Building an FSP Program in Rural California

1. Building an FSP Programin Rural California Alan Yamamoto, L.C.S.W San Benito County Behavioral Health Nancy Callahan, Ph.D. IDEA Consulting Kathy Montero, L.M.F.T Glenn County Mental Health, Health Services Agency Patricia Ayers, L.M.F.T San Benito County Behavioral Health

2. Overview of FSP Planning for a Small CountyAlan Yamamoto, L.C.S.W San Benito County Glenn County • Developing the CSS Plan • Planning process to develop FSP Services • Additional Funds: Expanding the number of FSP clients • FSP Eligibility Criteria (see Handout) • Panel will present on: • Referral Process • Authorization • FSP Service Team • Services and Support Planning • 24/7 Response • Drop-in Centers as an Adjunct to FSP Services • Working with the CA Network of Clients

3. Referral Process to Full Service Partnership ProgramNancy Callahan, Ph.D. • Develop an Eligibility Checklist that includes Medical Necessity information (e.g., Seriously Emotionally Disturbed; Seriously Mentally Ill; Serious impairment in functioning; Routine services not successful) to collect information on person referred for FSP • Assess client’s level of interest and motivation to participate in Full Service Partnership • Staff completes a Referral Request for Authorization (brief summary of client’s needs and history, why FSP level of care is needed if routine services have not been successful) • Staff and supervisor discuss client’s appropriateness for FSP and determine if there is a vacancy for FSP services • When there are no ‘vacancies’ for FSP, discuss other options for services? • Staff provide the highest level of services necessary to meet the needs of individuals until a vacancy is available • Review persons currently receiving FSP services and determine if there is someone who is ready to be discharged from FSP services • Review budget and determine if there is capacity to serve more clients with FSP services

4. FSP – Authorization Process Partnership Authorization Team (PAT) • Philosophy: Provide leadership and oversight to create a vision of wellness and recovery. • PAT Team consists of any combination of the following positions: Director/ Deputy Director, MHSA Coordinator, UR/QI Coordinator, Program Manager, Consumer/Mentor, Budget Analyst • PAT Activities: • Provide leadership and oversight to FSP services • Assess new referrals and authorize clients for FSP participation (dependent upon availability of funds and eligibility) • Review status of existing FSP clients, progress toward goals, exceptional events (Crisis, Inpatient Admissions), and celebrate successful completion of clients from programs • Discuss system-level issues • Authorize request of flex funds for items costing $50 or more • Track expenditures: year-to-date dollars per client; year to date dollars for all FSP; year-to-date dollars for MHSA

5. Full Service Partnership Service Team Kathy Montero, L.M.F.T. • Philosophy: • - Wellness and Recovery Philosophy • - Team approach • - Flexible services to meet the needs of individual clients and shared program function • Consists of direct service team members working with FSP clients (MHSA • Coordinator, clinician, consumer/peer mentor, family members, etc) • Regularly Scheduled Meetings • - Daily Check In (15 minutes) to provide staff a briefing on night/ weekend calls • - Weekly Staff meetings for • business announcements, training, discuss critical incidents • Key Events Tracking (prompt staff to report changes in living situation, • encounters with the law, etc.) -- Staff complete Key Event Tracking Forms • during meeting • Clinical support for staff development

6. FSP Services and Supports PlanningKathy Montero, L.M.F.T. • Client Care Plan (CCP) – Medi-Cal component addresses medical necessity and symptom reduction • Individual Services and Supports Plan (ISSP) – Outlines individual’s recovery and wellness goals (combine with CCP or create separate document) • Family/ Collateral/ Community Supports’ involvement in Planning Process • Meet to set goals, discuss role of each family member/ collateral person • What does it take for the individual and his/her family to thrive? • Who is the client’s support system? This may be someone different than ‘family,’ including a friend, neighbor, landlord, minister, coach, etc. • Development of Culturally Relevant Treatment Planning Strategies

7. 24/7 Response for FSP ClientsAlan Yamamoto, L.C.S.W. • Identify who will respond on a 24/7 basis to FSP clients • Establish a number for clients to call • Establish on-call rotation for staff (For example: one week on) • Develop a protocol for persons on-call • How they will be reimbursed for ‘stand-by’/working hours? • (Example: $2.50 per hour stand-by weekdays; Time and a half for hours worked in the evenings) • Are staff required to work the next day if they were up all night? (flexibility) • Establish a back-up response plan when the person on-call needs additional clinical support • Policy for going into the field during the day; at night (safety issues)

8. 24/7 Response for FSP Clients (Continued…)Alan Yamamoto, L.C.S.W. • Deliver cross training to FSP Staff, police and first responders, crisis staff, hospital staff to help coordinate care • Share client’s Advance Directives with FSP team members to coordinate care and follow client’s wishes during an emergency • Develop a policy for responding to residential complaints including resolving conflicts, noise problems, fighting, behavior problems, and potential evictions. Train staff on how to support landlords and/or family members with the client. • Develop a policy on staff’s use of the county car(s) for after hours response. For example, determine if staff can drive the car home at night; or come into the office to pick up vehicle, when needed.

9. Developing a Drop-In Center with Small County ResourcesPatricia Ayers, L.M.F.T. DROP-IN CENTER (This is a Location of Services, Not a Type of Service) Center can be used as an adjunct to FSP services – allows support without an appointment Services Which May be Available at the Drop-In Center or other Location • New Requests for Services • Groups • Life Skills/ Classes • Social/ Recreational Connections • Telemedicine • Other Agency Services • Weekly Community Meeting (for clients)

10. SummaryAlan Yamamoto, L.C.S.W • FSP in a rural county • Services are multipurpose to maximize limited dollars • Work with CA Network of Mental Health Clients – Pilot Project

11. Contact Information Alan Yamamoto, L.C.S.W, Director San Benito County Behavioral Health 1113 San Felipe Rd., Hollister, CA 95023 (831) 636 – 4020 alan@sbcmh.org Nancy M. Callahan, Ph.D. IDEA Consulting 2108 Alameda Ave., Davis, CA 95616 (530) 758-8815 nancycal@dcn.davis.ca.us Kathy Montero, L.M.F.T., Program Manager, Children’s Mental Health & MHSA Glenn County Mental Health Department, Health Services Agency 242 N. Villa Willows, CA 95988 (530) 865-6459 kmontero@glenncountyhealth.net Patricia Ayers, L.M.F.T, Assistant Director San Benito County Behavioral Health 1113 San Felipe Rd., Hollister, CA 95023 (831) 636 – 4020 payers@sbcmh.org