Mental Health Services Act Prevention & Early Intervention Local Planning CPCA Mental Health Task Force December 7

1. Mental Health Services ActPrevention & Early InterventionLocal Planning CPCA Mental Health Task ForceDecember 7th, 2007 Carmela Castellano-Garcia, President & CEO California Primary Care Association

2. Presentation Overview • Development of PEI Principles • CPCA Advocacy • Highlights from Final Guidelines • Plan Review Process • Next Steps Discussion

3. Prevention & Early Intervention • Prevention and Early Intervention (PEI) is one of five components of the MHSA. • PEI funding will be used to prevent mental health problems or to intervene early with relatively short duration and low intensity approaches to achieve intended outcomes.

4. Prevention & Early Intervention PEI funding is to be used to: • Prevent mental health problems. • Intervene early with relatively short duration and low intensity approaches to achieve intended outcomes.

5. Prevention & Early Intervention • Lessons learned from the CSS planning process fueled our advocacy around PEI. • Because the CSS county requirements were not prescriptive enough on the inclusion of community-based providers, many clinics found themselves excluded from the planning & funding processes.

6. Prevention & Early Intervention • CPCA was an active participant in the PEI Committee process where the critical policy principles and criteria were developed. • CPCA was supportive of the Policy Direction document adopted by the MHSOAC in January because of the safeguards it provided CCHCs.

7. PEI Guidelines • The State DMH is charged with setting forth guidelines and criteria for the release of PEI funds to counties. • These proposed guidelines cover the period of Fiscal Years 2007-08 and 2008-09, for the initial implementation of the PEI component.

8. PEI Guidelines • In late July, DMH released Draft Guidelines for PEI Program and Expenditure Plans. • CPCA was extremely concerned to find the safeguards afforded to community-based providers in the original principles and criteria noticeably absent from the Draft Guidelines.

9. CPCA Advocacy • With valuable input from the CPCA Mental Health Task Force, CPCA quickly responded by submitting written comments to the MHSOAC highlighting our concerns. • CPCA members further elevated the concerns of community clinics and health centers by overwhelmingly dominating the public comment period at the July 26th-27th convening of the MHSOAC in Riverside.

10. CPCA Advocacy • CPCA member clinics and consortia submitted letters to DMH urging the inclusion of stronger safeguards for CCHCs. • CPCA worked within a coalition of statewide advocates for the underserved to submit a joint comment letter reemphasizing the importance of CBOs in providing access to individuals who are unlikely or unable to ever seek traditional mental health services

11. CPCA Advocacy • CPCA drew upon relationships with key legislators and commissioners to help elevate our concerns with the Department. • Due to these advocacy efforts, DMH Director Dr. Steve Mayberg agreed to meet with CPCA to discuss our concerns. • DMH, after considerable input from key Commissioners, agreed to share with CPCA revised language before the release of the final guidelines.

12. Final PEI Guidelines • Due to considerable advocacy efforts of CPCA staff and membership, DMH made several critical changes to the draft guidelines. • Overall, CPCA is pleased with the changes made by DMH as reflected in the final guidelines. • We believe these changes will help safeguard the involvement of CCHCs as counties develop their plans for PEI programs.

13. Prevention & Early Intervention Highlights from Guidelines

14. Highlights • PEI programs must align with a number of key transformational concepts, among which is the concept of community collaboration. Specifically, the guidelines assert that the community program planning process is intended to bring together various stakeholders, including groups of individuals and families, agencies, organizations and businesses to share information and resources to accomplish a share vision for PEI (Guidelines, Page 2).

15. Highlights • The PEI framework is built upon a number of principles developed through the statewide stakeholder process, beginning with the work of the PEI Committee of the MHSOAC. • Specifically, the guidelines assert that PEI efforts shall reduce disparities in access to early mental health interventions due to stigma, lack of knowledge about mental health services or lack of suitability (i.e. cultural competency) of traditional mainstream services (Guidelines, Page 4).

16. Highlights • PEI projects shall address those who are unlikely to seek help from any traditional mental health service whether because of stigma, lack of knowledge, or other barriers (such as members of ethnically/racially diverse communities, members of gay, lesbian, bisexual, transgender communities, etc.) and would benefit from PEI programs and interventions (Guidelines, Page 5).

17. Highlights • PEI programs must have certain characteristics. Specifically, the guidelines assert that programs are generally delivered in a natural community setting (e.g. among others…primary health care, community clinic or health center) (Guidelines, Page 8).

18. Highlights • Counties are required to include certain sectors and partner organizations in the community program planning process. Among those required sectors is health – under which community clinics and health centers, school-based health centers, primary health care clinics, and Native American health centers are all included (Guidelines, Page 13).

19. Highlights • The accountability and evaluation framework for PEI is intended to achieve multiple objectives. Specifically, counties must document how the PEI component utilizes more non-traditional community partners (Guidelines, Page 21).

20. Highlights • County plans must include an explanation of how the county has ensured that the community program planning process included certain stakeholders, including providers of mental health and/or related services such as physical health care and/or social services (Budget & Planning Worksheet, Page 4).

21. Highlights • County plans must describe each PEI project to include, among other things, a description of implementation partners and type of organization/setting that will deliver the PEI program and interventions. Specifically, the instructions assert that if the setting is a traditional (rather than non-traditional) mental health treatment/services site, the plan must explain why this site was selected in terms of improved access, quality of programs and better outcomes for underserved populations (BPW, Page 13).

22. Highlights • County plans must describe linkages to a variety of services. Specifically, plans must describe how the PEI project links individuals and family members to other needed services, including those provided by community agencies not traditionally defined as mental health and have established or show capacity to establish relationships with at-risk populations (BPW, Page 14).

23. Highlights • County plans must describe relationships, collaborations or arrangements with community-based organizations such as schools and primary care. • Specifically, plans must describe how the PEI component will strengthen and build upon the local community-based mental health and primary care system including community clinics and health centers (BPW, Page 14-15).

24. Prevention & Early Intervention Plan Review Process

25. Plan Review Process • Counties create their local program & expenditure plan. • Plans are then submitted to the local mental health board for a 30-day public comment period. 3) Final county plans are submitted to the State DMH.

26. Plan Review Process 4) Plans are reviewed by a review team to include “experts” who will either recommend the plan for approval or send it back to the county for more work. 5) If recommended for approval, the plan will be added to the consent agenda at the next Commission meeting.

27. Plan Review Process 6) Commissioners will then have the opportunity to pull the plan off consent for further discussion if they have concerns with the plan. 7) The Commission may approve the plan based on the recommendation of the review team OR send the plan back to the county for more work.

28. Plan Review Process IMPORTANT: • Stakeholders must raise any and all concerns with plans at the local level during the 30 day local comment period. • The only concerns that will be heard at the state level will be those that have already been raised locally but have not been adequately addressed.

29. Plan Review Process • It is critical that members be sure to document efforts to raise concerns with their counties via submitting written comments during that 30-day period. • CPCA can then point to those efforts if there is still a need for advocacy at the state level in the instances where folks have still been excluded.

30. Prevention & Early Intervention How can we best work together to ensure CCHC inclusion in local plans?

31. Questions? Contact: Molly Brassil, Senior Policy Analyst California Primary Care Association mbrassil@cpca.org (916) 440-8170, ext. 207