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 recommendations of 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 Class Criteria Requirements 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 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 Diagnoses FY10 FY11 Diagnosis Frequency Adjustment Disorder With Mixed Disturbance of Emotions and Conduct 13 12 Anxiety Disorder NOS 9 Attention-Deficit/Hyperactivity Disorder NOS Attention-Deficit/Hyperactivity Disorder, Combined or Predominantly Hyperactive Type 32 37 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type 8 Depressive Disorder NOS 24 Disruptive Behavior Disorder NOS 29 45 Mood Disorder NOS 18 Oppositional Defiant Disorder 39 42 Parent-Child Relational Problem 16 11 Posttraumatic Stress Disorder 33 36

TBS Contact Information 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