Utilization Management Analyst 1.0 Cultural Competency Coordinator 1.0 Cultural Competency Coordinator

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

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

Crosscutting Strategies FH-01 – Community & Family Outreach and Engagement Initiative – to develop culturally competent outreach and engagement strategies to underserved populations. FH-01 – Community & Family Outreach and Engagement Initiative – to develop culturally competent outreach and engagement strategies to underserved populations. HC-01 – Behavioral & Primary Health Care Partnership – to establish integrated pilot primary care services for clients of the mental health system. HC-01 – Behavioral & Primary Health Care Partnership – to establish integrated pilot primary care services for clients of the mental health system.

Crosscutting Strategies EE-01 – Education, Employment, and Self- Sufficiency Services - to develop comprehensive education, employment and benefit assistance system for all clients of the system. EE-01 – Education, Employment, and Self- Sufficiency Services - to develop comprehensive education, employment and benefit assistance system for all clients of the system. ST-01 – Regional Survivors of Torture Treatment Services – to establish regionally available specialty treatment services for Bay Area refugee survivors of torture. ST-01 – Regional Survivors of Torture Treatment Services – to establish regionally available specialty treatment services for Bay Area refugee survivors of torture.

Following initial Three-Year Plan County will submit renewal plan Following initial Three-Year Plan County will submit renewal plan Increased revenues expected in future years to finance one-time initiatives and expand strategies to further populations Increased revenues expected in future years to finance one-time initiatives and expand strategies to further populations MHD may revise strategies depending on outcomes achieved with DMH approval MHD may revise strategies depending on outcomes achieved with DMH approval FY09 and Beyond

Next Steps December 5 th – Proposed Plan to MHB December 5 th – Proposed Plan to MHB December 7 th -Proposed Plan to HHC December 7 th -Proposed Plan to HHC December 13 th – Proposed Plan to BOS December 13 th – Proposed Plan to BOS December 30 th – Final Plan to State DMH December 30 th – Final Plan to State DMH January – April – Implementation Readiness January – April – Implementation Readiness April - June – Implementation of Programs April - June – Implementation of Programs

Contact Info Contact Info Nancy Pena, Ph.D., Director, MHD, Bruce Copley, Deputy Director, MHD Tiffany Ho, M.D., Medical Director, MHD, Sheila Yuter, MHSA Coordinator, Maria Fuentes, Ethnic Services Manager, Santa Clara County MHD Website State Dept. Mental Health website