INSTRUCTIONS FOR COMPLETING QUARTERLY REPORTS PART A: MHSA PROGRAM BACKGROUND 1. Agency/Organization: Enter the name of your contracted agency/program. MHSA Initiative: Check the MHSA initiative that funds your program. Current Quarter: Check the current quarter to which this report refers. 2. Name: Enter the names of the individuals who completed this Quarterly Report. Email Address: Enter the email addresses of the individuals who completed this Quarterly Report. Phone Number: Enter the phone number(s) of the individuals who completed this Quarterly Report. PART B: DIRECT SERVICES: DEMOGRAPHIC BACKGROUND OF INDIVIDUALS SERVED 3. Total Numbers Served: Tally the total number of individuals served. 4. Total Numbers Served by Age: Tally the total number of individuals served by age group. In the Missing/Unknown/ row, enter the total number of individuals for whom data related to age were not collected. 5. Total Numbers Served by Gender: Tally the total number of individuals served by gender. In the Missing/Unknown/ row, enter the total number of individuals for whom data related to gender were not collected. 6. Total Numbers Served by Race/Ethnicity: Tally the total number of individuals served based on race/ethnicity. This total could be larger than the other totals because some clients may identify themselves by multiple races/ethnicities (e.g., Hispanic and White). In the Missing/Unknown/ row, enter the total number of individuals for whom data related to race/ethnicity were not collected. 7. Total Numbers Served by Primary Language: Tally the total number of individuals served based on their primary language. In the Missing/Unknown/ row, enter the total number of individuals for whom data related to primary language were not collected. 8. Total Numbers Served by Culture: Tally the total number of individuals served by cultural group. 9. Total Numbers Served by Medi-Cal. Tally the total number of individuals served that are Medi-Cal beneficiaries. Information should be completed only by Community Services and Support (CSS) programs. 10. Total Number of Sessions/Contacts/Visits. Tally the total number of sessions/contacts/visits for clients who are new and from previous quarters. PART C: OUTREACH AND ENGAGEMENT (NON-DIRECT SERVICE DATA) 11. Estimated Numbers Encountered/Reached: Enter estimated counts of individuals in attendance at program activities where individual-level data were not collected. Activities may include outreach at health fairs, conference presentations, or workshops where individuals did not provide specific demographic information. 1
PART D: NARRATIVE DESCRIPTION OF SERVICES 12. Services: Describe the number and types of services that your agency/program provided to your target population(s). Provide additional information about these activities, such as: How often did participants receive these services (e.g., once a week)? How long did they receive them (e.g., six months)? 13. Client, Consumer, & Family Outcomes: Describe the impact of the services to participants. This includes data that shows: Changes in participants overall functioning Results from screenings/assessments Participant satisfaction with program delivery, implementation, and content 14. Implementation Challenges: Describe any difficulties implementing services and/or reaching your target population(s). Service Types Case Management: Services that provide coordination, support, and advocacy to address multiple needs (e.g., mental health, vocational, educational, child welfare, other community services) Crisis Intervention: Services to support individuals experiencing a psychiatric crisis designed to reduce symptoms, assist in stabilization, and aid in restoring a level of functioning Group-level Interventions: Psychotherapeutic programs and services (e.g., social skills groups, peer support groups) that are delivered in a group format to reduce psychiatric symptoms and promote adaptive functioning Individual-level Interventions: Psychotherapeutic programs and services delivered one-onone to reduce psychiatric symptoms and promote adaptive functioning Medication Management: Support for the use of psychotropic medicines, administration of those medicines, and appropriate observation and follow-up Outreach: Public awareness activities (e.g., social media campaigns, health fairs) to promote knowledge of an agency s program and services Referrals: Coordinated linkages with other providers for additional mental health resources and supports Screenings/Assessments: Mental health evaluations (e.g., comprehensive psychological testing, educational diagnostic testing) that help identify service needs and recommendations for treatment Trainings: Educational activities (e.g., presentations, workshops) that support the knowledge and skill development of providers and community leaders 2
PART A: MHSA PROGRAM BACKGROUND Sonoma County Department of Health Services Behavioral Health Division MHSA Quarterly Report EXAMPLE 1. MHSA Program Background Agency/Organization: Kansas Street Community Youth Clinic MHSA Initiative: System of Care (CSS, INN) X PEI Current Fiscal Year: FY 16-17 Current Quarter: X 1 (July Sept) 2 (Oct-Dec) 3 (Jan-Mar) 4 (April-June) 2. Quarterly Report Contact Information Name(s) Email Address Phone Number Raul Martinez rmartinez@harderco.com (415) 522-5400 Audrey Bangi abangi@harderco.com PART B: DIRECT SERVICES: DEMOGRAPHIC BACKGROUND OF INDIVIDUALS SERVED 3. Total Numbers Served 4. Total Numbers Served by Age Children & Youth (0-15) 30 Transition Age Youth (16-25) 22 Adult (26-59) Older Adult (60+) 5. Total Numbers Served by Gender Female 23 Male 27 Transgender 2 Other 3
6. Total Numbers Served by Race/Ethnicity White 16 African American 12 Asian Pacific Islander Native American Hispanic 24 Multi Other 7. Total Numbers Served by Primary Language English 29 Spanish 23 Other 8. Total Numbers Served by Culture LGBTQ 15 Veteran Homeless Individuals in Foster Care 10 Other: (please specify below) Total 25 4
9. Total Numbers Served by Medi-Cal* Medi-Cal Beneficiaries Total *Table 9 should only be completed by Community Services and Supports (CSS) programs serving Medi-Cal clients 10. Total Number of Sessions/Contacts/Visits (for clients who are new and from previous quarters) Total PART C: OUTREACH AND ENGAGEMENT (NON-DIRECT SERVICES DATA) 11. Estimated Numbers Encountered/Reached Total 300 5
PART D: NARRATIVE DESCRIPTION OF SERVICES 12. NUMBER AND TYPE OF SERVICES PROVIDED 13. CLIENT, CONSUMER & FAMILY OUTCOMES 14. IMPLEMENTATION CHALLENGES A) Provided three 90-minute parenting workshops focused on strengthening relationships between fathers and their children. Overall, 25 teen fathers were in attendance. B) Conducted a two-hour training to Regional High School staff (total of five staff members) about addressing the needs of teen fathers. C) Conducted five weekly group sessions with young women between 15-21 years old. On average, 15 African American and Latina young women attended each session. We discussed topics such as sexual health, relationships, self-esteem, and HIV/STI prevention. D) Tabled at local health conference on August 13 & 14 to outreach to an estimated 250 service providers and community leaders/advocates. This event provided an opportunity for us to broaden the network of those who are aware of our agency and the services that we provide. E) Workshop evaluations indicated that 75% of participants were satisfied with the content and delivery of the workshop. Participants shared that they enjoyed the interactive activities and the group discussions. Training evaluations showed that 95% of staff increased their knowledge about the challenges teen fathers face and ways to better support them. Participants brainstormed ideas to work together to identify the needs of teen fathers and provide resources (e.g., support groups, educational materials). None at the end of the current quarter. These sessions are part of a 9-week program that began September 1 st. Pre-post evaluations will be compared after the program ends in October. Findings will be discussed in the Quarterly 2 Report. None Without any current bilingual/bicultural staff members, we were limited in the extent to which we were able to focus on young Latino fathers. The specific cultural and linguistic needs of this group will be addressed in future workshops and through community partnerships. Only teachers were in attendance at this training. Improved outreach to other staff (e.g., principal, school counselor) would have helped raise greater awareness about this population and enhance support for the development of future interventions. None On the second day of the conference, there was much less foot traffic at our booth. There was a lengthy morning plenary session that limited the time participants had to browse through the exhibition hall. 6