County of San Diego Health and Human Services Behavioral Health Services Adult/Older Adult Industry Day

1. County of San DiegoHealth and Human ServicesBehavioral Health ServicesAdult/Older AdultIndustry Day Prevention and Early Intervention Services for Transition Age Youth First Break ‘Cool’ Program RFP #3496 April 20, 2009

2. Executive Summary First Break Program • This new San Diego County program has a three-pronged approach to early detection of at-risk and high-risk youth for psychotic episodes for TAY, ages 14 to 24 year old. • The early intervention component will provide services that shall identify community gatekeepers –teachers, primary care providers and families who will be educated and provided with information on how to identify at risk or high risk youth for features and behaviors for psychotic episodes. • Prevention services shall engaged ‘gatekeepers’ and provide education to these providers and individuals, and provide information and materials to support their efforts to identify at risk youth . • Youth and families referred by these ‘gatekeepers’ shall be engaged through outreach and assessed for services to be provided by the Cool program.

3. Background • The third component of the First Break program, is the At Risk Mental State (ARMS) services, hereafter referred to as the Cool program, in the Central region of San Diego County. This component shall provide biopsychosocial and mental health services for up to 18 months to eligible and youth. • The PEI standards for low intensity and short duration do not apply to services for individuals experiencing ARMS or first onset of a serious psychiatric illness with psychotic features. • During the community forums for the MHSA in 2005, support for a program for TAY and their families was proposed to avoid the often devastating effects of the first psychotic break that often leads to the loss of academic progress, loss of employment and loss of family support. Research has shown that early intervention can help to prevent these problems and that maintaining family support can lead to a much more hopeful future. • Funding shall be provided through the Mental Health Services ACT on going Prevention and Early Intervention (PEI) dollars.

4. Community Partnerships • Partnerships and collaborations will be reinforced and/or developed with: • community health centers • primary care • mental health • alcohol and drug services • San Diego Unified School District and its high schools • San Diego City College • San Diego State University • Family Resource Centers in the Central region • local social service agencies • faith based organizations • foster care and justice system sector for youth and TAY • other TAY non-profit organizations such as the Access Center, serving LGBT, and the Monarch High School for TAY homeless • Gatekeepers are to be identified within these organizations.

5. Target Population • Transitional Age Youth, 14 to 25 year olds and their families, who reside in the Central Region and are at risk or high risk of experiencing a psychotic episode. • Education and outreach services to 350 unduplicated individuals in the community to identify and engage at-risk or high risk youth and their families and link them to Seriously Emotionally Disturbed, Specialty Mental Health Services or the ‘Cool’ program. • The ‘Cool’ program shall assess 100 unduplicated youth and families and they will provide Mental Health Assessment with intensive biopsychosocial and mental health services.

6. Goals and Outcomes • Contractor shall enter into a contract with Biosocial Training Institute (BTI) of Maine for training and evaluation of implementation of the program. • BTI of Maine will also provide technical assistance, consultation and supervision of the implementation of the program. • This training provides for contracted staff a comprehensive training in mental health intervention methods, including family psycho education and prodromal psychosis intervention and prevention. • Tools to be utilized under the BTI training include the SIPS, a structured diagnostic interview used to diagnose the three prodromal syndromes and may be thought of as analogous to the Structured Clinical Interview for DSM-IV (SCID). • The SIPS includes the SOPS (Schizotypal Personality Disorder Checklist) and a version of the Global Assessment of Functioning scale (GAF). • The SIPS also includes operational definitions of the three prodromal syndromes [Criteria of Prodromal Syndromes (COPS)] and an operational definition of psychosis onset [Presence of Psychotic Syndrome (POPS)

7. Program Description • Education and outreach to community gatekeepers to assist them in identifying youth at risk. • Then an intensive service component envisioned to provide mobile outreach and engagement; TAY/youth, family, and parent psycho education classes/groups to assist in the identification and management of at-risk behaviors and features. • This would include consultation and care coordination with integrated primary care, mental health and substance abuse treatment. • In-home services and support, crisis intervention and transportation for approximately 100 TAY/youth and families. ‘Cool’ services for At Risk Mental State (ARMS) TAY/youth provides short term services (up to 18 months) for identified and eligible TAY that meet the criteria for at-risk or high risk behaviors.

8. Services and Staffing • Interventions that are required in the ‘Cool’ component include: • Outreach, engagement, evaluation and assessment; and • Mobile and site-based short term treatment, intervention, and support services for the first 3 to 9 months until capacity of services are reached. • Staffing of the ‘Cool’ Program includes: • Psychiatrist with a specialization in TAY/youth • Psychiatric nurse • Licensed clinicians • Peer Specialists • Employment and education service staff • Clinical, research and evaluation team. It is expected that contractor retain the services of the Biosocial Training Institute under this contract in order to implement services. 8

9. Specific Service Delivery Requirements • Contractor shall have a MediCal certified facility that has space for individual and group services (up to 50 persons) with necessary resources to operate. • Contractor shall provide all required mental health services during the 6-18 months of treatment in the ‘Cool’program. • TAY/Youth who are deemed appropriate for further mental health assessment/treatment and services will be transitioned and linked to existing MHSA Child (under 18 y/o) or MHSA TAY (18 to 24 y/o) outpatient specialty mental health programs. TAY will also be linked to primary care physicians, substance abuse services, and other appropriate social and recreational services in the community. • Peer Specialist position acts as a role model/mentor for youth to support engagement, education, wellness, and recovery. They will also assist the youth/TAY to link to youth appropriate services with transportation or support.

10. Thank you! Questions?