1. California Mental Health Older Adult System of Care Project Janet C
California Mental Health Older Adult System of Care Project Janet C. Frank, DrPH, MSG Kathryn G. Kietzman, PhD, MSW CBHDA MHSA Coordinators Meeting June 5, 2017

2. California Mental Health Older Adult System of Care Project
What We’ll Cover
Overview of Research Question and Methods for Study
Preliminary Study Findings
Planned Dissemination Products

3. California Mental Health Older Adult System of Care Project
Primary Research Question
What progress has been made since the passage of the MHSA toward implementing an integrated and comprehensive system
of care for older adults with serious mental health needs?

4. Participating Study Counties
Siskiyou
Alameda
Monterrey
Tulare
Los Angeles
San Diego

5. TRIANGULATION OF STUDY METHODS
Stakeholder Interviews
Focus Groups
Secondary Data Analyses

6. Secondary Analyses Data
REPORT TYPE
YEARS
NUMBER REPORTS REVIEWED
NUMBER of REPORTS ANALYZED
Mental Health Services Oversight & Accountability Commission (MHSOAC) contracted reports and evaluations 37 16
Stakeholder reports and evaluations 7
Three-Year Program and Expenditure Plans and Annual Updates
Three-Year Plans
FY and
Annual Updates FY 56
12 (2 per county)
TOTALS
100 35

7. Key Findings: Secondary Review
Development of an OASOC pre-dated the MHSA, ~ 25% of counties have
MHSA has generated $13 billion dollars, ~ 25% of mental health service funding
MHSA outcomes reporting is inadequate and should be strengthened
Seniors and veterans least common stakeholder groups that took part in MHSA planning
Data showed a steady improvement in the numbers of older adults receiving services since MHSA
Great unmet need across all MHSA services
One study reported data from 45 counties, showing 15 counties (33%) using PEI programs to serve older adults. Those age 60 and above accounted for 1.5% of those receiving prevention services. Of the 40 counties reporting early intervention services, 32 counties (80%) served older adults. Clients age 60 and above were 13.1% of those receiving early intervention services. However, when older adults are linked to services, for example FSP, they show clinical improvements and reduced costs of care, such as hospitalizations. Based on state FSP data, reports documented important outcomes for older adults, including reductions in emergency room visits, psychiatric hospitalizations, arrests and incarcerations and homelessness.

8. County-Level Key Stakeholder Interviews
Stakeholder Type 15
Consumers, Family Members
Mental Health Administrators 12
Clinicians/Direct Providers: Mental Health/Aging Services 14
Aging Services Administrators 2
Advocates (professional) 1
Health and Human Services Administrator 59
= TOTAL COUNTY-LEVEL STAKEHOLDERS
6 Counties:
Alameda
Los Angeles
Monterey
San Diego
Siskiyou
Tulare

9. State-Level Key Stakeholder Interviews
Stakeholder Type 1
Administrator, Public Health
Administrator, Health Care Services 2
Administrators, Aging Services 4
Administrators: State-Level Association, Council, or Commission
State-Level Advocates (professional)
Administrators, Office of Statewide Health Planning and Development
Other State-Level Perspective 13
= TOTAL STATE-LEVEL STAKEHOLDERS

10. Key Stakeholder Interview Findings: Domains

11. Key Stakeholder Interview Findings Overview
Variation in OASOC: no state mandate or funding allocation
All counties have programs (not systems of care) either specific for older adults, or inclusive of older adults
All counties offer services that are responsive to the needs of older adults and reflect the individual values promoted by the OASOC and MHSA

12. Key Stakeholder Interview Findings Overview (continued)
Counties reported limited service penetration with older adults
Outreach efforts vary by county
More needs to be done to reach out to older adults who are not making their way to services
Most older adults being served have been living with SMI, often for many years, and have aged within the system

13. Key Stakeholder Interview Findings: Barriers to Care
Unmet basic needs (e.g., food, housing), geographic disparities (especially rural vs urban areas), transportation and housing deficits, insufficient and untrained workforce, bureaucratic constraints, and insurance coverage and care costs
Gaps in services: older adults with cognitive impairment, long-term case management, transition/step-down services, and culturally-appropriate services

14. Key Stakeholder Interview Findings: Facilitators
Facilitators to accessing care include increased awareness about MH, increased consumer knowledge about the system and services available, home-based service provision, smooth referral pathways, and improved transportation
Integrated care, the co-location of mental health services with primary care, is an important innovation to improve access
Across the board, the co-location of mental health services with primary care was described as an important innovation that has improved access to care, especially for older adults who are more likely to have multiple chronic conditions.

15. Focus Group Sample Family Members (n=11) Consumers (n=33) Age
66 years (average)
years(range)
Female = 20 (61%)
Race/ethnicity
Hispanic/Latino (48%)
African American 14 (42%)
White (6%)
Multiracial (3%)
Spanish-speaking = 16 (48%)
History of homelessness
20 (61%)
Family Members (n=11)
Lives with consumer
4 (36%)
Female = 8 (73%)
Race/ethnicity
African American 8 (73%)
Multiracial (18%)
Hispanic/Latino ( 9%)
History of homelessness
(consumer) (64%)

16. Key Findings: Focus Groups
What matters most to older adult consumers and family members?
COMMUNITY: social engagement, through support groups, neighborhood, church
FAMILY: help with knowledge/access, invaluable in recovery, value intergenerational relationships
RELIGION: Recovery as a spiritual journey, a
source of strength and fulfillment

17. Key Findings: Focus Groups
What impedes recovery?
Distrust of the system, especially in marginalized communities
Cultural beliefs that stigmatize mental illness
Lack of appropriate and experienced providers
Geographic disparities in service availability
Bureaucratic barriers: lots of paperwork, long waits when applying, delays for referrals

18. Key Findings: Focus Groups
What supports recovery?
Information and services from trusted sources
Support groups with peers
One stop shopping: integration of physical health, mental health, and substance use services
Incorporating family and spirituality into recovery
Services for family members
Providers with compassion

19. Take Away Messages MHSA Programmatic Benefits PEI programs
Peer-led programs
FSP programs and services
Additional resources for county services
Increased services networks
Innovation projects – integrated programs very beneficial

20. Take Away Messages (continued)
Recommendations for Improvement
A need for leadership at every level
Address geographic disparities in access
Promote integrated systems and care
Address resource needs
Use outreach strategies, specific to older adults
Workforce preparation and adequacy
Need for both tracking and outcomes data
Increase the political will for older adult MH issues
State leadership regarding settings standards and expectations for OA services; County-level Leadership and Advocacy across sectors; Agency-level leadership: champions at every level
Huge issues of geographic disparity: “zip code lottery”, unequal access and care
Integrated systems and care: especially important for OA with multiple chronic conditions; across agency partnerships; across providers: behavioral health/substance abuse, MH and primary care; reduce redundant bureaucracy burden on client
Workforce: trained to work with OA; culturally competent; adequate numbers/types;
Data: Tracking of numbers of OA served; also Data collection practices and measures specific to/ inclusive of OAs (indicators work)

21. California Mental Health Older Adult System of Care Project
Dissemination Products
Two Policy Briefs:
Key Indicators for MH Services for Older Adults
Main Study Findings
Three Fact Sheets:
Promising Programs
Main Study Results (English & Spanish)

22. California Mental Health Older Adult System of Care Project
What Questions or Comments Do You Have?
Janet:
Kathryn: