Accessibility, Utilization, and Availability of Services

Accessibility, Utilization, and Availability of Services Section I Introduction and FY 16-17 Report prepared by: Janet Henry, IMF, AAII September 25, 2016

TABLE OF CONTENTS GENERAL Section Number Section Title Pages I 1-18 II Adult Services.. 1-67 III Children Services. 1-76 IV Youth and Young Adults. 1-56 V Crisis and Engagement Services.. 1-20 VI Fee-For-Service. 1-13 VII Substance Use Disorder Services. 1-32

SECTION I INTRODUCTION AND MHP OVERVIEW TABLE OF CONTENTS Executive Summary Introduction. Findings i v vii County Services... 1 5 Access Standards.. 7 Adult Services 14 Children Services.. 15 Youth and Young Adults (Specialized Services).. 16 17 Crisis and Engagement Services. 18 Substance Use Disorders.

Executive Summary The Accessibility, Utilization, and Availability of Services Report for Imperial County Behavioral Health Services provides a comprehensive view of the Mental Health Plan (MHP) from year to year. It provides data on the number of clients/beneficiaries served, the number of services provided by category, the staff available to provide services, and the cultural knowledge of providers in regard to the populations they serve. The analysis is based on a comparison of FY 15-16 with FY 14-15 and includes FY 13-14 data for historical reference. The number projected to seek services is based on the rate of change for the number of beneficiaries served from FY 14-15 to FY 15-16. Due to variances between service groups, the MHP makes projections based on the rate of change for each service group. Included in this year s report is information on Imperial County Behavioral Health Services Substance Use Disorders Services (SUDS). The data reported in the SUDS section is not included with the mental health services in the. Section I provides an overview of the MHP services including the unduplicated number of clients served (Medi-Cal and non Medi-Cal), the number of clients served and the demographic data, and services data by service division for specialty mental health services. A full analysis of accessibility, utilization, and availability of specialty mental health services by service division for FY 15-16, the projections for each for FY 16-17, as well as the services and availability of substance use disorder services are available in Sections II through VI of the report and summarized below. Adult Services Adult Services provides services to individuals over the age of 25. In FY 15-16 the MHP relocated the El Centro Anxiety and Depression Clinic to a larger site with easier access and added full service partnership (FSP) services to the existing services provided at this clinic. This expansion of FSP services increased the availability of services to individuals with anxiety and depression disorders, which broadens the targeted population eligible for FSP services. An analysis of Adult Services indicates the second highest rate of increase among the MHP service divisions with a 7.1% growth in FY 15-16. There was some variance in the number of beneficiaries accessing services with most teams either meeting or exceeding the number of beneficiaries served the previous year; however, only a few teams exceeded the anticipated number of beneficiaries for FY 15-16. The data indicates that there was also some variance in the number of services provided to beneficiaries during FY 15-16. The projected number of mental health i Accessibility and Availability Report FY 15-16 i

services and crisis services were exceeded; however, the projected number of medication education and management and targeted case management services were not met. The availability of staff is anticipated to meet the needs of beneficiaries seeking services from Adult Services during FY 16-17 with two exceptions. The El Centro Anxiety and Depression Clinic is anticipated to need an additional 57 hours per month in nurse time to support the needs of beneficiaries. The El Centro FSP Clinic is anticipated to need an additional 2 hours per month in nurse time to support needs of beneficiaries. Children Services Children Services provides services to individuals through the age of 13. During FY 15-16, Children s Services implemented First Steps to Success Program that focuses on transitioning kindergarten and kindergarten population to promote recovery and resilience that advances mental health. Additionally, the MHP improved access to Children Services in Brawley by moving the clinic to a new and larger location that is separate from the Adults and Youth and Young Adults Services divisions. An analysis of Children Services indicates the lowest rate of increase among the MHP service divisions with a 1% growth in FY 15-16. There was some variance in the number of beneficiaries accessing services; however, the majority of teams did not serve the anticipated number of beneficiaries. The data also indicates that Children Services did not provide the projected number of services to beneficiaries during FY 15-16, although some service categories did exceed the number provided during FY 14-15. The availability of staff is anticipated to meet the needs of beneficiaries seeking services from Children Services during FY 16-17. Youth and Young Adult Services Youth and Young Adult (YAYA) Services provides services to individuals between the ages of 14 and 25. During FY 15-16, YAYA Services completed its first full year of operation of the Brawley clinic, Provider 1381, which houses the YAYA Brawley Anxiety and Depression team and the YAYA Brawley Full Service Partnership team. The improved accessibility of YAYA services in Brawley and surrounding areas resulted in a significant increase in the number of beneficiaries receiving services from these teams, with the number of beneficiaries nearly doubling from the previous year. An analysis of YAYA Services indicates the highest rate of increase among the MHP service divisions with a 19.6% growth in FY 15-16. Most teams exceeded the anticipated number of beneficiaries accessing services in FY 15-16. The data indicates that there was some variance in the number of services provided to beneficiaries during FY 15-16; however, the overall findings indicate that YAYA ii Accessibility and Availability Report FY 15-16 ii

Services did not provide the projected number of services to beneficiaries during FY 15-16. The availability of staff is anticipated to meet the needs of beneficiaries seeking services from YAYA Services during FY 16-17 with two exceptions. The Brawley Anxiety and Depression Clinic is anticipated to need an additional 23 hours per month in psychiatrist time to support beneficiaries needs. The El Centro FSP Clinic is anticipated to need an additional 17 hours per month in nurse time to support beneficiaries needs. The Calexico FSP Clinic is anticipated to need an additional 5 hours per month in nurse time to support beneficiaries needs. Crisis and Engagement Services This group of services includes three specific services: The Crisis Referral Desk (CRD), Transitional Engagement Supportive Services (TESS) Program, and the Assessment Center. The CRD treats individuals who have been determined to need emergency services; the TESS Program provides specialty mental health services to beneficiaries between their release from hospitalization, jail, or the CRD, and assignment to outpatient services with the MHP; and the Assessment Center provides initial assessment services to all adult clients by appointment or on a walk-in basis. An analysis of Crisis and Engagement Services indicates an increase rate of 3% in FY 15-16. The most notable findings in this group are the increase in the number of beneficiaries receiving services in the TESS Program and the decrease in beneficiaries served by the CRD. These variances are reflected in the number of services provided by these units. Further, the CRD has experienced an increase in the number of beneficiaries in the lower age groups and a decrease in the higher age groups. The availability of staff is anticipated to meet the needs of beneficiaries served by this service group in FY 16-17. Fee-For-Service and Organizational Providers The Fee-For-Service (FFS) and Organizational Providers enhance the provider network and offer treatment options to MHP beneficiaries. The network includes contracted and non-contracted providers both in-county and out-of-county. This section reports on incounty, outpatient providers. An analysis of FFS and Organizational Providers indicates a significant increase in the number of beneficiaries seen by these providers in FY 15-16. Data reflects proportionate increase in the number of services provided, although the average number of services per beneficiary decreased. iii Accessibility and Availability Report FY 15-16 iii

Substance Use Disorder Services Individuals with substance use disorders are referred to the MHP s Substance Use Disorder Services (SUDS). These services are available to eligible adults at the Adult ODF Clinic in El Centro and to eligible adolescents at either the Adolescent ODF Clinic in El Centro or one of the 9 satellite sites located in the major population areas of the county. Satellite sites are located on School properties for easy access for participants. Services include group and individual substance use counseling, and coping skills to assist with emotional control and dealing with life situations. An analysis of SUDS indicates a significant difference in the number beneficiaries served by specific sites, as well as in the number of group therapy services from one group to another. The largest difference in group therapy services was between the beneficiaries in the Adolescent ODF Clinic with the average number per beneficiary was 3.7 services and the 30 services per beneficiary in the Calexico High School 9 th Grade (CHS2) group. This is a range of 26.3 services. There was also a difference in the number of services between the adolescent beneficiaries and the adult beneficiaries with adults receiving more group services. The availability of staff is anticipated to meet the needs of beneficiaries in these programs. iv Accessibility and Availability Report FY 15-16 iv

Introduction Imperial County Behavioral Health Services (ICBHS) is the county designated agency to manage the Mental Health Plan (MHP) for Imperial County. ICBHS has created a provider network that includes staff, contract, and fee-for-service providers of specialty mental health services to provide adequate levels of care to meet the needs of the Medi-Cal beneficiaries of Imperial County. As the MHP, ICBHS is required by contract with the Department of Health Care Services (DHCS) to ensure the availability and the accessibility of personnel to provide medically necessary services. The purpose of this report is to evaluate the following areas in order to ensure the contracted requirements are met: 1. Anticipated number of Medi-Cal beneficiaries. 2. The expected utilization of services, taking into account the characteristics and mental health needs of the beneficiaries of the county. 3. The expected number and types of providers in terms of training and experience needed to meet expected utilization. 4. The number of contract providers not accepting Medi-Cal beneficiaries. 5. The geographic location of providers considering distance, travel time, means of transportation ordinarily used by Medi-Cal beneficiaries, and physical access for disabled beneficiaries. The anticipated number of Medi-Cal beneficiaries seeking services at ICBHS facilities is determined by using the percentage of change in Imperial County Medi-Cal population and applying that percentage to each program. The average caseload per month is determined by multiplying the average caseload per month for FY 15-16 by the rate of change. Due to changes in the reporting of data from state sources in recent years, the MHP has determined to utilize rate of change in the number of beneficiaries served from one fiscal year to the next. The rate of change for this report was calculated by determining the difference between the number of beneficiaries served from FY 14-15 to FY 15-16 based on data from the MHP s data system, Avatar, and dividing that difference by the number of beneficiaries served in FY 14-15. The overall rate of change for the MHP was determined to be a 6.1%, which will be used only in the and the Fee For Service Organizational Provider Sections of this report to project the anticipated number of Medi-Cal beneficiaries, services and staffing for FY 16-17. The rate of change in all other sections is determined using the numbers for each specific section to make the projections. The rates by section are: Section II Adult Services 7.1%; Section III Children Services 1%; Section IV Youth and Young Adult Services (YAYA) 19.6%; Section V Crisis and Engagement Services 3%; and Section VI Fee-For-Service Providers 6.1%. Section VII is a new section (Substance Use Disorders Services [SUDS]) in the FY 16-17 report and does not provide projections due to the lack of history on which projections are based. The anticipated utilization of services is based on the utilization of services in FY 15-16 and the average number of contacts for each type of service for the same period. The methodology is multiply the anticipated number of Medi-Cal beneficiaries by the average number of contacts for each service type for FY 15-16. The results are the expected utilization of service for FY 16-17 by category of service. The number of hours available for each staff is based on the number of hours available at v Accessibility and Availability Report FY 15-16 v

specific site(s) in FY 15-16. The combined full-time equivalent of staff assigned hours by discipline is used to calculate the availability of staff by discipline by team or program. Information provided on the availability of staff to meet the needs of Medi-Cal beneficiaries is based only on direct service providers by team and program. The direct service providers available to meet the service utilization of the anticipated Medi-Cal beneficiaries in FY 16-17 are described in detail in each team or program section. Staff ethnicity, cultural competence and linguistic capabilities are identified in an effort to ensure that staff has the cultural and linguistic competence to provide services to the program s target population. Using a survey method, information was collected from staff regarding ethnicity, ability to communicate in other languages, and knowledge of other cultures through a direct survey. Each staff member was requested to complete the survey according to his or her perception of knowledge and awareness. Information in this report is based on the number of surveys completed and returned to the Quality Management Unit. County Services are discussed in seven sections: (1) Introduction and ; (2) Adult Services, including the outpatient clinics, Family Resource Centers, Anxiety and Depression clinics, and Full Service Partnership (FSP) programs; (3) Children Services, including outpatient clinics, Family Resource Centers, the Vista Sands Program, the Prevention and Early Intervention Trauma-Focused Cognitive Behavioral Therapy Program (PEI TF-CBT), and the First Steps to Success program (FSS); (4) Youth and Young Adults (YAYA) Services, including Anxiety and Depression clinics, FSP programs, and the Adolescent Habilitative Learning Program (AHLP); (5) Crisis and Engagement Services, which includes the Crisis Referral Desk, Transition Engagement Supportive Services (TESS) Program, and the Assessment Center; (6) Fee-For-Service providers; and (7) Substance Use Disorder Services. Individual team/program information is identified and discussed under one of these sections of the County Services. vi Accessibility and Availability Report FY 15-16 vi

Findings for MHP The general findings for the MHP indicate a lower rate of change in the number of beneficiaries served in FY 15-16 than in the previous year, with a few teams or programs experiencing a decrease in the number of beneficiaries served. These decreases are a reflection of the difference between the rate of change for FY 15-16 Report which was 13.4% and the 6.1% rate of change used for this report. Although there were increases in the number of beneficiaries served from the previous year, the number of services did not increase proportionately across the MHP in all categories in all teams/programs and most service categories did not meet the projection as seen in Figure 1.9. The category of therapy services was the only service category to exceed the projection in FY 15-16; there were 4% more therapy services than projected for FY 15-16. Three categories did not meet the projections, but did exceed the numbers from the previous year: mental health services had 7% more; medication support had 6% more; and crisis intervention had less than 1% more than the previous year. Targeted case management was the only category to fall below the number provided the previous year - 26% less in FY 15-16 than in FY 14-15; this was 1,037 beneficiaries compared with 1,393 beneficiaries. The availability of services provided by the MHP meets the needs of the population served with few exceptions. These exceptions are: Adults Services, nurse time in the El Centro Anxiety and Depression Clinic and the El Centro FSP Clinic. YAYA Services, psychiatrist time in the Brawley Anxiety and Depression Clinic, and nurse time in both the El Centro FSP and the Calexico FSP clinics. vii Accessibility and Availability Report FY 15-16 vii

viii Accessibility and Availability Report FY 15-16 viii

COUNTY SERVICES As the MHP for Imperial County, ICBHS provides services in a rural area that extends over 4,579 square miles, located in the southeast corner of California. The county extends from the Colorado River on the East to the San Diego County line on the West, and from the International border with Mexico on the South to Riverside County on the North. The incorporated cities of Brawley, Calexico, Calipatria, El Centro, Holtville, Imperial, and Westmorland are the most heavily populated areas in the county. Although residents in the more populated areas can easily access ICBHS services, those in the less populated, outlying areas may face time and distance barriers when accessing services. Making services readily accessible to residents in these remote, outlying areas has been part of ICBHS strategy in planning and establishing service sites. During FY 15-16, the MHP continued the expansion of mental health services throughout the area by moving the El Centro Adult Anxiety and Depression clinic to a larger and more convenient location and adding a separate clinic in Brawley for children. The location of each provider is illustrated in Figure 1.1. Figure 1.1. Imperial County Medi-Cal Certified Provider Sites 1301-CAOS 1351-ICBHS Central Services 1359-Brawley Outpatient Clinic 1366-El Centro Outpatient Clinic 1335-Vista Sands Program 1363-El Centro FRC 1376-Brawley Integrated Clinic 1356- Youth and Young Adult 1379-Adult Brawley RCP/OP Clinic 1 st Flr. Menvielle Building 1381-Youth and Young Adults 1332-Vista Sands Program Brawley Clinic 1338-AHLP 1384-Brawley Children and 1329-Youth and Young Adult Adolescent Outpatient Clinic 2 nd Flr Menvielle Building 1373-El Centro CAOS 1382-Adult El Centro Anxiety and Depression Clinic 1364-San Pasqual FRC The provider sites include outpatient clinics 1350-Calexico (Team Centers FRC and Family Resource Centers Winterhaven 1334-Vista Sands Program 1375-Calexico Integrated Clinic Mexicali The provider sites include outpatient clinics (Team Centers and Family Resource Centers [FRC]) for children and adolescents and/or adults, integrated clinics for adults, full service partnerships, school-based socialization programs (Vista Sands), a school-based habilitative 1 Accessibility and Availability Report FY 16-17 1

learning program for adolescents (AHLP), Youth and Young Adults services, and assessment and crisis services. The 20 Medi-Cal certified MHP Provider sites are listed by provider number, name and address in Table 1.1. Table 1.1. Provider List and Address Provider Provider Name Provider Address 1301 Children and Adolescent Outpatient Services 1329 Youth and Young Adult Services (YAYA) 2 nd Flr Menvielle Building 120 North Eighth St. El Centro, CA 92243 1295 State Street El Centro, CA 92243 1332 El Centro Vista Sands 1530 Waterman Ave El Centro, CA 92243 1334 Brawley Vista Sands 1401 B Street Brawley, CA 92227 1335 Calexico Vista Sands 2300 Rockwood Avenue Calexico, CA 92231 1338 AHLP (Adolescent Habilitative Learning Program) 1001 Brighton Ave El Centro, CA 92243 1350 Calexico Family Resource Center 604 W. Birch St. Calexico, CA 92231 1351 ICBHS Central Services (Crisis, TESS, Assessment Center) 1356 Youth and Young Adult Services (YAYA) - 1 st Flr Menvielle Building 202 North Eighth St. El Centro, CA 92243 1295 State Street, El Centro, CA 92243 1359 Brawley Outpatient Clinic 220 W. Main St., Ste 201,203 Brawley, CA 92227 1363 El Centro Family Resource Center 1027 North Eighth St. El Centro, CA 92243 1364 San Pasqual Family Resource Center 676 Baseline Road Winterhaven, CA 92283 1366 El Centro Outpatient Clinic (MHSA RCP, Adult Dual Diagnosed Program) 1373 El Centro Children and Adolescent Outpatient Services 1375 Calexico Integrated Clinic Closed January 2016 1376 Brawley Integrated Clinic Closed February 2016 1379 Adult Brawley RCP-OP Clinic/Recovery Center 2695 South Fourth Street El Centro, CA 92243 801 Broadway El Centro, CA 92243 223 W. Cole Road Calexico, CA 92231 900 Main Street Brawley, CA 92227 205 Main Street Brawley, CA 92227 2 Accessibility and Availability Report FY 16-17 2

1381 Youth and Young Adult Brawley Anxiety and Depression Clinic and FSP 1382 Adult El Centro Anxiety and Depression Clinic 1384 Brawley Children and Adolescent Outpatient Clinic 1535 Main Street Brawley, CA 92227 1699 W. Main Street, Ste. A El Centro, CA 92243 195 S. 9 th Street Brawley, CA 92227 The MHP s outpatient clinics and FRCs are located throughout the county for adults, children and youth and young adults. Each outpatient clinic and FRC has a multidisciplinary group of professionals that provide outpatient specialty mental health services to beneficiaries utilizing a team concept. Each team is composed of a program supervisor, administrative support staff, a clinician, a psychiatrist, a nurse, and mental health rehabilitation technicians (MHRTs). Specific programs are assigned a Mental Health Rehabilitation Specialist (MHRS) as appropriate. The program supervisor oversees daily operations and is responsible for monitoring staff and daily activities. The administrative support staff provides assistance with clerical functions; scheduling appointments and maintaining client records; and recording activities in the information systems, AVATAR. The clinician provides initial intake assessments and therapy. Clinicians are licensed professionals or registered interns in social work or marriage and family therapy; these include licensed clinical social worker (LCSW), associate clinical social worker (ACSW), marriage and family therapist (MFT), and marriage and family therapist intern (IMF), as well as clinical psychologists (PhD). Clinicians assess the mental health condition of the beneficiary, determine medical necessity for services, provide a diagnosis, and make treatment recommendations for the beneficiary. Initial intake assessments are scheduled for 60-90 minutes each and individual psychotherapy appointments are scheduled for 60-90 minutes each. The psychiatrist oversees the physical and mental condition of beneficiaries and prescribes, administers and monitors psychiatric medication(s) consistent with the beneficiary s diagnosis. The psychiatrist provides initial psychiatric assessments (IPAs), which are scheduled for 60 minutes each, and medication support services which are scheduled for 30 minutes each. The nurse provides initial nursing assessments (INAs) and medication support services which include education services, develops and reviews client plans, and monitors treatment progress. INAs are scheduled for 60 minutes each and medication support services are scheduled for 30 minutes each. In addition, the nurse is available to assist the psychiatrist with IPA and medication support services. The mental health rehabilitation technician (MHRT) and the mental health rehabilitation specialist (MHRS) provide specialty mental health services which include rehabilitation, assessment, collateral, plan development, crisis intervention, targeted case management, and Therapeutic Behavioral Services. The MHRS is assigned to programs co-located at school sites, specifically Vista Sands and AHLP, and has the responsibility of lead person in addition to providing specialty mental health services. Information provided on the availability of staff to meet the needs of Medi-Cal beneficiaries is based on direct service staff and is calculated based on full time equivalent (FTE). 3 Accessibility and Availability Report FY 16-17 3

The MHP also has four organizational providers with 2 certified sites, and 2 FFS providers, which are discussed in Section VI. Table 1.2 In-County Organizational Provider List and Address Provider Provider Name Provider Address 1372 CHARLEE Family Care, Inc. 495 E. Orange St. El Centro, CA 92243 1380 Center for Family Solutions 510 Main Street, Suite 106 El Centro, CA 92243 Additionally, the MHP has two Medi-Cal certified clinics and 9 satellite sites where substance use disorder services are provided. These sites are listed in table 1.3 and discussed in Section VII of this report. Table 1.3 Medi-Cal Certified Alcohol and Drug Sites 1303 Adolescent Outpatient Drug Free (ODF) Clinic 1295 State Street, Suites 101-106 El Centro CA 92243 1309 Adult Outpatient Drug Free (ODF) Recovery Center 2695 S. 4 th Street, 2 nd Floor El Centro, CA 92243 1310 Brawley Union High School (Satellite) 480 N. Imperial Avenue Brawley, CA 92227 1311 Calexico High School 1030 Encinas Avenue Calexico, CA 92231 1312 Desert Valley High School 104 Magnolia Street Brawley, CA 92227 1315 Aurora High School 641 Rockwood Avenue Calexico, A 92231 1318 Central Union High School 1001 W. Brighton Avenue El Centro, CA 92243 1319 Calexico High School 9 th Grade 824 Blair Avenue Calexico, CA 92231 1320 Valley Academy School 253 E. Ross Avenue El Centro, CA 92243 1321 Del Rio Academy School 1501 I Street Brawley, CA 92227 1322 Calexico Academy School 813 Andrade Avenue, Rooms A&B Calexico, CA 92231 4 Accessibility and Availability Report FY 16-17 4

Access Standards The Imperial County MHP uses several tracking mechanisms to ensure access standards are met. The Quality Management Unit ensures accessibility is maintained for beneficiaries by monitoring the following areas: Timeliness of routine appointments Access to after-hours care Urgent crisis conditions within one hour of initial contact Responsiveness of the MHP s 24-hour toll free telephone line Timeliness of Routine Appointments Report This report measures the timeliness of routine appointments and is prepared quarterly by the Quality Management Unit. The report provides information from the MHP s Access Log which identifies the date of initial contact with the MHP to request a routine mental health appointment, the date of the scheduled intake appointment and the number of working days between the date of initial request and the date of scheduled intake appointment to determine if the appointment was scheduled with the 7-day standard. This report is presented to the Quality Improvement Committee at least annually. Access to After-Hours Care Report This report measures the beneficiary s access to after-hours care and is prepared quarterly by the Quality Management Unit. The report compares the Access Logs, which identifies the beneficiary s request and access to after-hours care to the Crisis Logs, which identifies contacts as a result of the request made to access staff for after-hours care to determine if access was provided as required. This report is presented to the Quality Improvement Committee at least annually. Timeliness of Services for Urgent Conditions Report This report measures the timeliness of services for urgent conditions within one hour of initial request and is prepared quarterly by the Quality Management Unit. The report compares the date and time of initial request for urgent services on the Access Logs (requests during afterhours, weekends and holidays) and the Tracking Logs (requests during working hours) to the time and date of initial contact for services on the Crisis Logs to determine if services were provided within one hour of initial request. This report is presented to the Quality Improvement Committee at least annually. Responsiveness to the MHP s 24-Hour Toll-Free Telephone Line Report This report measures the responsiveness of the 24-hour toll-free telephone line and is prepared bi-annually by the Quality Management Unit. The monitoring process entails conducting test calls in both English and the MHP s threshold language, Spanish. The test calls, made at random times of the day and days of the week, verifies that the 24 hour toll-free telephone line is in operation 24 hours a day, seven days a week. Test callers also assess the staff s knowledge regarding the types of services available, including services to treat an emergency or urgent condition, hours of operation and accessibility to services. In addition, the Access Logs are reviewed to verify that test calls are logged as required. This report is presented to the Quality Improvement Committee at least annually. 5 Accessibility and Availability Report FY 16-17 5

6 Accessibility and Availability Report FY 16-17 6

Overview of MHP In FY 15-16, ICBHS provided an array of specialty mental health services at 20 Medi-Cal certified sites. Services were provided to a total of 7,058 unduplicated MHP clients. The number of unduplicated clients includes Medi-Cal beneficiaries and non-medi-cal clients. The unduplicated MHP numbers count individuals only one time regardless of how many teams or programs provided services to an individual client/beneficiary; the unduplicated number of individuals by group will collectively exceed the MHP number of unduplicated individuals. In FY 15-16 the unduplicated MHP mental health clients/beneficiaries were: 6,400 Medi-Cal beneficiaries (90.7%) 658 non-medi-cal clients 7,058 Total individuals served The total MHP mental health population is shown by Medi-Cal (MC) and non-medi-cal (NMC) by general service groups in Table 1.2. The group numbers include beneficiaries that may have received services in more than one team/program, but are counted only one time in each team/program in which they received services. Table 1.2. Total Clients by Population Type Divisions/Populations* FY 14-15 FY 15-16 MC % NMC Total MC % NMC Total Total Adults 2,518 90% 281 2,799 2,696 90% 305 3,001 Total Children 2,693 96% 103 2,796 2,703 96% 146 2,849 Total YAYA 1,134 89% 147 1,281 1,363 89% 164 1,527 Crisis and Engagement Services 1,049 72% 409 1,458 1,080 76% 346 1426 Total ALL Individuals Served 7,394 89% 940 8,334 7,842 89% 961 8,803 * The unduplicated numbers reported by Division do not match the unduplicated numbers reported for the MHP, due to movement by clients/beneficiaries between teams and programs during the course of the reporting period. MHP Medi-Cal Totals The combined overall totals for the MHP are included to provide an overview of MHP services. This section provides the total unduplicated individuals served by the MHP for mental health services, as well as the demographic data for the Medi-Cal beneficiaries served in FY 15-16. These are the same demographic data reported by Division in Sections II through V. However, the numbers for the MHP and the total of division numbers will not match due to the movement of clients/beneficiaries and the need to account for all clients/beneficiaries served by individual teams and programs. Individual site/programs data is reported as follows: Section II Adult Services, Section III Children Services, Section IV Youth and Young Adults (YAYA), and Section V Crisis and Engagement Services. Data for the Fee-For-Service providers is found in Section VI. The number of unduplicated Medi-Cal beneficiaries and non-medi-cal clients served by the MHP in FY 15-16 is illustrated in Figure 1.2. The Medi-Cal beneficiaries served by the MHP s Alcohol and Drug Services are illustrated and 7 Accessibility and Availability Report FY 16-17 7

186 336 325 282 200 344 308 312 502 530 439 570 483 693 601 798 1,411 1,258 1342 1482 discussed in Section VII of this report and are not included with the specialty mental health services data in Sections I through VI. Figure 1.2 Medi-Cal Beneficiaries and Non-Medi-Cal Clients Over Time 7,058 FY 15-16 658 6,400 FY 14-15 640 6,002 6,642 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 Total Non-Medi-Cal Medi-Cal FY 15-16 MHP Medi-Cal Population The number of MHP unduplicated Medi-Cal beneficiaries accessing services at the MHP in FY 15-16 was 6,400 or 90.7% of the individuals served by the MHP, compared with 6,002 (90.4%) in FY 14-15. The MHP s Medi-Cal beneficiaries were 82% Hispanic compared with 79% Hispanic the previous year, although less than half of the Hispanic beneficiaries, 35%, identified Spanish as their primary language in FY 15-16 compared with 46% in FY 14-15. The distribution of the Medi-Cal population receiving services at the MHP is shown by age, gender, ethnicity, language, and city of residence in Figures 1.3 through 1.6 and in Tables 1.4 through 1.5. Figure 1.3 MHP Unduplicated Medi-Cal Beneficiary 1,600 1,400 1,200 1,000 800 600 400 200 0 0-5 6-11 12-17 18-20 21-24 25-34 35-44 45-54 55-64 65+ FY 14-15 FY 15-16 The two largest groups of beneficiaries served by the MHP were the 6-11 and 12-17 age groups; these groups represent 23% and 21%, respectively, of all Medi-Cal beneficiaries served by the MHP in FY 15-16. The next largest group was the 25-34 age group with 13% of the Medi- Cal population. 8 Accessibility and Availability Report FY 16-17 8

The male gender group remained the largest in FY 15-16 with 52.7% of the Medi-Cal beneficiaries the same proportion as in FY 14-15. The female gender group represented 47.3% of the Medi-Cal beneficiaries in FY 15-16, a slight increase over the 46.7% in FY 14-15. The Other group had a significant decrease in FY 15-16 with 5 beneficiaries, 29 less than the previous year. Figure 1.4. MHP Medi-Cal Beneficiary Gender Distribution 3500 3000 2500 2000 1500 1000 500 0 3,369 3,026 3,165 2,803 5 34 FY 15-16 FY 14-15 Male Female Other The male gender group has historically been the largest group in the MHP with 3,369 beneficiaries in FY 15-16 compared with 3,165 beneficiaries in FY 14-15, a 6.5% change in the group. In FY 15-16 the MHP served 343 more male beneficiaries than female beneficiaries. The female gender group had the largest increase in FY 15-16 with an increase of 223 beneficiaries compared with 204 for the male gender. Table 1.5. MHP Medi-Cal Beneficiary Ethnic Distribution Period NtvAmr % Black % Hispanic % White % Other % FY 14-15 42 <1% 184 3% 4,927 82% 745 12.4% 104 1.7% FY 15-16 51 1% 195 3% 5,256 82% 755 13% 143 2.2% The Hispanic group was the largest ethnic group of the MHP with 5,256 beneficiaries in FY 15-16 compared with 4,927 beneficiaries in FY 14-15; this was an increase of 329 beneficiaries from the previous year which reflects a 5.5% change in the Hispanic group. The White group was the second largest group with 755 beneficiaries, 13% of the population in FY 15-16 compared with 745 beneficiaries, 12.% the previous year. The Other group includes: Asian/Pacific Islander, Other Asian and all ethnicities not identified in Table 1.3. The language distribution is shown in Figure 1.5 and a comparison of the Spanish speaking beneficiaries with the Hispanic ethnic group is shown in Figure 1.6. English was the primary language identified by a majority, 62% of MHP beneficiaries. Spanish speaking beneficiaries accounted for 35% of the MHP population. The proportion of English speaking beneficiaries was unchanged from the previous year, but there was a slight decrease of 1.6% in the number of Spanish speaking beneficiaries, 35.4% compared with 36% in FY 14-15. Beneficiaries that identified Other languages as their primary language accounted for 2.6% of the MHP Medi-Cal population. 9 Accessibility and Availability Report FY 16-17 9

268 299 203 236 201 204 403 454 491 527 1271 1348 1206 1261 1959 2071 Figure 1.5. MHP Medi-Cal Beneficiary Language Distribution Other, 170 Figure 1.6. MHP Medi-Cal Beneficiary Language Ethnicity Comparison Spanish, 2,263 Spanish, 2,263 English, 3,967 Other Ethnic Groups, 1,144 Hispanic, 5,256 English Spanish Other Hispanic Other Ethnic Groups Spanish Figure 1.7. Beneficiary City of Residence 2500 2000 1500 1000 500 0 Brawley Calexico Calipatria/ Niland El Centro Heber Holtville Imperial Other FY 14-15 FY 15-16 The 527 beneficiaries residing in other areas include: Salton City 65; Seeley 84; Thermal 69; Westmorland 105; Winterhaven 102; and 102 in 52 other cities or areas. Anticipated Number of MHP Medi-Cal Beneficiaries FY 16-17 Applying the 6.1% rate of change to the 6,400 unduplicated Medi-Cal beneficiaries served by the MHP in FY 15-16, it is anticipated the MHP will provide services to 6,790 unduplicated beneficiaries in FY 16-17. Utilization of Services FY 15-16 During FY 15-16 the MHP s utilization of services exceeded that of the previous year in the categories of mental health services, therapy, and medication support; these increases were 8%, 27.5%, and less than 1%, respectively. The utilization in the categories of targeted case management and crisis intervention decreased by 28% and 10%, respectively. The utilization of services along with the projections for FY 16-17 are shown in Figure 1.8. The projected 10 Accessibility and Availability Report FY 16-17 10

4,930 5,899 7,520 4,282 4,282 3,096 3,093 8,212 3,329 3,681 3,303 3,429 Number of Services 51,290 57,098 27,481 33,892 33,901 35,964 61,525 67,327 number of services for FY 15-16 was exceeded only in therapy and was not met in all other categories. The number of beneficiaries served was 4% more than projected. A comparison of beneficiaries served in FY 14-15 with the number projected for FY 15-16 and the actual number served by type of service in FY 15-16 is illustrated in Figure 1.9. Anticipated Utilization of Services FY 15-16 The anticipated utilization of services for the 6,790 beneficiaries anticipated to seek services from the MHP in FY 16-17 is based on the 6.1% change in the number of beneficiaries served from FY 14-15 to FY 15-16, and calculated by multiplying the anticipated number of beneficiaries by the average number of services per beneficiary in FY 15-16. The utilization of services for the past three fiscal years is shown with the projected utilization of services for FY 16-17 in Figure 1.8. A comparison of utilization from the previous year, the projected number of services for FY 15-16 and the actual utilization for FY 15016 are shown in Figure 1.9. The number of beneficiaries anticipated to receive each type of service, and the average number of services per beneficiary by type is shown in Table 1.5. These projections are based on the rate of change and the average number of services the previous year. The expected utilization is based on the overall totals for the MHP; individual Team/Program averages may vary from those in this table. Figure 1.8. Overall MHP Utilization by Number of Services with Projections by Type of Service 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Mental Health Services Therapy Medication Support TCM Crisis FY 13-14 FY 14-15 FY 15-16 Projected FY 16-17 11 Accessibility and Availability Report FY 16-17 11

Number of Beneficiaries 968 1,098 662 1,142 1,393 1,580 1,037 751 665 5,123 6,180 5,810 5,243 7,008 6,640 Figure 1.9. Overall MHP Utilization by Number of Beneficiaries by Service Type Comparison 8000 7000 6000 5000 4000 3000 2000 1000 0 Mental Health Services Therapy Medication Support TCM Crisis Actual FY 14-15 Projected FY 15-16 Actual FY 15-16 Table 1.5. Overall MHP Anticipated Utilization by Number of Beneficiaries and Average Number of Services in FY 16-17 Service Type Number of Beneficiaries Average Number of Contacts Mental Health Services 7,050 9.3 Mental Health Services Therapy 1,240 6.6 Medication Support 5,618 6.5 Targeted Case Management 1,112 3 Crisis Intervention 698 5 Staff Cultural Competence and Linguistic Capability The linguistic capabilities of the MHP direct service staff in FY 15-16 were proportionate to the staff ethnic composition. Of the 221 direct service staff (Staff Cultural Competence Survey FY 15-16), 170 (77%) reported speaking Spanish. The proportion of Spanish-speaking direct service staff is more than adequate to meet the needs of MHP beneficiaries who are 34% Spanish-speaking. The ethnicity and cultural awareness of direct service staff are illustrated in Table 1.6 and 1.7. Table 1.6. MHP Staff Ethnic Distribution Period Alskn/NtvAm Asian/PacIsl Black Hispanic White Other Total Staff FY 13-14 1 7 4 138 13 1 164 FY 14-15 1 7 6 154 13 6 187 FY 15-16 2 10 6 187 15 1 221 12 Accessibility and Availability Report FY 16-17 12

The MHP direct service staff is predominantly Hispanic (84.6%), which is comparable to the beneficiary population with beneficiaries indicating 81% Hispanic ethnicity in FY 15-16. Data for the cultural awareness of staff was taken from the Staff Cultural Competence Survey Report FY 15-16. Table 1.7. Cultures Known to MHP Staff Cultures FY 13-14 FY 14-15 FY 15-16 Alaskan/Native American 63 38% 63 34% 80 36% Asian/Pacific Islander 54 33% 58 31% 69 31% Black 109 67% 129 69% 135 61% Hispanic 157 96% 185 99% 214 97% White 123 75% 148 79% 149 67% Older Adult 107 65% 137 73% 140 63% Lesbian, Gay, Bisexual, Transgender, Queer 105 64% 116 62% 141 64% Mental Health Client 148 90% 162 87% 194 88% Family of Mental Health Client 129 79% 153 82% 155 70% Disabled 106 65% 137 73% 124 56% The number of direct service staff reporting cultural awareness reflected some changes in FY 15-16. Five cultures were below 65% compared with 3 the previous year, these five were: the Alaskan/Native American 36%, the Asian/Pacific Islander 31%, Older Adult 63%, LGBT 64%, and Disabled 56%. In FY 15-16 the Older Adult and Disabled cultures reflected significant decrease in awareness falling below 65%; the White and Family of Mental Health Client cultures also decreased significantly although remaining above 65%. The direct service staff reported 97% were culturally aware of the Hispanic culture, which was 1% more than the previous year. Additionally, awareness of the mental health client culture was reported at 88%, which was 1% more than the previous year.. The MHP direct service staff has an overall cultural awareness as evidenced by the percentage of Hispanic staff (84.2%), the percentage of staff fluent in Spanish (77%), and the percentage of staff reporting cultural awareness of the Hispanic culture (97%), which are proportionate to the population served. 13 Accessibility and Availability Report FY 16-17 13

ADULT SERVICES Outpatient Clinics (Team Centers and Family Resource Centers) Five outpatient clinics (Team Centers), and one Family Resource Center (FRC) provide services to adult beneficiaries. The Adult Brawley Anxiety and Depression Clinic is located at Provider 1359, Brawley Outpatient Clinic, and provides services to beneficiaries residing in the northern region of the MHPs service area with primary diagnoses of depression and/or anxiety. The Adult Brawley RCP-OP Clinic is located at Provider 1379, directly across the street from Provider 1359, and provides services to northern region beneficiaries with primary diagnoses of schizophrenia and psychosis. The Adult Brawley Full Service Partnership (FSP) Program is also located at Provider 1379 to serve northern region FSP beneficiaries. The Adult El Centro Anxiety and Depression Clinic is located at Provider 1382 in El Centro and provides services to beneficiaries with diagnoses of anxiety and mood disorders. The Adult El Centro RCP-OP Clinic is located at Provider 1366 in El Centro and provides services to beneficiaries with diagnoses of schizophrenia and psychotic disorders. Beneficiaries from all areas of the county receive services at these two specialized clinics. The Adult El Centro MHSA FSP team is also located at Provider 1366. The San Pasqual FRC is located in Winterhaven at Provider 1364 and provides services to both adults and children. The San Pasqual FRC targets and provide services to all adult beneficiaries in the eastern region in an effort to continue the improved access to services for beneficiaries in this outlying area. This clinic does not specialize in treating a specific group of diagnoses, as do the centrally located clinics. The Calexico Integrated Clinic, Provider 1375 and the Brawley Integrated Clinic, Provider 1376; were closed as of January 15, 2016, due to lack of space in the facilities they were located. The number of beneficiaries served by individual teams and programs in Adult Services, as well as the demographics for each program, are illustrated under the individual Teams and programs in Section II. 14 Accessibility and Availability Report FY 16-17 14

CHILDREN SERVICES Outpatient Clinics (Team Centers and Family Resource Centers) Two outpatient clinics (Team Centers) and three Family Resource Centers (FRC) provide services to child beneficiaries. The Brawley Children s clinic, Team 6, moved to a new facility in FY 15-16, located at 195 South 9 th Street in Brawley. The clinic is certified under Provider number 1384, Brawley Children and Adolescent Outpatient Clinic. Teams 5 and 12 are located at Children Outpatient Services at Provider 1301. The FRCs are co-located with other community services at school sites. The El Centro FRC operates at Provider 1363. Two of the FRCs serve as clinics to outlying areas: Calexico FRC located at Provider 1350, and San Pasqual FRC located in Winterhaven at Provider 1364. The Brawley Children and Adolescent Outpatient Clinic and the San Pasqual FRC continue to target and provide services to all child beneficiaries in their geographic regions in an effort to continue the improved access to services for beneficiaries in these outlying areas. Vista Sands Program Additionally, Children s Services has one program located at three school sites that provides grant funded socialization services along with SD/MC specialty mental health services, targeted case management services, and crisis intervention to students between 7 and 12 years of age with mental health diagnoses and skill deficits that meet the criteria for participation in the program. The program is designed to assist children whose capacity to function at home, school, and community has been impaired by emotional and behavioral problems. The structure of the program is based on the school schedule. Children attend regular school in the morning and are bussed midday to one of the three Vista Sands Programs. The program meets on a daily basis, Monday-Friday from 1:00 p.m. to 4:00 p.m. Staff is available to provide case management services from 8:00 a.m. to 11:00 a.m. and from 4:00 p.m. to 5:00 p.m. The capacity for each program is 15 children in the classroom. Vista Sands sites are staffed by ICBHS employees assigned to the program, this includes program supervisors, MHRS and/or MHRT and administrative support staff who work together to provide the children with the services necessary to develop socialization and coping skills. Vista Sands Programs are located at: Brawley, Provider 1334; Calexico, Provider 1335; and El Centro, Provider 1332. The number of beneficiaries served by individual Teams and programs in Children Services, as well as the demographics for each program are illustrated under the individual Teams and programs in Section III. 15 Accessibility and Availability Report FY 16-17 15

YOUTH AND YOUNG ADULT (YAYA) SERVICES The Youth and Young Adult Services (YAYA) opened a clinic in Brawley in the Spring of 2015, Provider 1381 that houses both the YAYA Brawley Anxiety and Depression team and the YAYA Brawley FSP team; these are two distinct treatment teams. In its first full year of operation, FY 15-16, the number of beneficiaries served at this site nearly doubled the number served in FY 14-15 when the teams were located in El Centro most of the fiscal year. YAYA Services continued in FY 15-16 to focus on treatment by diagnosis groups. Anxiety and Depression clinics provide services to individuals with anxiety, depression, mood disorders, and ADHD; and full service partnerships (FSPs) provide services to psychotic and schizophrenic spectrum disorders utilizing whatever methods work to ensure beneficiaries receive treatment. Other YAYA services are based in the city of El Centro with the YAYA Services at Providers 1329, Youth and Young Adult Services Second Floor Menvielle Building and at Provider 1356, Youth and Young Adult Services First Floor Menvielle Building. Teams providing services to YAYA beneficiaries at the El Centro site include: YAYA El Centro Anxiety and Depression Clinic, YAYA El Centro FSP Program, YAYA Calexico Anxiety and Depression Clinic, and YAYA Calexico FSP Program. Beneficiaries in YAYA programs are able to access clinical, case management, and substance abuse services at one central location, providing easier access to all services, while promoting improved collaboration among service providers. Staff is onsite Monday-Friday from 8:00 a.m. to 5:00 p.m. The number of beneficiaries served by these programs and demographics for each program are illustrated under the individual programs in Section IV. Adolescent Habilitative Learning Program (AHLP) The AHLP located at Provider 1338 is a school-based habilitative program offering mental health and education services for adolescents throughout Imperial County, ages 13-18 or from grades 7-12, whose emotional behavior disturbances prevent them from learning and functioning in regular classrooms. Academic class work is designed to assist with difficulties in performance that result from emotional problems. Regular class placement is available to provide continuity in curriculum. Rehabilitative and recreational group activities, designed and conducted by the staff, include: social skills development, independent living skills, psycho-education and anger management skills. In addition, staff provide specialty mental health services at this site including rehabilitation, assessment, plan development, collateral, crisis intervention and targeted case management on an individual basis. Although AHLP is a centralized site that provides services to adolescents from throughout Imperial County. Administration of the AHLP program was transitioned in FY 13-14 from Children Services to YAYA. The number of beneficiaries served by individual teams and programs in YAYA Services, as well as the demographics for each program are illustrated under the individual Teams and programs in Section IV. 16 Accessibility and Availability Report FY 16-17 16