1. Older Adult Intensive Program Full Service Partnership Bernice Zaborski, MHA Presented at the Integrated Services Conference April 5, 2006

2. Objectives To understand fundamentals of an Older Adult Full Service Partnership Review of Sacramento County MHSA process and determination of older adult needs Identify the basic program design of an Older Adult Intensive Program Identify the core components of an Older Adult Intensive Program Discuss older adult system of care and relationship to full service partnership program

3. Sacramento County MHSA Structure Mental Health Kick-Off May 2, 2005 Participants included consumers, family members, mental health providers, advocates, senior service providers Stakeholder Groups Frail, Homebound, Isolated Elderly Older Adult Medical and Mental Health Co-Occurring

4. Successful Stakeholder Groups and System Change Welcome and manage multiple points of view Self-interests are minimized; system needs are maximized Broad and diverse representation Defined period of time Facilitated by an objective party

5. MHSA Planning Process: Key Components Community Needs Assessment Training & Stakeholder Input Task Forces Steering Committee Community Services & Support (CSS) Plan 6 Proposals including the Older Adult Intensive Service Program

6. Transition Age Adults Persons age 55-59 There is increased risk for health related issues Clients in the 55 to 59 age group are the highest users of Crisis and In-Patient Unit service

7. Barriers to Older Adults Seeking Mental Health Services Stigma/myths regarding lack of benefit Cultural and linguistic barriers Isolation/transportation issues Lack of accessibility, availability and usability of services Lack of geriatric trained staff Inadequate assessment of mental and physical problems Physical illness and disabilities

8. Prevalence of Psychiatric Disorders in Older Adults According to the Surgeon General: 20% of persons age 55+ will experience a mental disorder in a 1-year period 37% in primary care settings suffer depressive symptoms Clinically significant depression is 25% higher among those with chronic illness Highest suicide rate relative to other age groups, the consequence of untreated depression

9. Sacramento County Older Adult Profile Fiscal Year 2004-2005 1,778 Clients Less than 5% of Sacramento County Mental Health System Age range 55-104 Average age is 68.1 years Underserved/Unserved Males (69.4% of outpatient clients are female) Transitional Age Adults Age 55-59

10. Ethnicity Comparison FY 2004-2005 Caucasian 60% Asian11.6% African-American11.9% Spanish/Hispanic 8.0% Other 8.6%

11. Older Adult Intensive Program Eligibility Criteria Age 60 and over (5% transitional age 55-59) Must transfer from Regional Support Team Have complex, co-occurring mental health, physical health, substance abuse, and social service needs Require intensive case management to coordinate range of services At risk for emergency room utilization, hospitalization, nursing home care, institutionalization, eviction/homelessness

12. Older Adult Intensive Program Overview Program Design Features Capacity to serve 100 clients from Regional Support Team 1/15 staff/client ratio Home-based services Regular hours with 24/7 on-call service Culturally and linguistically appropriate

13. Special Considerations for Older Adults Increasing cultural and linguistic isolation Substance abuse and misuse Sensory loss Homelessness/displacement Economic hardship

14. Special Considerations for Older Adults continued… Cognitive impairments Physical and biochemical impairments/ co-morbidity Poor nutrition/dental health issues Medication issues Loss of interpersonal, social and family supports

15. Service Components Multidisciplinary Assessment Services Comprehensive culturally competent bio-psycho-social evaluation Assess mental health, medical, substance abuse and social service needs Linkage with a primary care physician and other healthcare services

16. Service Components continued… Treatment Services Individual, Group and Family Counseling Medical and Medication Services Psycho-Educational Services Peer Counseling Linkage with Social, Family and Community Supports

17. Service Components continued… Intensive Case Management Services Clients will be assigned to a personal service coordinator Work collaboratively to develop individualized service and support plan Referral to multidisciplinary team members or community service providers

18. Program Personnel Multidisciplinary Team Members Mental Health Program Coordinator (1 FTE) Clinical and administrative supervision Mental Health Counselors (7 FTE) Mental Health Services Psychiatric Nurse (1 FTE) Medication management/coordinate with physical healthcare Psychiatrist (1 FTE) Medication services (contracted)

19. Program Personnel c ontinued… Nurse Practitioner (1 FTE) Physical healthcare/medication management Family/Consumer Advocate (.40 FTE) Education, training, patients rights (contracted) Senior Peer Counselors (4 FTE) Volunteers with $85/mo. Stipends/$40 bus passes Cultural/Linguistic Consultant (.20 FTE) Cultural/linguistic services (contracted) Total FTEs = 16.60

20. Staff Training Wellness and Recovery Philosophy Cultural Competency Language, Race, Ethnicity, Customs, Family Structure, Sexual Orientation and Community Dynamics Co-Occurring Disorders Drug/Alcohol Co-Morbidities Dementia, Delirium, Depression Disease prevention/management

21. Promising and Evidence-Based Practices Multidisciplinary Assessment and Treatment Case Management Mobile Services/Home Visitation Collaborative Service Planning with Community Providers Peer Counselors

22. Older Adult System of Care Values Quality of Life Clients Strengths/Empowerment Self Help Cultural & Linguistic Competence Assessment & Treatment Protocols Access to Community-Based Services Preventing Inappropriate Hospitalization Preventing Suicide Multidisciplinary Service Coordination Medical/Psychiatric Interface Family & Community Involvement Support Services for Caregivers Education and Prevention Multiple Funding Sources

23. Resources Websites For a complete copy of Sacramento County MHSA Community Services and Support Plan visit www.sacdhhs.com www.sacdhhs.com For the Older Adult System of Care Framework and Transitional Age Adult Workgroup information visit CMHDAs website at www.cmhda.orgwww.cmhda.org For the California Mental Health Master Plan (Chapter 6 – The Planned System of Care for Older Adults visit www.dmh.ca.gov/mhpc/reportswww.dmh.ca.gov/mhpc/reports

24. Thank You Questions and Answers