MHSA Steering Committee

1. MHSASteering Committee April 6, 2009 1 p.m. – 4 p.m. Health Care Agency/Behavioral Health Services

2. Sharon Browning Welcome

3. Consumer Perspective Report on the CNMHC Client Forum February 20-22 Theresa Boyd William Gonzalez

4. Mark Refowitz Local/State Updates

5. Technology Update • Orange County Behavioral Health Service's path to an Electronic Health Record (EHR) has begun to be defined: • It is a two prong process: • Clinical Content Design and Definition of Methodology. • Upgrade Network and System Infrastructure to support an EHR application.

6. Clinical Content Design • We are performing our due diligence to design the best and most efficient clinical content and execution methodology to reflect Recovery oriented services and support compliance with Medi-Cal and Medicare billing standards • An additional design consideration is to allow for outcome measures to be gathered from our clinical documentation • To assist us in this effort we have hired an EHR Project Coordinator • We are also part of a Statewide Coalition that is coming together to identify the best practices for treatment plans and other clinical documentation

7. Upgrade Network and System Infrastructure to support an EHR application • Existing systems and supporting applications are old and past end-of-life, and need to be upgraded to better support current technologies and to sustain the development and deployment of an integrated EHR system. • MHSA funds will be needed to pay the Mental Health Plan’s proportional share of the servers and other hardware peripherals required for this upgrade. • We will be back before the end of this Fiscal Year with a specific infrastructure upgrade plan.

8. Technology Stakeholder Process We will be forming two Advisory Committees to assist us with our efforts: EHR Design Advisory Committee • Its purpose will be to ensure our content is recovery oriented and that any IT expenditures support MHSA goals Outcome Measures Advisory Committee • Its purpose will be to assist us in identifying meaningful outcome measures using the data currently available and data from the EHR in the future • If you would like to participate in either of these Advisory committees, please provide your contact information to Kate Pavich at the break or after today’s meeting

9. Rochelle Pierre MHSA Housing

10. Jenny Qian Prevention and Early Intervention (PEI) Update

11. PEI Plan Update PEI Plan approved unanimously by Oversight and Accountability Commission (OAC) on 3/26/09 Orange County will fund 8 projects which includes a total of 33 programs

12. PEI Plan Update • Current Procurement Plan • Provider Preparation for PEI • Principles and Trainings for PEI SIQ/RFP • Prevention vs. Treatment

13. Kate Pavich MHSA Updates

14. MHSA Updates Spirituality Initiative • California Conference on Mental Health and Spirituality - June 4, 2009 • To increase awareness of spirituality as a potential resource • To encourage collaboration among faith-based/mental health groups, consumer and families in combating stigma and reducing disparities in access

15. California Strategic Plan on Reducing Mental Health Stigma & Discrimination - Public Workshop - March 19, 2009 Workshop was co-sponsored by the California Department of Mental Health and Orange County Health Care Agency Total of 92 attendees Solicited input on the draft: Vision, Core Principles, Strategic Directions, and Recommended Actions for the 10-year California Strategic Plan on Reducing Mental Health Stigma and Discrimination

16. Recovery Arts Program April 16: MHSA Coordinators Regional Meeting May 21: Art Fair and Calendar Contest July 11 - August 23: Arts Festival Such Great Heights by Theresa Boyd

17. Innovation Component Received notice of funding approval for $2,893,800 Funds will be used for community program planning. Information regarding stakeholder meetings will be released in April.

18. Capital FacilitiesProject Proposal The Capital Facilities Project Proposal was approved on March 12, 2009 by the Department of Mental Health for $18,300,125. These funds will be used for developing the Crisis Residential, Wellness/Peer Support Center, and the Education and Training Program at 401 S. Tustin St., Orange CA.

19. 401 S. Tustin Street Maricela Loaeza

20. 401 S. Tustin St. (Front View) Education and Training Center Crisis Residential Wellness/Peer Support Center

21. 401 S. Tustin St. (Rear View) Education and Training Center Wellness/Peer Support Center Crisis Residential

22. Crate and Barrel: Furniture • Crate and Barrel has been featuring renewable woods and sustainable materials for a number of years. • The majority of the upholstered sofas and chair frames are now certified sustainable by the Forest Stewardship Council (FSC). • Since 2005, Crate and Barrel has worked closely with the Tropical Forest Trust (TFT) to ensure that certain hardwoods selected for furniture are from plantations that are responsibly and socially managed.

23. Crisis Residential Furniture

24. Maureen Robles Veteran Services

25. BUILDING BRIDGESFOR OUR VETERANS OC Health Care Agency Behavioral Health Services: Caring for Orange County Veterans and their Families

26. How Many Vets Are We Talking About? • Total US veteran (all wars) population as of September 2008: Approx.23.4 million • Total Orange County veteran (all wars) population September 2008: Approx.148,915 • 5% of OC’s population are veterans

27. How Many Female VetsAre We Talking About? • US female veterans (all wars) number 1,802,491 • California has the highest number of female vets (all wars) at 166,984 • Orange County has the second highest female veteran (all wars) population at 9,638 (Los Angeles has 30,590) • Total registered female vets at Long Beach Veteran’s Administration (including LA vets): 1,000

28. Now That You Are Home… POST COMBAT ISSUES • Transition – combat stress • PTSD • Anger • Depression • Anxiety • Self-medication with substances such as alcohol, medications and illegal drugs

29. Symptoms/Behaviors Symptoms can lead to behaviors such as: • Inability to concentrate at work/jobs • Marital problems, domestic abuse, child abuse • Substance abuse • Legal problems (DUI, tickets, etc.) • Inability to sleep • Reckless driving • Civil disturbances (bar fights, etc.) • Apathy, inability to keep appointments

30. Symptoms/Behaviors • Multiple deployments equals more depression, PTSD, alcohol use, etc. • Army Reserve/National Guard and Marines have seen more combat in the current conflicts(OIF/OEF)* and have more behavioral health issues *Operation Iraqi Freedom/Operation Enduring Freedom (Afghanistan)

31. What’s the Problem? • In 2007, 300,000 vets self-disclosed moderate levels of depression and anxiety at the 90-day PDHRA (post deployment health readiness assessment) • Only 60% of those veterans registered at the Veterans Administration (PDHRA started in 2005. There are no stats on previous combat veterans)

32. Final Outcome • Broken marriages • Job loss • Incarceration • Homelessness • Repeated hospitalizations • Reliance on county/state/federal social-support programs • Suicide • Accidental death or severe medical issues

33. Final Outcome • Veterans lose • Families lose • Society loses

34. Proposed Veterans’ Plan for BHS: Primary Premise • The Veterans Administration healthcare system is “priority positioned” to provide superior mental health outcomes for veterans to seek and complete treatment • Orange County should not be the primary provider of mental health care to the American veteran

35. Core Issues: • Many Veterans do not seek services for behavioral health issues • Many Veterans will not seek help at the VA • Veterans will show up in their community for symptoms related to their combat issues • Increasing number of veterans are involved in the legal system (domestic violence, drug related charges, etc.)

36. Do You Knowthe Way to the VA? Why don’t vets seek care at the VA? • Not eligible • Don’t trust the VA or government • Transportation issues • Co-pays and wait times • Unaware of benefits and VA capabilities • Don’t know how to access • Privacy concerns

37. Barriers to SeekingBehavioral Health Care • Warrior mentality • Stigma • Lack of insight (symptoms recognition vs. cognitive dysfunction from traumatic brain injury – TBI) • Lack of eligibility or lack of knowledge about benefits • Military career concerns

38. Million Dollar Question • How to get the Veterans to intersect with Behavioral Health Care Provider? • And, how to overcome barriers for the Veteran to receive definitive mental health care preferably at the VA?

39. Recommendation: Conceptual Framework For Veterans Behavioral Health Care • VA has skilled, up-to-date, trained behavioral health clinicians and integrated veterans’ programs • There are many effective community groups that wish to positively intervene to assist veterans • The OC Community wants veterans and families to be healthy • Case finding and overcoming reluctance to seek care at the VA is a primary barrier to positive outcomes

40. Conceptual Framework ForVeterans Behavioral Health Care • OC should primarily assist with case finding and providing a ‘warm’ hand-off to the VA • OC should provide follow-up to insure that veterans continue to seek treatment at the VA • Some situations may require OC intervention for short term ‘bridging’ care • OC will treat veterans who request treatment by OC BHS rather than VA. Some veterans may complete entire course of care with OC BHS. • We will respect our client’s choice of provider • There are many effective community groups that wish to positively intervene to assist veterans

41. Treatment Modality for Combat Stress and PTSD • There is recent evidence from many sources that early treatment results in better outcomes. • Ongoing research supports first line treatments such as: • Cognitive Behavioral Therapy • Eye Movement Desensitization and Reprocessing (EMDR) Therapy • Exposure Therapy • Pharmacological Therapy

42. Cornerstones All approaches should include: • Cultural competency • Evidence-based practices • Performance outcome measurements • Consumer involvement • Recovery philosophy • Integration of co-occurring treatment

43. Successful Outcomes Keys to successful outcomes are: • Early recognition and intervention • Evidence-based practice • Multi-agency, community and family collaboration

44. Orange County: Veterans/Behavioral Health Services Plan

45. Early Interceptors Train early interceptors Early interceptors are contacts at places where the veteran or family may first present with problems/issues

46. Early Interceptors Healthcare: • Primary providers • Emergency rooms/urgent care • Emergency behavioral health teams Colleges: • Classroom instructors • Guidance counselors • Student health • Student Veteran Associations

47. Early Interceptors Law enforcement: • Public defenders • Courts • Emergency response • Probation Substance abuse: • Primary provider • Substance abuse clinics/groups

48. Early Interceptors • Community organizations (NAMI, etc.) • Veteran’s organizations—non-government • Faith-based organizations • Social service agencies • Employment Development Department

49. Early Interceptors Community behavioral health providers: • Governmental • Private

50. Veterans in LA/Orange Counties are recognized by DOD as the most underserved in the nation One of the largest veteran communities and largest geographic area OC does not have an active military post OC does not have a VA Medical Center OC VA & MilitaryCollaboration