Contra Costa County s Mental Health Commission Hosts a PUBLIC HEARING

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1 AGENDA AGENDA I. Call to Order- Regular meeting of the Mental Health Commission/Introductions II. Proclamation to declare May as Mental Health Awareness Month By: Supervisor Candace Andersen, District II III. CREATE an ad hoc committee to screen Mental Health Commission applicants, to forward to the Board of Supervisors for approval and appointment IV. RECEIVE introduction to 1420 Willow Pass renovation and CREATE an ad hoc committee for continuing review of the project: -Adam Down V. APPROVE minutes from April 5, 2017 Contra Costa County s Mental Health Commission Hosts a PUBLIC HEARING On the Fiscal Years 2017 to 2020 Mental Health Services Act Three Year Program and Expenditure Plan Wednesday, May 3, :30pm to 6:30pm 550 Ellinwood Way, Pleasant Hill VI. Adjourn Mental Health Commission meeting I. Call to order -Public Hearing on the Mental Health Services Act Three Year Program and Expenditure Plan II. Opening Comments by the Mental Health Commission-Chair A. Review of authority for Public Hearing, Welfare & Institutions Code 5848 (a) (b). A draft plan and update shall be prepared and circulated for review and comment for at least 30 days to representatives of stakeholder interests and any interested party who has requested a copy of the draft plans. The Mental Health Commission shall conduct a public hearing on the draft plan and annual updates at the close of the 30 day comment period. The Mental Health Commission shall review the adopted plan or update and make recommendations to the County Mental Health Department for revisions. B. Review of Public Hearing purpose to confirm and complete the process. The Commission will provide reasonable accommodations for persons with disabilities planning to attend. Please contact the Executive Assistant at: , at least 48 hours prior to the meeting. Thank you.

2 III. Fiscal Years2017 to 2020 Mental Health Services Act (MHSA) Three Year Program and Expenditure Plan- by Warren Hayes, MHSA Program Manager. The plan is available for review at: IV. Public Comment regarding the Plan- Members of the public may comment on any item of public interest within the jurisdiction of the Mental Health Commission. Public Comment cards are available on the table at the back of the room; please give your card to the Executive Assistant of the Mental Health Commission. In the interest of time and equal opportunity, speakers are requested to please adhere to a 3 minute time limit, per person. In accordance to the Brown Act, if a member of the public addresses an item not on the agenda, no response, discussion or action on the item will occur, except for the purpose of clarification. V. Commissioner Comments- Members of the Commission may comment on any item of public interest within the jurisdiction of the Mental Health Commission. Commissioner Comment cards are available at your seats. Please give your card to the Executive Assistant of the Mental Health Commission. In the interest of time and equal opportunity, speakers are requested to please adhere to a 3 minute maximum time limit, per person. In accordance with the Brown Act, if a member of the public addresses an item not on the agenda, no response, discussion or action on the item will occur, except for the purpose of clarification. VI. Develop a list of Comments and Recommendations to the County Mental Health Administration (MHA) and to the Board of Supervisors (BOS) VII. Adjourn- Public Hearing The Commission will provide reasonable accommodations for persons with disabilities planning to attend. Please contact the Executive Assistant at: , at least 48 hours prior to the meeting. Thank you.

3 MENTAL HEALTH COMMISSION MONTHLY MEETING MINUTES April 5, 2017 First Draft Agenda Item / Discussion Action / Follow-Up I. Call to Order / Introductions Commission s Vice Chair, Barbara Serwin, called the meeting to order at 4:39pm. Members Present: Vice Chair- Barbara Serwin, District II Supv. Candace Andersen, District II Sam Yoshioka, District IV Diana MaKieve, District II Gina Swirsding, District I Douglas Dunn, District III Connie Steers, District III Meghan Cullen, District V Commissioners Absent: Chair- Duane Chapman, District I Lauren Rettagliata, District II Jason Tanseco, District IV Mike Ward, District V EA-Transfer recording to computer II. Other Attendees: Cynthia Belon, Director of Behavioral Health Jill Ray, Field Rep Supv. Andersen s Office, District II Patrick Wilson, Chief Information Security Officer (CISO) Megan Rice, CCLink Behavioral Health Project Manager Amanda Dold, MFT-Integration Program Manager Liza A. Molina-Huntley, Executive Assistant for MHC Chair Report, Announcements, and Comments: Barbara- read letter created by Commissioner Lauren Rettagliata and MHSA/Finance Chair whom was not present. The letter was distributed has a handout, prior to the meeting. No comments or discussion was allowed. Statements were noted as a comment only. III. Commissioner s comments: - NONE IV. PUBLIC COMMENTS: April Langro, RI (Recovery Innovations International) Administrator, informed public of up and coming training for those interested in Peer Counseling. The PET training is a Peer Employment Training, an 80-hour educational course designed to prepare students for peer employment opportunities in the MHC 4/5/2017 meeting minutes Page 1 of 6

4 workforce. Graduates become Certified Peer Specialists. The training will be held at 3701 Lone Tree Way, in Antioch. Training will start May 8 and continue through May 19, from 9am to 3pm. Cost is $556, which includes materials. Any interest in RI International can contact April, via at, April.Langro@riinternational.com V. APPROVE minutes from March 1, 2017 meeting Motion to approve the minutes was made by Sam, Gina seconded the motion No corrections required VOTE: YAYS: Supervisor Andersen, Barbara, Gina, Diana, Sam, Doug, Connie and Meghan NAYS: none ABSTAIN: none ABSENT: Duane, Lauren, Jason, and Mike VI. RECEIVE presentation regarding the Electronic Health Record project plan- by Megan Rice, Amanda Dold and Patrick Wilson Regarding the cclink update, a brief summary was given regarding the implementation plan of the new electronic patient records, the goals and the benefits of the plan, scope, guiding principles, and rollout along with the support plan. Presenters gave a background of the previous paper clinical documentation and the new cclink (Epic), electronic record integrated system. Integrated because previously Behavioral Health Services (BHS) and Medical records were completely separate. BHS clinicians were still utilizing paper documentation. Hospital and primary care clinics are using cclink (Epic) an electronic record keeping system. BHS has taken steps in integrating to the hospital system, such as: clinician referrals via Epic, in basket message communication and coordination of patient care and medication management, problem listing and diagnosis, intake information model use, integrated appointment centering and E- prescribing. The plan is to implement the cclink (Epic) electronic health record for clinical documentation in all of the Behavioral Health clinics throughout the county. The vision is to have a single patient health record, integrating medical and mental health records, for better patient care. The goals and benefits of cclink (Epic) is patient centeredness care, provide more holistic care to improve patient outcomes, enable patients to become more actively involved in decision making regarding their own care, enable patients to access their electronic health record, improve communication among all providers involved in each patient s care, improve data collection and research, and allow network providers the Patrick Wilson will try to provide information regarding the implementation budget and costs of the system MHC 4/5/2017 meeting minutes Page 2 of 6

5 ability to view the patient s health history through the cclink Provider Portal. The first phase of the work s scope is to have all 12 clinics, operating with cclink by September 26 of this year. The proposed second phase will be to have Discovery House and AODS on board, BHS patient MyChart access, The Network Provider Portal Access and the integration with ShareCare for billing by February 1 of After all implementation has been integrated and completed, optimization of phase one will commence. The phase one scope of facilities include: West County Adult, West County Children s, East County Adult, East County Children s Central County Adult, Central County Children s, Older Adult, Forensics, Transition team, First Hope, Juvenile Hall, and Conservatorship will not be able to chart, only view The guiding principles of the system is to be patient centric, safety and quality care, support the vision of the Contra Costa Health Services and the Behavioral health Services Division s mission and vision for facilitating and optimizing patient care, better collaboration and communication between doctors, clinicians and patients, standardization, accountability, usability, continuous performance improvement, optimize financial outcomes, change management, training and adoption, business continuity and contingency planning, and compliance with state and government regulations and practices. The rollout approach is to have all 12 clinics starting to use cclink on the same day. Regarding training and support- there will be a comprehensive in-class training followed by at-the-elbow support in the clinics. Meaning that those users that are well versed in the system will be available, on site, at each clinic, training and troubleshooting on the spot. The Super Users, Subject Matter Experts, Champions, Trainers and IT analysts will provide support continuously throughout and during the phase one process. Gina- asked if the system is the same as the Epic system at Kaiser and informed that she is concerned about misdiagnosis. Megan-assured that they are aware of other similar systems and cclink will have fail safe features to try to prevent such issues. Patrick- added that although there will be safeguards; there is always human error on behalf of the patient, doctors and clinicians at times. Part of the system will be for the patient to be able to access their own record and inform of the error immediately so it can be corrected. The goal is for the patient to have optimum care. MHC 4/5/2017 meeting minutes Page 3 of 6

6 Connie- How can a caregiver be involved and have access to schedule appointments and obtain prescriptions, if only the patient can access the record? Patrick- A proxy can be accessed online, or at the next medical visit, the patient can sign the proxy to allow their immediately family member or caregiver to have access to their medical records. It is important not to have too many proxies, one or two, should be enough. Doug- What about the patient s medical history? Will that be included in the new system? Patrick- the best way to assure that all of the patients medical history has been downloaded into the new system is to access the system and inform the doctors of any discrepancies and have available any medical records that maybe pertinent to the appointment on hand, to assure a better outcome for the patient. Going forward, the system will have history, but some patients with a more historical record may not have everything completely transferred, at first, the goal is to have everything under one record. Sam- Is seems unfathomable to have all 12 clinics completed simultaneously- how can you assure accuracy, security of the records, proper implementation and adequate training? Amanda- The process has been ongoing for the last few years. Of course implementation will have some snags but there is a staff of approximately 40 members that are dedicated to training their peers. Cynthia- There has been staff in the day to day implementation of the system from day one. Barbara- can you elaborate regarding the budget, the team and projects? Megan- a government structured was followed by an Executive Steering Committee including the Director of Behavioral Health and the Chief Financial Officer, Pat Godley. The two simultaneous projects are EPIC, which is the electronic medical record system and the second is the billing part known as ShareCare, which is utilized to bill MediCal. I am the IT analyst that will continue on as a staff member and consultant, until the process is completely implemented. Patrick is the Chief Information Security Officer to assure that all the records are safe and firewalls are in place to assure confidentiality and protect patient s records. Amanda will help coordinate the system Champions and Mr. David Runt, whom reports to Pat Godley. As far as the budget, does not recall the overall amount for all costs involved. The goal is to have a patient centered, electronic medical record for better overall access for the patient, the clinicians and doctors and be able to provide better care under one single medical MHC 4/5/2017 meeting minutes Page 4 of 6

7 record. The cclink, Epic, will be the same as the Kaiser system, it allows the patient to make appointments, consult with their doctors and request prescriptions- all online. Doug- What is the learning curve? Is there a budget timeline? Patrick- Yes to both. The system is meant to provide better care by minimizing miscommunications, building better collaboration and shortening medical visits due to appointment reminders and notifications to reschedule. VII. DISCUSS the Behavioral Health Services Strategic Plan for Director Cynthia Belon- The update, regarding the strategic plan for 2017 for Behavioral Health Services is focused on cclink (Epic) being implemented at all clinics and all the staff trained and the system operating successfully at all sites. Requests for specific questions or comments can be forwarded to the Executive Assistant for the Mental Health Commission, Liza. VIII. RECEIVE update from MHSA/Finance meeting on March 16, by Committee Chair- Lauren Retttagliata Absent IX. DISCUSS resolution, to recognize May 2017 as Mental Health Awareness Month in Contra Costa County Barbara- Jill, can you elaborate on the process of declaring May as the Mental Health Awareness month? Jill- the Chair, of the Mental Health Commission, can call the Chair of the Board of Supervisors and ask the office to assist in creating the proclamation. Once the proclamation has been created, the proclamation is agendized, and then the Board will approve the proclamation and present it to the Commission, declaring May as Mental Health Awareness month in Contra Costa County. The Advisory Bodies of the County can take it a step further and distribute the proclamation to each city throughout the county, by asking the City Council, of the city where they reside to do the same and proclaim May as Mental Health Awareness month for that city. Supervisor Andersen- the proclamation is one sheet, stating the Mental Health Commission as the ambassadors of Mental Health Awareness Month. Ask for assistance if no response is received. Barbara- Duane or I will call Supervisor Glover s office to get the proclamation done. I will call you if I need help. X. RECEIVE the Commission Representative Reports AOD= Alcohol and Other Drugs Advisory Body- Sam Yoshioka- the AOD Advisory Body did not change their name to SUD (Substance Use Disorders), they will continue to use AOD. AOD is currently planning their annual awards for MHC 4/5/2017 meeting minutes Page 5 of 6

8 people who make a difference in the community. CPAW= the Community Planning Advisory Workgroup- Lauren Rettagliata -Absent CPAW, Children s Committee- Gina Swirsding- -Did not attend meeting Barbara- I will commit to attending the Children s meeting. Council on Homelessness- Lauren Rettagliata- -Absent Doug- Next month the commission will host the public hearing for the MHSA 3 year plan. XI. Adjourn Meeting The meeting was adjourned at 6:10pm. Respectfully submitted, Liza Molina-Huntley Executive Assistant to the Mental Health Commission CCHS Behavioral Health Administration MHC 4/5/2017 meeting minutes Page 6 of 6

9 William B. Walker, M.D. HEALTH SERVICES DIRECTOR Cynthia Belon, L.C.S.W. BEHAVIORAL HEALTH DIRECTOR Contra Costa Behavioral Health Administration 1340 Arnold Drive, Suite 200 Martinez, CA Ph (925) Fax (925) SUBJECT: 1420 Willow Pass Project Introduction Background: Approximately 3 years ago the Vocational Services unit of the Behavioral Health Department relocated from their suite on the 1 st floor of 1420 Willow Pass to a newly renovated facility at 1430 Willow Pass. Since that time, the suite has remained vacant Willow Pass is occupied by Central County Adult Mental Health and a satellite clinic for the Concord Health Center. In November 2015 staff at Behavioral Health Administration engaged the clinic management and a cross section of staff members at the clinic to help determine operational needs and goals to help improve clinic function and welcoming environment. Over the course of a series of meetings that workgroup began to put together a wish list of items and areas of concern that they hoped to address. Health Services Finance approved the Behavioral Health Division to engage General Services for preliminary design and cost analysis. Simultaneous to these activities the Division also engaged Real Estate Services to survey the area for potential re-location. This process included preliminary negotiations for an alternative site. Terms were not able to be reached. Project: Clinic staff were engaged in a community process to allow each staff classification to express the strengths, future needs and current inadequacies of the environment at 1420 Willow Pass. This input was translated to a preliminary design. Critical components of this project include: increased lobby/patient waiting area size, decompression of crowded staff areas in the clinic, improved clerical work function, better patient circulation, additional treatment rooms, and creation of welcoming environment. The preliminary project proposal was approved by Health Services Finance in April This proposal was approved for approximately $700,000 in renovation costs and $280,000 in furniture and fixtures. This project will be funded 100% from County General Funds. Next Steps: At the April 25, 2017 meeting the Executive Board approved a motion, to forward to the full Commission, to create an ad hoc committee to engage in on-going consultation with Behavioral Health Administration. This arrangement will help to ensure an appropriate public process and the Commission may fulfill their mandated duties of advising the Board of Supervisors and the Mental Health Director with regard to services and facilities. The Behavioral Health Division looks forward to continuing the growing partnership with the Mental Health Commission and collaboration in successfully and productively seeing through the renovation activities at 1420 Willow Pass.

10 Public Hearing Presentation MHSA Three Year Program and Expenditure Plan for FY Contra Costa Behavioral Health Services is pleased to present the Draft Mental Health Services Act (MHSA) Three Year Program and Expenditure Plan for Fiscal Years through Included for your consideration this evening are copies of the draft plan, and copies of a summary outline of the plan. We welcome your input. The Three Year Plan proposes to set aside $51.6 million for fiscal year in order to fund over 80 programs and plan elements. This is an $8.5 million annual increase in requested budget authority from the current Three Year Plan. This increase will be offset by estimated additional Medi-Cal reimbursement, increase in state MHSA Trust Fund revenue, and use of unspent MHSA funds from previous years. The Three Year Plan includes $37.6 million to fund 39 programs and plan elements in the Community Services and Supports component that will serve approximately 2,000 individuals who are experiencing a serious mental illness. Our Prevention and Early Intervention component plans to set aside $8.7 million to fund 26 programs serving approximately 13,000 persons, and are designed to prevent mental illness from becoming severe and debilitating. $2.1 million is budgeted for six Innovative Projects, and $2.5 million is set aside for programs to recruit, train, retain and support our public mental health workforce. Finally, our Capital Facilities/Information Technology component will utilize the remaining funds allocated for implementation of the electronic mental health records project. A data driven Needs Assessment was conducted of public mental health services, and an inclusive Community Program Planning Process engaged stakeholders in identifying service gaps, prioritizing community public mental health needs, and suggesting strategies to meet these needs. All identified service gaps and prioritized needs from the Needs Assessment and Community Program Planning Process are referenced and addressed in the Three Year Plan. Significant changes to the Three Year Plan include the following: $1.7 million earmarked for permanent subsidized housing for persons with serious mental illness (Special Needs Housing Program), and introduction of planning for use of state funding to be available sometime in fiscal year for the No Place Like Home initiative. The No Place Like Home initiative, when implemented, will earmark state level MHSA funds for permanent supportive housing for persons with serious mental illness. $.2 million for start-up funding to establish a 24 bed transitional residential facility for transition age youth at the County s Oak Grove facility.

11 $2.5 million for expansion of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program for children to meet new state expanded eligibility requirements, and to meet reform legislation for services to foster children. $.7 million to expand the county operated First Hope program s capability to now serve adolescents and young adults experiencing a first psychotic break. $.5 million to support expanding the hours of availability for the County funded mobile response team to respond to children and their families when in crisis. $.5 million to augment and expand the capacity of the County s Mental; Health Evaluation Team (MHET) in order to field a countywide mobile crisis response intervention for adults experiencing mental health crises. $.7 million to establish two new Innovative Projects; one to bring mental health services to seriously mentally ill adults living in augmented board and care facilities, and one to serve adolescents experiencing mental health and substance abuse disorders. This $.7 million will be offset by the ending of two Innovative Projects that sunset in current fiscal year. $.6 million to establish a family support program consisting of recruiting, training and supervising volunteers to support family members and loved ones of persons experiencing serious emotional disturbance or mental illness. $.2 million to expand various training and staff development initiatives; most notably certifying mental health first aid trainers to partner with first responders and community organizations supporting persons experiencing trauma and violence. $.3 million to establish a locally administered student loan forgiveness program to address identified significant workforce shortages, such as psychiatrists. $1.3 million (or 3%) added to allow for both County and contract operated increases in the cost of doing business. We anticipate that the plan s proposed total budget spending authority will not need to be reduced in the foreseeable future, and that all MHSA programs and plan elements can be sustained at their proposed level of funding. Again, we welcome both Public and Commission input this evening. The Draft Three Year Plan will be sent to the Board of Supervisors for review once we have included our written response to any substantive recommendations for revisions received by either the Public or the Commission.

12 Mental Health Services Act (MHSA) FY Three Year Program and Expenditure Plan OUTLINE OF DRAFT PLAN Version #2 4/26/2017 1

13 FY Plan Summary The Three Year Plan proposes to set aside $51.6 million for fiscal year to fund 85 programs and plan elements. This is a proposed $8.5 million annual increase in budget authority from the previous Three Year Plan. This increase will be offset by estimated additional Medi- Cal reimbursement, increase in state MHSA Trust Fund revenue, and use of unspent funds from previous years. It is anticipated that current total budget spending authority will not need to be reduced in order to fully fund MHSA programs and plan elements in the foreseeable future. Version #1 4/26/2017 2

14 Plan Outline Summary Introduction Table of Contents Vision Community Program Planning Process The Plan The Budget Evaluating the Plan Acknowledgements Appendices o Mental Health Service Maps o Program and Plan Element Profiles o Glossary o Certifications, Funding Summaries o Public Comment and Hearing o Board Resolution Version #1 4/26/2017 3

15 Introduction Describes MHSA, MHSA values, statutory and regulatory requirements Outlines changes to the current Three Year Plan o A description of this year s Needs Assessment and Community Program Planning Process o Addition of outcome indicators for FSP programs and PEI categories o Planning for re-purposing the County s Oak Grove facility o Introduces the No Place Like Home Initiative o Adds the Special Needs Housing Program o Funds the EPSDT expansion requirements o Expands children and adult mobile crisis response capacity o PEI programs are aligned with new required PEI categories o First Hope is adding a first psychotic break program o Two new innovative projects are introduced o A Family Support Program is added to the WET component o Mental Health First Aid is linked to community first responders o A Loan Forgiveness Program added to address workforce shortages o Funds added to allow for programs increased cost of doing business Version #1 4/26/2017 4

16 Vision We intend to utilize MHSA funding to assist Behavioral Health Services in addressing three key areas: Access improve assistance with eligibility, transportation, shorten wait times, increase availability after hours, provide services that are culturally and linguistically competent Capacity take the time to partner with the individual and his/her family to determine the level and type of care needed, coordinate necessary health, mental health and other needed resources, and then successfully work through challenging mental health issues Integration work with our health, behavioral health and community partners as a team to provide multiple services coordinated to a successful resolution. We need to continually challenge ourselves to improve our response to individuals and their families who need us the most, and may have the most difficult time accessing care. Version #1 4/26/2017 5

17 Needs Assessment In 2016 CCBHS conducted a data driven assessment of public mental health needs to complement the planning process. Prevalence and penetration rates were used to determine that the County is proportionally serving all three regions as well as by race/ethnicity, age group and identified gender. Asian/Pacific Islanders, Latina/os, children ages 0-5 and the elderly are slightly underrepresented. All service rates exceed state averages. Expenditure data indicate significant services available at all levels of care, with an oversubscription of funds paying for locked facilities. Workforce analysis indicate a critical shortage of psychiatry time, with an underrepresentation of Latina/os in the CCBHS workforce. Version #1 4/26/2017 6

18 Community Program Planning Process Describes the process Describes the Consolidated Planning and Advisory Workgroup and ongoing stakeholder participation Describes and summarizes results of the recently completed Community Program Planning Process for FY Links prioritized needs to MHSA funded programs, projects and plan elements contained in the Three Year Plan Version #1 4/26/2017 7

19 Community Program Planning Process Highlights (1) CPAW planned and hosted three community forums Over 300 individuals attended forums in San Pablo (West), Pleasant Hill (Central), and Bay Point (East) Attendees self identified: o 23% as a consumer o 32% as a family member o 39% as a service provider o 14% as a community member Small group discussions addressed topical questions developed by consumer, family member and service provider representatives Attendees prioritized identified mental health needs Version #1 4/26/2017 8

20 Community Program Planning Process Highlights (2) Prioritized Needs: 1. More housing and homeless services 2. More support for family members 3. Better coordination of care 4. Children and youth in-patient and residential beds 5. Finding the right services when you need it 6. Improved response to crisis and trauma 7. Support for peer and family partners 8. Intervening early in psychosis 9. Getting care in my community, my culture, my language 10. Assistance with meaningful activity 11. Getting to and from services 12. Care for homebound frail and elderly 13. Serve those who need it the most 14. Help moving to a lower level of care as one gets better 15. Better program and fiscal accountability Version #1 4/26/2017 9

21 The Plan Community Services and Supports (CSS) Prevention and Early Intervention (PEI) Innovation (INN) Workforce Education and Training (WET) Capital Facilities and Technology (CF/TN) Each component leads with a short description of the component and categories within the component, and then lists and describes each program or plan element, cost allocated, and number to be served. Version #1 4/26/

22 Community Services and Supports $37.6 million to fund programs and plan elements that provide services to approximately 2,000 individuals - children who are seriously emotionally disturbed, transition age youth (TAY), adults and older adults who are seriously mentally ill. Full Service Partnerships ($23.7m): o 9 Full Service Partnership Programs serving all age groups and all county regions o Assisted Outpatient Treatment o FSP support staff at all children and adult clinics o 3 Wellness and Recovery Centers o Hope House (transitional residential center) o Oak Grove Youth Residential Center (in planning) o MHSA funded housing services (temporary, supported or permanent) General System Development ($13.8m): o Children s Wraparound and EPSDT expansion o Older Adult Program o Clinical staff at the Miller Wellness Center, Concord Health Center o Clinic support and liaison staff to PES and CCRMC o Administrative support and quality assurance staff Version #1 4/26/

23 Prevention and Early Intervention $8.7 million to fund 25 MHSA programs that provide prevention and early intervention services to approximately 13,000 individuals. All are designed to prevent mental illness from becoming severe and debilitating, and 1) creates access and linkage to mental health services, 2) reduces stigma and discrimination, and 3) provides outreach and engagement to underserved populations. All programs are in the following 7 categories: 1. Seven programs provide Outreach for Increasing Recognition of Early Signs of Mental Illness ($1m) 2. Five programs provide Prevention Services that reduce risk factors and increase protective factors ($1.6m) 3. The First Hope program provides Early Intervention Services for youth at risk of or who are experiencing early onset of psychosis ($2.6m) 4. Four programs provide Access and Linkage to Mental Health Services ($1.1m) 5. Six programs Improve Timely Access to Mental Health Services for Underserved Populations ($1.5m) 6. The Office for Consumer Empowerment (OCE) provides leadership and staff support that addresses efforts to Reduce Stigma and Discrimination ($.3m) 7. Contra Costa Crisis Center and County staff address Suicide Prevention ($.6m) Version #1 4/26/

24 Innovation $2.1 million in FY to fund new or different patterns of service that contribute to informing the mental health system of care as to best or promising practices that can be subsequently added or incorporated into the system. 4 projects are approved and will be in operation for FY ($1.4m): o Recovery Through Employment Readiness. Contra Costa Vocational Services adding pre-vocational services for consumers as part of their mental health treatment plan o Coaching to Wellness. Adding peer wellness coaches to the adult clinics o Partners in Aging. Support for frail, homebound older adults o Overcoming Transportation Barriers. Assisting consumers overcome transportation barriers to accessing services 2 projects are in development, and are expected to be in operation during the Three Year Plan ($.7m estimated): o CORE multi-disciplinary treatment team to serve youth with mental health and substance use disorders o CBSST bringing cognitive behavioral social skills training to clients living in augmented board and care facilities Version #1 4/26/

25 Workforce Education and Training $2.6 million annually from Contra Costa s MHSA unspent funds to recruit, support and retain a diverse, qualified paid and volunteer workforce. The five WET categories are: 1. Workforce Staffing Support. ($1.23m) Funds the county operated senior peer counseling program, a new contract operated family support volunteer program, and WET administrative staff 2. Training and Technical Assistance. ($.23 m) Funds Mental Health First Aid, Crisis Intervention Training, NAMI Basics/Faith Net/Familia de Familia and various county and contract staff trainings 3. Mental Health Career Pathway Programs. ($.44m) Funds the college accredited SPIRIT course where approximately 50 individuals yearly are trained as peer providers and family partners 4. Internship Programs. ($.35m) Provides approximately 75 graduate level clinical intern placements in county and contract operated community mental health programs to increase workforce diversity 5. Financial Incentive Programs. ($.3m) Establishes a locally administered loan forgiveness program to address critical workforce shortages, such as psychiatrists, and supports upward mobility of community support workers Version #1 4/26/

26 Capital Facilities and Information Technology This component enables counties to utilize MHSA funds on a one-time basis for major infrastructure costs necessary to implement MHSA services and supports, and to generally improve support to the County s community mental health service system. For FY 17-20: $696,00 remaining of MHSA funds to complete and integrate Behavioral Health Services electronic records system with the Epic system currently in use by the County s Health Services o Completion forecasted for FY o As per the provisions of the 2010 proposal any costs that exceed the originally approved $6 million will be born by the County s Health Services Department Version #1 4/26/

27 Program Component Changes Due to component fidelity the following programs and plan elements have changed component funding from current (FY 14-17) to proposed (FY 17-20) Three Year Plan: The Older Adult Senior Peer Counseling program has moved from CSS to WET Funding for the mental health clinicians at the Concord Health Center have moved from PEI to CSS Rainbow Community Center has moved from INN to PEI The Perinatal Depression (WELL) Project has moved from INN to PEI OCE staff supporting the SPIRIT program has moved from PEI to the WET component Version #1 4/26/

28 The Budget Provides estimated available funds, revenues, expenditures and projected fund balances by component for Fiscal Years , and Projected fund balances will be updated in subsequent FY and MHSA Plan Updates as revenues and expenditures actualize Projected revenues include state MHSA Trust Fund distribution, interest earned, and federal financial participation (Medi-Cal reimbursement) The County maintains a prudent reserve of $7,125,250 to ensure that services do not have to be significantly reduced in years in which revenues are below the average of previous years. This is in addition to available unspent funds from previous years. NOTE: This current draft version contains dollar amounts that are approximate. This is because Finance is in the process of finalizing the Funding Summaries that will be included as Appendix E. The Budget in the Plan needs to match the Funding Summaries, and will be adjusted accordingly. Version #1 4/26/

29 The Budget (2) $7.8m in unspent CSS funds from previous years is transferred to the WET component in order to finance the proposed WET category expenditures for the three year period The $1.7m received in 2016 for the Special Needs Housing Program has been added to the CSS budget for FY Any of these funds not spent during FY will be added to the FY budget when the Three Year Plan is updated in 2018 A collective increase in budget authority for FY and allows for an increase in the cost of doing business. Subsequent Three Year Plan annual budget authority will be reviewed based upon actual costs and adjusted, if appropriate, for Board of Supervisor review and approval It is projected that the requested total budget authority for the Three Year Plan period enables the County to fully fund all proposed programs and plan elements while maintaining sufficient funding reserves (prudent reserve plus unspent funds from previous years) to offset any reduction in state MHSA Trust Fund distribution or federal financial participation (Medi-Cal reimbursement) Version #1 4/26/

30 Evaluating the Plan Describes a program and fiscal review process with written report to determine whether MHSA funded programs: o Meet the letter and intent of MHSA o Support the needs, priorities and strategies identified in the community program planning process o Meet agreed upon outcomes and objectives o Are cost effective Includes a quarterly MHSA financial report to enable ongoing fiscal accountability. Version #1 4/26/

31 Acknowledgements A thank you to individuals who shared their stories, provided input, and who are working to make the system better. Version #1 4/26/

32 Appendix A - Mental Health Service Maps Provides six one page pictorial of all Contra Costa Mental Health s services broken down by the following: East County adult, older adult and transitional age youth East County Children s Central County adult, older adult and transitional age youth Central County Children s West County adult, older adult and transitional age youth West County Children s Version #1 4/26/

33 Appendix B - Program Profiles Provides a profile of each MHSA funded program or plan element according to the following outline: Organization contact information Brief organization description Title(s) and brief description(s) of MHSA funded program or plan element o Total MHSA funds allocated o FY outcomes Contains an alphabetized Program and Plan Element Profile Table of Contents Version #1 4/26/

34 Appendix C - Glossary Provides an alphabetical listing and definition of terms and acronyms used in the document. Version #1 4/26/

35 Appendix D Certifications Appendix E - Funding Summaries County Behavioral/Mental Health Director Certification County Fiscal Accountability Certification MHSOAC required funding summaries Version #3 4/26/

36 Appendix F - Public Comment, Hearing Appendix G Board Resolution Will include evidence of Public Comment period and Hearing, and summary of public comments. Mental Health Commission s review of draft plan and recommendations. Contra Costa Behavioral Health Service s response to public comments and Mental Health Commission recommendations. Board of Supervisor Resolution Version #1 4/26/

37 Timeline MAR 2-1 st DRAFT Three Year Plan shared with CPAW/MHC for input MAR 20-2D DRAFT Three Year Plan posted for 30 day public comment period MAY 3 - Mental Health Commission (MHC) hosts Public Hearing on Three Year Plan MAY (early) Public Comment, Hearing and MHC recommendations addressed MAY (late) - Three Year Plan submitted to County Administrator for inclusion on Board of Supervisors (BOS) agenda JUNE BOS considers Three Year Plan Version #1 4/26/

38 Issues for MHSA FY Three Year Program and Expenditure Plan Any additional uses for MHSA funds that is not currently depicted in the Three Year Plan will eventually deplete the County s unspent reserve and potentially trigger a contraction of programs The County s level of participation in the No Place Like Home initiative is currently unknown Level of future federal financial participation for California is unknown Full budget impact of new initiatives is unknown o Re-purposing of Oak Grove facility o Full impact of Continuum of Care reform requirements for Children s System of Care o mobile crisis response teams Version #1 4/26/

39 Your Input Is Most Welcome! Point of Contact: Warren Hayes MHSA Program Manager 1340 Arnold Drive Version #1 4/26/

40 Contra Costa County Mental Health Services Act Three Year Program and Expenditure Plan Fiscal Year

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42 Introduction We are pleased to present Contra Costa County Behavioral Health Services (CCBHS) Mental Health Services Act (MHSA) Three Year Program and Expenditure Plan (Three Year Plan) for fiscal years This Three Year Plan starts July 1, 2017, and integrates the components of Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities/Information Technology (CF/TN). This Three Year Plan describes programs that are funded by MHSA, what they will do, and how much money will be set aside to fund these programs. Also, the Three Year Plan will describe what will be done to evaluate their effectiveness and ensure they meet the intent and requirements of the Mental Health Services Act. California approved Proposition 63 in November, 2004, and the Mental Health Services Act became law. The Act provides significant additional funding to the existing public mental health system, and combines prevention services with a full range of integrated services to treat the whole person. With the goal of wellness, recovery and self-sufficiency, the intent of the law is to reach out and include those most in need and those who have been traditionally underserved. Services are to be consumer driven, family focused, based in the community, culturally and linguistically competent, and integrated with other appropriate health and social services. Funding is to be provided at sufficient levels to ensure that counties can provide each child, transition age youth, adult and senior with the necessary mental health services and supports set forth in their treatment plan. Finally, the Act requires this Three Year Plan be developed with the active participation of local stakeholders in a community program planning process. Plan Changes for FY Significant changes to the FY Three Year Plan that are incorporated into the FY Three Year Plan include: A data driven assessment of community mental health needs in Contra Costa County (pages 9-10). A description of this year s Community Program Planning Process (pages 11-27). Outcome indicators for FY are included in the County s Full Service Partnerships program description (page 29). The County is planning to re-purpose their county owned Oak Grove facility in Concord to establish a 24 bed residential treatment facility for youth ages (page 35) A description of the State initiative No Place Like Home is introduced (page 36). The Special Needs Housing Program has been added (page 37). MHSA funding has been added to support Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) expansion requirements (pages 40-41). Funding has been added to expand the County s Mobile Crisis Response capacity in both Children s and Adult Systems of care.(pages 29 and 43). New PEI outcome indicators are described (page 46). PEI programs are aligned with the seven new PEI categories (pages 46-55). DRAFT 3

43 The County s First Hope Program has added staff to now serve transition age youth experiencing a first psychotic break (page 50). Two emerging Innovative projects are described; Center for Recovery and Empowerment, and Cognitive Behavioral Social Skills Training (pages 57-58). A Family Support Program is added to the Workforce Education and Training Component (pages 59-60). Mental Health First Aid Training is linked to community first responders to provide ongoing mental health training, support and consultation (page 63). A locally administered Loan Forgiveness Program to address workforce shortages is added. (page 65). DRAFT 4

44 Table of Contents Introduction..3 Vision 7 Needs Assessment 9 The Community Program Planning Process.11 The Plan Community Services and Supports (CSS) Prevention and Early Intervention (PEI).46 - Innovation (INN) Workforce Education and Training (WET) Capital Facilities/Information Technology (CF/TN) 66 The Budget Evaluating the Plan.71 Acknowledgments 72 Appendices - Mental Health Service Maps...A-1 - Program and Plan Element Profiles.B-1 - Glossary... C-1 - Certifications D-1 - Funding Summaries...E-1 - Public Comment and Hearing...F-1 - Board Resolution G-1 Note. Program and plan element profiles and a glossary section are included in the Appendices to provide more information regarding a specific program or plan element, and to assist in better understanding terms that are used. DRAFT 5

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46 Vision The Mental Health Services Act serves as a catalyst for the creation of a framework that calls upon members of our community to work together to facilitate change and establish a culture of cooperation, participation and innovation. We recognize the need to improve services for individuals and families by addressing their complex behavioral health needs. This is an ongoing expectation. We need to continually challenge ourselves by working to improve a system that pays particular attention to individuals and families who need us the most, and may have the most difficult time accessing care. Our consumers, their families and our service providers describe mental health care that works best by highlighting the following themes: Access. Programs and care providers are most effective when they serve those with mental health needs without regard to Medi-Cal eligibility or immigration status. They provide a warm, inviting environment, and actively and successfully address the issues of transportation to and from services, wait times, availability after hours, services that are culturally and linguistically competent, and services that are performed where individuals live. Capacity. Care providers are most appreciated when they are able to take the time to determine with the individual and his or her family the level and type of care that is needed and appropriate, coordinate necessary health, mental health and ancillary resources, and then are able to take the time to successfully partner with the individual and his or her family to work through the mental health issues. Integration. Mental health care works best when health and behavioral health providers, allied service professionals, public systems such as law enforcement, education and social services, and private community and faith-based organizations work as a team. Effective services are the result of multiple services coordinated to a successful resolution. We honor this input by envisioning a system of care that supports independence, hope, and healthy lives by making accessible behavioral health services that are responsive, integrated, compassionate and respectful. Cynthia Belon, L.C.S.W. Behavioral Health Services Director DRAFT 7

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48 Needs Assessment Introduction Contra Costa Behavioral Health Services (CCBHS) conducted a quantitative assessment of public mental health need in preparation for developing the Fiscal Year Mental Health Services Act (MHSA) Three Year Program and Expenditure Plan (Three Year Plan). This data driven analysis complements the Community Program Planning Process (CPPP), where interested stakeholders provided input on priority needs and suggested strategies to meet these needs. Data was obtained to determine whether CCBHS was a) reaching the people it is mandated to serve, b) appropriately allocating its resources to provide a full spectrum of care, and c) experiencing any significant workforce shortfalls. Benchmarks for the CCBHS target population were established for the county and county regions (East, Central, West) as well as by race/ethnicity, age group and identified gender to determine whether CCBHS was serving more or less than these benchmarks. Benchmarks for appropriate resourcing by level of mental health care, ranging from locked facilities to basic services for prevention and health maintenance, were also established to determine whether the level of funding CCBHS spent on each level met recommended standards. Finally, all CCBHS position classifications were reviewed to determine whether any significant shortfalls existed between authorized versus filled positions, staffing demographics, and bi-lingual staff. Results Data analysis supports that CCBHS is serving the number of clients that approximate the estimated number of individuals requiring services, and moreover serves more eligible clients than the majority of counties in California. This is based upon prevalence estimates and penetration rates of low income children with serious emotional disturbance and adults with a serious mental illness as compared with other counties. In addition, each Contra Costa County region (West, Central, East) and demographic sub-population within the County are equitably and appropriately represented, with the exception of Asian/Pacific Islanders, Latina/os, children ages 0-5 years, and adults ages 60 and over as being slightly underrepresented in each region when compared to other sub-populations within Contra Costa County. Fiscal Year expenditure data indicate services were available at every level of care as defined by the Level of Care Utilization System (LOCUS/CALOCUS). However, compared to benchmarks, CCBHS over spends on the most acute level of in-patient care (Level 6), and is below the benchmark in expenditures related to programs providing high intensity communitybased services (Levels 4 and 5). DRAFT 9