1. Therapeutic Behavioral Services (TBS)
Mental Health Board
System Planning and Fiscal Committee
January 5, 2012
Santa Clara County Mental Health Department

2. 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.

3. 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.

4. 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, 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.”

5. 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

6. 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

7. 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

8. Client Gender Gender FY10 FY11 Female 130 142 Male 228 235 Total 358
377

9. Client Ethnicity

10. Diagnosis Acuity Diagnosis Acuity FY10 FY11 1 Diagnosis 64 96
2 or more Diagnoses
285
270
Unknown 9 11
Total
358
377

11. 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

12. TBS Contact Information
County TBS Office: (408) fax: (408)  
QI Authorization:
Mary Harnish, MFT, QI Coordinator at (408)
Family & Children’s Division Contact:
Sherri Terao, Ed.D. (408)
DMH TBS Website:
and_Youth/EPSDT.asp