Santa Clara County Mental Health Services Act Planning A Presentation to the Board of Supervisors December 13, 2005 Santa Clara County Mental Health Services Act Planning CSS Three-Year Plan A Presentation to the Board of Supervisors December 13, 2005 Department of Mental Health SCVHHS

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%)* *requirements and allocation method undetermined

Current Plan Before the Board  Community Services & Supports Plan  Santa Clara: $13.4 Million x 3 yrs  Broad stakeholder process required  51%+ in Full Service Partnerships  49% System Development/Outreach  Public Hearing hosted by Mental Health Board  Subject to DMH approval  Each distinct program must be approved/denied

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

Stakeholder Process 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

Most Frequently Noted Concerns Across all Age Groups Across all Age Groups –In trouble with the law, incarceration –Concurrent substance abuse –Abuse, neglect, violence, trauma –Sadness, depression, loneliness, isolation –Poverty, homelessness, inadequate housing –Failing school & jobs, meaningless activities –Concurrent medical problems –Institutionalization, hospitalization –Problems with family and peers

Focal Populations Defined Per Requirements Children 1.Zero to Five Years High Risk 2.Foster Care Youth 3.Juvenile Justice Involved Youth 4.Underserved Seriously Emotionally Disturbed Transition Age Youth 5.First Time Psychosis 6.Sixteen to 25 Years Aging Out of Child Systems Adults 7.Jail Involved/Homeless/Dual Diagnosed SMI 8.Underserved/Un-served SMI Older Adults 9.High Risk/Homebound SMI Seniors

Estimates of Unmet Need Based on 200% of poverty population by prevalence estimates (FY03 service data) Based on 200% of poverty population by prevalence estimates (FY03 service data)AGE Fully Served Served Under- served Un- served* , , ,8911,3021, ,6082,5173, , Total441(2%)22,056(100%)4,855(22%)8,930 * Understated estimate of public need (closer to 300% of poverty) and prevalence among certain populations (e.g. 8.5% general population vs. 50+% in jail, foster care, juvenile justice)

Disparities in Unmet Need Latino, Asian and American Indian underserved among all ages Latino, Asian and American Indian underserved among all ages Latino, African American and American Indian over- represented in CJS, un-housed, and foster care with greater need (prevalence) and less served Latino, African American and American Indian over- represented in CJS, un-housed, and foster care with greater need (prevalence) and less served Refugee, immigrant and monolingual greater need and less served Refugee, immigrant and monolingual greater need and less served LGBTQ greater need and less served LGBTQ greater need and less served Developmentally disabled greater need and less served Developmentally disabled greater need and less served

Overview of Recommendations

Children 0-15 C-01 Full Service Partnerships – 30 slots; est. $20K per year per child, with up to 30% 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 30% 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, American Indian 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, American Indian 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 30% 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 30% 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 30% 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 30% 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 – ( $2.5 M proposed to satisfy Jail Task Force solution #15) for criminal justice involved mentally ill: A-03 Jail Aftercare and Recovery Services – ( $2.5 M proposed to satisfy Jail Task Force solution #15) for criminal justice involved mentally ill:  Full Service Partnerships - 75 slots; est. $20K per year per client, with up to 30% 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 30% 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 30% 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 to 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 to several cross-cutting initiatives.

Crosscutting Strategies HO-01 – Housing Options – HO-01 – Housing Options –   Establishes $2 million fund to develop housing options in collaboration with Office of Affordable Housing. Upon State approval of this proposal, MHD and OAH will jointly design expenditure plan with assistance of housing experts, and will bring back to BOS for approval. Objective will be to leverage these funds in order to maximize the establishment of ongoing permanent housing for the mentally ill in Santa Clara County.

Crosscutting Strategies  Housing Component Summary  Full Service Partnerships (C-01, T-01, A-01, A-03 and OA-01). Est. $2-3 Million (30% of annual resources) will go to securing and maintaining stable permanent living for clients.  MHSA Housing Fund (HO-01) - $2 Million to develop permanent housing resources.  Jail Aftercare & Recovery (A-03) - $625,000 for 75 Transition Housing Units dedicated to jail aftercare. Length of stay and provider requirements will be determined through collaboration with Jail Task Force members.

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.

Total CSS Funding Allocations FY06 – FY08 Age $17.4m 46% Age 60+ $3.8m 10% Cross Cutting $4.6m Admin $3.4m 9% Age 0-15 $3.8m 10% Age $4.9m 13% 12%

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

Timeline October 28 th - Leadership Committee Endorsed Plan October 28 th - Leadership Committee Endorsed Plan November th - Public Hearings November th - Public Hearings December 5 th - Mental Health Board Endorsed Plan December 5 th - Mental Health Board Endorsed Plan 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 – RFP Process, Training, Start-Up January – April – RFP Process, Training, Start-Up April – Jan 07 – Implementation of Programs April – Jan 07 – Implementation of Programs