Creation Date: 08/05/16 Revision Date: 01/27/17 1 of 28

Transcription

1 Revision Date: 01/27/17 1 of 28

2 This document includes Mental Health Services Act (MHSA) funded Population focused: Mental Health Promotion & Early Intervention (Pop Focus) programs process and outcomes objectives for Fiscal Year These individualized objectives apply the SMART (Specific, Measurable, Achievable, Realistic, & Timely) format. This document will be referenced in each applicable contract in the Appendix A section. Contractors that operate Population Focused programs must review and comply with their respective program s Process and Outcome Objectives listed in this document. These objectives will be examined for contract compliance by DPH. In addition, at the close of the Fiscal Year, all MHSA contractors will be required to complete two Year End Reports 1. a Narrative report and 2. a Demographics report. This requirement is stated in the Objectives section of the program's Contract Narrative and in the Business Office Contract Compliance (BOCC)'s Declaration of Compliance. For contractors that do not operate Pop Focus programs (e.g. Full Service Partnership programs), please consult with your MHSA Program Manager to clarify which type of Performance Objectives apply to your program. Many thanks to all of the Pop Focus programs staff who dedicated their time and effort toward this capstone work. We appreciate all of you very much. Also, special thanks to the staff of Harder & Company (the consulting firm that assisted MHSA) who were catalytic to this collective work; SFDPH s Contract Development and Technical Assistance (CDTA) section; and SFDPH s Business Office of Contract Compliance (BOCC) for working with us to integrate this body of work into the overall SFDPH system. ~ San Francisco Mental Health Services Act Administrative & Office of Quality Management Staff Revision Date: 01/27/17 2 of 28

3 TABLE OF CONTENTS: Page Program 4 Community Youth Center (CYC): Asian & Pacific Islander Youth & Family, Community Support Services 6 Family Service Agency (FSA): Curry Senior Drop in Center 7 Horizons Unlimited of San Francisco: Emic Behavioral Health Services 9 Hospitality House: Community Building Program 11 Hospitality House: Sixth Street Help Center 13 Hospitality House: Tenderloin Self Help Center 15 Huckleberry Youth Programs: Transitional Aged Youth (TAY) Multi Services Center 17 Institute on Aging 18 Instituto Familiar de la Raza (IFR): Indigena Health & Wellness Collaborative (IHWC) 20 Larkin Street Youth Services 21 Native American Health Center (NAHC): Living in Balance Program 23 Rafiki Coalition of Health and Wellness: SF Live D10 Wellness Collaborative 24 Richmond Area Multi Services (RAMS): Asian and Pacific Islander Mental Health Collaborative 26 Westside Community Services: Ajani Program 27 YMCA Bayview: African American Holistic Wellness Program 28 YMCA Bayview: SF Live D10 Wellness Collaborative Revision Date: 01/27/17 3 of 28

4 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. CYC: Asian & Pacific Islander Youth & Family, Community Support Services By the end of Fiscal Year , 50 A&PI individuals will be contacted through continuous Drop in Center operations and individual school outreach as shown by the outreach log, located in the Monthly Report Binder. By the end of Fiscal Year , 350 A&PI individuals (including youths families) will be contacted through outreach at schools and community events (i.e., Health and Cultural Fairs, Back to School Nights, etc.), as shown by the outreach summary report from APIYFCSS agencies, located in the Monthly Report Binder. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. By the end of Fiscal Year , 50 A&PI youth will be screened for behavioral health concerns using the agency s assessment tool, as shown in the client folders and summarized in the Annual Program Report. Of those screened in Fiscal Year , 80% of the clients screened will be referred to mental health and other services, as summarized in the Annual Program Report. 3. WELLNESS PROMOTION: Activities are intended to By the end of Fiscal Year , 100 A&PI youth will provide support and opportunity for emotional and participate in educational workshops related to behavioral spiritual growth to individuals, by promoting healthy health, as evidenced in the workshop attendance sheets behaviors (e.g. coping mechanisms, mindfulness from APIYFCSS agencies, located in the Workshop Tracking techniques) and emotional wellbeing through spiritual Binder. and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. For Fiscal Year , 80% of workshop participants will demonstrate increase in quality of life (QOL), as measured by a QOL survey, summarized in the Annual Program Report. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: Activities will create a culturally competent and safe space for API youth who are at risk in order to increase their sense of wellbeing, to build community, strengthen their resilience to trauma and improve behavioral health outcomes by engaging cultural traditions. By the end of Fiscal Year , 50 A&PI youth will receive 1 on 1 individual case management and clinical services, as evidenced and located in the agencies case management tracking logs. By the end of Fiscal Year , 50 A&PI youth will have developed at least one individual treatment goal as evidenced by the agencies case management tracking log and reported in the MHSA Annual Report. Revision Date: 01/27/17 4 of 28

5 CYC: Asian & Pacific Islander Youth & Family, Community Support Services Modality Process Objective Outcome Objective (if applicable) 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. By the end of Fiscal Year , 80% of A&PI youth receiving case management services will be referred to behavioral health and social services, as evidenced by the agencies case management tracking log, located in MHSA Annual Report. By the end of Fiscal Year , 50 A&PI youth will have a written case care plan with up to date progress notes, as evidenced by the agencies case management tracking log and reported in MHSA Annual Report. By the end of Fiscal Year , 50 A&PI youth will complete at least one individual treatment goal in their plan, as evidenced by the agencies case management log, located in MHSA Annual Report. Revision Date: 01/27/17 5 of 28

6 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. FSA: Curry Senior Drop in Center By the end of the Fiscal Year , FSA will conduct at least 12 outreach presentations at SRO hotels to reach a total of 50 SRO staff and 25 SRO residents, as documented by outreach sign in sheets stored in the Outreach Binder. 2. SCREENING AND ASSESSMENT 3. WELLNESS PROMOTION: Activities are intended to By the end of the Fiscal Year , 150 unduplicated provide support and opportunity for emotional and individuals will participate in BINGO as evidenced by spiritual growth to individuals, by promoting healthy attendance sheets stored in the activities binder. behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. By the end of the Fiscal Year , 30% of BINGO participants will report that they have maintained or increased feelings of social connectedness as evidenced by social connectedness items on the guest feedback form, and analyzed and summarized in the activities binder and MHSA Year End Report. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. (1) By the end of the Fiscal Year , 30 guests will be connected to behavioral health (MH+SA) services, as evidenced by a behavioral health service linkage log, stored in the Case Management binder. (2) By the end of the Fiscal Year , 50 guests receiving case management services will have a care plan, as documented by a care plan form and stored in the Case Management binder. By the end of the Fiscal Year , 20 guests receiving case management services will have accomplished at least one care plan goal. Revision Date: 01/27/17 6 of 28

7 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Horizons Unlimited of SF: Emic Behavioral Health Services During Fiscal Year , 150 individuals will be contacted through outreach efforts (i.e., cultural events, resource fairs, etc.) as evidenced by sign in sheets and/or clicker data, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Outreach and Engagement section. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. During Fiscal Year , 60 individuals will be screened and/or assessed using Horizons' intake and assessment form for behavioral health concerns; as evidenced by the completion of the assessment form, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Screening/Assessment Section. During Fiscal Year , 40 individuals will participate in wellness promotion activities (i.e., exercise groups); as evidenced by sign in sheets; recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Wellness Promotion Section. During FY , 36 of the 60 individuals screened and/or assessed will be referred to behavioral health and/or other supportive services; recorded and tracked in the MHSA Activities Spreadsheet; recorded in annual summary reports located in the MHSA Binder's Screening and Assessment Section. During FY , 24 of the 40 individuals of exercise group participants who complete a minimum of 10 sessions will report an increase in their quality of life as measured by the program's Quality of Life survey; data recorded by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Wellness Promotion Section. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: [1] During FY , 25 individuals will receive Activities will create a culturally competent and safe individual/family therapeutic services as evidenced by space for participants in order to increase their sense of sign in sheets; recorded and tracked in the MHSA wellbeing, to build community, strengthen their resilience Activities Spreadsheet by the assigned staff; recorded in to trauma and improve behavioral health outcomes by annual summary reports located in the MHSA Binder's engaging cultural traditions. Therapeutic Services Section. During FY , 18 of the 25 clients will complete at least one behavioral health service goal and/or plan of care goal; recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Therapeutic Services Section. Revision Date: 01/27/17 7 of 28

8 Horizons Unlimited of SF: Emic Behavioral Health Services Modality Process Objective Outcome Objective (if applicable) 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. [2] During FY , 25 will have a stated goal and/or case/care plan; as evidenced by case/care plan and recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Therapeutic Services Section. [1] During FY , 30 clients will receive nonclinical case management services and/or be referred to behavioral health and/or social services; as evidenced by the case manager's notes and/or referral form, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports located in the MHSA Binder's Service Linkages Section. [2] During FY , 20 clients receiving non clinical case management will have a written case/care plan f care; as evidenced by the case/care plan, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports and located in the MHSA Binder, Services Linkage Section. [1] During FY , at least 22 of the 30 clients receiving non clinical case management services will complete 1 case/care goal as evidenced by the case/care plan, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff, recorded in annual summary reports located in the MHSA Binder's Service Linkages Section. [2] During FY , at least 15 of the 20 clients receiving non clinical case management services will complete at least one case/care plan goal as evidenced by the case/care plan, recorded and tracked in the MHSA Activities Spreadsheet by the assigned staff; recorded in annual summary reports and located in the MHSA Binder, Service Linkages Section. Revision Date: 01/27/17 8 of 28

9 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Hospitality House: Community Building Program For Fiscal Year , 4 community events (i.e. community violence prevention events, increasing community cohesion, strength, and the ability to respond to and recover from trauma) will be held to reach 150 participants, as documented in sign in sheets, maintained by the Program Associate and stored in the file room. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. For Fiscal Year , 80 participants will be screened and/or assessed for behavioral health concerns measured by the Case Management Assessment conducted by the program case managers, and documented in Monthly Outcome Forms, maintained by the Program Associate and stored in the file room. For Fiscal Year , 75% of participants screened and/or assessed will be referred to behavioral health services as measured by a harm reduction plan in the Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. For Fiscal Year , 8 participants will enroll in wellness promotion activities, as evidenced by participation in the 18 week Healing, Organizing & Leadership Development internship, and documented in sign in sheets, maintained by the Program Associate and stored in the file room. For Fiscal Year , 4 participants will increase social connectedness as assessed by staff through observation of participants conducting community organizing (i.e., presenting at a community event) documented in event programs, maintained by the Program Associate and stored in the file room. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: Activities will create a culturally competent and safe space for participants in order to increase their sense of wellbeing, to build community, strengthen their resilience to trauma and improve behavioral health outcomes by engaging cultural traditions. For Fiscal Year , 50 individual therapy participants will have a stated case plan, as measured by the HRTC case plan and documented in the HRTC Unicorn database that will be maintained by HRTC staff and stored electronically. For Fiscal Year , 75% will complete at least one case plan goal, as measured by the HRTC case plan and documented in the HRTC Unicorn database that will be maintained by HRTC staff and stored electronically. Revision Date: 01/27/17 9 of 28

10 Hospitality House: Community Building Program Modality Process Objective Outcome Objective (if applicable) 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. For Fiscal Year , 80 participants will be referred to behavioral health services, as measured by creation of a harm reduction plan, and documented in Monthly Outcome Forms, maintained by the Program Associate and stored in the file room. For Fiscal Year , 60 participants will have a written case plan, as documented in the Monthly Outcome Forms, maintained by the Program Associate and stored in the file room. For Fiscal Year , 50 participants will achieve at least one case plan goal, as measured by the case plan, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. Revision Date: 01/27/17 10 of 28

11 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Hospitality House: Sixth Street Help Center For Fiscal Year , 1,000 participants will be contacted through participation in a range of socialization and wellness services (e.g. immediate survival and support services, wrap around services, socialization and cultural activities, case management, housing assistance fund, holistic behavioral health services) as documented in sign in sheets, maintained by the Data Entry Clerk and stored in the file room. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. For Fiscal Year , 40 participants will be screened and/or assessed for behavioral health concerns as measured by the Case Management Assessment conducted by the program case managers, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. For Fiscal Year , 75% of participants screened and/or assessed will be referred to behavioral health services as measured by a harm reduction plan in the Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. For Fiscal Year , 75 participants will attend Harm Reduction support groups conducted by the Harm Reduction Therapy Center, as measured by group sign in sheets, and documented in the HRTC Unicorn database that will be maintained by HRTC staff and stored electronically. For Fiscal Year , 50% of Harm Reduction support group participants will demonstrate reduced risk behaviors (e.g. reduction in substance use, unsafe substance use practices, sexual risk, self injurious behavior, or other injurious behavior) as reported by group participants as documented by facilitator on the sign in sheet and documented in the HRTC Unicorn database. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. For Fiscal Year , 40 participants will be referred to behavioral health services, as measured by creation of a harm reduction plan, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. For Fiscal Year , 25 participants will achieve at least one case plan goal, as measured by the case plan, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. Revision Date: 01/27/17 11 of 28

12 Hospitality House: Sixth Street Help Center Modality Process Objective Outcome Objective (if applicable) For Fiscal Year , 30 participants will have a written case plan, as documented in the Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. Revision Date: 01/27/17 12 of 28

13 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Hospitality House: Tenderloin Self Help Center For Fiscal Year , 2,500 participants will be contacted through participation in a range of socialization and wellness services (e.g. immediate survival and support services, wrap around services, socialization and cultural activities, case management, housing assistance fund, holistic behavioral health services, primary care triage) as documented in sign in sheets, maintained by the Data Entry Clerk and stored in the file room. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. For Fiscal Year , 80 participants will be screened and/or assessed for behavioral health concerns as measured by the Case Management Assessment conducted by the program case managers, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. For Fiscal Year , 75% of participants screened and/or assessed will be referred to behavioral health services as measured by a harm reduction plan in the Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. For Fiscal Year , 175 participants will attend Harm Reduction support groups conducted by the Harm Reduction Therapy Center, as measured by group sign in sheets, and documented in the HRTC Unicorn database that will be maintained by HRTC staff and stored electronically. For Fiscal Year , 50% of Harm Reduction support group participants will demonstrate reduced risk behaviors (e.g. reduction in substance use, unsafe substance use practices, sexual risk, self injurious behavior, or other injurious behavior) as reported by group participants and documented by facilitator on the sign in sheet and documented in the HRTC Unicorn database. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. For Fiscal Year , 80 participants will be referred to behavioral health services, as measured by creation of a harm reduction plan, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. For Fiscal Year , 50 participants will achieve at least one case plan goal, as measured by the case plan, and documented in Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. Revision Date: 01/27/17 13 of 28

14 Hospitality House: Tenderloin Self Help Center Modality Process Objective Outcome Objective (if applicable) For Fiscal Year , 60 participants will have a written case plan, as documented in the Monthly Outcome Forms, maintained by the Data Entry Clerk and stored in the file room. Revision Date: 01/27/17 14 of 28

15 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. Huckleberry Youth Programs: TAY Multi Services Center During FY , 1875 (duplicated) TAY youth will be engaged through street outreach and TAY drop in centers (Haight Street Referral Center and 3rd Street Youth Center & Clinic), as evidence by sign in sheets and head counts; recorded by outreach workers and drop in center staff and health educators; documented in the outreach binders, and stored in the outreach office/room at each agency (HYP, HSRC and 3rd Street). During Fiscal Year , 700 (duplicated) TAY will participate in group activities (such as community events, health fairs, workshops and cultural events) as evidenced by sign in sheets and head counts; recorded by health educators and community health outreach workers; documented on the HYP General Outreach Form, stored in the outreach binder in the health education office at HYP. Health education workshop participants will be recorded in quarterly summary reports. During FY , 350 (unduplicated) TAY will be screened and/or assessed, for behavioral/mental health concerns as measured by the HYP screening and assessment tools and evidenced by the date of the encounter documented and stored in the agency tracking database Salesforce, and summarized in Annual TAY Outcomes Reports. 3. WELLNESS PROMOTION: During FY ; 66% (250) TAY youth who were screened and/or assessed will be referred for or will receive on site behavioral health services as evidenced by supporting documentation in HYP agency tracking database Salesforce and summarized in the Annual TAY Outcomes Report. Revision Date: 01/27/17 15 of 28

16 Huckleberry Youth Programs: TAY Multi Services Center Modality Process Objective Outcome Objective (if applicable) 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: (1) By the end of the current fiscal year, 45 unduplicated TAY clients will receive individual/family therapeutic services as evidenced in a secure cloud based data system. An additional 20 unduplicated TAY will be served through clinical consultation with case management staff. (2) By the end of the current fiscal year, 65 individuals will have a stated goal and/or case/care plan as evidenced in a secure cloud based data system. (2) By the end of the current fiscal year, 75% of clients will complete at least one individual treatment goal as evidenced by reports available in a secure cloud based data system. 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. During FY , 125 TAY and/or their families will have a written plan of care as evidenced by a case management episode in the Salesforce tracking database, reported in the Quarterly Case Management Report. During FY , 75 TAY and/or their families (60% of those with written care plans) will achieve at least one case/care plan goal as evidenced by the case management tracking database Salesforce, recorded by the service delivery staff, and summarized in the Quarterly Case Management Report. Revision Date: 01/27/17 16 of 28

17 Institute on Aging (IOA) Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. By June 30th, 2017, 100 home based and within clinic By June 30th, 2017, 80 (80%) of home based and within individuals ages 55+, as a result of a positive score on the clinic individuals ages 55+ who participate in behavioral gaiting screen, will receive intensive behavioral health health screening will successfully receive culturally screening by doctoral level psychology trainees competent feedback about their mental health, supervised by licensed psychologists to identify clinically prevention focused psycho educational resources, and significant mental health concerns in the domains of referrals to appropriate behavioral health intervention depression, anxiety, social isolation, chronic pain, (internally or externally) as evidenced by the Institute on substance abuse, sleep quality, and cognition as Aging Adult Behavioral Health Screening Excel Database evidenced by the Institute on Aging Adult Behavioral and summarized in the annual Screening and Feedback Health Screening Excel Database and summarized in the Report located in the DPH Binder. annual Screening and Feedback Report located in the DPH Binder. 3. WELLNESS PROMOTION: 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: 5. SERVICE LINKAGE: Revision Date: 01/27/17 17 of 28

18 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. IFR: Indigena Health & Wellness Collaborative By the end of December 2016, 198 individuals will participate in 5 group activities (Vaqueria, Carnaval, Health Fairs, powwows) as evidenced by Head Count forms stored in the Units of Service binder located in the Program Manager s (PM) office. By the end of December 2016, 50 individuals will be contacted through outreach activities (street outreach, phone calls, home visits) as evidenced by Logs/Units of Service forms located in the Units of Service binder located in PM office. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. By the end of December 2016, 35 individual participants will be screened for practical, emotional and mental health concerns using the Information & Referral Form administered by staff, and as evidenced by the Summary of I&R document located in Units of Services binder in PM office. By the end of December 2016, 100% will be referred to internal or external services as needed as evidenced by I&R forms stored in Information & Referrals binder located in PM office. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. By the end of December 2016, 50 unduplicated clients will participate in small psychosocial peer support group/talleres, as evidenced by signatures on Attendance Logs stored in the Units of Service binder located in the PM and Billing offices. By the end of December 2016, at least 50% of individuals participating in the Psychosocial Peer Support Groups/Talleres will take the Holistic Wellness Social Connectedness Survey. At least 65% of individuals participating in the Holistic Wellness Social Connectedness Survey will demonstrate increase or maintain social connectedness as a result of participating in the Peer Support Groups/Talleres; as evidenced by survey results stored in Program Evaluation binder located in PM office. Revision Date: 01/27/17 18 of 28

19 IFR: Indigena Health & Wellness Collaborative Modality Process Objective Outcome Objective (if applicable) 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: Activities will create a culturally competent and safe space for participants in order to increase their sense of wellbeing, to build community, strengthen their resilience to trauma and improve behavioral health outcomes by engaging cultural traditions. By the end of December 2016, 35 unduplicated clients will receive individual/family therapeutic services as evidenced in monthly Therapeutic Services Tracking Form stored in the Units of Service binder located in the PM and Billing offices. By the end of December 2016, 75% of clients will remain engaged in services as evidenced by Client Summary of Engagement developed based on individual records of attendance to sessions. For the purpose of this objective, a client is considered engaged in services if client attends at least four sessions. By the end of December 2016, 35 individuals will have a stated goal and/or case/care plan as evidenced by random review of 10 charts at the end of fiscal year by Clinical Supervisor and documented in M.H. Annual Monitoring Form form stored in the Evaluation Binder binder located in the PM office. 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. By the end of December 2016, 20 clients receiving nonclinical case management will be referred to behavioral health and/or social services as evidenced by random review of 10 Case Management charts at the end of fiscal year by Program Manager and documented in the C.M. Annual Monitoring Form stored in the Evaluation Binder located in the PM s office. By the end of December 2016, 20 clients will have a written case/care plan evidenced by random review of 10 Case Management charts at the end of fiscal year by Program Manager and documented in the C.M. Annual Monitoring Form stored in the Evaluation Binder located in the PM s office. At least 80% of clients who receive non clinical Case Management will achieve one case/care goal as evidenced by random review of 10 Case Management charts at the end of December 2016 by Program Manager and documented in the C.M. Annual Monitoring Form stored in the Evaluation Binder located in the PM s office. Revision Date: 01/27/17 19 of 28

20 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Larkin Street Youth Services In Fiscal Year , 300 homeless youth ages 13 through 24 will be contacted through services or events at the Drop in Center as shown by Drop in Center sign ins recorded in the agency s database. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. In Fiscal Year , 75 at risk youth will be screened In Fiscal Year , 75% of individuals for behavioral health needs using a screening tool (TBD) screened/assessed will be referred to behavioral health, i.e. administered by the Wellness staff and recorded in the ETO mental health/substance use services (internally or client management database. externally), as documented by the Wellness staff and stored in the ETO client management database. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. In Fiscal Year , 80 youth will attend at least three sessions of the Fruity Wednesday wellness group, as evidenced by group participation forms entered into ETO. For Fiscal Year , 60% of regular Fruity Wednesday participants (attended at least 3 sessions) will report an increase in their social connection, as measured by a survey of social connection administered by Larkin Street s Research & Evaluation Department, and recorded in the agency database or client records in the ETO database. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. In Fiscal Year , 25 homeless youth will have a case plan as evidenced by the agency ETO client management system. For Fiscal Year , 60% of individuals with a case plan will achieve at least one case plan goal as evidenced by the agency ETO client management system. Revision Date: 01/27/17 20 of 28

21 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. NAHC: Living in Balance Program By the end of fiscal year , Living In Balance (LIB) will reach 156 individuals through street fairs and pow wows as evidenced by sign in sheets, stored in NextGen Practice Management System[1] and summarized in Prevention and Early Intervention (PEI) Events Report. 2. SCREENING AND ASSESSMENT: Activities will identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. 3. WELLNESS PROMOTION: Activities are intended to provide support and opportunity for emotional and spiritual growth to individuals, by promoting healthy behaviors (e.g. coping mechanisms, mindfulness techniques) and emotional wellbeing through spiritual and/or traditional healing practices. All activities are intended to provide individual, family and/or group support to increase awareness and understanding of the healing effects of culture and to increase a sense of social connectedness within the community. By the end of fiscal year , cultural and traditional art groups will reach 330 attendees as evidenced by sign in sheets, stored in NextGen Practice Management System and summarized in PEI Community Group Report. By the end of fiscal year , 70% of individuals will maintain or increase feelings of social connectedness as measured by our PEI Follow up Questionnaire, stored in PEI Wellness Binder located in the Evaluator s office and summarized in PEI Wellness Report. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: Activities will create a culturally competent and safe space for participants in order to increase their sense of wellbeing, to build community, strengthen their resilience to trauma and improve behavioral health outcomes by engaging cultural traditions. By the end of fiscal year , 17 individuals will receive one on one behavioral therapeutic services as evidenced and stored in NextGen electronic health records system and summarized in PEI report. By end of the fiscal year , 17 individuals will have at least one stated behavioral health goal as evidenced by individualized care plans stored NextGen electronic health records system and summarized in Clients Care Plan report. By end of the fiscal year , 17 individuals will complete at least one behavioral health service goal as evidenced through individualized care plans stored NextGen electronic health records system and summarized in Clients Care Plan report. Revision Date: 01/27/17 21 of 28

22 NAHC: Living in Balance Program Modality Process Objective Outcome Objective (if applicable) 5. SERVICE LINKAGE: Activities will target facilitating referrals and successful linkages between mental health and social services. By end of the fiscal year , 17 individuals will be referred to mental health services or other resources as evidenced and stored in NextGen electronic health records system and summarized in PEI Service Linkage report. By end of the fiscal year , 35 individuals will have a written case/care plan as evidenced through Individualized Care Plan Reports stored in NextGen electronic health records system and summarized in Clients Care Plan report. By the end of fiscal year , 14 individuals will achieve at least one case/care plan goal as evidenced by NextGen electronic health records system and summarized in Individualized Care Plan reports. Revision Date: 01/27/17 22 of 28

23 Rafiki Coalition of Health & Wellness: SF Live D10 Wellness Collaborative Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH and ENGAGEMENT: 2. SCREENING AND ASSESSMENT: 3. WELLNESS PROMOTION: Activities for individuals or groups intended to enhance protective factors, reduce riskfactors and/or support individuals in their recovery; promote healthy behaviors (e.g. mindfulness, physical activity); increase the awareness and understanding of healing effects of cultural, spiritual and/or traditional healing practices By the end of Fiscal Year , 150 community contacts will participate in ongoing Stress Reduction classes (i.e., Zumba, Afro Hip Hop, Bike the Hood, Soul Line Dancing, etc.) at BCA / Rafiki Wellness, as evidenced by class sign in sheets and summarized in the Subcontractor Semi Annual Progress Report. By the end of Fiscal Year , 50% of the Stress Reduction Class participants will report an increase in social connectedness and its impact on their mental health, as measured by positive responses from Stress Reduction participant feedback survey, documented in an Excel datafile and summarized in the DPH Population Health Division D10 Live year end program report. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: 5. SERVICE LINKAGE: Revision Date: 01/27/17 23 of 28

24 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. RAMS: Asian and Pacific Islander Mental Health Collaborative By June 30, 2017, 600 Asian American and Pacific Islander (AA & PI) individuals will be contacted through community specific events (such as cultural specific or community gatherings, celebrations, festivals, workgroup meetings) as shown by signatures on a sign in log collected by community partners and their staff and stored in a labeled binder at community partner s site. Other outreach data collection methods include # of outreach materials given out, ticker count, and/or raffle tickets. 2. SCREENING AND ASSESSMENT: Activities intended to identify individual strengths and needs resulting in a better understanding of the physical, psychological, and social concerns impacting individuals, families and communities. By June 30, 2017, 80 AA & PI individuals will be screened and/or assessed for behavioral health needs and/or basic / holistic needs using an AA PI specific assessment tool developed by RAMS and community partners, as evidenced by assessment summary reports generated by community partners and their staff and stored in a labeled binder in community partner s locked file on site. By June 30, 2017, 80 AA & PI individuals screened for behavioral health and/or basic/holistic services will be referred to such services as evidenced by summary assessment reports generated by community partners and their staff and stored in a labeled binder in community partner s locked file on site. 3. WELLNESS PROMOTION: Activities for individuals or groups intended to enhance protective factors, reduce riskfactors and/or support individuals in their recovery; promote healthy behaviors (e.g. mindfulness, physical activity); increase the awareness and understanding of healing effects of cultural, spiritual and/or traditional healing practices By June 30, 2017, 200 AA & PI individuals will participate in culturally relevant psycho education workshops as evidenced by signatures on a sign in sheet collected by community partners and their staff and stored in a labeled binder in community partner s locked file on site. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: By June 30, 2017, at least 60 of 200 participants in culturally relevant wellness promotion activities will demonstrate increased knowledge about mental health issues as measured by responses to the items on the Participant Feedback Survey* administered and collected by community partners and stored in a labeled binder in community partner s locked file on site. 5. SERVICE LINKAGE: Activities will facilitate referrals and successful linkages to health and social services. By June 30, 2017, 80 AA & PI individuals will receive case management for behavioral health and/or basic/holistic services as evidenced by the completed forms and case management client list (with unique identifier) in a labeled binder stored in community partner s locked file on site. By June 30, 2017, 70 AA & PI individuals will achieve at least one goal in their case/care plan as evidenced by caseload summary report generated and stored in a labeled binder by community partners and their staff and stored in community partner s locked file on site. Revision Date: 01/27/17 24 of 28

25 RAMS: Asian and Pacific Islander Mental Health Collaborative Modality Process Objective Outcome Objective (if applicable) By June 30, 2017, 80 AA & PI individuals will have a written case/care plan as evidenced by completed forms in a labeled binder and stored in community partner s locked file on site. Revision Date: 01/27/17 25 of 28

26 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. Westside Community Services: Ajani Program By June 30, 2017, 10 outreach activities (cultural events, health fairs, community activities, psycho education groups) will be held to reach a total of 350 residents of San Francisco. This will be demonstrated by an event log sheet located in the MHSA Outreach Binder. 2. SCREENING AND ASSESSMENT: 3. WELLNESS PROMOTION: 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: 5. SERVICE LINKAGE: Revision Date: 01/27/17 26 of 28

27 Modality Process Objective Outcome Objective (if applicable) 1. OUTREACH AND ENGAGEMENT: Activities are intended to establish/maintain relationships with individuals raising awareness about mental health and connecting them with available services. YMCA Bayview: African American Holistic Wellness Program JULY 1 DECEMBER 31, 2016: In the FY 16/17, 25 new persons will be reached and added to the program newsletter distribution list, as evidenced by a printout of the new contracts. JANUARY 1 JUNE 30, 2017: (20) new persons will be reached out to & added to the program announcement distribution list, as evidenced by a printout of the new contacts 2. SCREENING AND ASSESSMENT: JULY 1 DECEMBER 31, 2016: JULY 1 DECEMBER 31, 2016: 3. WELLNESS PROMOTION: Activities for individuals or groups intended to enhance protective factors, reduce riskfactors and/or support individuals in their recovery; promote healthy behaviors (e.g. mindfulness, physical activity); increase the awareness and understanding of healing effects of cultural, spiritual and/or traditional JULY 1 DECEMBER 31, 2016: In the FY 16/17, 18 individuals will participate in at least 4 sessions of continuously offered Wellness Promotion educational activities (Sister Love, Senior Wellness and/or Physical Wellness such as Zumba Wellness), as measured by sign in sheets, and maintained in an Excel file in the YMCA office. JULY 1 DECEMBER 31, 2016: By the end of the FY 16/17 contract, 75% of regularly attending (at least 4 sessions) any of the selected Wellness Promotion groups (Sister Love, Senior Wellness and/or Physical Wellness) will report having maintained or increased their social connectedness, as evidenced by social connectedness items on the Overall healing practices JANUARY 1 JUNE 30, 2017: (30) individuals will participate Program Participation survey, stored and summarized in an in at least four sessions of continuously offered Wellness Promotion educational activities (physical activities, cooking matters, social connectedness activities, support groups and gardening), as measured by sign in sheets, and maintained in an Excel file in the AAHW main office. Excel file in the YMCA office. JANUARY 1 JUNE 30, 2017: 75% of individuals who regularly attended (at least four sessions) any of the selected Wellness Promotion groups physical activities, cooking matters, social connectedness activities, support groups and gardening) will report having maintained or increased their social connectedness on the Program Participant Survey, stored and summarized in a binder located in the AAHW main office. 4. INDIVIDUAL AND GROUP THERAPEUTIC SERVICES: JULY 1 DECEMBER 31, 2016: JANUARY 1 JUNE 30, 2017: (10) participants would received 1:1 short term counseling with a licensed clinical specialist. 5. SERVICE LINKAGE: JULY 1 DECEMBER 31, 2016: JANUARY 1 JUNE 30, 2017: at least (6) participants would be referred to the Family Resource Center and/or a Wellness Coach session JULY 1 DECEMBER 31, 2016: JANUARY 1 JUNE 30, 2017: JULY 1 DECEMBER 31, 2016: JANUARY 1 JUNE 30, 2017: Revision Date: 01/27/17 27 of 28