Maria Fuentes, MSW Senior Services Manager Adult and Older Adult Division Santa Clara County Mental Health Department

Introduction One voice from two sources is guiding the mental health system to better address the Mental Health needs of Santa Clara County’s elder community: the system transformation from MHSA and the community input from the Older Adult Summit. Getting to a Common Voice Older Adult Summit Recommendations MHSA (Proposition 63) – the purpose Community Support Services (CSS) – Santa Clara County Framework CSS Older Adult Services On-going Older Adult FSP (Community Solutions, Golden Gateway) On-going Outreach and Engagement ( Catholic Charities - Golden Gateway) New Older Adult Behavioral Health Outpatient Redesign (APS, City of San Jose)

The Older Adult Summit On June 1, 2011, 348 seniors, family members, providers and community members spoke out and developed a plan of action to improve the ability of senior-serving systems to address the mental health of their clients and families. The community’s concerns for senior mental health focused on critical topics: Cultural Competency Physical HealthFamily/Caregiver Inclusion & Support Services Access EducationOutreach & Engagement Advocacy Sigma Reduction Service Quality & Design PolicyHealth Insurance & Social Benefits

Using the continuum to serve seniors Community Engaged, System Partners Family Support System Mental Health Services for Seniors

The Older Adult Summit Recommendations Community Education and Advocacy – Community education to increase public awareness regarding older adult mental health needs and concerns. Access and Engagement – Outreach, engagement and access strategies to connect older adults served through all county systems to needed mental health services and supports. Service Integration and Quality – Increase mental health funded services and implement service delivery strategies that improve mental health outcomes through integration with health, social service and CBOs. Training and Professional Development – Implement training to help health, mental health and social service providers to address the holistic social, cultural, emotional, physical and spiritual needs of seniors. Family, Caregiver, and Peer Support – Implement strategies that empower and enhance natural support systems to care and provide for elders, their loved ones and caregivers. Policy Development – Champion and implement policies that improve benefits and resources that impact the well-being of older adults. The community’s thoughtful, comprehensive recommendations are leading us to strategic strategies implemented with our Partners. The OA Summit Plan is a component of the Santa Clara County Senior Agenda initiative.

The Mental Health Services Act November 2004 passage of Proposition 63, increased revenues ($974.9 million in Fiscal Year 12) Called on Counties to transform systems: > access easier > services more effective > out-of-home, institutionalization reduced > stigma eliminated MHSA challenges counties (us) to create comprehensive, state-of the art, culturally competent mental health services that promote recovery and wellness for adults and older adults with severe mental illness and resiliency for children and youth with severe emotional disorders and their families.

Community Support Services MHSA has five Programs: Community Support Services Prevention and Early Intervention Innovation Workforce Education and Training Capital Facilities and Technological Needs Community Support Services – Funds ongoing system expansion and improvement for new and current clients and comprises largest portion of MHSA Funding.

Community Services and Support Plans County CSS Plans submitted to the State were evaluated for contributions to: meaningful use of time and capabilities, safe housing, network of supportive relationships, access to help in crisis, reduction in incarceration and involuntary services. Concepts required in the county plans: community collaboration and stakeholder involvement, cultural and language competence programs and services to eliminated racial and ethnic disparities, client and family driven, wellness focused, integrated experiences for clients and families. Service categories: Full Service Partnership, System Development, and Outreach and Engagement.

Santa Clara County CSS Framework per Planning Process Essential Plan Principles Initial CSS Plan Objectives Life Span Approach Community Engaged and Supported Cultural Competency Social Ecology Focus Connectedness Emphasis Recovery and Resiliency Guided Consumer and Family Driven Based in System Partnerships Emphasis on Quality and Continuous Learning Grounded in respect, hope, self-help and empowerment. Increase: Meaningful use of time and capabilities in school, work, activity Access to substance abuse treatment Natural supportive relationship network Self-help and consumer/family involvement Safe and permanent housing Reduce: Subjective suffering from mental illness Homelessness Multiple foster care placement Incarceration Juvenile justice involvement Disparities in services access

CSS Principles and Objectives and OA Summit Recommendations CSS MHSA ESSENTIAL PLAN PRINCIPLES Life Span Approach Community Engaged and Supported Cultural Competency Social Ecology Focus Connectedness Emphasis Consumer and Family Driven Based in System Partnerships Emphasis on Quality and Continuous Learning Grounded in respect, hope, self-help and empowerment. OBJECTIVES FOR INITIAL CSS PLAN Increase meaningful use of time and capabilities in school, work, activity natural supportive relationship network self-help and consumer/family involvement safe and permanent housing Reduce subjective suffering from mental illness disparities in services access > access easier > services more effective > out-of-home, institutionalization reduced > stigma eliminated OA Summit Cultural Competency Physical Health Family/Caregiver Inclusion & Support Services Access Education Outreach & Engagement Advocacy Sigma reduction Service Quality & Design Policy Health Insurance & Social Benefits

Linking Common Voices OA SUMMITMHSACSS Cultural Competency Physical HealthBased in System Partnerships Family/Caregiver Inclusion & Support Connectedness Emphasis Increase Natural Supportive Relationship Network Services AccessAccess Easier Out-of-home, Institutionalization Reduced Life Span Approach Reduce Disparities in Services Access EducationSocial Ecology Focus Outreach & EngagementCommunity Engaged and Supported AdvocacyGrounded in Respect, Hope, Self-help and Empowerment. Consumer and Family Driven Sigma ReductionStigma Eliminated Service Quality & Design Services More EffectiveEmphasis on Quality and Continuous Learning Increase Meaningful Use of Time & Capabilities in School, Work, Activity Increase Self-help and Consumer/Family Involvement PolicyReduce Subjective Suffering From Mental Illness Health Insurance & Social Benefits: Increase Safe and Permanent Housing

OA Summit Recommendations offer an approach that follows the MHSA model of consumer and community driven Training and Professional Development Integration and QualityPolicy Development Community Education and Advocacy Access and EngagementFamily, Caregiver, Peer Support Service

Pertinent CSS Programs PROGRAMFY 2012FY 2013 A01Adult Full Service Partnerships$4,545,934 A02Adult Behavioral Health Services Outpatient System Redesign (CWBC moved from A02 to HC01 below) $11,186,981$7,589,738 A03Criminal Justice System Jail Aftercare Program$6,930,608$6,680,608 A04Urgent Care$3,449,971$3,523,171 A05Consumer & Family Wellness & Recovery Services$1,059,761 OA01Older Adult Full Service Partnership$371,288 OA Older Adult Behavioral Health Services Outpatient Redesign$1,054,806$1,585,042 HC01Behavioral and Primary Health Care Partnership (CWBC moved from A02 above) $1,502,960$5,230,979 HO01Housing Options Initiative$2,140,791$2,437,350 LP01Learning Partnership$1,593,772$1,845,676 CSSAD01 Administration1,241,341$1,573,287

Outreach and Engagement Community /Home -based – “whatever it takes” to reach seniors most at need and at risk for mental health services. Initial interventions and assessments, and referrals to needed ongoing services. FY 12 BudgetFY 12 ExpensesFY 13 Budget Catholic Charities $1,075,763$1,092,964$1,075,763 Asian/ Pacific Islander AfricanLatinoEuropeanOtherUnknownTotal Catholic Charities Golden Gateway Average Age: %21.8%1917.7%2422.4%1211.2%2523.3%107

Full Services Partnership (FSP) Intensive wraparound to needs of persons with serious mental illness including psychiatric, homelessness or risk of, hospitalization or institutionalization, and risk of physical, financial or psychological harm. Update: FY 11 EPS admission decreased by 33%, hospitalization increased by 33%, arrest at zero; increase in European and Latino, decrease in African and Native American, Asian remained the same. FY 12 BudgetFY 12 ExpensesFY 13 Budget Catholic Charities $422,189$429,301$346,228 Community Solutions $175,237$173,377$180,877 TOTAL $597,426$602,678$527,105 Asian/ Pacific Islander AfricanLatinoEuropeanOtherUnknownTotal Catholic Charities Average age: %39.6%412.9%1651.6%26.4%2 31 Community Solutions Average age: %457.1%114.2%1 7 TOTAL410.5%37.8%513.1%2052.6%37.8%3 38

SYSTEM REDESIGN Older Adult Behavioral Health Services Outpatient Redesign Improved access, engagement, assessment and level of care assignment for outpatient clients. Training on transformation principles and intervention, including recovery focused, consumer and family involvement and cultural competency. UPDATE: Implementation of OA Summit Recommendations Training on Cognitive Behavioral Therapy to evaluate depression, and deliver effective clinical interventions for older adults with depression. New Program: City of San Jose Geriatric Specialist in senior centers to explore staff ability to identify & address behavioral health needs. County Psychiatric Social Worker stationed at Adult Protective Services to provide accessible mental health services to APS referrals. Home based : outreach, engagement, education. FY 13 Budget Adult Protective Services : County Psychiatric Social Worker/Marriage Family Therapist Pilot Program $124,956 City of San Jose: City Geriatric Specialists in Senior Centers $280,000

Acknowledgement Thank you to teachers, family and friends and colleagues who have helped us learn what it means to provide mental health services to Older Adult. We work as one voice to voice the needs and concerns of older adults, and their families and caregivers, as they try to overcome suffering from mental illness, emotional problems and social isolation.

Maria Fuentes, MSW Senior Services Manager Santa Clara Co. Mental Health Dept. Adult and Older Adult Division 828 S. Bascom Avenue, Suite 200 San Jose, CA (408)