1

Mental Health Services ActSteering Committee

July 7, 20081:00 – 4:00

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Consumer Perspective

MHSA Newsletter:Recovery Connections

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MHSA Participation

By Tho Be

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Kites: By Margarita Noguera

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Mark Refowitz

Local/State Updates

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Kate Pavich

MHSA/Capital Facilities Update

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1. Framework and Goal Support Briefly describe how the County

plans to use Capital Facilities and/or Technological Needs Component funds to support the programs, services and goals implemented through the MHSA

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Allowable Costs To purchase a building for use as a wellness

and recovery center and office space

To purchase a building where vocational, educational and recreational services are provided and where the County is the owner of record

To purchase a building for short-term crisis residential care to avoid hospitalization and allow for a quick return to the family/community

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County Property:401 S. Tustin Avenue, Orange

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New Facilities Crisis Residential program to serve as an

alternative to hospitalization for acute and chronic mentally ill persons

Wellness/Peer Support Center to offer clients assistance with benefits, socialization, self-reliance, and recovery

Vocational Training to provide education and employment support to consumers and their families

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Tustin Avenue Campus Three 7,500 square foot buildings

Green belts, walkways, and outdoor activity areas

Architects to incorporate “green” construction including lighting, flooring, building materials, transportation and use of recycling

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1. Framework and Goal Support

Briefly describe how you derived the proposed distribution of funds

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Split of Allocation

80% Capital Facilities 20% Technology ($22.6 million) ($5.6 million)

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2. Stakeholder Involvement Provide a description of stakeholder

involvement in identification of the County’s Capital Facilities and/or Technological Needs Component priorities along with a short summary of the Community Program Planning Process and any substantive recommendations and/or changes as a result of the stakeholder process.

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Stakeholder Process Training and workshops from local and

national experts on system transformation, recovery-based planning, and creating a recovery culture

Consumer Action Advisory Committee advises MHSA Office on development of programs; participated in eleven meetings regarding capital facilities and technology; toured the Tustin facility and unanimously supported the development of the site for MHSA programs

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Wellness Center Planning Committee

Identified a list of components that shouldbe included in a wellness recovery center

Nourishing culture Green facility A safe place that is non-discriminatory Peer staffing Advisory board made up of at least

51% consumers

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Steering Committee 62 member committee composed of

community members, consumers, and family members that represent a diverse cross-section of the community – reviewed 6 presentations on Capital Facilities and Technological Needs

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Stakeholder Meetings Workforce Education and Training (WET)

meetings discussed using the property for a Recovery Education Institute and a vocational training program

Capital Facilities and Technology Advisory Board met regarding programs to be housed on the property, creating a timeline, and determining the spilt of funds

Mental Health Board presentations and Public Hearing

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3. Capital Facilities NeedsNorth Orange County – 401 S. Tustin

Centrally located with easy access for public transportation

Has Conditional Use Permit to allow residential program on site

Property can accommodate three 7,500 sq. ft. buildings with green belts and outdoor activity areas

South Orange County – to be determined

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4. Technological Needs Electronic Health Record (EHR) – plans to

implement an EHR “lite” system

By end of 2008 will have accomplished the Practice Management phase with the implementation of scheduling.

Build the Clinical Data Management component to create clinical assessments, treatment plans, and progress notes on line.

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Component Proposal TimelineActivity Date

30-Day Public Comment Period

June 6 – July 6, 2008

Mental Health Board/ Public Hearing

July 10, 2008

Board of Supervisors Meeting

July 15, 2008

Send Proposal to DMH End of July, 2008

Department of Mental Health Approval

August/September, 2008

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Project Schedule Feasibility Study

Phase

Programming Phase: data collection/staff interviews

Schematic Design Phase: preliminary design development drawings

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Alan Albright

Prevention and Early Intervention Coordinator

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Develop universal and selective interventions and programs to help prevent the development of serious emotional or behavioral disorders and mental illness.

Provide “short–duration”, “low-intensity” interventions to avoid more extensive mental health services or to prevent a mental health problem from getting worse.

Create PEI interventions that are distinct from Community Services and Support services.

Engage persons prior to the development of SMI or SED.

Alleviate the need for additional mental health treatment and/or transition to extended mental health treatment.

Through the Prevention and Early Intervention (PEI) component, the MHSA provides funding to:

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KEY TO TRANSFORMATION: HELP FIRST

“To facilitate accessing supports at the earliest possible signs of mental health problems and concerns, PEI builds capacity for providing mental health early intervention services at sites where people go for other routine activities (e.g., health, education, community organizations).”

(DMH PEI Guidelines Sept. 2007, page 2)

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PEI PROJECTS

Each PEI project should be designed to address one or more PEI Key Community Mental Health Need: • Disparities in Access to Mental health Services • Psychosocial Impact of Trauma

• At-Risk Children, Youth, and Young Adult Populations• Stigma and Discrimination

• Suicide Risk and one or more PEI Priority Population:

• Underserved Cultural Populations • Individuals Experiencing the Onset of Serious

Psychiatric Illness• Trauma Exposed• Children/Youth in Stressed Families

• Children/Youth at Risk of School Failure • Children/Youth at Risk of Juvenile Justice Involvement

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PEI PRIORITY AGE

PEI County Plans will address all age groups, however, a minimum of 51% of the overall County PEI budget must be dedicated to individuals who are between the ages of 0-25.

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NON-SUPPLANTATION

Funds must be used for programs authorized in Section 5892 of the W&I Code.

Funds cannot be used to replace other state or county funds required to be used to provide mental health services in fiscal year 2004-05 (the time of enactment of the MHSA).

Funds must be used on programs that were not in existence in the county at the time of enactment of the MHSA (new programs) or to expand the capacity of existing services that were being provided at the time of enactment of the MHSA (11/02/04).

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ALLOWABLE EXPENSES

Personnel (such as mental health professionals, culturally/linguistically competent family liaisons, program managers)

Operating costs (such as curricula and other educational materials, supplies, travel, equipment and facilities rental)

Subcontracts (such as professional services for training or program evaluation)

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NON-ALLOWABLE EXPENSES Filling gaps in treatment and recovery services for

individuals who have been diagnosed with a serious mental illness or serious emotional disturbance Capital projects or housing Technology projects Workforce Education and Training activities (as described in

the Workforce Education and Training Component – Proposed Three Year Program and Expenditure Plan Guidelines) in the following categories:

Mental Health Career Pathway Programs Residency, Internship Programs Financial Incentive Programs

Broad social marketing campaigns (State-administered projects will support this activity)

Development of new training curricula (State-administered projects will support this activity)

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ORANGE COUNTY’S PEI PLANNING PROCESS

Community Information  http://www.ochealthinfo.com/mhsa/pei/

Community Input: Regional Focus Groups and Stakeholder Meetings Community and Organizational Surveys

Recommended Planning Partners Underserved Communities Education Client and Family Member Organizations Mental Health Providers Health Social Services Law Enforcement

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COMMUNITY AND STAKEHOLDER PRIORITIES

Ten most frequently identified PEI program/service needs:1. Culturally competent outreach/engagement, care

coordination, information/referral, follow-up assistance, consultation targeting at-risk populations (e.g., 211/mobile/senior center I&R/”Friendly Visitor”, ER/hospital, MD-based, etc.)

2. PEI/mental health early intervention/counseling/ support groups/substance abuse/trauma resources for children, teens, parents, care givers, spouses, seniors, military families in community/home-based, school, primary care, and culturally competent settings.

3. Culturally competent PEI/mental health training/ education for professionals (schools, health, law enf., faith-based, SSA, caregivers, etc.)

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COMMUNITY AND STAKEHOLDER PRIORITIES

4. Community information / education / training / stigma reduction campaigns (culturally competent media / community / web-based)

5. Community-based assessment/ screening /early identification at various service sites for all individuals / ages

6. Volunteer / mentor / peer counselor resources for children, TAY, adults, parents, and seniors

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COMMUNITY AND STAKEHOLDER PRIORITIES

7. School-based PEI / mental health / family-focused resources (screening / early identification, PBIS, SARB resources, etc.)

8. PEI-focused / community-based socialization, after school, arts, recreational, life skills, nutritional resources, etc.

9. Culturally competent parenting resources, classes, education, information

10. OC-based suicide hotline, crisis services, warm line services, resources

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•

PPRREEVVEENNTTIIOONN && EEAARRLLYY IINNTTEERRVVEENNTTIIOONN PPLLAANNNNIINNGG AANNDD AAPPPPRROOVVAALL PPRROOCCEESSSS

Community

and Stakeholder

Input

MHSA Steering

Committee

PEI Sub-

Committee

Project Workgroup

30-Day Public

Review of PEI Plan

Mental Health Board Public

Hearing

County Board of

Supervisors

Approved PEI Plan

State Dept. of Mental Health

MHS Oversight and Accountability

Commission

Project Workgroup

Project Workgroup

Etc.

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Next Steps

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Kimari Phillips

Community & Organizational Surveys

Involving OC MH Consumers & Providers in the

Prevention & Early InterventionPlanning Process

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Data Collection Methods Surveys (online & printed)

Organizational Community (Spanish, Vietnamese, English)

Stakeholder Meetings

Focus Groups

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Survey Measures A collaborative team from OCHCA’s:

Behavioral Health Services Quality Mgmt – Planning & Research

Two comprehensive surveys for OC: Organizational Providers Community/Consumers

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Survey Dissemination Mailed over 3,000 surveys to OC

organizations and community members

Handed out over 5,000 surveys throughout OC at meetings, clinics, community based organizations, etc.

E-mailed announcements regarding the online surveys (including a hyperlink for easy access)

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Mail & E-mail Distribution: CBOs & Family/Senior Resource Centers City & County Offices Law Enforcement & Legal Services Educational Institutions Faith-based Organizations Financial Institutions & Foundations Housing & Transportation Agencies Medical, Mental Health, & Social Services Utility Companies & Media

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Surveys Received to DateCommunity (n = 1,329)

78% Print (n = 1035) 22% Online (n = 294)

85.5% English (n = 1136) 11.4% Spanish (n = 152) 3.1% Vietnamese (n = 41)

Organizational (n = 380) 74% Print (n = 281) 26% Online (n = 99)

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General Types of Respondents MH Providers/Advocates

Non-MH Providers & Other Government Agencies

Interested Community Members and MH Consumers

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Information Gathered from OC Community Members/Consumers

Satisfaction with amount & accessibility of PEI services in OC

Demographic info (age, gender, race/ethnicity, annual household income, ZIP code)

Opinions regarding: Populations in greatest need of PEI in OC Priority PEI issues in OC communities Most effective settings for identifying OC

residents with a need for PEI services Best approaches for addressing PEI in OC

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Preliminary Data Analysis Results

Community PEI SurveyOrange County

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Race/Ethnicity of Community Respondents (n=426)

3.1% 2.1% 1.6% 0.9%

14.3% 9.6%

68.3%

0%

20%

40%

60%

80%

100%

White

/Cauc

asian

Hispan

ic/La

tino

Asian

Black/A

frica

n Am

erica

n

Amer

India

n/Nat

ive A

mer

Other

/Mult

iple

Pacific

Islan

der

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Age & Gender of Community Respondents

Average Age (n=420)

45.2 years (15-89 yrs) Gender (n=432)

71.1% Female 28.9% Male

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Average Annual Household Income

10.0%

32.9%

31.2%

25.9%

< $25,000 $25,000-$74,999 $75,000-$124,999 $125,000+

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Community Opinions Regarding Priority Populations for PEI in OC

(Averages on a 5-point scale, where 1=Very Low Need, 5=Very High Need)

4.424.21 4.16 4.05 3.97 3.94

4.62 4.53

3.8

0

1

2

3

4

5

52

Community Opinions Regarding Priority Goals/Needs for PEI in OCReduction of:

0%

10%

20%

30%

40%

50%

Suicide

(41.

2%)

Traum

a & S

uffer

ing (3

3.5%

)

Violen

ce (3

3.5%

)

Homele

ssne

ss (3

1.0%

)

Undete

cted

MH Pro

bs (2

9.8%

)

Schoo

l Fail

ure/

Dropo

ut (2

9.4%

)

Remov

al of

Chil

dren

(20.7

%)

MH S

tigm

a (16

.4%)

Arrest

& Jail (

15.5%

)

Milit

ary V

et Pro

bs (1

4.1%

)

Unemplo

ymen

t (5.

9%)

Elderly

, AOD &

Oth

er (1

0.0%

)

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Community Opinions Regarding Effective Settings for Identifying OC Residents Needing PEI Services

61.0%

29.6% 29.4% 28.0%

11.4% 9.3% 8.2%

44.4%

34.4%

13.4%

3.9%

0%

10%

20%

30%

40%

50%

60%

70%

Schoo

ls

Docto

r Offi

ces/C

linics

Social

Ser

vices

Comm

unity

Org

s

Hospit

als, S

NF, etc

Lega

l Set

tings

Faith-B

ased O

rgs

Work

plac

es

In-H

ome

(Fam

ily, S

vcs)

Emplo

yment

Cent

ers

Oth

er Set

tings

54

Community Opinions RegardingBest Approaches/Strategies for Addressing PEI in OC

64.6% 60.3%

16.9%

2.6%

73.1% 69.7%

0%

20%

40%

60%

80%

100%

Traini

ng fo

r Pro

fessio

nals

Early

Scree

ning

Commun

ity E

duca

tion

Info

& Refe

rral R

esou

rces

Wor

k-Bas

ed P

rogr

ams

Other

Stra

tegies

55

There are enough existing PEI resources and services in OC. (n=436 public responses, average=1.87 on a 5-point scale, where 1=Strongly Disagree, 5=Strongly Agree)

48.9%

2.1%

16.5%

6.7%

25.9%

0%

10%

20%

30%

40%

50%

60%

StronglyDisagree

SomewhatDisagree

Neither AgreeNor Disagree

SomewhatAgree

Strongly Agree

56

There is enough information available about how to find and access existing PEI resources and services in OC.

(n=432 public responses, average=1.97 on a 5-point scale, where 1=Strongly Disagree, 5=Strongly Agree)

42.8%

30.1%

9.3%

1.6%

16.2%

0%

10%

20%

30%

40%

50%

StronglyDisagree

SomewhatDisagree

Neither AgreeNor Disagree

SomewhatAgree

Strongly Agree

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Sample of Community Respondent Suggestions for OC PEI Services (Related to Provider Needs) Focus on a strength-based model instead of

pathology and symptoms More training opportunities for employees Funding should provide for safe placement of MI Needs to be a way to keep MI in Tx & on meds Support community infrastructure non-profits

which provide referrals and public education Increase number of small, short-term triage

centers where law enforcement can drop off pts Need to support existing programs while trying

to expand services to at risk populations

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Sample of Community Respondent Suggestions for OC PEI Services (Related to Consumer Needs) Need for on-site technical assistance in schools,

especially in all preschools & child care centers More counselors & free counseling at school sites More accessible services for single parents/kids Advertise on TV, radio, local papers, etc. Training for family members of newly diagnosed Bilingual services in South OC are severely limited More housing options (with SUPPORT) for MI Ability to see a professional sooner once a referral is

made. We’ve been waiting over 6 months.

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Information Gathered from Organizational Providers in OC

Types of organizations serving OC community Populations, ages & numbers served in OC Types of PEI services provided Annual budget and percent allocated to PEI Priority goals for PEI in OC Satisfaction with number of PEI resources &

amount of info to find/access PEI services in OC PEI resources needed by OC providers How OC can best deliver PEI svcs to

underserved

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Preliminary Data Analysis Results

Organizational PEI SurveyOrange County

61

Types of Respondent Organizations (Potential PEI Partners)

27.6%29.5% 27.1%

7.4% 6.8% 6.3% 5.3%

3.2% 2.1%

0%

5%

10%

15%

20%

25%

30%

35%

CBO (n=11

2)

MH S

vcs (

n=10

5)

Educ (

n=103

)

Healthca

re (n

=28)

Soc S

vcs (

n=26

)

Law (n

=24)

Other

(n=2

0)

Rep MI (

n=12

)

Empl

Svcs (

n=8)

62

Provider Opinions Regarding Priority Goals/Needs for PEI in OCReduction of:

0%

10%

20%

30%

40%

50%

Undet

ected

MH P

robs

(43.

2%)

Schoo

l Failu

re/D

ropo

ut (38.

9%)

Violen

ce (3

6.3%

)

Homel

essn

ess (

36.3

%)

Traum

a & S

uffe

ring (3

4.7%

)

Suicid

e (2

7.6%

)

MH S

tigm

a (1

7.1%

)

Arrest

& Jail (

16.8

%)

Remov

al of

Chil

dren

(15.

3%)

Unem

ploym

ent (

14.7

%)

Milit

ary

Vet P

robs

(5.5

%)

AOD U

se/A

buse

(3.0

%)

63

There are enough existing PEI resources and services in OC. (n=372 provider responses, average=1.72 on a 5-point scale, where 1=Strongly Disagree, 5=Strongly Agree)

58.3%

21.8%

11.8%

1.9%

6.2%

0%

10%

20%

30%

40%

50%

60%

70%

StronglyDisagree

SomewhatDisagree

Neither AgreeNor Disagree

SomewhatAgree

Strongly Agree

64

There is enough information available about how to find and access existing PEI resources and services in OC.

(n=377 provider responses, average=1.85 on a 5-point scale, where 1=Strongly Disagree, 5=Strongly Agree)

8.8%

1.3%

10.1%

32.4%

47.5%

0%

10%

20%

30%

40%

50%

60%

70%

StronglyDisagree

SomewhatDisagree

Neither AgreeNor Disagree

SomewhatAgree

Strongly Agree

65

PEI Resources Needed by Respondent Organizations

42.1% 41.6% 40.5% 40.5% 39.7%

23.2%

12.9%

0%

10%

20%

30%

40%

50%

66

Strategies to Reach Underserved Groups with PEI Services

61.1%57.9%

41.8%

28.2%

12.6%

0%

10%

20%

30%

40%

50%

60%

70%

Services WhereGroups

Congregate

InvolveCommunity &

ReligiousLeaders

Info Provided inMultiple

Languages

Work-basedPrograms (e.g.,

EAP)

Other

67

Sample of Organizational Respondent Suggestions for OC PEI Services (Related to Provider Needs)

Full partnership between public/private providers Bring services to the people at school, work, home,

malls, EDs, government offices (e.g., DMV, HCA) Web-based “Efforts to Outcomes” tracking system Promote more screening at clinics & doctor offices Keep funding Family Resource Centers Administer assessment tool at school enrollment Attention to alcohol and drug abuse Tx community Ongoing education for educators, med providers, etc Involve leaders from faith-based communities

68

Sample of Organizational Respondent Suggestions for OC PEI Services (Related to Consumer Needs) Community education seminars by area professionals More groups for DV, anger mgmt, coping skills, etc More culturally/linguistically sensitive services & staff TV ads with information for parents & teens More “drop-in” centers available for homeless Services for underserved workforce in South OC, e.g.,

some areas with up to 90% Hispanic residents Increase awareness of early signs of MH problems Increase accessibility to low-cost counseling/referral Tx for the whole individual (physical & psychological)

69

Next Steps (July ’08)

Continue analyzing survey data (including surveys received by 6/30/08)

Report findings to BHS re: Public opinions re priority populations, settings,

issues & goals for PEI in OC Satisfaction ratings for amount and accessibility of

PEI resources/services in OC Suggested PEI goals, strategies, settings,

approaches, etc. for reaching those in need

70

For more information regarding methods used for data collection, preliminary

analyses, or this summary of results …

Contact:Kimari Phillips, MA, CHES

Research Analyst, OC Health Care AgencyOffice of Quality Management

Planning & Research(714) 834-7402

kphillips@ochca.com

71

Sharon Browning

Review of Steering Committee Guidelines

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Role of the Steering Committee 1. Be fully educated about the status of State

MHSA funding availability and requirements and the status of OC MHSA program implementation.

2. Support the County’s ability to meet both state funding requirements and Orange County funding needs.

3. Make timely, effective decisions that maximize the amount of funding secured by Orange County and preclude Orange County from losing funding for which it is potentially eligible.

73

Role of the Steering Committee4. Ensure that funding is allocated to services for

identified needs and priorities.

5. Support and ensure the proper implementation of Orange County’s MHSA approved plan for each MHSA component and the MHSA Integrated Plan, when it is developed.

6. Remain informed about Stakeholder Focus Group and Community Advisory meetings and the recommendations made by members of these groups.

74

Decision-Making Decisions will be made via consensus.

Consensus is defined as agreement of all committee members or the decision will not move forward.

A “yes” means that the decision will be actively supported or at a minimum nothing will be done to undermine the success of the decision.

A “no” means that the proposed decision cannot move forward.

The goal in effective consensus decision-making is to find ways to say “yes” wherever possible and to say “no” only when absolutely necessary and when prepared to stop the proposed decision [as stated] from moving forward.

75

Decision-Making Only those representatives officially designated

to participate in decision-making by their organization may participate in discussions/decisions and sit at the Committee tables.

There will be time for Public Comment at the end of each meeting. Each comment should be limited to three minutes.

76

Break

77

Sharon Browning

PEI Planning Guidelines

78

Planning Guidelines PEI Vision Statement

Purpose of the PEI Planning Process

Key PEI Community Mental Health Needs

PEI Priority Populations

Planning Structure

79

Guiding Principles Difference Between CSS and PEI

Age Distribution of Funding

PEI Transformational Concepts

Non-Supplantation Requirement

80

Planning Process Review Needs Assessment Data

Workgroup, PEI Sub Committee, and HCA Staff Draft Recommendations

HCA Staff Presents Recommendations to the Steering Committee Steering Committee discuss recommendations Make suggestions for changes, if needed Come to consensus on final recommendations

81

Next Steering Committee Meeting

Monday, August 4, 2008 1:00-4:00 PMat

Delhi Community Center 505 East Central, Santa Ana, CA 92707