Nevada County Mental Health Board Minutes Date: November 02, 2018 Time: 9:30 a.m. 12:00 p.m. Place Behavioral Health Department 500 Crown Point Circle, Grass Valley STANDING ORDERS 1. Call to Order Self-introductions were made and a sign in sheet was passed around. 2. Public Comment. Members of the public may address the board on items not appearing on the agenda. Please understand that no action shall be taken on items not appearing on the agenda. There were no public comments. 3. Announcements. Lori Malone announced there will be a NAMI Walk on May 4, 2019 and NAMI is looking for sponsors. Lori handed out some event flyers. Annette LeFrancois announced the Point in Time Count Homeless Count and Survey will take place on January 24, 2019. There was a flyer about the event included in today s handouts. 4. Mental Health Board Minutes for October 5, 2018. Ann Kelley made a motion to approve the minutes. The motion was seconded by Iden Rogers; all members present were in favor. 5. Behavioral Health Budget Phebe Bell. Handout. Phebe Bell presented a PowerPoint overview of the Behavioral Health budget process. Included in today s handouts is Fiscal Year 2018/19 budget development calendar, a flow chart of the budget process, Fiscal Year 2017/18 accomplishments, objectives, projected revenue and expenses. The Board of Supervisors sets objectives and priorities. Next Behavioral Health looks at State funding levels and whether or not there will be budget increases or reductions. Behavioral Health begins developing a draft budget. The draft then goes to the County Executive Office (CEO) where their analysts review it. Then the draft budget is presented to the Budget Subcommittee. The final draft is then presented at a public Board of Supervisors meeting to be approved. There was a question as to where in the budget process the Mental Health Board would give input. Typically there is a need for input when there are budget increases/decreases or when a contract provider is not meeting expectations. Also there is input in the Mental Health Services Act budget. The budget process begins in January. In late February the Behavioral Health budget is due to the CEO s Office. In late March and early April the Budget Subcommittee review and presentations take place. In May a draft budget is available to the public. In early June budget hearings take place. In mid-june the final budget is adopted by the Board of Supervisors. The Behavioral Health budget is 32 million with the largest portion spent on adult services (ages 18 and up). The alcohol and drug services portion of the budget will increase due to the implementation of the Organized Delivery System (ODS). There are four main funding streams: realignment (1991 and 2011), Medi-Cal revenue, and Mental Health Services Act (MHSA) funds. Phebe Bell passed around a copy of the County Budget Book. 1
Nevada County budget information is also available on the County Budget Portal web page: https://www.mynevadacounty.com/366/county-budget-portal. 6. Behavioral Health Director s Report Phebe Bell. Behavioral Health hired an alcohol and drug program manager, Suzanne McMaster. With ODS implementation Behavioral Health has been Medi-Cal certified in order to bill for expanded drug and alcohol services. Our contract providers must also become certified. Community Recover Resources (CoRR) has been trying to get certification for their residential programs. CoRR applied last March. ODS went live in July. You can only back bill Medi-Cal for six months and the State can also decide there is a finding and prohibit the ability to back bill. As of Monday this week CoRR is certified. The Bost/Lovett Recovery Center has been full most of the time. The number of assessments at Behavioral Health for drug and alcohol services have increased about 30% from last year. The drug and alcohol assessments are taking about six hours to complete from time of contact to completing the paperwork. Behavioral Health is trying to streamline this process. There has been discussion on creating a drop-in substance use assessment clinic scheduled at a specific time every day. AB1299 Presumptive Transfer Behavioral Health is concerned about the fiscal impact and the amount of staff time spent when a child is transferred from out of county to a residential treatment placement in Nevada County. Nevada County is responsible for the cost, yet has no say in where the child is placed and whether or not it is an appropriate placement. In theory the sending County is responsible for paying Nevada County yet there is no mechanism in place for re-payment. 7. Peer Support Priya Kannall. Maureen Gerecke gave an update for Priya to share. Mindfulness and Self Awareness Training is occurring at the jail for six weeks. In January there are plans to start a Moral Reconation Training. SPIRIT is having challenges balancing peer support and a mental health training focus with the needs of individuals experiencing homelessness. It is impacting their ability to provide the mental health focused services. Iden Rogers mentioned that when there are very troubled individuals participating in group activities, people who are not used to it often do not return to participate in activities at SPIRIT. Shera Banbury mentioned that the Respite Center is short on experienced staff with the manager out and another staff person who left. Shera recently participated in a webinar on access state of the community report that was very good. For stakeholder advocacy there are 30 people at the State level who will come into any community by request and setup a town meeting to talk about what the State Peer Support people are doing and strategies to get more peer activity in our area to reduce stigma. 8. Forensic Task Force Iden Rogers. Iden Rogers gave an overview on the history of the Forensic Task Force that was formed over concerns about the criminalization of individuals with mental illness. NAMI recommended the creation of a Task Force. Task Force members include representatives from the criminal justice system, County, Behavioral Health contractors, Sierra Nevada Memorial Hospital, and community organizations. 2
Hospitality House can now drive people to appointments. There is also recuperative boarding at Hospitality House for individuals recently discharged from the hospital with no place to go. There will be a separate low barrier dorm area for individuals who may not be alcohol or drug free. No drugs or alcohol will be permitted on site. Odyssey House is a 10-bed adult residential program for Behavioral Health clients needing this level of care. Odyssey House is often used for individuals returning to Nevada County from psychiatric hospitalization. There is a 3 million dollar grant that will be used for expansion and remodeling that will start in July. Placer and Nevada County crisis services are also housed there. Relocating crisis and client services during construction will be a challenge. 9. Truckee Anne Rarick. The Homeless Task Force has reconvened. Agencies participating include Tahoe Forest Hospital, Truckee Police, and the Emergency Warming Center. The threat of fire has been a big issue. There was a homeless connect event in the summer. There has been conversation around services that are fragmented with different service locations depending on where residents reside (Placer or Nevada County). Most likely the Warming Center will be open the night of the Point in Time Count. 10. Mental Health Board Goals Nancy Ramsey, Iden Rogers, Ann Kelley, and Shera Banbury. The subcommittee met to work on goals. There is no report this month. The next subcommittee meeting will be on November 16 th at 12:30 p.m. in the Telegraph Mine Room. 11. Mental Health Services Act (MHSA) Report Priya Kannall. Handout. There was a Community Mental Health Services Act Meeting yesterday. Priya brought handouts from yesterdays meeting. The meeting was well attended. There is a Health Education Coordinator position through Public Health that closed last week. The position will be half drug and alcohol prevention and half suicide prevention. The post-vention piece will be filled by Behavioral Health through an existing position. Behavioral Health is participating in the State led suicide prevention learning collaborative related to strategic planning. Particularly in western Nevada County there is work to be done on goal setting and where to focus efforts with limited funding. There is a Suicide Prevention Task Force meeting in western Nevada County on the third Friday of each month from 10:30 am to 12 noon in the Sheriff s office conference room. Maureen Gerecke is the meeting chair. In Eastern Nevada County the Tahoe Truckee Suicide Prevention Coalition is also participating in the learning collaborative. Innovation Five percent of MHSA funding is allocated for Innovation each year. An Innovation Project can last for up to five years. Innovation funds cannot be used to purchase buildings or houses. In community meetings over the past few years stakeholders have identified homelessness as a top priority for our next Innovation Project. Looking at the 2018 Point in Time Count, 44% identified as chronically homeless, whereas the State average was 28%. There are also many unmet physical health needs with this population 43% identified as having a physical disability, 41% identified as having a chronic health condition, 46% identified as having a mental health disorder and 70% identified as having some criminal justice involvement. 3
The Innovation Project we are hoping to fund is called HOME, Homeless Outreach and Medical Engagement Team. The Team would include a nurse, personal services coordinator and peer counselor to identify physical health, mental health and substance use disorder needs. The target population would be the most vulnerable individuals and families experiencing homelessness, regardless of involvement with County Behavioral Health services. There will also be a criminal justice focus with the HOME Team working closely with the forensic liaison and jail staff to engage individuals from the criminal justice system. The goal is to pair the HOME Team with low barrier, Housing First approach master-leased units/homes similar to the Bridges to Housing model. The goal is to house 12 16 individuals per year and include a housing case manager for post-housing support. There was a suggestion to highlight the post-housing part of the program. If we embed the HOME Team and easier outreach points like physical healthcare and low-barrier housing can we lower the number of chronically homeless in our County? There was a suggestion to have this in the first paragraph. There was also a suggestion to be more client driven for example: have a homeless or formerly homeless person on the HOME Team. Another suggestion is to describe why we are not successful with the population we are targeting. Suggestion to change the name peer counselor to peer support specialist. Our Innovation Plan will be presented to the Mental Health Services Act Oversight and Accountability Commission (MHSOAC) for them to decide if we meet the criteria and are innovative enough. Included in today s handout is a rough estimate of the Innovation Project budget that Priya reviewed in today s meeting. We would like to have this Innovation Plan posted for 30 day public comment by Monday of next week. If we are able to meet this timeline, the Public Hearing would be held at the December 7 th Mental Health Board Meeting. After the Public Hearing our Innovation Plan can be submitted to the MHSOAC for approval. It can take two months or longer to get on the MHSOAC agenda. We are also required to say when our Plan would go to the Nevada County Board of Supervisors. 12. Communication Future Mental Health Board Agenda Items. Email future agenda items to Nancy Ramsey at nancy@dvsac.org or Annette LeFrancois at annette.lefrancois@co.nevada.ca.us. Nancy Ramsey has created a list of future speakers that Mental Health Board members have suggested. a) SPIRIT Peer Empowerment Center Data from year end. b) Children s Behavioral Health, Cindy Morgan. c) Common Goals. d) Insight Respite Center, Theresa. e) Client Satisfaction Surveys, Yvonne Foley. f) Performance Improvement Projects (PIP). g) 211 Connecting Point. h) Turning Point. i) Moving Beyond Depression. 4
ATTENDANCE: Members Present: Excused Absent: BH Staff: Visitors: Iden Rogers, Nancy Ramsey, Laura Preston, Ann Kelley, Shera Banbury, Janice Deardorff, Anne Rarick. Amanda Wilcox. Priya Kannall, Annette LeFrancois, Phebe Bell. Ginny Cutler, Lori Malone. Minutes by Annette LeFrancois 5