Older Adult System of Care Conference. California Mental Health Directors Association and Riverside County. December 1-2, 2009.

Transcription

1 Older Adult System of Care Conference presented by California Mental Health Directors Association and Riverside County What s Age Got To Do With It? Valuing All Elders: Eliminate disparities, Increase Collaboration, Support Prevention and Recovery Through the Mental Health Services Act (MHSA) December 1-2, 2009 Riverside Convention Center 3443 Orange Street Riverside, California (951)

2 CONFERENCE OBJECTIVES Understand the need for community education and other strategies to eliminate the stigma and discrimination experienced by older adults who have a mental illness. Recognize that older adults are ethnically, racially and culturally diverse which requires the provision of age-appropriate, culturally competent services by a culturally competent, diverse workforce. Identify strategies to reduce disparities in access to health and mental health services as well as to promote integrated care models and service collaboration among health and human services providers, including primary care, to address in a comprehensive way the health, mental health, alcohol/drug, social service and other needs of all older adults. One of the identified strategies is cross-training of system partners working with older adults with mental health and co-occurring needs to promote integrated service delivery and quality of care. Acquire knowledge about older adult evidence-based practice prevention and early intervention models that can be integrated into programs across systems serving older adults at-risk for or experiencing early onset of mental illness including depression and suicide risk. Gain understanding of Co-occurring Disorders, Full Service Partnerships and the Recovery Model as they relate to older adults. TUESDAY, DECEMBER 1, :45 AM - 5:00 PM REGISTRATION... Ben H. Lewis Hall - North 8:00 AM - 9:00 AM CONTINENTAL BREAKFAST... Ben H. Lewis Hall - North 9:00 AM - 9:30 AM WELCOME AND OPENING REMARKS... Ben H. Lewis Hall - North Denise C. Hunt, RN, MFT - Co-Chair, Older Adult System of Care Committee (OASOC), Behavioral Health Director, Behavioral Health & Recovery Services, County of Stanislaus Jerry A. Wengerd, LCSW - Director, Department of Mental Health, County of Riverside Sandra Naylor Goodwin, PhD, MSW - President/CEO, California Institute for Mental Health (CiMH) Vicki Smith, MSW, CPRP - Director of Adult Services, California Institute for Mental Health (CiMH) 9:30 AM - 10:30 AM KEYNOTE: Stigma and Discrimination of Older Adults: I Am What I Am : Ageism and the Older LGBT Community... Ben H. Lewis Hall - North Patrick Arbore, EdD - Director and Founder of Center for Elderly Suicide Prevention and Grief Related Services, a Program of the Institute on Aging, San Francisco, CA 10:30 AM - 10:45 AM BREAK Ageism, which is every bit as offensive and dangerous as discrimination based on gender and race, can be especially crippling to older LGBT individuals. If ageism reduces older heterosexual people to sexless, inflexible, unproductive stereotypes, then such ageism is especially threatening to older LGBT people. Professionals need to consider the challenges in the aging process for LGBT individuals. You may be the first person who has an accepting attitude about this person s sexual orientation or gender identity. You may be the first professional who actually sees this LGBT older person. As in the lyrics written by Jerry Herman Life s not worth a damn til you can say Hey world, I am what I am.

3 TUESDAY, DECEMBER 1, :45 AM - 11:45 AM KEYNOTE: Models of Integrated Behavioral Health and Primary Care... Ben H. Lewis Hall - North Kathy Reynolds, LMSW, ACSW - Vice President for Health and Wellness, National Council for Community Behavioral Healthcare, Washington D.C. This workshop will review the specific rationale for providing integrated behavioral health and primary care services for older adults. Based on the results from the landmark PRISM-E study of older adult mental health and substance abuse service access patterns, this workshop will provide attendees with data supporting integration and two models of integrated services for older adults. The impact Model for treating depression in primary care and the use of peer supports in integrated care for older adults will be reviewed. 11:45 AM - 12:45 PM LUNCH (included with registration)... Ben H. Lewis Hall - North 12:45 PM - 2:45 PM WORKSHOP SESSION I Workshop A: Evidence Based Practices for Older Adult Depression Care Management (PEARLS & Healthy IDEAS)... De Anza Room Moderator: Christine Basterrechea - Program Manager, Orange County Health Care Agency, Behavioral Health Services, Adult Services, County of Orange Mark Snowden, MD, MPH - Associate Professor, University of Washington, Harborview Center, Department of Psychiatry and Behavioral Sciences, Seattle, Washington (PEARLS) Nancy L. Wilson, MA, LMSW - Deputy Director, Baylor College of Medicine, Huffington Center on Aging, Department Medicine Geriatrics, Houston Center for Quality Care and Utilization Studies, Care for Elders, Houston, Texas (Healthy IDEAS) Attendees of this workshop will become familiar with PEARLS (Program to Encourage Active and Rewarding Lives) and Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) evidence-based practice depression care models for older adults. As more information is gathered on the phenomenon of depression, precipitants and course of the disease, the need and benefits of early detection and intervention for positive outcomes is evident and has led to program development. The attendees will learn about depression in the elderly and how to develop and implement these programs for positive results. Workshop B: A Model of Collaboration: Development of Partnerships to Provide and Enhance Aging Services... Magnolia Room Moderator: Vikki Neugebauer, LMFT - Coordinated Care Program Manager, Office on Aging, County of Riverside Barbara J. Mitchell, LCSW - Older Adult Services Program Manager, Department of Mental Health, Older Adult Services, County of Riverside, Co-Chair, OASOC Planning Committee Ed Walsh, MSW - Director, Office on Aging, County of Riverside, Co-Chair, OASOC Planning Committee A collaborative partnership is the bench mark of service delivery in Riverside County for older adults. The development of the partnership between Department of Mental Health and Office on Aging has enhanced aging services. The workshop will address the following goals: the development of the core elements needed for collaboration to take place, reducing fragmentation and duplication of services while maximizing coordination of services within the departments, principles of planning within a partnership, and strategies for the development and maintenance of the partnership. This model can be duplicated within your county.

4 TUESDAY, DECEMBER 1, :45 PM - 2:45 PM WORKSHOP SESSION I (continued) Workshop C: Treatment and Recovery Programs for Older Adults with Alcohol/Substance Use Issues and/or Co-Occurring Disorders... La Sierra Room Moderator: Deborah Levan, MPH - Director, Senior Services, Behavioral Health Services, Inc., Gardena, CA Gretchen Blais, LMFT - St Mary s Center, Recovery 55 Program, Oakland, CA Jane Farmer - Executive Director, La Vista Recovery and Wholeness Center for Women, San Jacinto, CA Mark Odom LCSW - Service Chief II, START (Substance Abuse Resource Team), Orange County Health Care Agency, Behavioral Health, Older Adult Services, County of Orange Substance abuse can negatively impact an older adult s health, mental health, family and social relationships, and overall quality of life. Abuse and misuse of alcohol, prescription and other drugs affects an estimated 20% of older adults and is expected to rise as the Baby Boomers age. It may be difficult to identify and address due to the reluctance or lack of awareness of the older adult, caregiver or the service provider. When substance abuse co-occurs with mental disorders, it increases the risk of poor health outcomes, inpatient and outpatient service use and suicidal thoughts and attempts. As with mental illness, substance abuse should be identified and treated by service providers with special competencies, using an integrated approach. This workshop will present several programs providing treatment and recovery services to older adults with alcohol/substance use issues as well as co-occurring disorders. Each program will describe the population served, their program structure and design and a qualitative review of issues related to outreach and engagement, assessment, treatment and retention. Workshop D: What Does Recovery Look Like for Older Adults?...Victoria Room Moderator: Cynthia Jackson Kelartinian, PhD - Executive Director, Heritage Clinic, Division of Center for Aging Resources, San Diego and Pasadena, CA Ed Fletcher - Peer Support Specialist, Mission Trails Wellness and Recovery Clinic for Mature Adults, Department of Mental Health, County of Riverside Mariann Sandor - Family Advocate, SMART Team-Cathedral Canyon, Department of Mental Health, County of Riverside Lisa St. George, MSW, CPRP - Regional Vice President, Recovery Innovations of California, San Diego, CA Carmen A. Lee - Consumer Advocate, Program Director, Stamp Out Stigma and Vice Chair Older Adult Committee, California Mental Heath Planning Council Recovery for older adults experiencing mental health challenges may look very similar conceptually to recovery for a younger population, however sometimes the form of recovery may look different. Given that the older adult population has the widest age range of any population, cohort issues often become relevant. For example, recovery for someone who is 60 may be very different than recovery for someone who is 92. In this workshop, these similarities and differences will be discussed, and audience participation will be encouraged as we continue to work on revising the markers used for younger populations to be more fully relevant for older adults. Client focused quality of life outcomes will be discussed. 5

5 TUESDAY, DECEMBER 1, :45 PM - 2:45 PM WORKSHOP SESSION I (continued) 2:45 PM - 3:00 PM BREAK Workshop E: The Deadly Triangle: The Relationship between Depression, Alcoholism, Suicide and Older Adults...Citrus Heritage Moderator: Clint Nix, LCSW - Older Adult System of Care Director, Behavioral Health Care Service, County of Alameda Patrick Arbore, EdD - Director and Founder of Center for Elderly Suicide Prevention and Grief Related Services, a Program of the Institute on Aging, San Francisco, CA The workshop will provide an opportunity for mental health, aging, alcohol and drug and other health and human services providers to experience an engaging presentation about the interaction of depression, suicide and alcohol use in older adults. The educational objectives of the workshop are: recognition of risk factors of depression, suicide and alcohol use in older adults including ethnically, racially and culturally diverse older adults; understand screening tools for depression and alcohol dependence/abuse in older adults; provide a suicide risk assessment; and to understand effective interventions for someone who is exhibiting signs/symptoms of depression, suicide or alcohol abuse. The American Society on Aging, under contract to the California Department of Alcohol and Drug Programs, offers free training and technical assistance on abuse and misuse of Alcohol and Other Drugs (AOD) for providers in nonprofit and governmental agencies in California to help them better serve their older clients. 3:00 PM - 4:45 PM WORKSHOP SESSION II Workshop F: Older Adult Full Service Partnership: What We Have Learned? Where Are We Going?... Magnolia Room Moderator: Jennifer Clancy, MSW - Senior Associate, California Institute for Mental Health (CiMH) Cynthia Jackson Kelartinian, PhD - Executive Director, Heritage Clinic, Division of Center for Aging Resources, San Diego and Pasadena, CA Patty Lyons, MA, MFT - Supervisor, HOPE Program and Senior Peer Counseling, County of Marin Barbara J. Mitchell, LCSW - Older Adult Services Program Manager, Older Adult Services, SMART Team, County of Riverside This workshop will focus on full service partnership strategies specific to working with older adults exhibiting the most serious and long term mental health challenges. It will include and emphasize work with homeless older adults and those with co-occurring disorders. Since these programs and partnerships in support of recovery have been made available to the older adult population, our system has learned, what does and does not work effectively in helping individuals move towards well-being and self efficacy. These lessons learned will be shared as part of the presentation. 6

6 TUESDAY, DECEMBER 1, :00 PM - 4:45 PM WORKSHOP SESSION II (continued) Workshop G: Older Adult Prevention and Early Intervention Program Models... La Sierra Room Moderator: Lin Benjamin, MSW, MHA - Geriatric Mental Health Specialist, Long Term Care and Aging Services, California Department of Aging Terri Restelli-Deits, MSW - Planner, Area Agency on Aging Serving Napa and Solano Counties Jane Adams - Deputy Director, Department of Aging and Adult Services, County of San Bernardino Kristen D. Smith, MPH - Health Promotion Manager, Aging and Independence Services, San Diego County Three distinctive MHSA-funded Older Adult Prevention and Early Intervention Programs will be presented that involve Area Agencies on Aging in Solano (AAA Older Adult Prevention and Early Intervention Program), San Bernardino (High Desert Older Adult Prevention and Early Intervention Program) and San Diego (SALUD) counties. Aging services providers perform an important gatekeeper function in identifying older adults who are at risk for or may be experiencing the onset of a serious mental illness such as depression which is a significant risk factor for suicide. Older adults who require prevention and early intervention services include those who are trauma exposed due to medical illness, elder abuse, neglect, social isolation, or loss of spouse, partner and friends; experience stigma and discrimination as a result of having a mental illness; experience disparities in access to mental health services, particularly older adults from diverse populations. The MHSA Prevention and Early Intervention (PEI) funding component provides an opportunity to transform the public mental health system and build capacity in system partners to address these community needs in older adults. Workshop H: Complexities of Communication in Clinical Care: Why You re Still Talking and They Aren t Listening...Citrus Heritage Moderator: Clint Nix, LCSW - Older Adult System of Care Director, Behavioral Health Care Service, County of Alameda Karyn Skultety, PhD - Director of Behavioral Health, Lifeways/Onlok, Institute on Aging, San Francisco, CA This workshop will address issues related to the behavioral aspects of providing interdisciplinary care to the older adult population. We will explore ways that providers can communicate more clearly to help clients respond to treatment recommendations and how to work through the different perspectives that often exist between clients and providers. The complex, multiple factors that contribute to poor communication and disagreements about treatment courses will be explored. In addition, the presentation will review common communication pitfalls that occur in response to behavioral issues and discuss ways to avoid these pitfalls and improve communication. Communication between providers on teams, particularly in addressing behavioral aspect of care, will also be explored to help improve team and provider functioning.

7 TUESDAY, DECEMBER 1, :00 PM - 4:45 PM WORKSHOP SESSION II (continued) Workshop I: Older Adults Mental Health Education and Training Models for MHSA Funding...Victoria Room Moderator: Kevin Tsang, LCSW, MBA - District Chief, Department of Mental Health, Countywide Older Adult Program Administration, County of Los Angeles James Cunningham, PhD - Mental Health Clinical Program Head, Department of Mental Health, Countrywide Older Adult Program Administration, County of Los Angeles Velia Gitari, MA - Peer Counseling Coordinator, Heritage Clinic, Division of Center for Aging Resources, San Diego, CA Lisa St. George, MSW, CPRP - Regional Vice President, Recovery Innovations of California, San Diego, CA Janet Anderson Yang, PhD - Heritage Clinic, a division of the Center for Aging Resources, Pasadena, CA The passage of Proposition 63 in 2004 and the advent of Mental Health Services Act (MHSA) have provided mental health funding streams and program opportunities in California to serve persons 60 years old and above. As these programs were being implemented statewide, a shortage of trained and experienced mental health workers specialized in the older adult arena has emerged as an evident challenge. This workshop will focus on: 1) the development of a bio-psycho-social geriatric mental health curriculum, 2) Incorporating the philosophy and values of older adult recovery in training, 3) Ttraining the new and transforming workforce, 4) Development of peer support and advocacy training, and 5 Cross-training models with older adult system of care partners. Workshop J: Implementing an Evidence-Based Suicide Prevention Model in the Aging Network...Ben H. Lewis Hall - North Moderator: Sarah Gelberd, MD - Senior Physician, Geriatrician, Department of Mental Health, Countywide Older Adult Program Administration-GENESIS, County of Los Angeles Donna Carender, MSG - Carender Consulting LLC, LivingWorks Master Trainer, Sahuarita, AZ Unique issues contribute to suicide among older adults and the growing number of individuals that will be entering the older adult population. Community awareness, alertness to the signs of suicide, and the ability to intervene with potentially suicidal individuals are the keys to addressing this serious community health problem. To establish an age-appropriate prevention/intervention model requires collaboration between the behavioral health and aging networks. This workshop will identify the methodology for collaboration between the systems of care and the implementation of a suicide prevention program, utilizing the aging network of service providers. The workshop will highlight the use of the LivingWorks Education training modules of suicidetalk, safetalk, and Applied Suicide Intervention Skills Training (ASIST), and the two-year outcomes of the Pima Council on Aging Suicide Prevention Program. 5:00 PM - 6:00 PM Networking at the Riverside Mission Inn (Light Hors d oeuvres)... Spanish Art Gallery Room\ Riverside Mission Inn 3649 Mission Inn Avenue Riverside, CA (951) Kick-off: California Elder Mental Health and Aging Coalition Dinner on your own 6:00 PM - 12:00 AM Evening Entertainment - Mission Inn Festival of Lights The Mission Inn invites you to their Festival of Lights, the most dazzling holiday spectacular. The 3.5 million lights transforms the Riverside historic hotel into pure magic. There are gourmet restaurants, and downtown Riverside, horse-driven carriage rides, and live entertainment. 8

8 WEDNESDAY, DECEMBER 2, :30 AM - 1:00 PM REGISTRATION... Ben H. Lewis Hall - North 7:30 AM - 8:30 AM CONTINENTAL BREAKFAST... Ben H. Lewis Hall - North 8:00 AM - 8:15 AM WELCOME AND INTRODUCTIONS... Ben H. Lewis Hall - North Bruce Gurganus, M, Div., MFT - Director of Community Mental Health Services, County of Marin, Co-Chair, OASOC Committee Barbara Mitchell, LCSW - Mental Health Service Program Manager, Older Adult Services, Department of Mental Health, County of Riverside and Co-Chair OASOC Planning Committee Ed Walsh - Director, Office on Aging, County of Riverside and Co-Chair, OASOC Committee 8:15 AM - 8:30 AM LEADERSHIP AWARD CEREMONY... Ben H. Lewis Hall - North Presented by Laura Trejo, MSG, MPA - General Manager, Department of Aging, Area Agency on Aging, City of Los Angeles Award Recipient: Barbara Massey, MSNP - Retired Program Head, GENESIS, Department of Mental Health, County of Los Angeles 8:30 AM - 9:00 AM SERVICE DEVELOPMENT AND SYSTEM COLLABORATION THAT VALUES ELDERS AND PROMOTES WELLNESS AND RECOVERY... Ben H. Lewis Hall - North Moderator: Bruce Gurganus, M, Div., MFT - Director of Community Mental Health, County of Marin, Co-Chair, OASOC Planning Committee Lynn Daucher - Director, California Department on Aging Stephen W. Mayberg, PhD - Director, State Department of Mental Health The directors will focus on the importance of valuing our elders in our society, and the role of mental health and aging services/systems/providers. They will lead a discussion about what the mental health and aging services systems are doing to promote health, mental health and wellness; reducing disparities in access to services particularly for diverse elders; and promoting independence and dignity for our elders. The directors will discuss the challenges that the mental health and aging services systems face in achieving these outcomes. 9:00 AM - 9:30 AM MENTAL HEALTH SERVICES OVERSIGHT AND ACCOUNTABILITY COMMISSION (MHSOAC) UPDATE... Ben H. Lewis Hall - North David Pating, MD - Commissioner, Mental Health Services Oversight and Accountability Commission (MHSOAC) and Chief, Addiction Medicine, Kaiser San Francisco Medical Center Chemical Dependency Recovery Program In November 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA) with 53.4% of the vote. The MHSA established the Mental Health Services Oversight and Accountability Commission (MHSOAC). The Mission of the MHSOAC is to: 1) Provide the vision and leadership, in collaboration with clients, their family members, and underserved communities, to ensure Californians understand mental health is essential to overall health; 2) Hold public systems accountable and provide oversight for eliminating disparities, promoting wellness, recovery and resiliency; and 3) Ensure positive outcomes for individuals living with serious mental illness and their families. Dr. Pating will provide an update on the activities of the MHSOAC, its Committees and Work Groups. 9

9 WEDNESDAY, DECEMBER 2, :30 AM - 11:15 AM DISPARITY AND OLDER ADULTS: WHAT WE KNOW AND WHAT WE CAN DO ABOUT IT... Ben H. Lewis Hall - North Moderator: Alfredo Aguirre, LCSW - Director, Mental Health Services, Behavioral Health Division, County of San Diego Sergio A. Aguilar-Gaxiola, MD, PhD - Professor of Internal Medicine Director, Center for Reducing Health Disparities, UC Davis School of Medicine Rachel Guerrero - Chief, Office of Multicultural Services (OMS), California Department of Mental Health Steven Wallace, PhD - Associate Director, UCLA Center for Health Policy Research, Professor, UCLA School of Public Health, Los Angeles, CA 11:15 AM - 11:30 AM BREAK In 2006, the nation s first generation of baby-boomers who turned 60 years of age emerged as the first waver of older adult boomers. Ample studies, research, data and literature have suggested gaps exist between the older adult population and the socio-medical-economic resources that are available and accessible to them. This panel aims to discuss the multi-faceted aspect of system disparity issues with the following areas of learning: 1) Demographic data and trends that portray the continued growth of the older adult population, corollary, the increase and unmet demands for services 2) Strategies that are in place or could be developed to address the unique linguistic and cultural needs of older adults in California due to its multi-ethnic demographics. 3) Understanding of some recent date sources. i.e. the Elder Economic Security Standard Index and their ramifications to older adults disparity and advocacy issue. 4) Understanding the statewide PEI reducing disparities project. 11:30 AM - 12:45 PM WORKING WITH DIVERSE ELDERS: SUCCESSFUL PROGRAMS AND STRATEGIES... Ben H. Lewis Hall - North Moderator: Viviana Criado MPA - Former Older Adult Coordinator, HHSA, Behavioral Health Services, County of San Diego Renda Dionne, PhD - Clinical Psychologist, Turtle Mountain Chippewa, Clinical Director Indian Child and Family Services, Temecula, CA Yvonne J. Sun, MSW - Program Manager, Special Service for Groups, Older Adults Program, Los Angeles, CA Juana Infante, MSW - Psychiatric Social Worker, Department of Mental Health, GENESIS-FCCS, County of Los Angeles California is among the few states in the nation that has the most ethnically and culturally diverse populations. Older adults, who are ethnically under-represented in the mental health or geriatric services system, confront complex stigma, cultural, language barriers that impact their access and utilization of services. The development of culturally appropriate services, therefore, is germane to the client s recovery. The panel presents a host of geriatric services and mental health providers to share their experience in working with older adults of diverse ethnic and cultural background, highlighting barriers, effective interventions, and challenges in the coarse of service delivery. 12:45 PM - 1:00 PM CLOSING REMARKS, EVALUATIONS, AND ADJOURNMENT Bruce Gurganus, M, Div., MFT - Co-Chair, State OASOC Committee, Director of Community Mental Health Services, County of Marin Workshop handouts available at 10

10 2009 Older Ad u l t s Sy s t e m of Care C o n f e r e n c e Planning Committee Barbara J. Mitchell, LCSW Older Adult Services Program Manager, Department of Mental Health,. Older Adult Services, County of Riverside,. Co-Chair, OASOC Planning Committee Ed Walsh, MSW Director, Office of Aging, County of Riverside,. Co-Chair, OASOC Planning Committee Vikki Neugebauer, LMFT Coordinated Care Programs Manager Office of Aging, County of Riverside Christine Basterrechea Program Manager, Orange County Health Care Agency, Behavioral Health Services, Adult Services, County of Orange Lin Benjamin, MSW, MHA Geriatric Mental Health Specialist,. Long Term Care and Aging Services, California Department of Aging Viviana Criado, MPA Former Older Adult Coordinator County of San Diego HHSA, Behavioral Health Services Sarah Gelberd, MD Senior Physician, Geriatrician, Department of Mental Health, Countywide Older Adult Program Administration - GENESIS Los Angeles County Bruce Gurganus, M. Div., MFT Director of Community Mental Health Services, County of Marin, Co-Chair, Older Adults System of Care (OASOC) Planning Committee Eleni Hailemariam, MD Associate Medical Director, Orange County Health Care Agency, Adult Mental Health Services-Older Adult Services, County of Orange Denise Hunt, RN, MFT Behavioral Health Director, Behavioral Health & Recovery Services, County of Stanislaus, Co- Chair, OASOC Planning Committee Cynthia Jackson Kalartinian, PhD Executive Director, Heritage Clinic,. Division of Center for Aging Resources,. San Diego and Pasadena, CA Patty Lyons, MA, MFT Supervisor, HOPE Program and. Senior Peer Counseling,. County of Marin Clint Nix, LCSW Older Adult System of Care Director,. Behavioral Health Care Service,. County of Alameda Kevin Tsang, LCSW, MBA District Chief, Department of Mental Health, Countywide Older Adult Program Administration, County of Los Angeles

11 The California Institute for Mental Health is a nonprofit public interest corporation established for the purpose of promoting excellence in mental health. CiMH is dedicated to a vision of a community and mental health services system which provides recovery and full social integration for persons with psychiatric disabilities; sustains and supports families and children; and promotes mental health wellness. The California Mental Health Directors Association is dedicated to the accessibility of quality cost-effective mental health care for the people of California. Principal goals are to advocate for quality mental health systems of care, which are culturally competent, consumerguided, family-sensitive, and community-based. California Institute for Mental Health th Street, 2nd Floor Sacramento, California (916) Fax: California Mental Health Directors Association th Street, 2nd Floor Sacramento, California (916) Fax: