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1 MENTAL HEALTH SERVICES ACT THREE-YEAR PROGRAM & EXPENDITURE PLAN COMMUNITY SERVICES & SUPPORTS County of Santa Barbara Fiscal Years , , SUMMARY OF PROPOSED PROGRAMS IN THE DRAFT FOR PUBLIC REVIEW November 2005

2 Contents Public Commented Invited 3 Introduction 4 Types of MHSA Funding 5 Proposed s 6 Major Community Concerns 15 About the People Served By ADMHS 16 Proposed s by Age Group Children and Youth Major Community Issues and Concerns, page 15 Spirit for Youth at risk (for out-of-home placement), page 7 Countywide Crisis Mobile Services, page 8 Connections: Each One Reach One, (outreach to families with children who have severe emotional disorders not currently being served), page 12 Transition- Age Youth Adults Major Community Issues and Concerns, page 15 Vida Nueva (for people who are homeless or at risk of homelessness) page 6 Countywide Crisis Mobile Services, page 8 New Heights (drop-in center and hub of support), page 10 Major Community Issues and Concerns, page 15 Vida Nueva (for people who are homeless or at risk of homelessness), page 6 Countywide Crisis Mobile Services, page 9 Partners in Hope, (augmenting services with peer and family recovery staff), page 11 Justice Alliance (for adults involved in the justice system), page 13 Bridge to Care (for adults receiving alcohol and/or drug treatment) page 14 Older Adults Major Community Issues and Concerns, page 15 Countywide Crisis Mobile Services, page 8 OARRS (to expand multidisciplinary team to assist older adults in remaining in their homes) page 9 2

3 Public Comment Invited Comments on the draft Mental Health Services Act funding plan were received by fax, telephone, e- mail, and through a web-based community survey through November 7, A complete version of the draft MHSA proposal is available at or by calling (805) The public was also invited to express opinions at hearings held by the Mental Health Commission in Santa Barbara on November 9 th from 1:30-5:00 pm at the Board of Supervisors Hearing Room and in Santa Maria on November 10 th from 1:30-5:00 pm at the Board of Supervisors Hearing Room. A summary of substantive recommendations made during the public comment period appears on pages of the full version of the draft plan. We ve tried to define many unfamiliar terms, but for further help, a glossary with definitions of most of the mental health terms and acronyms appearing in this proposal is available at Also available at this site is extensive demographic information about Santa Barbara County, lists of individuals participating in the MHSA planning process, and more information planning, budgeting and other topics. 3

4 INTRODUCTION In recent years many community members has expressed the concern that components of the Santa Barbara County Department of Alcohol, Drug and Mental Health Services (ADMHS) tended to work in isolation from each other. To address this critical issue, four years ago the administration of ADMHS embarked on a comprehensive program of transforming the alcohol, drug and mental health system of care. ADMHS leaders began building the infrastructure capable of sustaining a System of Care based on biopsychosocial rehabilitation and recovery that deploys a team approach to service delivery. A three-day MHSA stakeholders summit drew approximately 150 individuals representing a diverse range of demographics, special interests, affiliations, and perspectives. Approximately two weeks later, a follow-up meeting to the summit drew 112 individuals. This meeting was designed to ensure that the MHSA planning group developed program proposals representing community preferences. Overall, the follow-up summit established that the draft plan closely reflected community recommendations. Many of the proposed mental health strategies are designed to expand access points to mental health care -- especially crisis services -- a goal receiving overwhelming support of consumers, families, and virtually all stakeholders throughout Santa Barbara County. Concerns were also expressed that Full Service Partnerships needed close ties to the homeless population, to children at high risk and to under-served areas of Santa Barbara County. During the 30-day public comment period, specific recommendations were collected and considered. Pages of the revised plan outline these recommendations and responses. We thank the community for extensive input received toward improving the public mental health and alcohol and drug system. Every effort is being made to transform the system in a way that truly responds to the needs of people with mental illness in Santa Barbara County. James L. Broderick, Ph.D., Director Santa Barbara County Department of Alcohol, Drug and Mental Health Services November 3,

5 Types of MHSA Funds Available: s and services proposed for Community Supports and Services (CSS) funding through MHSA must fall into one of these categories: Full Service Partnerships: provide all necessary services and supports for designated populations to be served in the first three years. Counties are required to request the majority of their total CSS funding for Full Service Partnerships to begin to provide full service to as many individuals/families as possible. At least half of the CSS funding request must be for Full Service Partnerships. General System Development Funds are used to improve programs, services and supports for the identified initial full service populations and for other clients consistent with the populations described in Part II of this proposal. Outreach and Engagement Funds support special activities needed to reach unserved populations and may be one component of an overall approach to reduce ethnic disparities. Additional information is available at including: More information about the Mental Health Services Act (MHSA) The full version of this draft proposal and exhibits 5

6 Proposed Name of : Proposed s Vida Nueva (for Adults, Older Adults, and Transition-Age Youth) Location: Lompoc, Central County, Guadalupe, Carpinteria Key Definition: Assertive Community Treatment (ACT) is a team-based approach to the provision of treatment, rehabilitation, and support services. ACT models of treatment are built around a self-contained multidisciplinary team that serves as the fixed point of responsibility for all patient care for a fixed group of patients. The treatment team typically provides all patient services using a highly integrated approach to care. Full Service Partnership Population Served: Seriously mentally ill adults, older adults, and transition-age youth who are homeless or at risk for homelessness, either un-served or under-served, with or without co-occurring substance abuse conditions Development of a culturally competent Assertive Community Treatment (ACT) model Description: program in Lompoc and Central County, a highly under-served region with an ethnically diverse population, to provide intensive community-based wrap around service delivery, 24 hours a day, seven days a week, in order to keep people in recovery living independently. Additionally, peer support staff and family member staff will be added to an Assertive Community Treatment Team in Santa Maria to enable services to Guadalupe. Santa Barbara services will be expanded to include peer support staff and family member support staff to each existing team and to an existing team in Santa Barbara to extend services to Carpinteria, an under-served community in South County. More Details: See pp of the full Community Services & Supports Draft Plan for Public Review. Strategies: Total Adult Cost: Total Adult MHSA Funds: Total Transition- Age Youth Cost: Total Transition- Age Youth MHSA Funds: Recovery Outcomes: Grass roots outreach to minority communities (Latino, Hmong, African American) will increase access to mental health services. Housing subsidies and supportive housing Youth peer and adult peer support staff Bilingual, culturally sensitive staff Vocational services Consumer and family members employed as staff to provide support Outreach and service delivery to un-served people in Lompoc and Guadalupe Linkage between Adult and Youth Services $1,277,000 $988,000 $559,550 $487,050 Consumers enrolled in the program will be engaged in vocational activities, vocational skills training, and/or educational activities between hours per month. Consumers enrolled in the program will report that they are engaged in meaningful social activities and relationships at least one time per week. 6

7 Full Service Partnership SPIRIT (for Children, Youth and Families) Proposed Name of : Location: County-wide Key Definitions: Wraparound: A family centered, community-oriented, strengths-based, highly individualized planning process aimed at helping people achieve important outcomes by meeting their unmet needs both within and outside of formal human services systems while they remain in their neighborhoods and homes, whenever possible. Seriously emotionally disturbed children, youth and their Population Served: families who are at risk for out-of-home placement or homelessness, either un-served or under-served, with or without co-occurring substance abuse conditions or family substance abuse issues. Development of culturally competent wraparound teams at all ADMHS children s Description: service sites by expanding existing staff resources, adding youth and/or parent partners hired as staff and licensed mental health professionals who will facilitate the wraparound process as Personal Service Coordinators with the capacity to provide 24/7 services as needed. Non-traditional services, supports and supplies will be utilized to meet individual needs identified through strengthbased assessments for all family members. More Details: See pp of the full Community Services & Supports Draft Plan for Public Review. Parent partners will be drawn from the same community as the clients and will mirror the language and culture of those being served. Strategies: Individualized services and supports Wraparound services for children/youth and their families Youth peer mentors hired as staff Reliance on natural community supports Serves as a blueprint for the comprehensive children s System of Care Services based on individual and family strengths Youth hired as staff Total Cost: $833,000 Total MHSA Funds: $423,000 Recovery Outcomes: Consumers enrolled will show improved academic performance and spend more days in the classroom during the year(s) enrolled as compared to the year(s) prior to enrollment. Consumers will have fewer incidents of incarceration during the year(s) enrolled as compared to the year(s) prior to enrollment. Parents will report that they are satisfied with the level of support offered by professionals, parent partners, and parent networks offered through the program. (Use a satisfaction scale at certain intervals throughout the program) Consumers enrolled in the program will spend more days per year living within their homes and/or community as compared to the year(s) prior to enrollment. 7

8 General System Development Proposed Name of : Location: County-wide Population Served: Description: Crisis and Recovery Emergency Services (CARES) Countywide Mobile Crisis (for all age groups) All Santa Barbara County Adults, Children, Youth and Families Expand existing reallocated resources in South and North County to establish a 24/7 Mobile Crisis Response by Alcohol, Drug and Mental Health Professionals More Details: See pp of the full Community Services & Supports Draft Plan for Public Review. Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Both mobile crisis response and the telephone crisis line will include bilingual, bicultural staff. 24/7 Alcohol Drug and Mental Health Services 24 Hour 888 Telephone Crisis Line County-wide reorganization of crisis delivery system Integration of crisis response to drug, alcohol and mental health emergencies Peers hired as staff to provide crisis support $3,343,000 $393,000 (includes Adult and Child MHSA Funds) Reduction of acute hospital and institutionalized care including jail time and recividism, tracked by age group Increased access to care, including in times of crisis measured by comparing the number of individuals served prior to program implementation and after program implementation. Follow-up care will occur within three days of crisis episode Consumers and community members will report increased satisfaction with responsiveness in times of crisis. 8

9 General System Development Proposed Name of : Location: County-wide Population Served: Older Adult Response and Recovery Service (OARRS) Older adults with severe mental illness who are at imminent risk for voluntary or involuntary out-of-home placement. A multi-agency, multi-disciplinary culturally competent team will be developed by Description: expanding and coordinating current resources from Adult Protective Services, Geriatric Assessment, and Public Guardian, adding mental health professionals, peer and/or family member staff in order to respond and intervene 24/7 to older adults in the community who, because of a serious mental disorder are at risk of acute psychiatric hospitalization. More Details: See pp of the full Community Services & Supports Draft Plan for Public Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Review. The multi-agency, multidisciplinary team receives ongoing training in specific cultural and acculturation issues affecting Latino older adults. Specialized countywide home-based, mental health services for older adults Older adult peer support Wraparound services, supplies and supports 24/7 access to mental health services Peer and family support Warm line response by older adults $795,000 $500,000 Increased medication compliance and fewer medication accidents. Increase in older adults returning to the community from long-term psychiatric care. Reduction of recidivism to acute care. Increased identification of co-occurring substance abuse conditions in older adults with mental illness. Decreased suicide rate for older adult people through increased responsivity to the hopelessness and despair that plagues isolated older adults. 9

10 General System Development Proposed Name of : Location: Lompoc Population Served: New Heights (for Transition-Age Youth) Transition-age youth who are receiving mental health services for serious emotional conditions or serious mental illness and aging out of the system (either through mental health, probation or child welfare services) and are at risk for homelessness including those with co-occurring disorders One-stop, hub of support drop-in center for services and social support; utilizing Description: peer support in order to build meaningful and productive lives and relationships. Mentoring, support groups, leadership development, vocational support, counseling, housing assistance, benefits assistance all will be available More Details: See pp of the full Community Services & Supports Draft Plan for Public Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Review. A Peer and Family Advisory Council will be developed to provide support in ensuring the linguistic and cultural competency of the center. Another strategy to ensure cultural competence is to hire staff from among the community members who are either consumers or former consumers. Linkage between Adult and Youth Services Supported employment and housing Youth-driven services Safety net for youth transitioning to adulthood Youth hired as staff to provide peer support and leadership development $325,000 $224,950 Reduction in the number of days of incarceration and number of bookings. Reduction in the number of days of psychiatric hospitalization and number of hospital admissions. Increase in the number of days of employment, volunteer work or school. Increase in consumer satisfaction with program services (level of community involvement) level of social support and vocational/educational experiences. 10

11 General System Development Partners in Hope (for Adults and Families) Proposed Name of : Location: County-wide Key Definition: Wellness Recovery Action Plans (WRAP) are authored by consumers to draw on their strengths, advance wellness, prevent escalation of symptoms, and promote successful recovery from crisis situations. Consumers work in collaboration with trusted peers to create and use their unique WRAPs. Population Adults with severe mental illness and family members Served: Working under the existing Consumer and Family Member Services Coordinator Description: position, additional family partners and peer recovery staff will be hired to augment the service delivery teams, providing recovery activities in each region of the county to strengthen peer and family member services, facilitate hope and wellness and clarify the role of peers and family in the Adult System of Care. More Details: See pp of the full Community Services & Supports Draft Plan for Public Strategies: Features Total Cost: Total MHSA Funds: Recovery Outcomes Review. Family partners and peer recovery staff will reflect the cultural, ethnic and linguistic backgrounds of the clients served. Peer and family member-directed care Recovery and healing approach Involvement of people in recovery at every level, from policy to service delivery Recovery activities as a main component of service at each service site $192,500 $187,000 People in recovery will be offered the opportunity to develop Wellness Recovery Action Plans as a part of their menu of care Peer and family partners hired as staff will attend at least one team meeting a week at ADMHS adult service delivery sites A regularly scheduled menu of recovery activities will be available at service delivery sites daily Regularly scheduled family member-specific activities and services will be available at service delivery sites. 11

12 Generall System Devellopment/Outreach & Engagement Proposed Name of : Location: County-wide Population Served: Description: More Details: Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Connections: Each One Reach One (for Families with Un-served Children) Families with children who have severe emotional disorders not currently being served. Strategically placing outreach peer/family member staff in community settings to link the un-served to needed services. Dedicated peer and family staff will provide education about children s mental health conditions to school staff including appropriate intervention for children and their families in the educational system See pp of the full Community Services & Supports Draft Plan for Public Review. Family partners and peer recovery staff will reflect the cultural, ethnic and linguistic backgrounds of the clients served. Youth and family-directed care Cultural and gender-sensitive outreach School, community and home-based Community engagement Services from peer and family members hired as staff Reduction of stigma through the development of welcoming schools and communities $441,000 $281,000 Increase incidents of successful linkage to appropriate care Parents will report that they are satisfied with the level of support offered by professionals, parent partners, and parent networks offered through the program To measure community outreach and engagement, At least four major community educational and or celebratory events related to mental illness will take place each year Increased availability of peer mentoring for youth and families 12

13 General System Development Proposed Name of : Location: County-wide Population Served: Justice Alliance (for Adults involved with the Justice System) Adults in custody, out of custody and on probation or at risk for being in custody who have either severe mental illness or severe mental illness and substance use conditions Alcohol, drug and mental health specialists who are dedicated to the courts, Description: probation, public defender, district attorney, community-based organizations and ADMHS service teams in order to facilitate quick linkage for incarcerated mentally ill people and/or people with mental illness and addiction to appropriate care in order to reduce recidivism through the justice system. More Details: See pp of the full Community Services & Supports Draft Plan for Public Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Review. Given the finding that Latinos are more likely to access physical health care providers rather than mental health providers, bilingual and bicultural staff will rotate through the Public Health Clinics linking Latino families to mental health services. Seamless access to appropriate care Coordination of care with legal team Treatment not punishment for individuals with mental illness Integration of Alcohol, Drug and Mental Health Services with Criminal Justice $302,000 $222,000 Linkage to appropriate care will occur within 2 days of discharge Reduction in the number of days of incarceration, number of bookings, and/or sanctions. Increase in compliance with mandated treatment. Increase in the number of days of employment, volunteer work or other meaningful activities. 13

14 General System Development Proposed Name of : Location: County-wide Population Served: Bridge to Care (for Adults receiving Alcohol and/or Drug treatment) Adults receiving alcohol and/or drug treatment in the community who also have a co-occurring serious mental illness Alcohol and or drug treatment community-based organizations in each region of Description: the county will contract with a psychiatrist in order to ensure quick and appropriate medication evaluation and monitoring until such time as the client is able to obtain medication services at an ADMHS clinic More Details: See pp of the full Community Services & Supports Draft Plan for Public Strategies: Total Cost: Total MHSA Funds: Recovery Outcomes: Review. appropriate services will be delivered through the hiring of bilingual and culturally sensitive staff. On-going training to the staff on cultural issues and best practices relevant to the target population will be provided. Integration of alcohol and drug and mental health services Access to psychiatric care Vocational services Development of mental health medication services at alcohol/drug treatment sites Links alcohol/drug programs with ADMHS mental health medical services $108,000 $90,000 Linkage to appropriate care will occur within 2 days of discharge Reduction in the number of days of incarceration, number of bookings, and/or sanctions. Increase in compliance with mandated treatment. Increase in the number of days of employment, volunteer work or other meaningful activities. 14

15 MAJOR COMMUNITY CONCERNS The major community issues identified through the MHSA community planning process, by age group, appear below. An asterisk (*) denotes community issues selected to be the focus of MHSA services over the next three years. A Summary of Major Community Issues By Age Group Identified in the Planning Process *Selected for MHSA Services over the next three years. Children/Youth Transition-Age Youth Adults Older Adults 1. Crisis Serviceshospitalization 2. Success in Schoolschool failure* 3. Protection from violence and abuseinvolvement in the child welfare and juvenile system* 4. Alcohol and drug problems experienced by people with mental illness 5. Helping families with members with mental illness or co-occurring conditions -out of home/area placement* 1. Housing/homelessness* 1. Crisis Servicesfrequent hospitalization* 2. Job training, placement, and education.-inability to work/school failure* 3. Access to culturally competent, coordinated system of case management and service* 4. Self-help, mentors, client-run services.* 5. Services for families with mental illness and addictions; parent education issues-peer and family problems* 2. Lack of treatment resources for cooccurring conditions.* 3. Lack of vocational services-inability to work.* 4. Lack of services for individuals who are homeless or at risk of homelessness* 5. Lack of services for people in trouble with the law-incarceration* 1. Crisis Servicesfrequent hospitalization &/or emergency medical care* 2. Need for homebased servicesisolation* 3. Homelessness.* 4. Need for counseling for co-occurring conditions. 5. Need for peer- and family-operated support services-peer and family problems. Access to culturally competent, coordinated system of case management and services is a top priority for all age groups. Although the term co-occurring conditions may be used to refer to a number of different combinations of conditions, in this proposal, co-occurring conditions refers to individuals with severe mental illness and addiction to alcohol and/or other drugs. 15

16 About the People Served by ADMHS New initiatives proposed for MHSA funding are designed to reach people with serious mental illness of all ages in Santa Barbara County who have received inadequate or no mental health services in the past. A major part of the emphasis in designing new programs focuses on addressing longstanding racial, ethnic, and cultural disparities that prevent people from receiving needed services. At least 35% of the population of Santa Barbara County and the largest ethnic minority, Latinos continue to be under-served. Latinos make up 24% of ADMHS adult clients, but 60% of the people living in poverty in the county. At the same time, while 64% of all ADMHS adult clients are Caucasian, they constitute only about a third of the people in the County living in poverty. Lesbians, gays, bisexual, and transgender persons (LGBT) and Native Americans are also underserved populations in need of greater access to culturally appropriate outreach and services. In ongoing programs as well as in new MHSA initiatives, ADMHS will continue to place a top priority on building culturally competency to better respond to the needs of the diverse populations of Santa Barbara County. Capacity-building efforts will include implementation of more effective recruitment and retention of bilingual and bicultural staff and network providers, development of more culturally appropriate clinical and assessment practices, ongoing consultations with the recently formed Latino Advisory Committee and more extensive outreach to under-served and isolated communities. 16

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