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MHSA Successes in LA: Perspectives on Recovery and Resiliency

Welcome. Catherine Bond, MFTVice Chair, Los Angeles County Client CoalitionDennis Murata, MSWDeputy Director, Program Support Bureau . 2. MHSA Overview. Proposition 63 ? Mental Health Services ActCalifornia ballot propositionPassed November 2004Funding began January 1, 2005How it is funded

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MHSA Successes in LA: Perspectives on Recovery and Resiliency

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    1. MHSA Successes in LA: Perspectives on Recovery and Resiliency 1

    2. Welcome 2

    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) 3

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

    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 5

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    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.” 9

    10. Making a Difference in Consumers’ 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 10

    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 11

    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) 12

    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 13 63,927 total assessments in OMA = 9,071 Baselines or Partnership Assessment Forms (PAFs) , 22,345 KECs or Key Event Tracking (KET) , and 32,511 3Ms. 63,927 total assessments in OMA = 9,071 Baselines or Partnership Assessment Forms (PAFs) , 22,345 KECs or Key Event Tracking (KET) , and 32,511 3Ms.

    14. Development of Reports Utilized AB2034 methodology for reports, including initial focus on living arrangements Data validity and reliability 14 Creation of exception reports to help providers clean up data so that more of their data could be included in analysis. Employment and Education Reports needed for ongoing data validation Reports that are needed by providers to better manage data Combination of outcomes data and expenditure dataCreation of exception reports to help providers clean up data so that more of their data could be included in analysis. Employment and Education Reports needed for ongoing data validation Reports that are needed by providers to better manage data Combination of outcomes data and expenditure data

    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 15 Recently we added graphic reports like the ones we will show today that allows them to see changes in residential status in a new way. They can also view how their provider site/ program is doing compared the other programs countywide. Recently we added graphic reports like the ones we will show today that allows them to see changes in residential status in a new way. They can also view how their provider site/ program is doing compared the other programs countywide.

    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 16

    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: 17

    18. Hospitalization Data (Measured by Number of Clients) 18 Child: 40% Reduction in number of clients, N=2658 TAY::42% Reduction in number of clients N=1214 Adults: 24% Reduction in number of clients N=4280 Older Adults: 24% Reduction in number of clients N=367 Child: 40% Reduction in number of clients, N=2658 TAY::42% Reduction in number of clients N=1214 Adults: 24% Reduction in number of clients N=4280 Older Adults: 24% Reduction in number of clients N=367

    19. Hospitalization Data (Measured by Number of Days) 19 Adults: 16% Reduction in number of clients N=4280 Older Adults: 17% Reduction in number of clients N= 367 Adults: 16% Reduction in number of clients N=4280 Older Adults: 17% Reduction in number of clients N= 367

    20. Jail Data (Measured by Number of Clients) 20 TAY::20% Reduction in number of clients, N=1214 Adults: 26% Reduction in number of clients N=4280 Older Adults: 26% Reduction in number of clients N= 367 TAY::20% Reduction in number of clients, N=1214 Adults: 26% Reduction in number of clients N=4280 Older Adults: 26% Reduction in number of clients N= 367

    21. Jail Data (Measured by Number of Days) 21

    22. Decline in Homelessness (for All Age Groups) 22 Robin’s notes: The graphs represent a reduction in homeless days by showing the number of pre-partnership and post-partnership days.  Pre-partnership days are the total amount of homeless days experienced in the 12 months immediately before enrolling in the Full Service Partnership (FSP) program.  Post-partnership days are the total number of homeless days experienced in the 12 months immediately after enrolling in the FSP program. Robin’s notes: The graphs represent a reduction in homeless days by showing the number of pre-partnership and post-partnership days.  Pre-partnership days are the total amount of homeless days experienced in the 12 months immediately before enrolling in the Full Service Partnership (FSP) program.  Post-partnership days are the total number of homeless days experienced in the 12 months immediately after enrolling in the FSP program.

    23. Homeless Data (Measured by Number of Clients) 23 TAY::37% Reduction in number of clients, N=1214 Adults: 44% Reduction in number of clients N=4280 Older Adults: 42% Reduction in number of clients N= 367 TAY::37% Reduction in number of clients, N=1214 Adults: 44% Reduction in number of clients N=4280 Older Adults: 42% Reduction in number of clients N= 367

    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 24 Fewer clients are hospitalized in an acute psychiatric hospital. Child TAY Adult Older Adult 40% of Adult FSP clients experienced homelessness in the 12 months immediately prior to FSP: On average, these clients were homeless for 8 out of the 12 months for a grand total of 421,597 days. While in FSP, clients experience 64% fewer homeless days when compared to baseline data. TAY(-20%), Adult (-26%), & Older Adult(-26%) FSPs show reductions in the number of clients in jail in FSP, compared to 12-month baseline data. Fewer clients are hospitalized in an acute psychiatric hospital. Child TAY Adult Older Adult 40% of Adult FSP clients experienced homelessness in the 12 months immediately prior to FSP: On average, these clients were homeless for 8 out of the 12 months for a grand total of 421,597 days. While in FSP, clients experience 64% fewer homeless days when compared to baseline data. TAY(-20%), Adult (-26%), & Older Adult(-26%) FSPs show reductions in the number of clients in jail in 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 25 There is also a reduction in the number of jail days for Adults (-38%) and Older Adults (-30%) experienced while in FSP compared to the year prior. The majority of Adult (26%) and Older Adult (37%) FSP clients are currently living independently in either an apartment of 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 (82%) and TAY FSP clients (53%) are currently living with their familiesThere is also a reduction in the number of jail days for Adults (-38%) and Older Adults (-30%) experienced while in FSP compared to the year prior. The majority of Adult (26%) and Older Adult (37%) FSP clients are currently living independently in either an apartment of 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 (82%) and TAY FSP clients (53%) 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 26 We have used this data to target provider sites that have underutilized Client supportive services dollars for housing. Providers that show a large percentage of clients that are homeless, in temporary housing or shelters, can be contacted to ensure they are aware of available housing resources. We have used this data to target provider sites that have underutilized Client supportive services dollars for housing. Providers that show a large percentage of clients that are homeless, in temporary housing or shelters, can be contacted to ensure they are aware of available housing resources.

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

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

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

    30. Older Adult Full Service Partnership Current Residential Status N= 284 30

    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 31 Methodology; Adult slots: 4,084 Cost $11,200, slots No Baseline treatment costs available at this time. This is the total allocation for service dollars per slot including FFP. Two-thirds of the slots are matched. For example, an adult Medi-cal slot is funded at $5,650 FFP and $5,650 MHSA; an Indigent slot cost $11,300. 3Rate is based on Fee for Service Inpatient Psychiatric Hospitalizations. 4Daily rates based on Los Angeles County Sheriff’s Department costs for incarceration in medical or mental health jail facilities for fiscal year 2007-2008. 5Data is annualized taking into account the client’s tenure in order to compare their pre-enrollment history. Data as of 4/21/10Methodology; Adult slots: 4,084 Cost $11,200, slots No Baseline treatment costs available at this time. This is the total allocation for service dollars per slot including FFP. Two-thirds of the slots are matched. For example, an adult Medi-cal slot is funded at $5,650 FFP and $5,650 MHSA; an Indigent slot cost $11,300. 3Rate is based on Fee for Service Inpatient Psychiatric Hospitalizations. 4Daily rates based on Los Angeles County Sheriff’s Department costs for incarceration in medical or mental health jail facilities for fiscal year 2007-2008. 5Data is annualized taking into account the client’s tenure in order to compare their pre-enrollment history. Data as of 4/21/10

    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 32 Methodology; Older Adult slots: 3,948 Cost $12,000, slots No Baseline treatment costs available at this time. This is the total allocation for service dollars per slot including FFP. Two-thirds of the slots are matched. For example, an adult Medi-cal slot is funded at $5,650 FFP and $5,650 MHSA; an Indigent slot cost $11,300. 3Rate is based on Fee for Service Inpatient Psychiatric Hospitalizations. 4Daily rates based on Los Angeles County Sheriff’s Department costs for incarceration in medical or mental health jail facilities for fiscal year 2007-2008. 5Data is annualized taking into account the client’s tenure in order to compare their pre-enrollment history. Data as of 4/21/10Methodology; Older Adult slots: 3,948 Cost $12,000, slots No Baseline treatment costs available at this time. This is the total allocation for service dollars per slot including FFP. Two-thirds of the slots are matched. For example, an adult Medi-cal slot is funded at $5,650 FFP and $5,650 MHSA; an Indigent slot cost $11,300. 3Rate is based on Fee for Service Inpatient Psychiatric Hospitalizations. 4Daily rates based on Los Angeles County Sheriff’s Department costs for incarceration in medical or mental health jail facilities for fiscal year 2007-2008. 5Data is annualized taking into account the client’s tenure in order to compare their pre-enrollment history. Data as of 4/21/10

    33. Roybal Mental Health Center Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach 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 33

    34. Young Mothers & Babies FSP Program Using 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 34

    35. Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach (continued) 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 35 In the past 28 months, the program has opened 67 cases: The cases are opened in either the child or the mother’s name, which means that the program has engaged a minimum of 134 mother-child dyads. Other Successes: A seeing-impaired client had lost custody of her child, and was living in an isolated existance, being exploited by “caretakers” has not regained custody of her child and is now active at the Braille Institute. In the past 28 months, the program has opened 67 cases: The cases are opened in either the child or the mother’s name, which means that the program has engaged a minimum of 134 mother-child dyads. Other Successes: A seeing-impaired client had lost custody of her child, and was living in an isolated existance, being exploited by “caretakers” has not regained custody of her child and is now active at the Braille Institute.

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

    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

    38. Project 50 Project 50 Early Timeline:

    39. Project 50 Participating Partners:

    40. Project 50 Phase I: Registry Creation

    41. Project 50 Phase I: Registry Creation

    42. Project 50 Phase II: Outreach Team

    43. Project 50 Phase III: Integrated Supportive Services Team

    44. Project 50 Phase III: Integrated Supportive Services Team (ISST)

    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

    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

    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

    48. Project 50

    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. 49

    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 50

    51. Westside UCC Operated by Exodus Recovery, Inc. Opened in December 2006 Located in the 1st Supervisorial District – Service Area 5 (3828 Hughes Avenue, Culver City, CA 90232) Open 365 days/year, 24 hours/day Lanterman Petris-Short Designated (February 2007) Located near Brotman Medical Center Provide intensive crisis services to individuals who otherwise would be brought to emergency rooms Provide up to 23 hours of immediate care and linkage to community-based solutions Provide crisis intervention services, including integrated services for co-occurring substance abuse disorders Focus on recovery and linkage to ongoing community services and supports that are designed to impact unnecessary and lengthy involuntary inpatient treatment 51

    52. Westside UCC Three (3) Service Components: Mental Health Crisis Program Emergency Shelter Bed Program, providing short-term residential services to homeless individuals receiving services from the Mental Health Crisis Program (through partnership with Ocean Park Community center) Transitional Residential Services Program, providing longer-term housing for individuals in need of ongoing support to live independently in the community (through partnership with Alcott) 52

    53. Westside UCC 53

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    55. Westside UCC Data Other Demographic Data: 55

    56. Westside UCC Data 56

    57. Westside UCC Data 57

    58. Westside UCC Data 58

    59. UCC Expansion 59

    60. Transformative Approaches Terri Boykins, LCSW District Chief, Transitional Age Youth 60

    61. Drop-In Centers Provide temporary safety & basic supports for seriously emotionally disturbed and severe and persistently mentally ill youth 16 – 25. Low-demand, high-tolerance environments. Served 4,405 clients from March 2008-2010 Gender: 64% male, 29% female Ethnicity: 61 Picture of Self-Help Library and artwork displayed. Probably two slides. Daily Living Skills (balancing checkbooks)Picture of Self-Help Library and artwork displayed. Probably two slides. Daily Living Skills (balancing checkbooks)

    62. Transformative Approaches Pacific Clinics TAY Drop-In Center Video 62

    63. Transformative Approaches Northeast Wellness Center Maria Aguilar, MD Psychiatrist, Northeast Wellness Center 63

    64. Northeast Wellness Center “Our dream is to help others achieve their dreams.” Consumers created vision and mission Vision: “Help consumers reach their hopes, dreams and goals.” Mission: “Everybody working together for one purpose: to assist consumers to realize their skills, gifts and talents, and to support their brilliance as they find their place in the world.” 64 Self-introduction, Dr. Maria Aguilar. Say that the Center is led by Laura Span, with administrator Linda Fazio. Very client-oriented.Self-introduction, Dr. Maria Aguilar. Say that the Center is led by Laura Span, with administrator Linda Fazio. Very client-oriented.

    65. Northeast Wellness Center Person-Centered Approach Social (family, community, friends) Physical (medical, nutrition, exercise) Basic needs (food, clothing, shelter) Vocational (job, school, volunteering) Psychological (emotional coping skills, harm reduction) Spiritual (sense of purpose and belonging) 65

    66. Northeast Wellness Center 1,800 Contact Services (FY July 2009-April 2010) 66 Picture of Self-Help Library and artwork displayed. All the Centers have such links to services. Recurrent and individual clients (points of service) Picture of Self-Help Library and artwork displayed. All the Centers have such links to services. Recurrent and individual clients (points of service)

    67. Northeast Wellness Center 67 Picture of Self-Help Library and artwork displayed. Probably two slides. Daily Living Skills (balancing checkbooks)Picture of Self-Help Library and artwork displayed. Probably two slides. Daily Living Skills (balancing checkbooks)

    68. 68

    69. Lives Touched Kathleen Piché, LCSW Public Information Officer, LACDMH 69

    70. Lives Touched Gary Gougis, Peer Advocate Video 70

    71. Question & Answer 71

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