Mental Health Services Act Steering Committee

1. Health Care Agency/Behavioral Health Services Mental Health Services Act Steering Committee August 3, 2009

2. Welcome Sharon Browning, Facilitator

3. Art Perspective Ron Gassaway, Art Instructor

4. Local/State Updates Mark Refowitz, BHS Director

5. Prudent Reserve • Originally, counties were required to establish a prudent reserve for Community Services and Supports (CSS). • Purpose of Prudent Reserve is to ensure that services can continue in years where revenues decline. • Counties are required to fund the Prudent Reserve at 50% of the most recent annual approved CSS funding level. • The Prudent Reserve has been expanded to include PEI funding. 5

6. Prudent Reserve (Cont’d) • DMH has issued a draft policy on Prudent Reserve. • Draft policy requires counties to fund Prudent Reserve at 50% of most recently approved CSS and 50% of most recently approved PEI. • Funds for Statewide PEI Projects are not included in calculation of Prudent Reserve. 6

7. Prudent Reserve (Cont’d) • Originally, counties were required to fully fund Prudent Reserve by 7/1/2010. • Time frame has been extended to 6/30/2011. • A county has only one Prudent Reserve for CSS and PEI combined (blended fund). • A county may use both CSS and PEI funds made available prior to FY 2008/09 to fund the Prudent Reserve. 7

8. Prudent Reserve (Cont’d) • Starting in FY 2008/09, there is a cap on the amount of PEI funding a county may use to fund the Prudent Reserve. • 20% of the average amount allocated to a county over the previous 5 years may be redirected from CSS to fund: • Capital & Technology • Workforce Education & Training • Prudent Reserve 8

9. Prudent Reserve (Cont’d) • Funds for PEI Statewide Projects may not be used to fund the Prudent Reserve. • Prudent Reserve Funds may be used in years in which revenues for the MHS Fund are below recent averages adjusted by CPI and CA population. • Expected that counties will be able to access Prudent Reserve Funds in FY 2010/11, or sooner. 9

10. Prudent Reserve (Cont’d) • DMH will suspend the 50% requirement in years when Prudent Reserve may be accessed. • Once access to the Prudent Reserve funds is no longer available, counties are expected to replenish their Prudent Reserves. 10

11. Statewide PEI Projects • DMH requested that counties assign funding for three of the five statewide projects back to DMH. • The three projects involved are: • Suicide Prevention • Student Mental Health • Stigma Elimination 11

12. Statewide PEI Projects • Counties were told they could not use the money locally. • 17 counties, including Orange County, assigned funds back to DMH to pay for these projects. • Recently decided that counties can use money locally as long as used in projects aligned with goal of statewide projects. 12

13. Statewide PEI Projects • Counties that assigned the funding to DMH will be able to request return of those funds. • State has not spent the funding assigned for these three projects. • Process for requesting return of funding is being developed. 13

14. PEI Update Jenny Qian, PEI Coordinator

15. PEI Update PEI Plan Roll-out Process Considerations in selecting first programs to be implemented: Priorities set by the community workgroups during the planning process Implement at least one program for each age group Fill major gaps in the service system (e.g., Hotline/Warm line) Reach out to underserved groups 15

16. PEI Update Some programs will be contracted Others implemented by HCA Others implemented through a combination of contract and HCA staff 16

17. PEI Update Who will implement a specific program is determined by a variety of factors: Level of community involvement needed: (For example, a program with high need for community involvement might be one targeting a specific ethnic underserved population) 17

18. PEI Update Timing: Some programs can be implemented earlier by using county staff. Requests for Proposals (RFPs) for a contract program take 9 months or longer. Feasibility of combining types of providers: (Some programs can be started earlier with county staff. An RFP can be conducted to select a CBO that can serve part of the population later). Type of contract to be used (RFP, Sole Source, other) 18

19. PEI Update Timeline for roll-out Selected county programs: early Fall Selected contract programs: RFPs out in mid or late Fall 19

20. PEI Update Contract Programs to be available for bid in mid or late Fall, include: Socialization Program for Older Adults Positive Behavioral Interventions Violence Prevention Education Promotora Modeling Parent Education Survivor Support Services Crisis Prevention Hotline/Warm Line Triple P 20

21. PEI Update HCA Programs include: Children of Substance Abusing/Mentally Ill Parents (CSPP) – currently operational First Onset-Post Partum – pilot in fall School Readiness – pilot in fall Outreach & Engagement – pilot in fall First Onset-First Break Services – TBD Juvenile Justice Youth’s Family Services 21

22. PEI Update Sustainability The amount of PEI funding in the next few years will be reduced; FY 2009/10 funds =$27.7 million (22.8 allocated and 4.9 supplemental). Estimate that $16-$18 million can be sustained, depending on continued monitoring of tax receipts and actions by OAC on Prudent Reserve for PEI 22

23. PEI Update How will we plan for sustainable level of programs? Education/Training Programs can be offered on a rotating schedule. Operate some programs for a limited timeframe. Flexible programming is needed. 23

24. WET/Innovation Component Casey Dorman, WET Coordinator

25. Veteran’s Services Maureen Robles, Veteran’s Services Coordinator

26. Technological Needs Project Proposal Kathleen Murray, Technological Needs Coordinator

27. Technology Goals of MHSA • To support the goal of transforming the Mental Health system, California State Department of Mental Health (DMH) allocated MHSA funds to meet their objective for all counties to develop an Integrated Information Systems Infrastructure through which they can securely access and exchange information • This is accomplished through an Electronic Health Record (EHR) 27

28. Benefits of an EHR • Improved real time access to critical clinical information including medications, allowing for: • A reduction in errors and delays in care • Greater consistency in service planning and interventions • Improvement in care from on-line clinical decision-support and links to educational and reference sources • Improved care coordination among consumer, family, and multiple providers through information sharing (with consumer consent) • Improved compliance with HIPAA and State/Federal billing requirements 28

29. Next Steps • We are ready to move forward with our first Project Proposal • It is the first of two phases that will result in a fully integrated Electronic Health Record (EHR) for Orange County Behavioral Health Services 29

30. Our Project Proposal • The first step towards building our EHR is to build out or upgrade our infrastructure to provide us the necessary platform on which to build the functionality we need • The MHSA Technology project currently proposed is to perform this infrastructure enhancement 30

31. Why is this Needed? • Our current EHR application is built upon an old hardware and software platform that cannot support any new functional development to add the tools that we need for: • Clinical Documentation Management • Medication Management • Interfacing/interoperability with other non-County clinics • Compliance with State and Federal regulations for billing, security, and privacy 31

32. What is Needed? • Upgrade to current release of Cerner Millennium application • Acquire new Hewlett Packard servers with enhanced operating system and newest version of Oracle database • Acquire supporting storage and other related hardware and network equipment • Acquire current support applications to better utilize and manage the system 32

33. Roadmap DMH EHR Roadmap Phase 1 Practice Management Electronic registration, scheduling and billing. 2008 Phase 2 EHR “Lite” Document Imaging, Clinical Notes and History 2009 Phase 3 Ordering Ordering Lab & Prescriptions, Viewing, Ordering, Reporting 2010-2011 Phase 4 Fully Integrated EHR Interface from external providers EHR and PHR 2012-2014 OCHCA Roadmap Phase 3 Fully Integrated EHR Integrate and Interface with external provider EHR and PHR systems including Lab 2012-2014 Phase 1 Practice Management Electronic registration, scheduling, billing, and lab (PH) 2007 Phase 2 Full EHR Infrastructure Buildout Clinical documentation management- Assessments and Treatment Plan. Clinical notes module Medication management- Computer Provider Order Entry (CPOE) for prescriptions Document Imaging Able to interface with other non-county providers 2009-2012 33

34. Timeline • The expected timeline for the project to enhance our infrastructure is 2009-2010 and the cost is estimated to be $3.8 million but we are budgeting for $4.5 million to allow for contingencies • We are asking for $3.3 million in MHSA Technology funds which covers the proportional share of the project costs that will benefit Mental Health Services • The proposed timeline for the build and implementation of the clinical documentation, medication management, and other components of a fully integrated EHR is 2011-2014 34

35. Project Summary • This project has been approved by the MHSA Technology Advisory Committee • Information about it has been presented to the Community Action Advisory Committee (CAAC) and the Mental Health Board • The project proposal has been posted on the County’s MHSA website and the public comment period started 7/24/09 35

36. Project Summary • We are asking for your consensus today to move forward on this project • Once approved by these stakeholder groups, we will submit the project to the County Board of Supervisors on 8/25/09 for approval • The final project proposal will be submitted to the Department of Mental Health on 8/25/09 for review and approval • DMH review will take 30 to 60 days 36

37. Questions? 37

38. Consensus on Project Proposal Sharon Browning, Facilitator

39. MHSA Program Kate Pavich, MHSA Coordinator

40. MHSA Updates • FY 08/09 Progress Report • Spirituality Initiative • MHSA Newsletter • 2nd Annual Vietnamese Family Fun Day • Celebration Recovery Picnic • MHSA Health Expo 9/24/09 at Delhi Center • Orange County Peer-To-Peer Employment Conference 2009 40

41. Recovery Arts • Call for Art Health Expo 9/24/09 • Call for Art/Writing for MHSA On-Line Gallery http://ochealthinfo.com/mhsa/arts-program.htm • Erase Stigma Art Festival • “Storms of the Mind” by Kymberli Kercher-Smith • MHSA 2010 Calendar 41

42. Orange County Health Care Agency Behavioral Health Services Mental Health Services Act Calendar 2010 “Gardened Again Tended” by Mark Doyle

43. MƠ XUÂNby K.N. Xuân đã đến, Muôn hoa đua nở, cây đâm chồi nẩy lộc. Bướm lượn trên muôn hoa thắm tươi. Bao ước mơ thành hiện-thực, Nắng vàng tươi lóng lánh trên tóc ai. Gió nhẹ lay hoa đào hồng thắm. Tôi mong mọi người đạt được mọi điều mơ ước. Đất nước luôn thanh-bình, thịnh-vượng, vinh quang. Dreaming in Spring Spring is coming Flowers open up; buds are growing Butterflies fly on bright flowers Many dreams will come true Sun shines on the lover’s hair The light wind stirs bright peach-blossoms by K.N. “Hummingbird” by Micaela Falcon 43

44. Reflections by Judy Ann Adams Mirror image shatters pieces falling randomly At their feet one sees a reflecting puzzle of what was collectively To survive the gartering of pieces becomes necessity Piecing together that of choice slowly, selectively Old reflection reshaped into new reality Now reflecting a courageous person perceptively “Tongues of Fire” by Kevin Burroughs 44

45. 401 S. Tustin St.Allen Hibbs, AIA 45

46. Steering Committee CommentsPublic Comments Sharon Browning, Facilitator

47. Next Steering Committee September 14, 2009 Delhi Community Center 1:00 pm – 4:00 pm