Imperial County Behavioral Health Mental Health Services. Mental Health Services Act

Transcription

1 Imperial County Behavioral Health Mental Health Services Mental Health Services Act Three-Year Program and Expenditure Plan Fiscal Year through Fiscal Year POSTED April 17, 2014 This is available for public review and comment through May 16, This document can be found at We welcome your feedback via phone, fax, or , or during the Public Hearing to be held on May 20, Public Hearing Information: Imperial County Behavioral Health Services 202 N. Eighth Street, El Centro, CA Training Room Second Floor Tuesday, May 20, 2014, at 12:00 p.m. Questions or comments? Please contact: Imperial County Behavioral Health Services 202 N. Eighth Street El Centro, CA Phone: (760) Fax: (760)

2 Imperial County Behavioral Health Services Love Upheaval This painting was created by Martin Ortega of Imperial County. It was selected to be in the MHSOAC Expressions, a special edition of the MHSOAC newsletter, featuring artwork and writings from California s mental health community at large. Mental Health Services Act Three-Year Program and Expenditure Plan Fiscal Year through Fiscal Year

3 Table of Contents MHSA County Compliance Certification MHSA County Fiscal Accountability Certification County Profile Workforce Needs Assessment MHSA Background Community Planning Process Requirements MHSA Three-Year Program Plan Community Services and Supports Full Service Partnership Youth and Young Adult Services Full Service Partnership Program Adult and Older Adult Services Full Service Partnership Program General Systems Development Recovery Center Program Outreach and Engagement Outreach and Engagement Program Transitional Engagement Supportive Services Program Prevention and Early Intervention Trauma-Focused Cognitive Behavioral Therapy Program Workforce Education and Training Capital Facilities and Technological Needs FY Through FY Three-Year Mental Health Service Act Expenditure Plan Funding Summary Community Services and Supports Component Worksheets Prevention and Early Intervention Component Worksheets Innovations Component Worksheets Workforce Education and Training Component Worksheets Capital Facilities and Technological Needs Component Worksheets

4 MHSA COUNTYCOMPLIANCE CERTIFICATION County/City: Imperial Three-Year Program and Expenditure Plan Annual Update Local Mental Health Director Name: Michael W. Horn Telephone Number: (760) Local Mental Health Mailing Address: Imperial County Behavioral Health Services 202 N. Eighth Street El Centro, CA92243 Program Lead Name: Andrea Kuhlen Telephone Number: (760) I hereby certify that I am the official responsible for the administration of county/city mental health services in and for said county/city and that the County/City has complied with all pertinent regulations and guidelines, laws and statutes of the Mental Health Services Act in preparing and submitting this Three-Year Program and Expenditure Plan or Annual Update, including stakeholder participation and nonsupplantation requirements. This Three-Year Program and Expenditure Plan or Annual Update has been developed with the participation of stakeholders, in accordance with Welfare and Institutions Code Section 5848 and Title 9 of the California Code of Regulations section 3300, Community Planning Process. The draft Three-Year Program and Expenditure Plan or Annual Update was circulated to representatives of stakeholder interests and any interested part for 30 days for review and comment and a public hearing was held by the local mental health board. All input has been considered with adjustments made, as appropriate. The annual update and expenditure plan, attached hereto, was adopted by the County Board of Supervisors on. Mental Health Services Act funds are and will be used in compliance with Welfare and Institutions Code section 5891 and Title 9 of the California Code of Regulations section 3410, Non-Supplant. All documents in the attached annual update are true and correct. Local Mental Health Director (PRINT) Signature Date Page 1

5 MHSA COUNTY FISCAL ACCOUNTABILITY CERTIFICATION 1 County/City: Imperial Three-Year Program and Expenditure Plan Annual Update Annual Revenue and Expenditure Report Name: Michael W. Horn Local Mental Health Director Telephone Number: (760) MichaelHorn@co.imperial.ca.us Local Mental Health Mailing Address: Imperial County Behavioral Health Services 202 N. Eighth Street El Centro, CA92243 County Auditor-Controller / City Financial Officer Name: Douglas Newland Telephone Number: (760) DouglasNewland@co.imperial.ca.us I hereby certify that the Three-Year Program and Expenditure Plan, Annual Update, or Annual Revenue and Expenditure Report is true and correct and that the County has complied with all fiscal accountability requirements as required by law or as directed by the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, and that all expenditures are consistent with the requirements of the Mental Health Services Act (MHSA), including Welfare and Institutions Code (WIC) sections , 5830, 5840, 5847, 5891, and 5892; and Title 9 of the California Code of Regulations sections 3400 and I further certify that all expenditures are consistent with an approved plan or update and that MHSA funds will only be used for programs specified in the Mental Health Services Act. Other than funds placed in a reserve in accordance with an approved plan, any funds allocated to a county which are not spent for their authorized purpose within the time period specified in WIC section 5892(h), shall revert to the state to be deposited into the fund and available for other counties in future years. I declare under penalty of perjury under the laws of this state that the foregoing and the attached update/report is true and correct to the best of my knowledge. Local Mental Health Director (PRINT) Signature Date I hereby certify that for the fiscal year ended June 30,, the County/City has maintained an interest-bearing local Mental Health Services (MHS) Fund (WIC 5892(f)); and that the County s/city s financial statements are audited annually by an independent auditor and that the most recent audit report is dated for the fiscal year ended June 30,. I further certify that for the fiscal year ended June 30,, the State MHSA distributions were recorded as revenues in the local MHS Fund; that County/City MHSA expenditures and transfers out were appropriated by the Board of Supervisors and recorded in compliance with such appropriations; and that the County/City has complied with WIC section 5891(a), in that local MHS funds may not be loaned to a county general fund or any other county fund. I declare under penalty of perjury under the laws of this state that the foregoing and the attached report is true and correct to the best of my knowledge. County Auditor-Controller / City Financial Officer (PRINT) Signature Date 1 Welfare and Institutions Code Section 5847(b)(9) and 5899(a) Three-Year Program and Expenditure Plan, Annual Update, and RER Certification (07/22/2013) Page 2

6 County Profile Imperial County is located in the southernmost region of California, bordering San Diego County to the west, Riverside County to the north, the State of Arizona to the east, and Mexico to the south. It extends over approximately 4,597 square miles and is comprised of seven incorporated cities (Brawley, Calexico, Calipatria, El Centro, Holtville, Imperial, and Westmorland) and seven unincorporated areas, some of which are located more than 45 minutes apart from each other. According to the 2010 U.S. Census Bureau, Imperial County s population was 174,528, growing by 22.6% since The county s demographic information is included in Table 1 below. Imperial County continues to have one of the highest unemployment rates in the state of California, with statistics from the Employment Development Department illustrating an average annual unemployment rate, not seasonally adjusted, of 27.2% in 2012, more than double the state s average of 10.4% during the same time frame. Table 1 Imperial County Demographics (2010 U.S. Census) U.S. Census Demographic Category 2010 Results Population % of Total Gender Male 89, Female 84, Age 9 years 27, to 19 years 29, to 24 years 13, to 59 years 78, years 25, Ethnicity Hispanic or Latino 140, White 23, Black or African American 5, American Indian/Alaskan Native 1, Asian 2, Pacific Islander Other 1, The number of Medi-Cal eligible individuals in Imperial County was 58,984 during FY , per the Department of Health Care Services. Imperial County s threshold languages are English and Spanish. In the Imperial County Behavioral Health Services Staff Cultural Competence Survey for FY , 81% of staff identified as Hispanic, 81% indicated they are fluent in Spanish, and 96% reported being culturally aware of the Hispanic culture. Page 3

7 Workforce Needs Assessment Imperial County Behavioral Health Services Occupational Category Imperial County has faced many obstacles in recruiting licensed medical professionals. Recruitment for the psychiatrist, nurse practitioner, registered nurse, and licensed vocational nurse positions has proven difficult over the past few years. The county also experiences difficulty in retaining licensed clinical professionals from under-represented racial/ethnic groups. One obstacle to hiring licensed medical professionals is that the salaries for these positions are low compared to community standards. Private employers, including two local hospitals and two state prisons that are able to provide higher salaries, create recruitment challenges for the county for key licensed positions. Another obstacle is the physical environment of this rural area. Imperial County is an isolated desert region with a hot and dry climate that ranges from lows in the mid 30 s in January to highs of 110+ in July and August. The county s historical earthquake activity is also above California s state average and is 2,508% greater than the overall U.S. average. In January 2011, Imperial County received federal designation as a Mental Health Shortage Area (MHPSA). Regions designated as a MHSPA experience a shortage of psychiatrists, clinical psychologists, licensed clinical social workers, and marriage and family therapists. Since the first Workforce Needs Assessment was completed in May 2011, Imperial County has hired an additional four psychiatrists, two MSW Registered Interns, nine MFT Registered Interns, and three licensed vocational nurses. It is hoped that the MHPSA designation, in combination with continued efforts to bolster the workforce through evidence-based training and collaboration with local universities and colleges, will help recruit and retain prospective and current employees who can address workforce shortages of under-represented racial/ethnic groups in our workforce. Table 2 on the following page depicts Imperial County s current workforce by group and position. Page 4

8 Page 5 Imperial County Behavioral Health Services Table 2 Imperial County Full Time Equivalent (FTE) Workforce by Group and Position Number of Ethnicity of FTEs currently in the workforce African Asian/ Group and Positions Current White/ Hispanic/ Native American/ Pacific FTEs Caucasian Latino American Black Islander Multi or Other How many identify as fluent in Spanish? Unlicensed Mental Health Direct Service Staff: Mental Health Rehabilitation Specialist Mental Health Rehabilitation Technician Access & Benefits Worker Other Unlicensed Direct Service Staff Subtotal: Licensed Mental Health Direct Service Staff: Psychiatrist Licensed Psychiatric Technician Licensed Clinical Psychologist Licensed Clinical Social Worker MSW Registered Intern MFT Registered Intern Subtotal: Other Mental Health Direct Service Staff: Registered Nurse Licensed Vocational Nurse Subtotal: Managerial and Supervisory Staff: Management Supervising Clinical Psychologist Supervising Psychiatric Social Worker Supervisors Subtotal: Support Staff: Analysts, tech. support, quality assurance Clerical, administrative assistants Other support staff (non-direct services) Subtotal Total Mental Health Direct Service Staff: Total Managerial, Supervisory, & Support Staff: Grand Total All Staff:

9 Language Proficiency As seen in Table 2 above, Imperial County currently employs FTE employees. 52% of employees are direct service staff and 48% are managerial, supervisory, and support staff. 82% of employees identify as Hispanic/Latino, with the same percentage also identifying as being fluent in Spanish, Imperial County s second threshold language. Further demographic breakdown may be seen in Chart 1 and Chart 2 below: Chart 1: Imperial County Workforce by Ethnicity 2% 1% 2% 3% 82% 10% White/Caucasian Hispanic/Latino African American/Black Asian/Pacific Islander Native American Multi or Other Chart 2: Imperial County Workforce Ethnicity by Major Group 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% White/Caucasian Hispanic/Latino African American/Black Asian/Pacific Islander Native American Multi or Other Direct Service Staff Managerial, Supervisory, & Support Staff Page 6

10 Moreover, when comparing the workforce by ethnicity to the populations receiving public mental health services, few disparities were found, as seen below in Table 3: Table 3 Imperial County Workforce vs. FY Med-Cal Beneficiaries Served FY Ethnicity Medi-Cal Workforce Beneficiaries Hispanic/Latino 82% 82% White/Caucasian 13% 10% African American/Black 3% 1% Asian/Pacific Islander 0.3% 2% Native American 1% 2% By collaborating with local universities and colleges, Imperial County has built a sustainable workforce of individuals who were born, raised, and educated locally, and thereby familiar with the cultures, values, and traditions that are specific to the community and its residents. Consumer and Family Member Employment Imperial County does not currently have positions that specifically include qualification statements in the job description requiring applicants with experience as a consumer or family member or express a preference for someone with such experience. The Staff Cultural Competence Survey Report conducted in April 2011 included a question that allowed staff to self-report being a consumer of mental health services. The survey results found below indicate the optional question regarding self-identified consumers was answered by seven staff members (Table 4), which is approximately two percent of the surveys returned. Table 4 FY Staff Cultural Competence Survey Function Administrative Direct Services Support Services n=42 n=152 n=105 Self- Identified Consumer Total n=299 # % # % # % # % Page 7

11 MHSA Background Imperial County Behavioral Health Services In November 2004, California voters passed Proposition 63, which became a state law entitled the Mental Health Services Act (MHSA). The MHSA is funded through a 1% tax on personal incomes of over $1 million. The MHSA was designed to expand and transform California s mental health service systems. It was enacted into law on January 1, The MHSA provides funding for services and resources that promote wellness, recovery, and resiliency for adults and older adults with severe mental illness, children and youth with serious emotional disturbances, and their family members. The MHSA aims to reduce the long-term adverse impact of untreated serious mental illness and serious emotional disturbance by expanding and transforming services that promote well-being, recovery, and self-help, and introduce prevention and early intervention strategies to prevent long-term negative impact of serious mental illness and reduce stigma. Services are culturally competent, easier to access, and more effective in preventing and treating serious mental illness. A core set of values apply to all MHSA activities: Promote wellness, recovery, and resilience. Increase consumer and family member involvement in policy and service development and employment in service delivery. Develop a diverse, culturally sensitive, and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. Deliver individualized, consumer, and family-driven services that are outcome oriented and based upon successful or promising practices. Outreach to underserved and unserved populations. MHSA funding was distributed to county mental health systems upon approval of their plans for each component of the MHSA. The MHSA is comprised of five major components. Each component addresses critical needs and priorities to improve access to effective, comprehensive, and culturally and linguistically competent county mental health services and supports. These components are: Community Services and Supports (CSS) The programs and services being identified by each county to serve unserved and underserved populations. Prevention and Early Intervention (PEI) Programs designed to prevent mental illnesses from becoming severe and disabling. Workforce Education and Training (WET) Targets workforce development programs to remedy the shortage of qualified individuals to provide services. Capital Facilities and Technological Needs (CF/TN) Addresses the infrastructure needed to support the CSS programs. Innovation Promotes recovery and resilience, reduces disparities in mental health services and outcomes, and leads to learning that advances mental health in California in the directions articulated by the MHSA. In March 2011, the signing of AB 100 into law by Governor Brown created immediate changes to the MHSA. The key changes eliminated the Department of Mental Health and the Mental Page 8

12 Health Services Oversight and Accountability Commission from their respective review and approval of county MHSA plans and expenditures. AB 1467, which was chaptered into law on June 17, 2012, requires that the three-year program and expenditure plans and annual updates be adopted by the county board of supervisors and submitted to the Mental Health Services Oversight and Accountability Commission. It also requires that the plans be certified by the county mental health director and the county auditorcontroller. Page 9

13 Community Planning Process Imperial County Behavioral Health Services The Imperial County Behavioral Health Services (ICBHS) Director, in collaboration with the Mental Health Board, headed the administration of the MHSA community planning process, as well as the development of the MHSA Three-Year Program and Expenditure Plan. A Steering Committee that includes stakeholders is involved at all levels of the MHSA community planning process. Stakeholders participating in the Steering Committee represent consumers, family members, and peer supporters; the local Probation Department, Sheriff s Department, Superior Court, SELPA, Social Services Department, County CEO s office, Child Abuse Prevention (CAP) Council, and Public Administrator s Office; education; community health agencies; and provider and system partners. The MHSA Steering Committee meets on a quarterly basis to provide input and recommendations to the department regarding the populations to be targeted for services under MHSA funding and evidence-based practices that would address issues and needs identified in the community. The committee is informed and directly involved by providing ongoing planning, monitoring, and oversight of the MHSA Program planning, development, and implementation. The following stakeholders are members of the MHSA Steering Committee: Name Title Representative Of Acosta, Claudia Community Service Worker II ICBHS Outreach & Engagement Program Bell, Yvonne Chief Executive Officer Clinicas de Salud del Pueblo Blanquel, Gloria Peer Supporter ICBHS Youth & Young Adults Division Brunswick, Gloria Division Manager Probation Department Castro, Mickey Deputy Director Department of Social Services Chavez, Isabel Behavioral Health Manager ICBHS Managed Care Unit Del Real, Nancy Behavioral Health Manager ICBHS Information Systems Unit Esquer, Mary Behavioral Health Manager ICBHS Adults & Older Adults Division Estrada, Adolfo Behavioral Health Manager ICBHS Accounting Unit Garcia, Yvette Director CAP Council Gonzalez, Claudia Accountant-Auditor ICBHS Accounting Unit Grass, John Behavioral Health Manager ICBHS Adults & Older Adults Division Guz, Cindy Deputy Director ICBHS Youth & Young Adults Division Holmes, Rose Local Coordinator National Alliance on Mental Illness Horn, Michael Director ICBHS Ibarra, Leticia Program Director Clinicas de Salud del Pueblo Jimenez, Gabriela Behavioral Health Manager ICBHS Youth & Young Adults Division Kuhlen, Andrea Assistant Director ICBHS Kussman, Kristi Court Executive Officer Courts LaWall, Amanda ISC Coordinator Interagency Steering Committee (ISC) Leptich, Kurt Director SELPA Mallory, Anne Superintendent Imperial County Office of Education Ortiz, Francisco Deputy Director ICBHS Adults & Older Adults Division Picazo, Joe Deputy CEO County Executive Office Plancarte, Leticia Deputy Director ICBHS Children & Adolescents Division Price, Margaret Director Department of Social Services Reyes, Barbara Quality Improvement Specialist ICBHS Managed Care Unit Rhinehart, Maria Operations Manager Courts Page 10

14 Name Title Representative Of Robinson, Lori Regional Manager San Diego Regional Center Ruiz, Maria Behavioral Health Manager ICBHS Adults & Older Adults Division Saikhon, Norma Public Administrator Public Administration Sauza, Margaret Director Sure Helpline Crisis Center Sheppeard, Scott Lieutenant Sheriff s Office Ulloa, Juan Judge Superior Court Valenzuela, Sylvia Peer Supporter ICBHS Youth & Young Adults Division Vargas, Gina Director Center for Family Solutions Vega, Jessica Peer Supporter ICBHS Youth & Young Adults Division Wyatt, Maria Behavioral Health Manager ICBHS Children & Adolescents Division In addition to the above, adult consumers, transition-age youth consumers, and family members play an active role in the MHSA community planning process. All stakeholder meetings are held at the ICBHS Recovery Center Program in order to encourage consumer and family member attendance. During FY , the MHSA Steering Committee met on the following dates: September 16, 2013 December 16, 2013 March 17, 2014 April 14, 2014 June 16, 2014 Meeting flyers advertising the date, time, location, and purpose of each respective MHSA Steering Committee meeting were posted in the waiting areas of ICBHS clinics and were distributed to consumers, family members, and community members by the MHSA Outreach and Engagement Program s outreach workers. Moreover, the meeting information was also made available to the public through ICBHS Network of Care website. ICBHS incorporates all feedback from the MHSA Steering Committee into its MHSA Workgroup meetings, which are scheduled on a monthly basis. The MHSA Workgroup met on the following dates during FY : July 29, 2013 September 30, 2013 October 28, 2013 November 25, 2013 December 23, 2013 January 27, 2014 February 10, 2014 February 25, 2014 April 7, 2014 April 28, 2014 May 27, 2014 June 30, 2014 Page 11

15 During FY , ICBHS continued a community planning process to identify needed supports and services for unserved and underserved populations. Outreach and engagement to underserved populations continued to expand through the scope of Let s Talk About It and Exprésate, the weekly-aired, locally produced and hosted behavioral health radio programs in English and Spanish, the two local threshold languages. MHSA Program information shows continued to provide the community with program overviews, referral and access information, who each programs serves, and contact information through broadcast on three separate local radio stations. KXO Radio provided internet podcast hosting of all the radio shows that aired. With this podcast storing, any community member, friend, neighbor, family member, as well as agency personnel from ICBHS or any community agency, can access the information and refer an individual to a particular topic that may apply to their recovery at any time. Moreover, anyone can search the archives and listen in support of their own interests and/or needs. The ongoing outreach and engagement to underserved populations identified in the MHSA processes received a variety of media and advertising support. The local English and Spanish newspapers and their internet sites, Imperial Valley Women s Magazine, and the local radio stations are targeted with program advertising. The shows, going on their tenth year of broadcasting, have attracted a regular listenership and have established their voice as the local voice of radio wellness in the community. 30-Day Review Process The will be posted for a 30-day public review and comment period from April 17, 2014, through May 16, Circulation The will be posted on ICBHS Network of Care website. In addition, it will be distributed through the MHSA Steering Committee and the Mental Health Board. Advertisement for the Public Hearing will be posted in the Imperial Valley Press, which is distributed throughout all regions of the county. ICBHS will also facilitate question and answer sessions to obtain public feedback regarding the. Imperial County is planning on facilitating sessions as follows: April 24, 2014, at 5:00 p.m. at 202 N. 8 th Street, El Centro, CA April 28, 2014, at 9:30 a.m. at 2695 S. 4 th Street, El Centro, CA May 1, 2014, at 5:00 p.m. at 608 Heber Ave., Calexico, CA May 6, 2014, at 10:00 a.m. at 2695 S. 4 th Street, El Centro, CA May 8, 2014, at 5:00 p.m. at 202 N. 8 th Street, El Centro, CA May 14, 2014, at 5:00 p.m. at 205 Main Street, Brawley, CA Public Hearing After the 30-day public review and comment period, a Public Hearing will be held by the Mental Health Board on May 20, All community input and comments will be reviewed to determine if changes to the MHSA Three-Year Program and Expenditure Plan are necessary. All input, comments, and Board recommendations will be documented and included as Attachment 1 to this plan. Page 12

16 Three-Year Program and Expenditure Plan Requirements In accordance with MHSA regulations, every county mental health program is required to submit a three-year program and expenditure plan and update it on an annual basis. This Three-Year Program and Expenditure Plan for Imperial County s MHSA programs is an overview of the work plans and projects being implemented as part of the series of service components launched with the passage of Proposition 63 in The passage of the MHSA provided Imperial County with increased funding, personnel, and other resources to support mental health programs for children, transition-age youth, adults, older adults, and families. The MHSA addresses a broad continuum of prevention, early intervention, and service needs, as well as the necessary infrastructure, technology, and training elements that support the County s public mental health system. The intent of the Three-Year Program and Expenditure Plan is to provide the community with a report on the various projects to be conducted as part of the MHSA. This report includes descriptions of programs and services to be implemented during FY through FY for the following MHSA components: Community Services and Supports (CSS) Prevention and Early Intervention (PEI) Workforce Education and Training (WET) Capital Facilities and Technological Needs (CF/TN) Page 13

17 MHSA Three-Year Program Plan Community Services and Supports Community Services and Supports (CSS) is the first and largest component funded under the MHSA. This component focuses on those individuals with serious emotional disturbances or mental illnesses for the following populations: Imperial County Behavioral Health Services Children and Families Transition-Age Youth Adults Older Adults To serve these four groups, counties are required to implement three components within their CSS programs: Full Service Partnerships Systems Development Outreach and Engagement Under the CSS component of the MHSA, counties can request three different kinds of funding to make changes and expand their mental health services and supports. Funding includes: Full Service Partnership Funds to provide all of the mental health services and supports a person wants and needs to reach his or her goals General Systems Development Funds to improve mental health services and supports for people who receive mental health services Outreach and Engagement Funds to reach out to people who may need services but are not receiving them Imperial County Behavioral Health Services (ICBHS) has requested Full Service Partnership funds for the Youth and Young Adult Services Full Service Partnership Program and the Adult and Older Adult Services Full Service Partnership Program. General Systems Development funds were requested for the Recovery Center Program and Outreach and Engagement funds were requested for the Outreach and Engagement Program and the Transitional Engagement Supportive Services Program. Page 14

18 Full Service Partnership Youth and Young Adult Services Full Service Partnership Program The Youth and Young Adult Services Full Service Partnership (YAYA-FSP) Program consists of a full range of integrated community services and supports for youth and young adults, ages 12 to 25, including direct delivery and use of community resources. These services and supports include case management; rehabilitative services; wrap-like services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. The target population for each of the Full Service Partnership teams for the Youth and Young Adult Services Clinic is as follows: Seriously Emotionally Disturbed (SED) adolescents, ages 12 to 15, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: selfcare, school functioning, family relationships, or the ability to function in the community and who are either at risk of or have already been removed from the home; or whose mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment; or who display at least one of the following: psychotic features, risk of suicide, or risk of violence due to a mental disorder. These individuals may also be diagnosed with a co-occurring substance abuse disorder. SED or Severely Mentally Ill (SMI) transition-age youth (TAY), ages 16 to 25, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or the ability to function in the community and are unserved or underserved and are experiencing either homelessness or are at risk of being homeless; aging out of the child and youth mental health system; aging out of the child welfare system; aging out of the juvenile justice system; have involvement in the criminal justice system; are at risk of involuntary hospitalization or institutionalization; or are experiencing a first episode of serious mental illness. These individuals may also be diagnosed with a co-occurring substance abuse disorder. Staff at the YAYA-FSP Program have been trained in the overall needs of individuals ages 12 to 25. The training provided to staff and treatment models currently being implemented at the YAYA-FSP Program include the following: Cognitive Behavioral Therapy (CBT): CBT is an evidence-based psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including anxiety, depression, and addiction. CBT is generally short-term and focused on helping consumers deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT is a treatment for children and youth, ages 4 to 18, that involves individual sessions with the consumer Page 15

19 and parent as well as joint parent-child sessions. The goal of TF-CBT is to help address the biopsychosocial needs of children and youth with Posttraumatic Stress Disorder (PTSD), or other problems related to traumatic life experiences, and includes active participation of their parents or primary caregivers. TF-CBT is a model of psychotherapy that combines trauma-sensitive interventions with cognitive behavioral therapy. Children and parents are provided knowledge and skills related to processing the trauma; managing distressing thoughts, feelings, and behaviors; and enhancing safety, parenting skills, and family communication. Cognitive Processing Therapy (CPT): CPT is a cognitive-behavioral therapy for PTSD and related conditions that focuses on thoughts and feelings. CPT is effective in treating PTSD across a variety of populations such as, veterans who have experienced combat, sexual assault victims, and individuals who experienced childhood trauma, as well as other types of traumatic events. CPT provides a way to understand why recovery from traumatic events has been difficult and how symptoms of PTSD affect daily life. The focus is on identifying how traumatic experiences change thoughts and beliefs, and how thoughts influence current feelings and behaviors. This treatment is designed for adults ages 18 and over. Depression Treatment Quality Improvement (DTQI): DTQI is an evidence-based cognitive behavioral intervention. The model utilizes quality improvement processes to guide the provision of therapeutic services to adolescents and young adults with depression. DTQI focuses on helping individuals reduce depressive symptoms and improve their quality of life. DTQI consists of three modules: 1) Fun Activities Module; 2) Thoughts Module; and 3) Social Relationships Module. DTQI includes a final session that focuses on termination and relapse prevention to enhance consumers success after the conclusion of treatment. Functional Family Therapy (FFT): FFT is a family-based treatment program for high-risk youth who are either at risk for or manifest antisocial behavioral problems such as conduct disorder, oppositional defiant disorder, disruptive behavior disorder, violent acting-out, and substance abuse disorders. FFT targets youth between the ages of 11 and 18 from a variety of ethnic and cultural groups. Co-morbid behavioral or emotional problems, such as anxiety or depression, may also exist, as well as family problems, such as communication and conflict issues. The FFT model allows for successful intervention through clinical practice that is flexibly structured, culturally sensitive, and accountable to youth, their families, and the community. FFT has a systematic, yet individualized, family-focused approach to juvenile crime, violence, drug abuse, and other related problems. FFT is a strength-based model that focuses on and assesses those risk and protective factors that impact the adolescent and his or her environment. FFT attempts to alleviate emotional disturbances, change maladaptive patterns of behavior, and encourage personality growth and development. FFT also pays specific attention to both intra-familial and extra-familial factors and how they present within and influence the therapeutic process. Motivational Interviewing: Motivational Interviewing is a form of collaborative conversation for strengthening a person's own motivation and commitment to change. It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change. It is designed to strengthen an individual's motivation for and movement toward a specific Page 16

20 goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. Aggression Replacement Training (ART): ART is a cognitive behavioral intervention program to help children and adolescents, ages 12 to 18, improve social skill competence and moral reasoning, better manage anger, and reduce their aggressive behavior. The program consists of 10 weeks (30 sessions) of intervention training, provided in one-hour sessions, three times per week. Incremental learning, reinforcement techniques, and guided group discussions enhance skill acquisition and reinforce the lessons in the curriculum. The ART Program is a multi-modal intervention consisting of three components: Skills Streaming: Teaches a curriculum of Pro-Social, interpersonal skills that train on more effective alternatives to aggressive and violent behavior. Anger Control Training: Trains the youth on the use of effective responses when provoked. Moral Reasoning: Assists in instilling values that respect the rights of others and promotes the use of the skills learned in the first two components. Research has shown that students who develop skills in these areas are far less likely to engage in a wide range of aggressive and high-risk behaviors. Lessons in this program are intended to address the behavioral, affective, and cognitive components of aggressive and violent behavior. Nurturing Parenting Program (NPP): The NPP is a validated, family-centered program designed to build nurturing skills as alternatives to abusive parenting and child rearing attitudes and practices. The NPP targets youth between the ages of 13 and 18, from a variety of ethnic and cultural groups, who present very serious problems, such as delinquency, conduct disorder, oppositional defiant disorder, disruptive behavior disorder, violent acting-out, and substance abuse. The NPP structural model is based on a re-parenting philosophy: parents and children attend separate groups that meet concurrently, participating in activities that build self-awareness, positive selfconcept/self-esteem, and empathy; provide alternatives to yelling and hitting; enhance family communication and awareness of needs; replace abusive behavior with nurturing; promote healthy physical and emotional development; and teach appropriate role and developmental expectation. The NPP utilizes the Adult-Adolescent Parenting Inventory (AAPI-2) to perform a Pre-Treatment Assessment, Process Assessment, and a Post- Treatment Assessment to the adolescent and his or her family to measure outcomes. The AAPI-2 is an inventory designed to measure the pre and post effectiveness of the NPP, determine parenting strengths and areas that need improvement. The Pre- Treatment Assessment is used to collect data prior to the formal start of the program to determine entry level capabilities; the Process Assessment is used to collect data during the course of the program to monitor Page 17

21 ongoing growth and changes; and the Post-Treatment Assessment collects data at the completion of the program to determine the level of growth and future intervention needs of the family. ICBHS has also entered into contracts with businesses and agencies within the community that can address the needs of the youth and young adults being served through the YAYA-FSP Program. The following are services currently being contracted by ICBHS: Equine Therapy: Animals Plus delivers horsemanship services to consumers with emotional and/or behavioral impairments that promote development of the individual s life skills. These services lead the individual toward increased confidence, patience, and self-esteem. Youth and young adults, ages 12 to 25, are paired with horses whose personalities and behaviors challenge them to explore the concept of responsibility for one s behavior and choices, logical consequences, nurturing of others, self-evaluation, and control. Youth and Young Adults Exercise Program: Fitness Oasis Health Club and Spa provides youth and young adult consumers with training and fitness guidance. This service promotes health and wellness for the consumers and guides them to a healthier and more active lifestyle. Consumers referred to Fitness Oasis Health Club and Spa can participate in Zumba and toning and resistance training classes. Consumers are also provided with education on healthy nutrition and the benefits of exercise. A MOU with Clinicas Del Salud Del Pueblo, Inc., was executed to provide an array of comprehensive primary health care services including a medical clearance examination for individuals participating in the exercise program. General Educational Development (GED) Classes: Imperial Valley Regional Occupational Program (IVROP) and ICBHS entered into a MOU to provide GED preparation classes and needed educational services to youth and young adults receiving mental health services at the YAYA-FSP Program. On September 15, 2013, ICBHS began the implementation of Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS) as required by Katie A. vs. Bonta. Youth and young adult consumers, ages 12 to 21, who meet Katie A. subclass criteria and accepted services are provided with intensive mental health services. Currently, the YAYA-FSP Program is providing ICC and IHBS services to two consumers. Page 18

22 The average number of unduplicated consumers served at the YAYA-FSP Program is approximately 330 per year. The cost per person is approximately $15, Currently, the YAYA-FSP Program is serving a total of 244 youth and young adults. Table 5 and the charts below provide a demographic summary of the YAYA-FSP Program: Table 5 YAYA-FSP Program Demographic Summary Demographic Category Number % of Total Age Group Youth, ages 12 to Young Adults, ages 16 to Gender Female Male Ethnicity Hispanic White Black Chinese Vietnamese Other Language English Spanish Vietnamese Unknown % 75.0% 50.0% 25.0% 0.0% Chart 3: YAYA-FSP Program by Age 22.5% 77.5% 12 to to % 75.0% 50.0% 25.0% Chart 4: YAYA-FSP Program by Gender 40.2% 59.8% 0.4% 0.8% 1.6% 3.3% 8.2% Chart 5: YAYA-FSP Program by Ethnicity 85.7% Hispanic White Black Chinese Vietnamese Other 0.0% Female Male Page 19

23 Performance Outcomes As of January 2014, the YAYA-FSP Program started the implementation of a standardized method for measuring outcomes by specific disorder and the implementation of two general tools that measure overall functioning. For the general tools, all youth, ages 12 to 17, and their parents are administered the Youth Outcome Questionnaire - Self Report (YOQ-SR) and Youth Outcome Questionnaire for parents at the time of intake and annually thereafter. The YOQ is a tool for children and youth, ages 4 to 17, who are receiving mental health services, that is designed to measure treatment progress. The YOQ tracks changes in functioning during the course of treatment. The areas of measurement include interpersonal distress, somatic symptoms, interpersonal relations, social problems, behavioral dysfunction, and other critical items. The YOQ is also being used with those youth who are receiving ART, FFT, Equine Therapy, and are enrolled in the exercise program. The YAYA-FSP Program is also administering the Behavior and Symptom Identification Scale 24 (Basis 24) measurement tool to those consumers who are between the ages of 18 and 25. Basis 24 is being administered at the point of intake and annually thereafter. Basis 24 provides a complete patient profile and measures the change in self-reported symptom and problems difficulty over the course of time. Basis 24 measures the consumers' level of depression, functioning, interpersonal relationships, psychosis, substance abuse, emotional liability, and risk for self-harm. The following is a list of measurement outcome tools currently being implemented at the YAYA- FSP Program that are specific by diagnosis and age: Instrument Name Adult ADHD Self Report Scale (ASRS-v1.1) Center for Epidemiologic Studies Depression Scale - Mood Questionnaire (CES-D) Conners 3 ADHD Index - Parent (3-P) Conners 3 ADHD Index - Parent Short (3-PS) Disorder Age Group Area of Measurement ADHD 18+ ADHD Symptoms in Adults Depression 12+ Depression ADHD 6 to 18 Inattention Hyperactivity/Impulsivity Learning Problems Executive Functioning Aggression Peer Relations ADHD 6 to 18 Inattention Hyperactivity/Impulsivity Learning Problems Executive Functioning Aggression Peer Relations Page 20

24 Instrument Name Conners 3 ADHD Index - Self Report (3-SR) Conners 3 ADHD Index - Self Report Short (3-SRS) Conners 3 ADHD Index-Teacher (3-T) Conners 3 ADHD Index-Teacher Short (3-TS) Eyberg Child Behavior Inventory (ECBI) Generalized Anxiety Disorder Assessment (GAD-7) Disorder Age Group Area of Measurement ADHD 8 to 18 General Psychopathology Inattention Hyperactivity/Impulsivity Learning Problems Executive Functioning Aggression Peer & Family Relations ADHD Inattentive ADHD Hyperactive-Impulsive ADHD Combined Oppositional Defiant Disorder Conduct Disorder ADHD 8 to 18 General Psychopathology Inattention Hyperactivity/Impulsivity Learning Problems Executive Functioning Aggression Peer & Family Relations ADHD Inattentive ADHD Hyperactive-Impulsive ADHD Combined Oppositional Defiant Disorder Conduct Disorder ADHD 6 to 18 Inattention Hyperactivity/Impulsivity Learning Problems (Full Length Only) Executive Functioning (Full Length Only) Defiance/Aggression Peer/Family Relations ADHD 6 to 18 Inattention Hyperactivity/Impulsivity Learning Problems (Full Length Only) Executive Functioning (Full Length Only) Defiance/Aggression Peer/Family Relations Disruptive Behaviors 2 to 16 Behavior Problems Intensity Scale Frequency of Problems Problem Scale Parent s Tolerance Anxiety 18+ Panic Disorder Social Anxiety Post-Traumatic Stress Disorder Page 21

25 Instrument Name Illness Management and Recovery Scale: Client Self-Rating (IMR) Disorder Psychotic Disorder Schizophrenia Bipolar Imperial County Behavioral Health Services Age Group Area of Measurement 18+ No Domains PTSD Checklist- Specific Civilian (PCL-C) PTSD Checklist- Specific Monthly (PCL-S) PTSD Checklist- Specific Weekly (PCL-S) UCLA Post Traumatic Stress Reaction Index - Parent (PTSD-RI-Parent) UCLA Post Traumatic Stress Reaction Index - Self Report (PTSD-RI -SR) PTSD 18+ PTSD Symptoms PTSD 18+ Measures PTSD Symptoms From the Past Month PTSD 18+ Measures PTSD Symptoms From the Preceding Week PTSD 3 to 18 PTSD Symptoms PTSD 7 to 18 PTSD Symptoms Information and scores for these measurement outcome tools are being submitted through the AVATAR electronic health record and it is expected that specific outcome reports for services provided at the YAYA-FSP Program will be available by the end of FY Program Goals and Objectives The following are goals and objectives for the YAYA-FSP Program during FY through FY : Continue to implement evidence-based practices that are specific to diagnosis and population and promote recovery. With the implementation of the measurement outcome tools, the YAYA-FSP Program will be able to gather information and produce outcome reports that demonstrate treatment progress overtime. With the use of measurement outcome tools, ICBHS will be able to gather outcome data that is client, team, unit, and department specific. Services will be modified as necessary based on the data to ensure positive outcomes. Improve access to services to unserved or underserved areas by securing two additional buildings in the cities of Brawley and Calexico to establish YAYA-FSP clinics. Achievement will be measured by tracking the increase of consumers served in the Page 22

26 south-end and north-end of Imperial County. It is anticipated that once these clinics have been established, the YAYA-FSP Program will experience a significant increase in caseload size by the end of the fiscal year. Implementation of the PIER Model for Early Detection and Intervention for the Prevention of Psychosis. The PIER Model is an early detection and intervention approach that focuses on the pre-psychotic (prodromal) phase of a developing psychotic illness. Upon identification of individuals experiencing a recent onset of psychosis, early and subsequent intervention will reduce the likelihood and/or severity of future psychotic episodes. The PIER Model is designed for adolescents and young adults between the ages of 12 and 25 and has three key parts: community outreach, assessment, and treatment. The implementation of the PIER Model will include training and consultation calls for staff that will be providing the outreach activities and treatment. Outcomes will be measures by the number of referrals received as a result of early detection and through the use of measurement outcome tools. Implementation of LGBTQQIAA (Lesbian Gay Transgender Queer Questioning Intersex Asexual Ally) sensitive services and clinic atmosphere. In January 2014, several staff were trained on the LGBTQQIAA population. Efforts will be made in ensuring that clinical facilities are made more LGBTQQIAA friendly and that the Intake Assessment and Re- Assessment both include the proper terminology to identify crucial information in this area. Future trainings in LGBTQQIAA are being coordinated to ensure that staff knowledge in this area increases and that cultural competency in this area is exhibited. Increased referrals to Equine Therapy and improved outcomes in the area of increased confidence, patience, and self-esteem. Consumers will be able to demonstrate better behavior choices, understanding of logical consequences, nurturing of others, selfevaluation, and control. These outcomes will be measured through the use of the YOQ- SR and by tracking the increase in the number of referrals per fiscal year. Improve consumers physical health by increasing the number of consumers referred to the YAYA-FSP exercise program at Fitness Oasis and the number of consumers referred for physical evaluation. The AVATAR system is now able to track individuals Body Mass Index (BMI), which will be calculated at the initial nursing assessment. Consumers that present a risk based on their BMI, or report a desire to improve their physical health, will be referred for a physical evaluation and to the exercise program. Outcomes will be measured by the consumers decrease in BMI, which will be measured at every nursing appointment, and by tracking the increase in the number of referrals per fiscal year. Increase number of consumers who obtain a GED. The YAYA-FSP Program will identify consumers and make referrals for GED classes. Consumers will be tested by IVROP instructors, which will determine their academic level. Consumers will be placed in GED classes based on these results. Outcomes will be measured by tracking the number of consumers referred to GED classes and the number of consumers who obtain a GED per fiscal year. Increase consumers engagement to services and decrease the no-show rate through the use of motivational interviewing skills. Clinical staff will participate in monthly consultation calls that will increase their knowledge and expertise. Outcomes will be Page 23

27 measured by tracking consumers attendance to appointments and tracking the decrease of the no-show rate. These goals and objectives should be accomplished by FY , but continued improvement toward these goals will be expected through FY Adult and Older Adult Services Full Service Partnership Program The Adult and Older Adult Services Full Service Partnership (Adult-FSP) Program is consumerdriven, community focused, and promotes recovery and resiliency. The Adult-FSP Program provides a whatever it takes approach to ensure that all consumers receive the services and assistance that are needed. Services provided by the Adult-FSP Program staff include case management, rehabilitative services, wrap-like services, integrated community mental health, alcohol and drug services, crisis response, and peer support. This program serves unserved and underserved adults and older adults, ages 26 and older. To be eligible for these services, individuals must meet the following criteria: Adults 26 years of age and older who have a co-occurring disorder of severe emotional disturbance and substance abuse/dependence; or, Severely Mentally Ill (SMI) adults between the ages of 26 and 59 who are incarcerated in the adult criminal justice system or have been incarcerated in the past year and are transitioning back into the community; or, Older adults, ages 60 and older, who are diagnosed with a severe mental illness and are homeless or at risk of being homeless, or isolated and homebound. These individuals may also be diagnosed with a substance use disorder. The Adult-FSP Program provides a variety of services, in a culturally competent environment, to adults and older adults, ages 26 and older. Individuals eligible to receive services under the Adult-FSP Program benefit from receiving medication support, therapy, and mental health rehabilitation/targeted case management services, if needed. Additionally, the program s mental health rehabilitation technicians will assist consumers with the reintegration process back into the community through linkage of the following applicable services: emergency shelter; permanent housing; emergency clothing; food baskets; SSI/SSA benefits application and/or appeal; DSS Cash Aide Application; Section 8 Housing Application; substance abuse treatment and/or rehabilitation referral; finding a general physician and/or dentist; and driver license/id application and/or immigration paperwork. Program staff promote recovery, resiliency, and hope through full community integration by offering the aforementioned linkage to eligible individuals. Additionally, for the older adult population, delivery of needed supports and services are provided at their homes if they are homebound or do not have transportation. Page 24

28 Consumers in the Adult-FSP Program who qualify for Medi-Cal services will be enrolled and all appropriate services will be billed to Medi-Cal. The average cost per each consumer per year is approximately $1, The Adult MHSA-FSP program serves approximately 200 consumers per year. Table 6 and the charts below provide a demographic summary of the Adult-FSP Program: Table 6 Adult-FSP Program Demographic Summary Demographic Category Number % of Total Age Group Transition-Age Youth, ages 16 to Adults, ages 26 to Older Adults, ages Gender Female Male Ethnicity Hispanic White Black Alaskan Native Other % 75.0% 50.0% 25.0% 0.0% Chart 6: Adult-FSP Program by Age 3.5% 85.0% 11.5% 16 to to % Chart 7: Adult-FSP Program by Gender Chart 8: Adult-FSP Program by Ethnicity 75.0% 60.0% 5.0% 1.5% 1.0% 50.0% 40.0% 19.0% Hispanic White 25.0% 73.5% Black Alaskan Native Other 0.0% Female Male Page 25

29 Performance Outcomes The Adult-FSP Program began utilizing the Behavior and Symptom Identification Scale (BASIS 24) in January 2014 during Initial Intake Assessment and at the time of annual treatment plan updates, which occurs annually, to measure progress and assess performance outcomes. This tool will be useful in assessing the outcome of mental health treatment from the consumer s point of view. It measures self-reported difficulty in the major symptoms and functioning domains (depression/functioning, relationships, self-harm, emotional lability, psychosis, and substance abuse) that lead to the need for mental health services. It will be used for outcome assessment purposes by comparing scores obtained overtime for progress or lack of progress, as well as program effectiveness. Below is a list of measurement tools that are currently being implemented at the Adult-FSP Program. These tools are specific to diagnosis and include the age and areas that are measured for each tool: Instrument Name Behavior and Symptom Identification Scale (Basis 24) Patient Health Questionnaire (PHQ-9) Center for Epidemiologic Studies Depression Scale (CES-D) (Mood Questionnaire) Generalized Anxiety Disorder Assessment (GAD-7) PTSD Checklist- Specific (PCL-C) Civilian PTSD Checklist- Specific (PCL-S) Monthly PTSD Checklist- Specific (PCL-S) Weekly Disorder Age Group Area of Measurement General 18 + Depression and Functioning Interpersonal Relationships Psychosis Substance Abuse Emotional Lability Self-Harm Depression 18+ Depression Depression 18+ Depression Anxiety 18+ Panic Disorder Social Anxiety Post-Traumatic Stress Disorder PTSD 18+ PTSD symptoms PTSD 18+ Measures PTSD symptoms from the past month PTSD 18+ Measures PTSD symptoms from the preceding week Page 26

30 Additionally, ICBHS gathers and records information via the utilization of the Quarterly Progress Report (Exhibit 6). This report assists in identifying the number of consumers served, noting penetration and if program objective (target number) was met and continued efforts to increase utilization if numbers are not met. Program Goals and Objectives The Adult-FSP Program goals and objectives for are to reduce: The symptoms of mental illness and alcohol or drug use; Homelessness; Incarceration/re-incarceration; Use of emergency room care; Inability to work; Inability to manage independence; and, Involuntary services. Program staff will continue to provide services and supports to assist with the reduction of isolation, family problems, suicide, violence, sexual and physical victimization, and serious medical illness (such as HIV and Hepatitis B and C), as well as improve safety and permanence at home, school, and in the community, and prevent early death. Meaningful data and achievements will be measured by monitoring the outcome data collected in the BASIS 24 instrument at the time of Initial Intake Assessment. This will measure any changes in symptoms over the course of time. Additionally, data from the Adult-FSP Program Assessment Form, Adult Quarterly Assessment Forms, and Key Event Tracking Form will be tracked and monitored during the course of treatment. Efforts will be made to ensure that clinical facilities are made more LGBTQQIAA (Lesbian Gay Transgender Queer Questioning Intersex Asexual Ally) friendly and that the Intake Assessment and Re-Assessment both include the proper terminology to identify crucial information in this area. In January 2014, several staff were trained on the LGBTQQIAA population. Future trainings in LGBTQQIAA are being coordinated to ensure that staff knowledge in this area increases and that cultural competency in this area is exhibited. Page 27

31 General Systems Development Recovery Center Program The main focus of the Recovery Center Program (RCP) is to provide engagement and education, and promote wellness, recovery, and self-sufficiency. Program staff serve the unserved and underserved adults and older adults, ages 26 and older, who are Severely Mentally Ill and have a diagnosis that includes Bipolar Type I and II disorders, Psychotic Disorders, Delusional Disorders, and/or Schizophrenic Disorders. RCP staff offer daily structured activities that assist consumers in their recovery from their mental illness, as well as assist them with rebuilding a healthy and more independent lifestyle. The RCP has partnered with outside agencies such as the Department of Rehabilitation/Work Training Center (DOR/WTC), Imperial Valley College (IVC), Fitness Oasis Gym, Imperial Valley Regional Occupation Program (IVROP), and Clinicas De Salud Del Pueblo. These agencies offer consumers educational classes and pre-employment readiness and employment training, as well as assist them in obtaining a high school diploma. Consumers also have access to computers and the internet to aid them in completing school assignments (i.e. research, homework, and projects). Program staff provide bus vouchers and/or arrange transportation through ICBHS based upon the consumer s specific transportation needs. Through the aforementioned agencies, consumers are also offered the opportunity to attend classes on English as a Second Language; arts & crafts; photography; self-esteem; life skills; cooking (such as baking and/or cake decorating); and quilting and/or sewing. Additionally, consumers are offered the opportunity to participate in various support groups, such as medication education, wellness groups, and health and fitness classes. Consumers also have an individualized Wellness and Recovery Action Plan (WRAP) to assess their specific level of recovery and plan appropriate recovery goals. The RCP staff offer an array of services through the RCP Outpatient Clinic to assist SMI consumers in reaching and maintaining their recovery goals. The program offers the following services: Medication Support Targeted Case Management Services Crisis Intervention Services Individual Therapy The majority of the populations served by the RCP is bilingual-spanish speaking. Services are offered and provided in the consumer s preferred language (English or Spanish when requested). This ensures that the program has the ability to provide interpretative services when needed. The services offered by the RCP are provided in a culturally competent setting. The RCP provides services to all eligible individuals. Services rendered are billed to Medi-Cal for eligible beneficiaries. The average cost per each consumer per year is approximately $1, Page 28

32 The RCP serves approximately 838 consumers per year. Table 7 and the charts below provide a demographic summary of the RCP Program: Table 7 RCP Demographic Summary Demographic Category Number % of Total Age Group 16 to to to to to Gender Female Male Unknown Ethnicity Hispanic White Black Alaskan Native Other Asian Native Hawaiian Other Asian Vietnamese Language English Spanish No Entry American Sign Language Vietnamese Chart 9: RCP by Age % 51 to % 41 to % 31 to % 22 to % 16 to % 0.0% 25.0% 50.0% Chart 10: RCP by Gender 100.0% 75.0% 53.2% 50.0% 46.5% 25.0% 0.3% 0.0% Female Male Unknown Chart 11: RCP by Ethnicity 75.0% 67.0% 50.0% 25.0% 0.0% 24.6% 6.0% Hispanic White Black Alaskan Native 1.2% 0.8% 0.1% 0.1% 0.1% 0.1% Other Asian Native Hawaiian Other Asian Vietnamese Page 29

33 This program will expand into the city of Brawley in FY and into the city of Calexico in FY where an Outpatient Mental Health Clinic and Mental Health Recovery Center will be established. A full array of outpatient services will be provided, including medication support, MHS Targeted Case Management and MHS Rehabilitation, and MHS Therapy. Expanding services will provide easier access to mental health services for residents in the Brawley and Calexico area. This will reduce the need for traveling long distances for mental health services and increase program engagement. Additionally, a Recovery Center offers daily structured activities which assist consumers with their recovery from their mental illness, as well as assist them with rebuilding a healthy and more independent lifestyle. Staffing for both programs will include the following: City of Brawley RCP Clinic 1 Program Supervisor 1 Psychiatrist 1 Nurse 1 Clinician 2 Mental Health Rehabilitation Technicians 1 Office Technician 1 Office Assistant III 1 Office Assistant II Recovery Center 1 Office Assistant III 2 Mental Health Workers City of Calexico RCP Clinic 1 Program Supervisor 1 Psychiatrist 1 Nurse 2 Clinicians 2 Mental Health Rehabilitation Technicians 1 Office Technician 1 Office Assistant III 1 Office Assistant II Recovery Center 1 Office Assistant III 3 Mental Health Workers Performance Outcomes The RCP staff are currently working toward improving the method of tracking progress and recovery of the SMI consumers served. As a result, effective January 2014, program staff have been inputting data for the compilation of performance outcomes. The Behavior and Symptom Identification Scale (BASIS 24) and Illness Management and Recovery Scale (IMRS) are the two outcome measurement tools that are currently being implemented. The Milestones of Recovery Scale (MORS) is in the process of being implemented; program staff are awaiting training by developers. Additionally, the Quarterly Progress Report (Exhibit 6) is utilized to provide estimated population to be served. Basis 24 will help assess the outcome of mental health treatment from the consumer s perspective. It will be administered at the initial Intake and annually thereafter at the outpatient clinics. The self-report identifies difficulty in symptoms for the following domains: depression/functioning, relationships, self-harm, emotional lability, psychosis, and substance abuse that lead to the need for mental health services. It will be used for outcome assessment purposes by comparing scores obtained overtime for progress or lack of progress made by the consumer. The Illness Management and Recovery Scale (IMRS) is helpful in treatment planning and assessing recovery in individuals with severe mental illness. This tool is useful for tracking outcomes. The tool is administered on a quarterly basis. It can be observed, based on score, if the consumer has made progress or not. Page 30

34 The MORS measures level of engagement, coping, risk, level of rehabilitation, and recovery. The purpose of the MORS is to assist administrators in evaluating the effectiveness of mental health programs and systems, specifically for full service partnership programs, to ensure that comparisons are made appropriately when determining the needs of the consumers and that they receive the appropriate level of services. Additionally, ICBHS staff gather and record information via the utilization of the Quarterly Progress Report (Exhibit 6). This report assists in identifying the number of consumers served, noting penetration and if program objective (target number) was met and continued efforts to increase utilization if numbers are not met. Program Goals and Objectives The goals and objectives for for the RCP is to continue increasing self-awareness; improve self-care; strengthen supports; increase involvement with jobs, school, and/or hobbies; and reducing homelessness, inability to work, inability to manage independence, isolation, and involuntary services. The expected outcome is to maintain recovery involving overall health, wellness, and self-sufficiency. Meaningful data and achievements will be measured through the use of the BASIS 24 at the time of the initial Intake Assessment. This instrument will collect data related to current symptoms and will measure any changes in symptoms over the course of time. The IMRS will be useful for tracking outcomes on a quarterly basis and will provide information on consumers progress. The MORS measures level of engagement, coping, risk, level of rehabilitation and recovery on a quarterly basis. The MORS will also assist in evaluating program effectiveness and determine the individual needs of the consumers. The Exhibit 6 report will continue to be utilized to provide the number of consumers served. This report indicates the target number of consumers that the program anticipates serving, as well as an actual count of the number of consumers that are actually served during each specific quarter. Additionally, the utilization of the PIER Model for Early Detection and Intervention for the Prevention of Psychosis will be implemented soon. The PIER Model is an early detection and intervention approach that focuses on the pre-psychotic (prodromal) phase of a developing psychotic illness. Upon identification of the individual experiencing a recent onset of psychosis, early and subsequent intervention will reduce the likelihood and/or severity of future psychotic episodes. The PIER Model is designed for adults and has three key parts: community outreach, assessment, and treatment. The implementation of the PIER Model will include training and consultation calls for staff that will be providing the outreach activities and treatment. Outcomes will be measured by the number of referrals received as a result of early detection and through the use of measurement outcome tools. Page 31

35 Outreach and Engagement Outreach and Engagement Program The Outreach and Engagement Program provides outreach and engagement services to unserved seriously emotionally disturbed and seriously mentally ill individuals in the neighborhoods where they reside, including those who are homeless, in order to reduce the stigma associated with receiving mental health treatment and increase access to mental health services. The program also provides education to the community regarding mental illnesses and symptoms, early identification of mental illness, and resources to improve access to care through outreach at local schools; homeless shelters; substance abuse treatment facilities and self-help groups; low-income housing; faith-based organizations; and community-based organizations. The program assists individuals in obtaining services from ICBHS by providing information pertaining to programs and services; educating them about the intake assessment process; scheduling intake assessment appointments; and providing transportation to intake assessment appointments when necessary. As of the end of the second quarter of FY (July 2013 through December 2013), 2,235 individuals have been provided with outreach. Table 8 and the charts below provide a demographic summary of the individuals who have been provided with outreach during this period: Table 8 Outreach and Engagement Efforts (July 1, 2013, through December 31, 2013) Demographic Category 1 st Quarter 2 nd Quarter Total % of Total Gender Female 297 1,178 1, Male Age Group 0 to to to Ethnicity African American Asian/Pacific Islander Hispanic 397 1,660 2, Native American White Multiethnic Other Page 32

36 100.0% Chart 12: Outreach by Gender (FY 13-14) 50.0% Chart 13: Outreach by Age (FY 13-14) 75.0% 66.0% 50.0% 34.0% 25.0% 18.7% 21.2% 22.1% 25.0% 1.7% 0.0% Female Male 0.0% 0 to to to Chart 14: Outreach by Ethnicity (FY 13-14) 100.0% 92.0% 75.0% 50.0% 25.0% 0.0% 0.7% 0.2% African American Asian/Pacific Islander Hispanic 2.2% 3.1% 1.5% 0.3% Native American White Multiethnic Other Between July 1, 2013, and December 31, 2013, 75 individuals were successfully linked to ICBHS. It is anticipated that this number will rise well above 100 by the end of FY Page 33

37 Performance Outcomes During FY , the Outreach and Engagement Program provided outreach to 7,361 individuals. The charts below provide a demographic summary of the individuals who were provided with outreach during this period: 100.0% Chart 15: Outreach by Gender (FY 12-13) 50.0% Chart 16: Outreach by Age (FY 12-13) 49.2% 75.0% 65.2% 50.0% 34.8% 25.0% 15.4% 19.8% 15.7% 25.0% 0.0% Female Male 0.0% 0 to to to Chart 17: Outreach by Ethnicity (FY 12-13) 100.0% 90.6% 75.0% 50.0% 25.0% 0.0% 1.8% 1.1% African American Asian/Pacific Islander Hispanic 0.4% Native American 3.9% 1.8% 0.3% White Multiethnic Other Page 34

38 The goal of the Outreach and Engagement Program is to educate local unserved seriously mentally ill and emotionally disturbed individuals and encourage utilization of mental health care by providing outreach at local schools, homeless shelters, substance abuse treatment facilities and self-help groups, low-income housing, faith-based organizations, and community-based organizations. During FY , the Outreach and Engagement Program focused outreach efforts at 43 different sites, including, but not limited to: alternative education schools; El Centro Elementary School District; Grace Smith School; Women, Infant, and Children (WIC) Program; Catholic Charities; the Center for Family Solutions; Imperial Valley Regional Occupational Program; Christ Community Church; the Methadone Clinic; Neighborhood House; Salvation Army; Villa de las Flores Apartments; Westmorland Family Apartments; and Countryside Apartments. As a result of outreach and engagement efforts, 82 individuals were successfully linked to Imperial County Behavioral Health Services during FY Program Goals and Objectives For, the goals of the Outreach and Engagement Program will continue to be to reduce the stigma associated with receiving mental health treatment and to increase access to mental health services. The objectives of the program are to engage unserved seriously emotionally disturbed and seriously mentally ill individuals through outreach in the community; educate the community about mental illnesses and available mental health resources; and increase awareness of the services available through ICBHS. Achievement of the program s goals will be measured directly by the number of individuals who are successfully linked to mental health treatment services at ICBHS as a result of outreach and engagement efforts. Transitional Engagement Supportive Services Program The Transitional Engagement Supportive Services (TESS) Program provides outreach and engagement activities to unserved and underserved Seriously Emotional Disturbed (SED) and Seriously Mentally Ill (SMI) adult individuals. The TESS Program targets individuals who are discharged from Lanterman-Petris-Short Act (LPS) Conservatorship by the Courts, acute care psychiatric hospital, or from the ICBHS Crisis and Referral Desk (CRD) and need supportive services while transitioning to outpatient treatment. The TESS Program provides individualized Mental Health Rehabilitation/Targeted Case Management services to adults and older adults, ages 18 years and older, who experienced a personal crisis in their life requiring involuntary or voluntary mental health crisis intervention services. In addition, the TESS Program provides supportive services to assist conservatees who have recently been released from LPS Conservatorship. These services assist the individual with reintegrating back into the community, as well as provide a supportive environment including gaining entry into the mental health system. The TESS Program continues offering services that are culturally competent, as well as strength- and community-based. Page 35

39 The role of the mental health rehabilitation technician (MHRT) for the TESS Program is to provide outreach and engagement services to unserved and underserved populations. The TESS MHRT contacts local community shelters on a weekly basis and coordinates face-to-face visits on a monthly basis to establish contact with potential consumers living in such facilities. The TESS MHRT educates local community shelter staff and potential consumers regarding the services offered by ICBHS. The TESS Program staff have also established a referral process with El Centro Regional Medical Center (ECRMC). Program staff work in collaboration with ECRMC - Emergency Room staff to identify individuals who are exhibiting psychiatric symptoms in order to educate them on the referral process and continuity of care offered by ICBHS. The TESS Program provides linkage to: emergency shelter; permanent housing; emergency clothing; emergency food baskets; SSI/SSA benefits application or appeal; DSS/Cash Aide application; Section 8 Housing Application; substance abuse treatment and/or rehabilitation referral; linkage to a general physician and/or dentist; referral to other MHSA programs; assistance in completing driver license/id applications; immigration paperwork; linkage to services for developmental disabilities; and communication with parole/probation officers when necessary. The individual is assigned a MHRT who is trained to engage and link consumers to the needed community resources when applicable. The TESS Program provides educational information on the importance of mental health treatment, recovery, and accessibility to services. Individuals are linked to the ICBHS Adults Division for continuity of care. Previously, TESS services were only available subsequent to receiving services from the CRD and/or a hospitalization. The TESS Program recently expanded the availability of services to include expedited services if an individual, after assessment, has been found to be in imminent need of services due to a high risk of decompensation and/or is in need of a higher level of care, homeless, or in need of linkage to community resources. Expedited services include immediate linkage to community services and linkage to mental health services. In addition to the aforementioned services, non-active individuals who are referred to the McAlister Institute for a 14 Day Drug and Alcohol Detox Program are also referred to the TESS Program for aftercare and follow up services. The objective of this program is to assist the individual in accessing mental health and substance abuse related services upon release from the McAlister Detox Program. TESS Program consumers who qualify for Medi-Cal services will be enrolled, and all appropriate services will be billed to Medi-Cal. The average cost per each participant per year is approximately $1, The TESS Program provides services to approximately 327consumers per year and receives an average of 30 referrals per month. Performance Outcomes As of January 1, 2014, the TESS Program began implementing the Behavior and Symptom Identification Scale 24 (Basis 24) outcome measurement tool to establish a baseline of symptoms and impairments of consumers entering outpatient services. The BASIS 24 is administered at the time of intake assessment and is re-administered on an annual basis. Page 36

40 During FY , the TESS Program served 327 consumers, helping link individuals experiencing a mental health and/or substance related condition to outpatient services. Table 9 and the charts below provide a demographic summary of the TESS Program: Table 9 TESS Program Demographic Summary Demographic Category Number % of Total Age Group Transition-Age Youth, ages 16 to Adults, age 26 to Older Adults, ages Gender Female Male Unknown Ethnicity Hispanic White Black Alaskan Native Japanese Korean Vietnamese Other to to 25 Chart 18: TESS Program by Age 11.3% 20.2% 68.5% 0.0% 25.0% 50.0% 75.0% 100.0% Chart 19: TESS Program by Gender Chart 20: TESS Program by Ethnicity Unknown 1.2% 0.3% 0.3% 0.3% 0.9% 1.5% Male 51.1% 5.8% Hispanic White 30.6% Black Female 47.7% 60.3% Alaskan Native Japanese Korean 0.0% 25.0% 50.0% 75.0% 100.0% Vietnamese Other Page 37

41 There were a total of 87 TESS Program consumers with admissions from November 1, 2013, to January 13, Out of those 87 consumers, 43 were successfully linked to mental health services, as follows: Recovery Center Program 11 consumers Adult and Older Adult Services Full Service Partnership Program 10 consumers Anxiety and Depression Clinic 10 consumers Conservatorship 5 consumers Youth and Young Adult Services Anxiety and Depression Clinic 4 consumers Youth and Young Adult Services Full Service Partnership Program 1 consumer Brawley Integrated Care 2 consumers During this timeframe, seven TESS consumers were provided linkage to receive an Initial Intake Assessment and were screened out due to not meeting medical necessity criteria. From the 87 TESS Program admissions, 35 did not complete linkage to mental health services through the ICBHS Adults Division. Contributing factors were the consumer declining/refusing outpatient mental health treatment (nine); non-compliance to treatment (nine); consumers relocating to other counties (six); or unable to make contact with consumer/unable to locate (11). Program Goals and Objectives The TESS Program s goals and objectives for are to reduce disparities in services provided to individuals residing in racially and ethnically diverse communities; reduce homelessness, hospitalization, incarcerations, and stigma associated with mental illness; increase collaboration the level of engagement in racially and ethnically diverse communities; and strengthen the local communities capacity to identify target populations and to promote their inclusion in the mental health service delivery system. The data will be collected by tracking and monitoring the following: The number of cases successfully linked to the clinical teams/full service partnership programs. The number of consumers re-hospitalized within a 30-day period. The number of consumers re-admitted to the Crisis and Referral Desk in a 30-day period. The number of consumers receiving referrals to the Homeless PATH services. The number referrals to community-based services Page 38

42 Prevention and Early Intervention Imperial County Behavioral Health Services The intent of Prevention and Early Intervention (PEI) programs is to move to a help first system in order to engage individuals before the development of serious mental illness or serious emotional disturbance or to alleviate the need for additional or extended mental health treatment by facilitating access to supports at the earliest signs of mental health problems. To facilitate accessing services and supports at the earliest 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 providers, education facilities, community organizations). Mental health becomes part of the wellness for individuals and the community, reducing the potential for stigma and discrimination against individuals with mental illness. Trauma-Focused Cognitive Behavioral Therapy Program The initial PEI Plan for Imperial County was approved by the Mental Health Services Oversight and Accountability Commission in This plan entailed three different strategies, the Nurturing Parenting Program for prevention services, and the Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) and the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Program for early intervention services. The initial plan proposed to evaluate services provided under the Nurturing Parenting Program, however, after three years of implementation and given the decrease in funding under PEI, it was decided to discontinue this program and to only continue with the two programs under early intervention for children, youth, and older adults exposed to trauma. In 2013, it was decided to no longer continue with PEARLS due to the limited number of qualifying individuals and low number of referrals from partner agencies. TF-CBT is the only program that is currently being implemented under PEI and it has been modified to include both prevention and early interventions components. Prevention The prevention component utilizes a universal strategy that addresses the entire Imperial County population focusing on providing outreach and educating on the effects of trauma and the importance of identification and early intervention. Prevention services are delivered to large or small groups in health fairs, career fairs and school presentations, etc., without any prior screening of attendance for mental health treatment. These preventative activities are provided by licensed or master level clinicians and a mental health rehabilitation technician. Other outreach and prevention services include individual discussions with school personnel, distribution of informational flyers in community events, articles on local magazines, and radio shows on ICBHS weekly radio show program Let s Talk About It. The presentations incorporate topics such as effects of trauma, bullying, anxiety, and depression in children and youth, respectful behaviors and empathy, as well as available resources. Prevention activities are universal and intended for all community members. Although a number of attendees have been collected in small groups, it has not always been possible to obtain specific numbers of attendees participating in larger groups such as those participating in school rallies or health fairs, or listening to the radio show, and therefore we are unable to determine how many people have participated in prevention activities and what the cost is per individual. Outreach activities have been conducted in pre-school programs, elementary schools, junior high schools, and community events, such as health fairs, the Annual Children s Fair, and career fairs. Prevention activities focus on providing education on the effects and symptoms related traumatic experiences. The interventions attempt to bring awareness to community Page 39

43 members on issues commonly experienced by children who have experienced trauma, such as poor self-esteem, difficulty trusting others, mood instability, and self-injurious behaviors, including substance abuse. Clinicians are culturally competent and flexible to meet the unique needs of children, youth, and parents by providing services in non-traditional settings such as schools, community centers, family resources centers, or the individual s home. Approximately 15% of staff time is dedicated to prevention activities and it is projected that this same percentage will continue for the next three years. For FY through FY , the program is expected to continue providing prevention and outreach services using the universal prevention strategy in order to educate and inform Imperial County residents of the effects of trauma and the importance of identification and early intervention in efforts to decrease the development of serious mental illness. Early Intervention The TF-CBT Program utilizes TF-CBT as the intervention to treat children and adolescents, ages 4 to 18, who have been exposed to a traumatic experience. This therapy model is being implemented as an early intervention activity aiming to prevent mental illness from becoming severe and disabling. TF-CBT was designed to help children, youth, and their parents overcome the negative effects of traumatic life events such as child sexual or physical abuse; traumatic loss of a loved one; domestic, school, or community violence; or exposure to natural disasters (earthquakes), terrorist attacks, or war trauma. TF-CBT incorporates cognitive and behavioral interventions with traditional child abuse therapies that focus on enhancement of interpersonal trust and empowerment. During the past three years, July 2011 through February 2014, the TF-CBT Program has assessed 277 children and youth, of which 232 met criteria for services under PEI. 45 children and youth assessed met criteria for Specialty Mental Health Services and were referred by the assessing clinician to the ICBHS Children and Adolescents Outpatient Clinic for mental health treatment. The proposed staffing for the TF-CBT Program was two full-time clinicians and one mental health rehabilitation technician; however, due to staffing turnover, the program has not been fully staffed at all times, which has affected the number of individuals served. This program has been very successful in regard to its need and support by community partners. The program has always had constant referrals and at times developed a waiting list, causing delays in providing needed interventions to identified children. Based on the number of children and youth served, the estimated cost per person during the past three years averages to $6, This cost includes therapy sessions conducted by master level clinicians, as well as rehabilitative, linkage and referral services by the mental health rehabilitation technician to the child/youth and parents/legal guardians. For, it was proposed to increase staffing by one additional clinical position to meet the demand of this program. The program is expected to have 3 FTE Page 40