County of San Diego BEHAVIORAL HEALTH SERVICES DIVISION

County of San Diego BEHAVIORAL HEALTH SERVICES DIVISION ADULT / OLDER ADULT BEHAVIORAL HEALTH SYSTEMS OF CARE Older Adult BHS SOC Council La Jolla Room 3255 Camino Del Rio South San Diego, CA 92108 Wednesday, February 19, 2014 1:00 2:30 pm Minutes + = Members in Attendance / = Absent / E = Excused ** Council Chair * Chair-Elect Agency 2/19 Council Member 2/19 Alternate Council of Community Clinics / Primary Care Adelman, Marty Aging & Independence Services / APS Alire, Chris + Nancy Garcia-Drew Sharp Mesa Vista Hospital E Atterton, Caroline Dara Schwartz CRF - Senior IMPACT FSP E Boyle, Troy + Nicole Loebach Family Member E Brummer, PhD Mary Ann Telecare Corporation Celnar, Martin Anna Ennis CHIP/University of California, San Diego + Covell, MD, Ruth Bob Brooks San Diego Psychological Assn + Dellefield, PhD, Ken Hugh Pates Older Adult Coalition + Disner, Burton Behavioral Health Services Housing Council Fyer, Jane Liz Kruidenier UPAC + Hajek, Agnes Fukiko Miyagi Universities SDSU + Harris, PhD, Olita Universities UCSD + Hayes, Jerrilyn Danielle Glorioso NAMI San Diego / Family Member Jaccard, Shannon + Annie Dunlop Universities UCSD Koh, MD, Steve + Rae Ann Miller Neighborhood House Project Enable Friendship + LeGardy, La Rita Alexandra Henley Clubhouse Family Member + Luton, Karen Consumer Advocate - CCHEA Neidenberg, Carol Mary Jo O Brien Consumer Advocate / Recovery Innovations + Opsal, Sandy Senior Community Centers + Piwowarski,* Maureen Jewish Family Service Patient Advocacy Purdy, Brittany Mike Phillips County of San Diego, HHSA + Rosengarten, MS, MPH, Ian Paul Ellingsen Healthy San Diego Health Plans E Scolari, George Rogelio Lopez Behavioral Health Education & Training Academy + Scott, Kellie TBD (BHETA) OptumHealth + Thompson, Joyce Kristie Tokar Mental Health America of San Diego County + Watson,** Daphyne Sue Olivier County of San Diego, HHSA E West, LCSW, Virginia Mental Health Board Vacant + Tom Behr CCICS/CADRE Representative Vacant E Rosalind Corbett Behavioral Health Services Staff in Attendance Aguirre, Alfredo, LCSW - Director, Behavioral Health Services Division; Garcia, Piedad, Ed.D., LCSW - Assistant Deputy Director, Adult/Older Adult BHS Systems of Care; Toroshinia Kennedy, MHSA-PEI; Paul Ellingsen, Q.I.; and Diane Layton, BHS/Adult/Older Adult SOC. 1

Others in Attendance Anabel Kuykendall, AIS I. Welcome & Introductions meeting was called to order at 1:10 pm Daphyne Watson, Chair, called the meeting to order, welcomed members, stakeholders, and guests, and then requested introductions. II. Public Comment - None III. Review and Approval of the November 20, 2014, minutes Approval of the January 15, 2014, minutes and the December 12, 2013, Annual Retreat meeting notes were moved, seconded, and passed unanimously. IV. Chair s Report Daphyne Watson, Chair Ruth Covell discussed the data on a table near the summary pages of a statewide, 48-page report on reducing disparities ( Evaluating the Impact of the Mental Health Services Act on Reducing Disparities in Access, Principal Investigator: Sergio Aguilar-Gaxiola, M.D., Ph.D. - Professor of Clinical Internal Medicine, Director, Center for Reducing Health Disparities) and will email to the group. Action Item(s): Send your comments, if any, to Diane to be forwarded to Dr. Covell. V. Behavioral Health Director s Report Updates Alfredo Aguirre Alfredo reported that the MHSA staff will soon be reporting on the new, 3-year plan, the new Innovations concepts, and associated upcoming activities. Alfredo said a large part of the budget planning is centered on the Mental Health Services Act (MHSA) and the Affordable Care Act (PPACA). BHS is being conservative with estimates of the ACA coverage and any possible impacted revenues, while attempting to capture as much mental health realignment funding as possible. A. Current AOD Activities for the Older Adult Population Drug Medi-Cal services are being expanded to serve the increasing number of eligible individuals. Some issues remain; for example, Drug Medi-Cal currently covers only screening, assessments and group treatment but neither individual treatment (except for crisis visit) nor case management is covered. There are general provisions for ADS in commercial health plans; however, the federal parity law does not apply to CMS regarding Medicaid coverage. The County of San Diego is more robust except for Drug Medi- Cal and is hoping for federal laws which will include Drug Medicaid parity. B. Relationship of such activities to ACA/Medi-Cal One thing that relates to the ACA is Drug Medi-Cal re-certification. There are currently problems around compliance with direct providers with the State. There was a CNN exposé which revealed gross misuse of federal funds in California, but not in San Diego. http://www.cnn.com/2014/01/10/us/california-rehab-oversight/ http://cironline.org/reports/medi-cal-agency-overhaul-drug-rehab-program-after-critical-audit-5777 An overreaction in Sacramento to the CNN exposé has resulted in problems for providers who have submitted certification applications resulting in denials for incomplete applications with instructions to submit again often with wait times of two months to hear back. 2

Services provided under Drug Medi-Cal include: screening, assessment, and treatment which includes behavioral therapy and residential services. Imagine if primary care doctors are required to do screening for recovery services at residential centers but cannot get Medi-Cal certification for payment. Alfredo mentioned recent meetings with Public Safety and Probation Department officials regarding court ordered services such as identifying the co-occurrence of AOD and MH issues in jails and prisons. Those incarcerated at County of San Diego jails can be signed up for health coverage and will have a medical home. Health plans will cover needs of Older Adults such as mild-to-moderate dementia and will fall under health plans and not under Medi-Cal specialty mental health. C. Progress on Integration of AOD and Mental Health Alfredo and Piedad described the on-going CADRE/CCISC* training for providers who then take back these learned skills, to their agencies, for training others to better treat clients with co-occurring conditions. * COMPREHENSIVE, CONTINUOUS, INTEGRATED SYSTEM OF CARE, By Kenneth Minkoff, MD The Comprehensive, Continuous, Integrated System of Care (CCISC) model for organizing services for individuals with co-occurring psychiatric and substance disorders (ICOPSD) is designed to improve treatment capacity for these individuals in systems of any size and complexity, ranging from entire states, to regions or counties, networks of agencies, individual complex agencies, or even programs within agencies. http://www.zialogic.org/ccisc.htm Tom Behr noted that Alfredo is working toward integrating the MH Board and ADS Advisory Board into one Behavioral Health Advisory Board. The integration committee is comprised of three (3) people from each board and the goal is to have a combined board by January 2015. Then the newly combined Behavioral Health Advisory Board will be seen as a model for the state. Piedad added that both the AOD and MH programs contract billing tools and forms are in the process of being standardized to create the most efficient billing practices for BHS staff, contractors, and clinicians. D. Role of CMH and Other County-Run Clinics in Relation to ACA/Medi-Cal As people (other than those already served) become eligible for ACA and are referred for care, will there be other individuals who will not be effectively served? There is a plan to include Psychiatric Nurse Practitioners to assist with the psychiatrist shortage. Fifteen percent (15%) of clients who meet low-to-moderate levels on MORS scores will be linked with and referred to primary care providers for services. If revenues become available, then monies can be added to contractor funding to mitigate increased demands. VI. Adult/Older Adult SOC Updates Piedad Garcia A. Impact of No Additional Psychiatric Emergency Response Team (PERT) Funding There are currently approximately twenty (20) local PERT teams. San Diego was not successful in receiving additional funding to increase this number. Other counties have zero PERT teams. The wait continues for capital facilities monies from a grant application for brick-and-mortar funds for the proposed North Inland START program. B. Number of Older Adults Served by In-Home Outreach Team (IHOT) The number of Older Adults served by IHOT was addressed by Virginia at the December OAC Retreat meeting. From January through June 2013, one hundred (100) clients and family members (11% were Older Adults) were served in Central, East, and North Coastal regions. 3

Senior Outreach Teams, imbedded in outpatient clinics around the county, link many services to Older Adults. In addition to the Senior Outreach Teams, AIS has Geriatric Specialists outreach staff; and there are also clinic-based services for Older Adults. The goal of Behavioral Health Services (BHS) is to increase the number of Older Adults receiving care by 5% annually. Action Item(s): Piedad will continue to impress upon participants at the collaborative level the issue of care coordination and communication. C. Update on Clinic Waitlist/Time to See Clinician (January Action Item) Despite the shortage of psychiatrists, the average wait time for psych assessments is 4.9 days in the Central region and 11 days in the North Inland region. Both are well within the 30-day standard for routine assessment and care. These wait-time averages are from combined routine and emergent/urgent data. Action Item(s): Piedad will take the question about imbedding Probation Officers into existing PERT teams to the Probation Department. VII.Substance Abuse Screening: What the County is doing related to AOD - George Scolari, BH Program Manager, Community Health Group George was unavailable to report. VIII. MHSA Update Including Innovations Adrienne Yancey Toroshinia Kennedy presented in Adrienne s absence. Last month s discussion centered on how Innovations will be integrated into the new, 3-year plan. The next step is to get Council members input during the Community Planning Process (CPP). Adrienne is requesting a 45-60 minute portion of the March meeting agenda to discuss the three key MHSA components (CSS, PEI, and CF/TN) and to gather input for the 3-year plan. A 30-day public review plan will be open before the plan is taken to the Board of Supervisors (BOS) in September for approval. Of the 76 ideas presented, eleven (11) of the submitted Innovation (INN) concepts met State-required criteria. The MHSA team will come back in April for an expanded discussion on INN. Action Item(s): Daphyne is a resource for community, grassroots groups input and will send info to Adrienne and Toroshinia. IX. Annual Report-Central and North Central Regions-Older Adult Activities Cecily Thornton-Stearns, MFT, Mental Health Program Coordinator (handout) Family Health Centers of San Diego ADS - Gay, Lesbian, Bisexual, Transgendered (GLBT) Program is an Alcohol and Drug Services program which provides non-residential alcohol and other drug (AOD) treatment, recovery, ancillary, and supportive services targeting Gay, Lesbian, Bi-sexual, and Transgender (GLBT) adults. In addition, enrolled clients who voluntarily disclose their status as Human Immunodeficiency Virus (HIV) positive are eligible for special early intervention case-work (ICW) services. The program supports clients in their efforts to be alcohol and drug free, as well as addressing and identifying serious health issues. From 2012 2014, the program has served seven clients over 60 years old. 4

START Programs provide a voluntary hospital alternative, in a home-like environment, for adults in acute psychiatric crisis and those who may also have co-occurring substance abuse. CRF Jary Barreto 13 OA (7%) CRF New Vistas...15 OA (7%) CRF Vista Balboa.7 OA (3%) Outpatient Behavioral Health Programs * UCSD Gifford Clinic.......177 (15%) * Neighborhood House Assn. Project Enable... 35 ( 7%) COSD North Central Mental Health.......203 (17%) CRF Douglas Young Center........59 ( 7%) CRF Areta Crowell Center............77( 9%) Family Health Centers Logan Heights.........9 ( 6%) UCSD Co-Occurring Disorders Program......1 ( 0%) COSD Southeast Mental Health......33 (12%) * CRF Jane Westin Center..........49 ( 4%) Deaf Community Services..........2 ( 9%) Union of Pan Asian Communities....154 (19%) *Denotes Walk-in urgent screening services Clubhouse Older Adults Served Corner Clubhouse.161 (42%) The Meeting Place 54 (31%) 3 Friend to Friend 53 (61%) Eastwind Clubhouse.120 (75%) Friendship Clubhouse.55 (35%) Discovery Clubhouse.. 23 (23%) Outreach and Education Services for Older Adults Neighborhood House Association-Project Enable, UPAC Mid City BPSR and Community Research Foundation- Douglas Young Center have dedicated Geriatric Specialists who respond to referrals of seniors in crisis from a variety of sources, including the APS reporting line, family members and the community. They provide or arrange services to older adults who may be unable to seek assistance via traditional methods. Services include outreach; psycho-education; short term counseling and case management; and linkage to other ongoing services. Since July 1, 2013, two hundred and two (202) older adult clients have been served (NHA/Project Enable: 58 clients; DYC: 90 clients; UPAC : 54) X. Committee Reports No reports were given and no committee meetings were held today. XI. Housing Council Update Liz Kruidenier Ruth Covell, Housing Council member, stressed the foremost thing needed is for more housing money to become available. As the population increases so will allocations to FSPs. Action Item(s): Ruth recommended advocating for a strong housing plan to be included in the MHSA 3-year plan. 5

XII. Announcements SAVE THE DATE: Creating a Safe and Caring Community - Thursday, June 12, 2014-8:30 AM to 2:30 PM Board of Supervisors Chairwoman Dianne Jacob and Supervisor Greg Cox are hosting the Aging Summit, coordinated by Aging & Independence Services (AIS), with the goal of bringing forward relevant and timely topics in the field of aging. If you have additional questions, please call Chris Boyer at (858) 514-4652 February OAC Meeting Minutes are now posted on the Network of Care: http://sandiego.networkofcare.org/mh/content.aspx?cid=861 XIII. Public Comment None The meeting adjourned at 2:36 pm. Next Meeting: Wednesday, March 19, 2014 1:00-2:30 pm La Jolla Room 3255 Camino Del Rio South, San Diego, CA 92108 Parking Lot: A. Tech Plan B. Personal/Electronic Health Records (EHR) C. Update of Telepsychiatry Use D. Homeless-Underserved-Legal Project E. Dual Eligible F. Care Coordination (Sept 2014) 6