MARIN BEHAVIORAL HEALTH AND RECOVERY SERVICES Department Update P R E S E N T E D B Y : S U Z A N N E T A V A N O, P H D B E H A V I O R A L H E A L T H A N D R E C O V E R Y S E R V I C E S D I R E C T O R M A R I N C O U N T Y H E A L T H A N D H U M A N S E R V I C E S 20 North San Pedro Road, Ste 2028 San Rafael, CA 94903 415 473 3696 T / 415 473 3344 F
Update on Key and Initiatives Homeless Outreach Team Pilot Community Crisis Response Teams Crisis Stabilization Unit Drug Medi-Cal Waiver Implementation Road to Recovery Chronic Inebriate Project Access Team AB1421 Update Slide 2
Homeless Outreach Team (HOT) Pilot I N I T I A T E D F E B R U A R Y, 2 0 1 6 Focused on homeless individuals in downtown San Rafael Based on evidence-based practices of: o individualizing solutions to homelessness o Providing wrap-around services Outcomes: 13 clients engaged o Those clients were housed 64% of the time in a variety of settings Two are permanently housed, Six in temporary residential services Decreased police contacts and medical transports for the highest utilizer of each of these services Initiating use of structured screening tool to prioritize outreach efforts Slide 3
BHRS Consumer Voices C O N S U M E R S A T I S F A C T I O N S U R V E Y : M A Y 2 0 1 6 No available housing in Marin Co. Very difficult for my social worker and myself. I wish I can find housing sooner. A low income housing. I wish I can afford this housing. Thank you very much. Slide 4
Residential Update Adult Transitional Housing: o Contracting with Progress Foundation for a 10-12 bed therapeutic transitional housing for adults: length of stay up to one year California Housing Finance Agency (CalHFA): o BHRS submitted forms to the State requesting return of housing funds; working to identify a project for permanent housing No Place Like Home: o Work groups are forming o Supervisor Connolly sits on the Technical work group o California Behavioral Health Directors' Association (CBHDA) will have one seat on the Advisory group Slide 5
Community Crisis Response Teams R E S P O N D I N G T O T H E C O M M U N I T Y T MCR O&E Transition Team Short-term (60 day) case management to stabilize and connect individuals with ongoing services Mobile Crisis Response Team Responds to mental health/substance use crises in the community seven days/week Outreach & Engagement Team Supportive outreach to individuals not engaged in services and to their families/friends Slide 6
Community Crisis Response Teams T 1,013 MCR O&E O & E: Launched February, 2015: served 158 clients with 599 encounters Transitions: Since March, 2015: served 312 clients with 2,171 encounters MCR: Since July, 2015: served 543 clients with 1,186 encounters 82% of the contacts initiated by community members or community entities Since the June BOS update, the teams have served 259 new individuals with 937 encounters Individuals Served 3,596 Provided Slide 7
Crisis Stabilization Unit Admissions I N C R E A S I N G A D M I S S I O N S 450 400 404 374 350 300 335 310 335 315 334 295 314 309 297 250 2014 200 2015 150 2016 100 50 0 Q1 Q2 Q3 Q4 Slide 8
Crisis Stabilization Unit R E V I E W O F 3 7 6 A D M I S S I O N S : A P R I L J U N E 2 0 1 6 6% 1% 2% 77% Consented to drug/alcohol screening 22% 32% Marijuana Benzodiazapines Amphetamines Opiates Barbituates Cocaine 53% Tested positive for alcohol or drugs 37% Most frequent drugs: 32% marijuana 37% benzodiazepines 22% amphetamines Slide 9
Psychiatric Hospitalization C R I T I C A L S T A T E W I D E S H O R T F A L L O F P S Y C H I A T R I C B E D S o Demand for inpatient beds projected to increase 17% over FY14/15 o Use of out-of-county hospitals has increased 60% in the past two years 100 90 80 78 81 90 84 70 64 63 67 65 65 68 60 50 40 30 20 10 42 2014 2015 2016 0 Q1 Q2 Q3 Q4 Slide 10
Drug/Medi-Cal Organized Delivery System (DMC-ODS) Waiver The DMC-ODS improves access to and quality of care for Marin Medi- Cal beneficiaries by: o Enhancing Continuum of o Expanding access to and federal Medicaid reimbursement for substance use services not currently covered by the Drug/Medi-Cal program. o Promoting integration and coordination of care with mental and physical health providers o Expanding eligible service providers to include Licensed Practitioners of the Healing Arts (e.g. Licensed Clinical Social Workers, Licensed Marriage and Family Therapists) Slide 11
DMC-ODS Waiver: Key Elements Coordination with Managed Care to Ensure Integrated Care o Memoranda of Understanding (MOUs) among Medi-Cal managed care plans Access and Authorization o 24/7 Toll free Access number and authorization for residential services Utilize Evidence Based Practices (EBPs) o Implement at least two of the identified EBPs and monitor fidelity County Oversight, Monitoring and Reporting o Provide quality improvement, utilization management and outcomes reporting Selective Provider Contracting o Procedures for selecting and retaining providers o Ensure availability and accessibility of required services Slide 12
Drug/Medi-Cal Organized Delivery System (DMC-ODS) Waiver o Enhanced Continuum of includes: Outpatient Treatment (General and Intensive) Case Management Medication Assisted Treatment Recovery Withdrawal management (at least one level) Residential Treatment (any size) Physician Consultation In September, 2016 BHRS hired a board-certified psychiatrist specializing in Addiction to guide development of the new treatment delivery system. Slide 13
State Plan DMC (Current) vs DMC- ODS Waiver Slide 14
Preparation for the DMC-ODS Expansion and Integration In CY 2015 and CY 2016, eight agencies submitted applications to the State to provide D/MC services as part of the DMC-ODS Waiver New Programs Launching in FY 2016-17 Status Intervention for Older Adults Implemented in September 2016 Additional Medication Assisted Treatment Hired Addiction Psychiatrist in October 2016 Outpatient Treatment for Adults with Co-Occurring Substance Use Disorders and Serious Mental Illness Adolescent Partial Hospitalization and Residential Substance Use Treatment Opening November 2017 Opening pending State licensure/certification Slide 15
BHRS Road to Recovery Drug/Medi-Cal certified county-operated outpatient clinic to provide services for individuals with co-occurring Serious Mental Illness and substance use disorders: Planned Opening: November 7, 2016 Slide 16
Chronic Inebriate Project Consultant-facilitated public policy/problem-solving process o Goals: Bring together key stakeholders Design a system focused on helping those with a pattern of chronic alcohol use and repeated criminal justice system contacts Implement a system featuring: Alternative sentencing Harm reduction-based treatment models Medication Assisted Treatment (Vivitrol) Slide 17
BHRS Access Team Relocated to 250 Bon Air to increase collaboration with the Crisis Stabilization Unit and Community Crisis Response Teams to promote voluntary service entry Initiating Walk-In Access Pilot: o Walk In assessments start November 1, 2016 on: Wednesdays 9:00 am to 2:00 pm Fridays 9:00 am to 12:00 pm Monthly: 750-1,000 Calls 150 Screenings 60 Assessments (capacity) Slide 18
If you or a loved one is in need Help is Available 24/7 O U R 3 C R I S I S T E A M S H A V E R E S P O N D E D T O C A L L S F R O M 2 5 0 + F A M I L Y A N D F R I E N D S Access Line (888) 818-1115 Psychiatric Emergency (415) 473-6666 Mobile Crisis Response Team (1 pm - 9 pm/7 days a week) (415) 473-6392 www./mhsus Slide 19
BHRS Consumer Voices C O N S U M E R P E R C E P T I O N S U R V E Y, M A Y 2 0 1 6 The STAR Program in Marin should be adopted everywhere in the State. The one-stop service hotel and peer groups are really good. Odyssey is a good company caring. Thank you. Thank you for All the Help. Marin County agencies Rock! Slide 20
AB1421 Update Monitor outcomes of implementations around the State Monitor emerging evidence in the scientific literature Continue to expand evidence-based programs Provide full update in February, 2017 as requested by the Board Slide 21
Recommendations Provide responsive, high quality care to our most vulnerable consumers: o Ensure access to timely hospital care o Provide access to permanent housing o Increase hours of operation of Community Crisis Response Teams o Expand capacity of Full Service Partnerships Slide 22
20 North San Pedro Road, Ste 2028 San Rafael, CA 94903 415 473 3696 T / 415 473 3344 F Thank You