1. Santa Clara County Mental Health Services Act Planning Stakeholder Leadership Committee May 20, 2005 Department of Mental Health

2. Objectives Launch the SCC Stakeholder Leadership Committee Provide brief overview of MHSA & planning process Provide overview of Community Services & Supports (CSS) Plan requirements & work to date Obtain SLC input on “Critical Issues” selection criteria

3. MHSA Funding  1% tax on taxable personal income over $1 million to be deposited into a Mental Health Services Fund (MHSF) in State Treasury  Administered by State Department of Mental Health  Oversight by 16-Member Accountability Commission  Distributed to Counties Via Current State-County Contract  $300 Est. Million in FY05; $700 Million Est. in FY06  Is used to expand, not supplant services; can “not be used to supplant existing state or county funds utilized to provide mental health services.”  Phased in approach to implementation, beginning with Planning and Expanded Service components

4. MHSA is Intended to   Introduce effective new service models that promote well-being, recovery and self-help   Introduce prevention and early intervention to prevent negative impact of serious mental illness   Enhance human resource, technology and capital infrastructure of current system   Reduce stigma and change negative social perceptions of mental illness   Correct fragmentation and inadequate funding

5. MHSA Components The MHSA addresses six components of building a better mental health system involving an extensive stakeholder process to guide policies and programs: 1. 1. Community Program Planning 2. 2. Services and Supports 3. 3. Capital (buildings) and Information Technology 4. 4. Education and Training (human resources) 5. 5. Prevention and Early Intervention 6. 6. Innovation

6. Initial Funding FY04-08  FY04-05 funds (est. $300 Million) 45% - Education and Training (DMH fund) 45% - Education and Training (DMH fund) 45% - Capital Facilities Technology (DMH fund) 45% - Capital Facilities Technology (DMH fund) 5% - Local Planning (to counties) 5% - Local Planning (to counties) 5% - State Implementation (to DMH Admin). 5% - State Implementation (to DMH Admin).  FY06, FY07 and FY08 (est. $600 – 800 Million) 10% - Education & Training 10% - Capital and Technology 50% - Children, Adult, Senior Services 5% - Innovative Programs 5% - Innovative Programs 20% - Prevention and Early Intervention 5% - State Administration 5% - State Administration

7. MHSA in Perspective  Research indicates the prevalence of mental illness in US is 8.55%, which equals 145,000 Santa Clara County residents  MHSA is projected to provide $700 Million in new revenue in FY 2005/06 with est. 55% going to direct service expansion, which will increase direct services by 15%  SCC share for first phase expansion of direct services is projected to be between $10 - $18 Million, depending on allocation method (2.5% - 5% of funds; MHD lost $58 Million since FY02)

8. The Process   Broad based stakeholder involvement process:   Open monthly forums to engage, inform, gather input, educate   Delayed establishment of Leadership Committee   Four clear phases of planning   Extensive “inreach” to consumers, families, providers; outreach to system partners, underserved, community

9. The Process Work Groups for specific topic areas   Child, Adolescent, Young Adult SOC   Adult and Older Adult SOC   Prevention and Early Intervention   Data, Infrastructure and Human Resources Strategy Teams for detailed research and design

10. The Process Stakeholder Leadership Committee to: Review & Input to Development of Plan Facilitate Stakeholder Involvement Educate Community Advise Board of Supervisors

11. Board of Supervisors State Dept. of Mental Health BOS Committees (HHC, CSFC, PSJC) County Executive SCVHHS Exec. Dir MHSA Stakeholder Leadership Committee Data, Technology, Budget Work Group Prevention & Early Intervention Work Group Children’s System of Care Work Work Group Adult/ Older Adult System of Care Work Group Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups Cultural CompetencyReadiness ForumsRecovery/Self HelpReadiness Forums Focus Group Focus Group Focus Group Focus Group Focus Group Accountability Commission Mental Health Board Project Management Team Santa Clara County MHSA Planning Structure

12. The Process - Santa Clara County Partial List of Stakeholders Mental Health Department (chair) County Executive’s Office (co-chair) Mental Health Board (co-chair) Mental Health Self-Help Centers MHD Office of Consumer Empowerment National Alliance for the Mentally Ill Association of Mental Health Contractors Non-AMHCA mental health providers Labor Organizations Foster Care Association Residential & Group Home Providers Parents Helping Parents Department of Alcohol and Drug Services Public Health Department VMC Acute Psychiatric Services Custody Health Services Valley Medical Center Office of the Public Guardian Police Chief Association SCC Sheriff Department of Social Services Probation Department Superior Court District Attorney’s Office Public Defender’s Office County Office of Education School District Superintendents First Five Commission Council on Aging Office of Affordable Housing Domestic Violence Council School Linked Services United Way Interfaith Council Silicon Valley Council of Non-profits San Andreas Regional Center

13. The Opportunity Will not achieve transformation without strong leadership and vision at the local level. That leadership must:   Engage local consumers and families, system partners, providers, and advocates   Establish a collective purpose and system-wide enthusiasm and desire for change   Provide a clear and understandable framework for the planning process   Provide opportunities for subjective and deep dialog as well as access to objective data and information

14. Planning Phases  Engagement and Commitment   Invite Stakeholder Involvement   Share Intent and Vision   Lay Out Planning Landscape  Learning and Assessment   Learn Current System   Learn Needs of Consumers, Stakeholders, Community   Learn Best Practice Strategies to Meet Needs  Prioritization and Planning   Establish Local Mission, Values & Transformation Objectives   Prioritize Local Needs   Select Most Effective Strategies to Meet Local Needs  Implementation   Obtain State Approval   Select Local Providers   Initiate, Monitor and Evaluate Services

15. The Approach– Lifespan Framework Determine and Prioritize Local Mental Health Needs Across Lifespan Prevention Early Intervention Intervention All Citizens Across Lifespan Citizens in need Unmet Need Current Public MH System

16. Work Groups Age Groups 1. Early Childhood 0-5 years 2. School Age 6-15 years 3. Transition Age 16-25 4. Adults 26-59 5. Older Adults 60+

17. The Approach Establish System Structure and Stakeholder Involvement Individual & Family Provider Services System Policy and Management Stakeholders System Performance: Expectations & Results Provider Performance: Expectations & Results Client Level Outcomes: Expectations & Results

18. The Approach Demonstrate process quality and favorable outcomes Who Do We Serve? What Are We Trying to Change? What Practices Do We Employ and Why? How Do We Insure Quality of Practices? How Do We Measure Results? What Results Do We Achieve?

19. MHSA Planning Work to Date Major Inreach and Outreach Campaign regarding Critical Concerns and needs through end of May Major Inreach and Outreach Campaign regarding Critical Concerns and needs through end of May Four Large Forums to address: Four Large Forums to address: –MHSA Orientation –Engagement and Commitment –Cultural Competency Readiness –Wellness, Recovery & Resiliency Readiness Work Groups to addres critical concerns of five age groups Work Groups to addres critical concerns of five age groups

20. Determining Critical Concerns Health & Well Being Stable Home, Family, Social Relations Meaningful S chool, Work Activity Safe From Harm or Harming in Community Emotional Suffering SA Abuse Poor Health Thriving With Mental Illness Failing With Untreated and Under-treated Mental Illness Homeless Adult Isolated Senior Removed Child Housed Adult Connected Senior Child at Home Emotional Well Being SA Remission Good Health Jobless Adult Inactive Senior School Failing Child Jailed Adult Victimized Senior Delinquent Child Employed Adult Active Senior Child in School Adult out of Jail Safe Senior Child out of Trouble Low Need Hi Need

21. MHSA Planning Individual and System Strengths & Weaknesses MHSA Planning Individual and System Strengths & Weaknesses Consumer Strengths Individual Family Community & Cultural System Strengths System Weaknesses Pre-ReferralAdmissionServices Discharge

22. Initial MHSA Component – Community Services and Supports (CSS) Plan Expands Services to New Clients Expands Services to New Clients Transform Current System Transform Current System Funds Outreach & Engagement Funds Outreach & Engagement

23. CSS Objectives & Desired Outcomes For Mental Health Clients Meaningful use of time and capabilities (employment, vocational training, education, and social and community activities) Safe and adequate housing (safe living environments with family for children and youth; reduction in homelessness) A network of supportive relationships Timely access to needed help, including times of crisis Reduction in incarceration in jails and juvenile halls Reduction in involuntary services including reduction in institutionalization and out-of-home placements.

24. Significant Changes Intended These requirements are intended to initiate significant changes including: Increases in the level of participation and involvement of clients and families in all aspects of the public mental health system Increases in client and family operated services Outreach to and expansion of services to client populations in order to eliminate ethnic disparities in accessibility, availability and appropriateness of mental health services and to more adequately reflect mental health needs Increases in the array of service choices for individuals diagnosed with serious mental illness and children/youth diagnosed with serious emotional disorders, and their families

25. Essential Concepts DMH considers it essential that all county plans address and incorporate five essential concepts. They are: 1. 1. Community collaboration 2. 2. Cultural competence 3. 3. Client/family-driven mental health system for older adults, adults and transition age youth and family-driven system of care for children and youth 4. 4. Wellness focus, which includes the concepts of recovery and resilience 5. 5. Integrated service experiences for clients and their families throughout their interactions with the mental health system

26. CSS - Three Types of Funding DMH is making three types of funding available to counties. The three types are: 1. 1.Full Service Partnership Funds – funds to provide necessary services and supports for initial populations 2. 2.General System Development Funds – funds to improve services and infrastructure 3. 3.Outreach and Engagement Funding – funds for those populations that are currently receiving little or no service

27. CSS Plan – Logic Model The MHSA Plan Requirements are based on a logic model that links: 1.Community issues resulting from untreated mental illness and a lack of services and supports 2.Mental health needs within the community, 3.The identification of specific initial populations to be served based upon the issues and needs identified, 4.The strategies and activities to be implemented, and 5.The desired outcomes to be achieved.

28. Inability to be in a mainstream school environment School failure Hospitalization Peer and family problems Out-of home placement Involvement in the child welfare and juvenile justice systems Community Concerns – For Children, Youth and Some TAY

29. Community Concerns – Some TAY, Adults and Older Adults   Homelessness  Frequent hospitalizations  Frequent emergency medical care  Inability to work  Inability to manage independence  Isolation  Involuntary care  Institutionalization  Incarceration

30. Determining Critical Community Concerns “Working with clients, families and other community stakeholders, counties should examine these issues and others in the context of their communities and identify which of these community issues and concerns they will focus on in their initial three-year program and expenditure plan”

31. Critical Concerns Lead to Initial Plan Populations “The selection of community issues to be addressed should inform a county’s choices about which populations or groups of individuals will be identified for full service partnership funding in this first three-year plan.”

32. Community Issues/Concerns Identified in the Public Planning Process Children/YouthTAYAdults Older Adults 1.1.1.1. 2.2.2.2. 3.3.3.3. 4.4.4.4. 5.5.5.5.

33. Selection of County Issues/Concerns Counties must describe: What factors or criteria led to the selection of the issues to be the focus of MHSA services over the next three years. How were issues prioritized for selection?

34. Selection of County Issues/Concerns Counties must describe specific racial ethnic, and gender disparities within selected community issues for each age group, such as:   Access disparities   Disproportionate representation in the homeless population and in county juvenile or criminal justice systems   Foster care disparities   Access disparities on American Indian reservations   School achievement drop-out rates   Other significant issues

35. Steps to Complete CSS Three-Year Plan – Full Service 1. Prioritize concerns by age group 2. Identify related needs & disparities 3. Identify populations most impacted 4. Determine strategies & activities to meet needs 5. Determine expected outcomes to be achieved

36. CSS Three-Year Plan – System Development Funds The funds will be available to improve services and infrastructure for the identified initial full service populations and for other clients with emphasis on reducing ethnic disparities. Examples:   client and family services such as peer support, education and advocacy services   mobile crisis teams   funds to promote interagency and community collaboration and services   funds to develop the capacity to provide values-driven, evidence-based and promising clinical practices.

37. CSS Three-Year Plan – Outreach and Engagement Recognizes special activities needed to reach unserved populations with a priority on eliminating racial ethnic disparities. Examples:   funding for racial ethnic community-based organizations   mental health and primary care partnerships   faith-based agencies   tribal organizations   health clinics   organizations that help individuals who are homeless or incarcerated and link potential clients to services   funds for clients and families to reach out to those that may be reluctant to enter the system   funds for screening of children and youth   school and primary care based outreach to children and youth who may have serious emotional disorders.

38. Stakeholder Leadership Committee Review input on Critical Concerns Review input on Critical Concerns Share views on Critical Concerns Share views on Critical Concerns Share views on Prioritizing Critical Concerns Share views on Prioritizing Critical Concerns

39. Next Steps June 17, 2005 – Work Groups: June 17, 2005 – Work Groups: Complete initial summary of critical concerns, individual strengths, system strengths and weaknesses, focal populations Input to draft priority critical concerns Input to needs and disparities June 24, 2005 – Leadership Committee June 24, 2005 – Leadership Committee Reviews community input to critical concerns (inreach/outreach results); Reviews WG Summary Reviews draft of priority concerns by age group; Reviews initial needs and disparities data

40. Evaluation & Closure What worked? What worked? What should be changed? What should be changed? Requests Requests Next Time and Place Next Time and Place Contact Info Contact Info Nancy Pena, Ph.D., Director, MHD, 408-885-5783 Bruce Copley, Deputy Director, MHD 408-885-5773 Sheila Yuter, MHSA Coordinator, 408-885-3885 Santa Clara County MHD Website www.sccmhd.orgwww.sccmhd. State Dept. Mental Health website www.dmh.ca.govwww.dmh.ca.gov