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SB 82 Triage Grant Program
Calaveras County Partnership
Health and Human Services Agency, MH Division
Sheriff’s Office
Dignity Health
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JOHN LAWLESS, LCSW M E N TA L H E ALT H D I R E C TO R , D E P U T Y D I R E C TO R O F
H E ALT H AN D H U M AN S E R V I C E ,
C AL AV E R A S C O U N T Y
INTRODUCTION
SB 82 Triage Grant Program
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Panelists
John Lawless, LCSW, Mental Health Director, Deputy
Director of Health and Human Services, Calaveras County
Brenda Hanley, MH Case Manager III, Sheriff Liaison
Acting Sheriff, Captain Jim Macedo
Dean White, LCSW, Regional Director of Social Work for
Dignity Health
Susan Sells, MHSA Senior Administrative Analyst
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Senate Bill SB 82
As a result of Senate Bill (SB) 82, known as the
Investment in Mental Health Wellness Act of 2013,
California has an opportunity to use Mental Health
Services Act (MHSA) dollars to expand crisis services
statewide
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Calaveras County
44,624 residents
Sierra foothills – mostly mountainous
1,000 square miles
80% living in unincorporated areas
Accessed primarily by two-lane roads
Geography determines service needs, access and
resources
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County Challenges
Butte Fire – over 1,000 homes & structures lost
Minimal public transportation
Limited crisis response services for psychiatric
emergencies
No inpatient psychiatric facility or crisis
stabilization beds
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SB 82 Grant-funded Triage Services
Calaveras Behavioral Health Services (BHS), Sheriff's Office
and Dignity Health Hospital partnered to provide triage
services funded by MHSOAC SB 82 Triage
Reducing:
1) response time to crisis calls
2) time officers spend on 5150 evaluations
and repeat crisis calls
3) decreasing over use of hospital’s ER
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Recruiting Challenges
Recruiting an individual who is:
Willing to move to a rural community and work non-
traditional days/hours
Has a strong background in mental health, law
enforcement, crisis management, and veterans issues
Work well independently in high profile position
Passes extensive law enforcement background clearance
Displays a strong commitment to go above and beyond
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Recruiting Challenges
It took a year and a half to find the
right person
Program implemented
June 2015
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Tips for Success
From inception, partnership with law enforcement
and local hospital is crucial
Establish and maintain confidence, buy-in and
cooperation of law enforcement and hospital
Case Manager needs strong collaboration &
coordination with officers and dispatchers
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Tips for Success – Cont.
House the case manager in law enforcement
Ensure case manager is available when calls to sheriff are
highest (evening and weekend hours)
Provide ongoing Crisis Intervention Training (CIT) and
Crisis De-Escalation/Combat to Community trainings for
law enforcement and first responders
120 trained in CIT since 2010
82 trained in Crisis De-Escalation in 2015
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Sheriff’s Office
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Calaveras County
Law Enforcement Calls for Service Response Times
Calls for Service in Calendar Year
2015---5150 W&I =130 Calls
2015—Attempt Suicides= 154 Calls
2015—Confirmed Suicides=18
Repeat Calls for Service
Deputies Not Assigned or Trained to Become Behavioral Health Detectives
Problem Oriented Policing
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Span of Control
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Flexibility with Position
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Custody Setting Field Setting
Coordination C.O.s
Follow-Up C.O.s
Communication
Planning with
Correctional Staff
Problem Solving
Dedicated Response
Establish Line of Communication Between LE and BehHealth
Coordination
Planning with Patrol Staff
Versatility
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Smart Policing
Reduced Calls for Service into the Sheriff’s 911 Call Center
Reduced Deputy Responses due to Alternative Triage Response.
Reduced inmates into the County Jail specifically for those who would be better served via comprehensive and ongoing Mental Health Services.
Significant Benefit to Law Enforcement
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BRENDA HANLEY, MH CASE MANAGER I I I ,
SHERIFF LIAISON
SERVICE DESCRIPTION
SB 82 Triage Grant Program
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Current Program Benefits
Reducing need for officers to respond to multiple calls from residents not meeting 5150 criteria
Reducing need for officers to wait at the ER
Becoming a part of law enforcement culture, building solid rapport with officers
Creating relationship with local veterans (Calaveras is home to 5,400 veterans - 12% of the total population, and more than double the number of veterans living in CA)
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Current Program Benefits - Cont.
Providing short term case management for
community members who don’t qualify for MH
services
Identifying ways to connect community members
with local resources
Providing follow-up support
Providing behavioral health case management
resources for the jail
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Anticipated Long Term Outcomes
Ability to address service gaps for crisis during
evening and weekend hours
Enhances the bridge between MH and law
enforcement on how best to help mentally ill
residents in crisis
Reduced repeat crisis calls
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Success Stories
Three examples of how this program is working….
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Dean White, LCSW, ACM
2016 California Behavioral Health Policy Forum
SB82 Triage Grant Program Triage Services
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Mark Twain Medical Center is the only hospital in the county. Critical Access with 8 Emergency Department beds
Long hold times in the ED- one 5150 hold that needs subsequent IP Psych bed can take between 4 hours to 3 days until transfer, with known outlier cases taking longer
Limited Psych access and supports along with minimal wrap-around services-rural areas
Shortage of BH providers & Primary Care MD’s
ED’s are a high intensity environment- increased anxiety/stress
Need diversion options to avoid the ED or at times jail
High Level Overview
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Build partnerships with community and county; jointly share resources and staff to meet mutual needs for the client
Co-development of protocols and delineation of provider roles; engage ED, behavioral health staff and law enforcement to optimize outcomes
Data collection, analysis and standardization to identify behavioral health clients, the interventions provided and best practices shared across services areas
Develop crisis response services for psychiatric emergencies
Expand OP resources -Community Health & Population Health
ED Solutions to System Gaps
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Reduces overall cost of care, while providing crisis care in the least restrictive manner possible
Reduced ED utilization, improved throughout and reduced wait time
Improves patient satisfaction by shifting care to the more appropriate level
Improves outcomes
Reduces acute crisis events
Summary
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SUSAN SELLSMHSA ADMINISTRATIVE ANALYST
JUSTIFICATION FOR SMALL COUNTY BASELINE FUNDING
SB 82 Triage Grant Program
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SB82 Investment in Mental Health Wellness Act
Request for Proposal
Calaveras BHS applied to MHSOAC and received
Triage grant in January 2014 for 3 year period for
crisis intervention services
Competed with very large counties in our central
region statewide
As a rural county, our request for 1 triage staff was
small compared to requests for up to 25 staff in
larger counties
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Justification and Recommendation
Small counties do not have resources to provide
adequate crisis services
Counties with population of less than 200,000
represent 52% (30 out of 58) of counties in California
If baseline funding of $120,000 is set aside for small
counties - would represent only 10% of the 32 million
SB 82 Triage funds allocated to California each year
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Recommendation- Cont.
Recommend SB 82 funds are set aside as ongoing non-
competitive baseline funding for small counties each year
Over half the counties in California could provide triage
services without having to reapply for these funds every
three years
Remaining funds (90%) could be distributed to larger
counties through competitive grant process or through
formula based on population and/or need
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Recommendation - Cont.
Calaveras County, along with 29 small counties, can
provide triage services that reduce costs associated
with expensive inpatient and emergency room care
and better meet the needs of individuals with mental
health conditions in the lease restrictive manner
possible across California.