MHSA Successes in LA: Perspectives on Recovery and Resiliency

1. MHSA Successes in LA: Perspectives on Recovery and Resiliency “Nurturing Hope, Promoting Wellness and Supporting Recovery”

2. Welcome Catherine Bond, MFT Vice Chair, Los Angeles County Client Coalition Dennis Murata, MSW Deputy Director, Program Support Bureau

3. MHSA Overview • Proposition 63 – Mental Health Services Act • California ballot proposition • Passed November 2004 • Funding began January 1, 2005 • How it is funded – 1% state tax on incomes of $1 million or more • What it funds – Expansion of mental health services and programs • Who it serves – All ages • Children (0-15) • Transitional Age Youths (16-25) • Adults (26-59) • Older Adults (60 and older)

4. MHSA Core Principles • Client / family driven • Cultural competence • Community collaboration • Service integration • Focus on recovery, wellness, and resilience

5. MHSA Components • Community Services and Support Plan February 14, 2006* • Workforce Education and Training Plan April 8, 2009* • Information Technology and Needs Plan May 8, 2009* • Prevention and Early Intervention Plan September 27, 2009* • Innovations Plan February 2, 2010* • Capital Facilities Plan April 19, 2010 (Submitted)* *Date of approval

6. CSS Ad Hoc Work Groups IT/CF Ad Hoc Work Groups INN Ad Hoc Work Groups Underrepresented Ethnic Populations SAAC 1 SAAC 2 SAAC 3 SAAC 4 SAAC 5 SAAC 6 SAAC 7 SAAC 8 County of Los Angeles MHSA Stakeholder Delegates WET Ad Hoc Work Groups PEI Service Area Level Planning Process Service Area Advisory Committees (SAAC)

7. System Leadership Team Department of Mental Health County Commissions & Councils Other Government Agencies Community and Faith Based Organizations Advocacy Groups: Consumers, Family Member, Caregivers Healthcare & Hospitals Underrepresented Ethnic Populations Contract Providers

8. County of Los Angeles MHSA Stakeholder Process Support Transformation of Overall Public Mental Health System MHSA Stakeholder Delegates System Leadership Team Monitor Progress of MHSA Implementation CSS PEI Develop, Deliberate and Recommend NEW MHSA Plans for Los Angeles County INFORMATION TECHNOLOGY & CAPITAL FACILITIES WORFORCE EDUCATION &TRAINING WORFORCE EDUCATION &TRAINING INNOVATIONS INNOVATIONS

9. MHSA Stakeholder Delegates Comments: “The process reinforced how important it is to have consumers and family members involved throughout the process.” “It was amazing how people from very varied backgrounds were able to reach unanimous consensus on each plan.” “All voices were heard, and they were heard equally.”

10. Making a Difference inConsumers’ Quality of Life: Full-Service Partnerships Debbie Innes-Gomberg, Ph.D. District Chief, MHSA Implementation Unit Kara Taguchi, Psy.D. Program Head, MHSA Implementation Unit

11. Data Collection of Full Service Partnership (FSP) Outcomes in Los Angeles County Size limitations resulted in LA County’s inability to enter data directly into State DMH Data Collection and Reporting System Outcomes Measures Application (OMA) developed in late 2005 Data elements include state mandated elements and additional outcomes based on stakeholder feedback Initiated provider training in September 2006 Data entry initiated in November 2006

12. Outcomes Data Collection (continued) • Our OMA is now used for 3 distinct programs: • Full Service Partnerships (2006) • Specialized Foster Care Intensive (2007) • Field Capable Clinical Services (FCCS) (2009)

13. Outcomes Data Collection (continued) Current total of 63,927 FSP outcome assessments in the OMA Data is also submitted electronically to LACDMH by third-party data collection systems (which yields an additional 10,835 outcome assessments) FSP outcomes uploaded to State DMH: First Upload to the state was on 12/30/08 for 13,135 records (2 years worth of data) As of 4/1/2010 a total of 50,137 records have been submitted to the state Data clean-up to enhance data submission to the state

14. Development of Reports • Utilized AB2034 methodology for reports, including initial focus on living arrangements • Data validity and reliability

15. Availability of Reports Reports are accessible to Providers via the Internet Reports are refreshed every Monday, so providers can view their own residential data on a regular basis without relying on DMH New reports continue to refine data quality and to include additional domains

16. Annualized Living Arrangement Data and Graphs Comparison of residential data for 12 months immediately prior to receiving FSP services and for 12 months of residential status while receiving FSP services Data is adjusted (annualized) by a percentage based on average length of stay in the FSP program Data must meet data quality standards to be included in the analysis

17. Annualized Living Arrangement Data and Graphs 41 Unique Residential Types listed across 4 age groups Residential types are grouped into 16 Living Arrangement Clusters:

18. Hospitalization Data (Measured by Number of Clients)

19. Hospitalization Data (Measured by Number of Days)

20. Jail Data (Measured by Number of Clients)

21. Jail Data (Measured by Number of Days)

22. Decline in Homelessness(for All Age Groups)

23. Homeless Data (Measured by Number of Clients)

24. What does the data tell us? Fewer clients are hospitalized in an acute psychiatric hospital while in FSP when compared to the 12 months immediately prior to FSP for all age groups 40% of Adult FSP clients experienced homelessness in the 12 months immediately prior to FSP, and on average, these clients were homeless for 8 out of those 12 months Transitional Age Youth, Adult, & Older Adult FSPs show reductions in the number of clients in jail when helped by FSP, compared to 12-month baseline data

25. What else does the data tell us? • There is also a reduction in the number of jail days for Adults and Older Adults experienced while in FSP compared to the year prior • The majority of Adult and Older Adult FSP clients are currently living independently in either an apartment or house where they pay rent, hold a lease, or pay mortgage, or in a Single Room Occupancy (SRO) where they hold the lease • The majority of Child and TAY FSP clients are currently living with their families

26. Current Living Arrangement (by Cluster) Looks at last reported/current residential type status LACDMH can see this data broken down by provider site or FSP program At a quick glance you can see the distribution of where currently enrolled clients are living

27. Child Full Service Partnership Current Residential StatusN= 1,629

28. Transitional Age Youth Full Service Partnership Current Residential StatusN= 847

29. Adult Full Service Partnership Current Residential StatusN= 3,111

30. Older Adult Full Service Partnership Current Residential StatusN= 284

31. Adult FSP Program Cost Avoidance Hospitalizations ($523/day) • Pre-Partnership Days – 60,489 • Post-Partnership Days – 50,868 • Cost Avoidance of $5,031,783 Incarcerations ($1,093/day) • Pre-Partnership Days – 79,243 • Post-Partnership Days – 49,141 • Cost Avoidance of $32,901,486

32. Older Adult FSP Program Cost Avoidance Hospitalizations ($523/day) • Pre-Partnership Days – 7,552 • Post-Partnership Days – 6,251 • Cost Avoidance of $680,423 Incarcerations ($1,093/day) • Pre-Partnership Days – 3,683 • Post-Partnership Days – 2,568 • Cost Avoidance of $1,218,695

33. Priority population is transition aged mothers ages 16 to 25 with children ages 0 to 5 years old Program targets young mothers with mental illness At risk of losing custody of their children With a history or at risk of psychiatric hospitalization Who are homeless or are about to become homeless Roybal Mental Health Center Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach

34. Young Mothers & Babies FSP ProgramUsing a “Whatever it Takes” Approach The program addresses a comprehensive list of needs: • Educates the entire family on reasonable developmental expectations • Provides education and role modeling for the mother and extended family • Gives flex-funding to help with financial emergencies, including: food, housing and educational expenses • Connects families to critical resources • Staff available 24/7

35. In the past 28 months, the program has opened 67 cases The program has reached more than 300 people by providing services to family members of enrolled clients 12 mothers who enrolled in the program with existing Department of Children & Family Services cases, successfully saw their cases closed Young Mothers & Babies FSP ProgramUsing a “Whatever it Takes” Approach(continued)

36. Project 50 Mary Marx, LCSW District Chief, Countywide Resource Management 36

37. Project 50 Overview As a result of a motion introduced by Supervisor Zev Yaroslavsky, the Board of Supervisors committed to funding a pilot project to house and provide integrated supportive services for 50 most vulnerable chronically homeless people on Skid Row on November 20, 2007 Modeled on an approach used by Common Ground to dramatically reduce the number of people living on the streets in New York City’s Times Square The Board also specified that Project 50 should begin housing people within 100 days 37

38. Project 50 Project 50 Early Timeline: 38

39. Project 50 Participating Partners: • Board of Supervisors • Chief Executive Office • Department of Mental Health • Department of Health Services • Department of Public Health • Department of Public Social Services • Sheriff’s Department • Probation Department • Alcohol Drug Program Administration • Housing Authority City of Los Angeles • Los Angeles Homeless Services Authority • CDC • Los Angeles Mayor’s Office • Los Angeles Police Department • Skid Row Housing Trust • Didi Hirsch • JWCH • Volunteers of America • Courts • Public Defender • Public Counsel • Los Angeles City Attorney’s Office • US Veteran’s Affairs Administration • Common Ground 39

40. Project 50 Phase I: Registry Creation 40

41. Project 50 Phase I: Registry Creation • Counted 471 homeless individuals (surveyed 350) • Identified the 50 most vulnerable persons who had a 40% likelihood of dying within the next seven years unless they could be successfully placed in housing and provided appropriate medical care • 25 Outreach personnel (with assistance from the Los Angeles Police Department) • 250 of the 350 allowed Outreach personnel to photograph them (used later during Phase II to identify prospective participants • Average length of homelessness: 9.6 years • 76% reported having Mental Health issues; 90% reported having Substance Abuse issues 41

42. Project 50 Phase II: Outreach Team • Maintain regular contact with identified individuals in efforts of establishing rapport and the goal of engaging these individuals in the services including transitional and permanent housing • Establish a trusting therapeutic relationship with identified individuals • Assess needs, define service goals, and reach agreement with the individual on a plan for service delivery • Connect and/or reconnect individuals to appropriate services and supports • Registry list was expanded to the top 140 individuals and was refreshed during the project 42

43. Project 50 Phase III: Integrated Supportive Services Team • Multi-disciplinary team (from different agencies) to provide housing, integrated health, mental health, and substance abuse services, and benefits establishment. • Supportive Services include: • Physical health care, mental health and substance abuse treatment • Money management • 24 Hour/7 day crisis services • Recovery-based self-help and support groups • Employment services • Transportation services • Education opportunities • Community Reintegration services (museums, fishing trips, Dodgers game, etc.) • Medication management • Benefits establishment 43

44. Project 50 Phase III: Integrated Supportive Services Team (ISST) • Mental health services provided through a DMH Medi-Cal certified outpatient clinic and a contracted outpatient clinic • Physical health services provided through a Federally Qualified Health Center • One record • Daily team meetings • Regular consultation • Visits conducted together • Shared office space • Non-traditional contacts 44

45. Project 50 Data Housed 67 participants since inception 42 participants are currently housed with Project 50 11 participants are alternatively housed (appropriate levels of care – SNF; reunited/living with family) Of the 42 participants currently housed: 67% recognized an increase in benefits since enrollment 33 successfully applied for and are currently receiving SSI benefits 100% are receiving benefits (77% receiving SSI) 100% are diagnosed with Mental Illness 95% are participating with Mental Health treatment 83% report a history of Substance Abuse 80% of those reporting are participating with Substance Abuse treatment 100% have Medical issues 100% are participating with Physical Health treatment 45

46. Project 50 Data(continued) Hospital Days: Year prior to enrollment: approximately 750 hospital days at an estimated cost of $677,000 Year after enrollment: less than 100 hospital days at an estimated cost of $185,000 Incarceration: Year prior to enrollment: approximately 750 jail days at an estimated cost of $79,000 Year after enrollment: approximately 150 jail days at an estimated cost of $15,000 46

47. Project 50 Progression and Replication Project 50 participants and the ISST are moving into the newly developed Cobb Apartment building. Project 50 is planning to expand services to 24 additional participants. Project 50 replications in downtown: Cobb, Carver, Venice, Santa Monica, San Fernando Valley, Long Beach, and Hollywood (under development) 1 participant moved into an independent apartment in Crenshaw with supportive services 1 participant is actively seeking re-employment; recently passed his Merchant Marine examination 47

48. Project 50 Before: After: 48

49. Westside Urgent Care Center Karen J. Williams, PhD District Chief, Service Area 5 Mary Marx, LCSW District Chief, Countywide Resource Management Luana Murphy, CEO Exodus Recovery, Inc.

50. Alternative Crisis Services • Alternate Crisis Services (ACS) provides a comprehensive range of services and supports for mentally ill individuals that are designed to provide alternatives to emergency room care, acute inpatient hospitalization and institutional care, reduce homelessness, and prevent incarceration • ACS programs are funded by the Mental Health Services Act (MHSA) and operate in conjunction with MHSA’s recovery-based model of service delivery • Urgent Care Centers (UCCs) are a component of ACS