California Senate s Distinguished Speaker Series Sandra Naylor Goodwin, PhD, MSW President and CEO, CiMH

Transcription

1 March 2013 California Senate s Distinguished Speaker Series Sandra Naylor Goodwin, PhD, MSW President and CEO, CiMH Dr. Sandra Naylor Goodwin, President and CEO of the California Institute for Mental Health (CiMH), addressed the California State Senate on Monday, February 25, as part of the Senate s Distinguished Speaker Series. The presentation covered a general overview of California s public mental health system, a description of core services under the Bronzan-McCorquodale Act, financing, the Mental Health Services Act (Proposition 63) including prevention, early intervention, and full service partnerships, and concluded with current challenges. As Dr. Goodwin explained to the Senators, mental health has been underfunded beginning with deinstitutionalization in the late 1960s. The groundbreaking Lanterman- Petris-Short (LPS) Act of 1968 afforded people who had been in state hospitals civil rights. This was a convergence of social scientists who determined institutionalization was harmful, fiscal conservatives who wanted to save money, new medications, and civil rights. Thus, the state hospitals slowly closed as people were released. The promise was that the funds saved from the closures would be transferred to communities to provide care locally. That did not happen, and many people with mental illnesses ended up on the streets. The 1970s and 1980s were a time of fiscal inflation and population growth. Mental health funds were regularly decreased each year resulting in a serious crisis in mental health funding. This led to the Realignment of 1991 to stabilize funding. Realignment funds are not a part of the state budget but go directly to counties to fund services as defined in the Bronzan-McCorquodale Act. Continued on page 2

2 California Senate s Distinguished Speaker Series Continued on page 3 The Bronzan-McCorquodale Act defines the mission of the mental health care system in California as: The mission of California's mental health system shall be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. Welfare and Institutions Code The Act also defines target populations for children, adults and older adults. However, in spite of the attempt to stabilize funding, California s mental health system continues to provide services to less than half those in need. Dr. Goodwin shared with the Senators that approximately 1.6 million California adults experience mental health distress that interferes with functions of daily living. Approximately 600,000 persons are currently served in the public mental health system. Healthcare reform and Medi-Cal expansion will provide coverage for another 500,000 (254,400 eligible for Medi-Cal and 228,500 eligible for coverage through the exchange). This still leaves approximately 500,000 people without coverage and without access to services.

3 California Senate s Distinguished Speaker Series Continued from Page 2 The voters of California passed Proposition 63, the Mental Health Services Act in The purpose of the Act is to: Define serious mental illness as a condition deserving priority attention Reduce long-term adverse impact from untreated serious mental illness Expand successful, innovative service programs Provide funding to adequately meet the needs Ensure that funds are expended in a cost effective manner and that services are provided consistent with best practices The components of the Act include Prevention and Early Intervention; Services to Children System of Care/Wrap Around; Adults and Older Adults Recovery; diversity; transition age; mentally ill offenders; Workforce Education and Training; Innovative Programs; and funds the Mental Health Services Oversight and Accountability Commission and state administration costs. Dr. Goodwin also provided the senate with impressive data on school based prevention programs in Los Angeles. Exciting data on early intervention for psychosis programs was presented and discussed, as well as current data on Full Service Partnerships. The Senators were very interested and asked many pertinent questions on program and data issues as well as fiscal issues. 3

4 2013 California Institute for Mental Health Evidence-Based Practices Symposium: Evidence-based Practices for Children and Adults In a Changing Health Care Environment April 25-26, 2013 Doubletree Hotel Anaheim-Orange County 100 The City Drive Orange, California The California Institute for Mental Health (CiMH) has been actively promoting the adoption of children s evidence-based mental health practices for a number of years now, and began convening annual symposiums as a key strategy for supporting ongoing model adherence, as well as providing a forum for new and or promising practices. CiMH has added Transition-Age Youth and Adult Evidence-based Practices to the Symposium this year. As healthcare reform begins to change the health care environment, evidence-based practices (EBPs) will become key strategies to promote well-being and recovery. Primary health care and mental health providers will need to promote local innovation, create program efficiencies, and ensure statewide equity to improve mental health and related services in the state. Increasing the consistent application of evidence-based practices is an essential strategy for improving the quality and effectiveness of services in California. The symposium tracks and workshops will target practitioners, supervisors and managers who are implementing evidence-based practices, or considering the implementation of evidence-based practices, and will include keynote addresses and workshops focusing on health care reform, advances in research and practice, enhancing clinical skills, and building organizational infrastructure to support practice implementation. Continued on page 5

5 ! 2013!California!Institute!for!Mental!Health!Evidence:Based!Practices!Symposium:! Evidence:based!Practices!for!Children!and!Adults!in!a!Changing!Health!Care! Environment! Continued)on)page)6) Keynote!Presentations:!! Parity!and!the!Affordable!Care!Act:!The!Incomplete!Story! Howard Goldman, M.D., Professor of Psychiatry at the University of Maryland School of Medicine Mental health insurance parity policy aspirations seemed to reach a climax after more than 50 years of efforts with the passage of legislation in The Affordable Care Act (ACA) of 2010 advanced mental health insurance parity from a specialized requirement into a mainstream mandate. These new laws have created many opportunities for improved behavioral health services, yet there are aspects of these policies that remain incompletely implemented, and there are elements of care still unaffected by parity and the ACA. In particular, a number of EBPs, such as ACT and Supported Employment, do not fit within the scope of parity or the essential benefits of the ACA, and we need to think of ways to promote and pay for these important services. Community!Engagement!to!Implement!Depression!Best!Practices:!!The!Added!Value!of! Networks! Kenneth Wells, M.D., MPH, Professor in Residence, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Department of Health Services, UCLA School of Public Health, Director of Health Services Research Center; Senior Scientist, RAND Health Services This address will review a new model based on community engagement and partnership to address depression disparities through collective action across healthcare and community-based organizations that work together to implement evidence-based practices in under-resourced communities of color. The rationale and framework will be reviewed as well as data from a randomized comparative effectiveness trial in Los Angeles County touching upon health and social outcomes and changes in services utilization. Implications for community health home models in healthcare reform will be discussed. We will be convening a single Symposium that will include tracks (five sessions) specific to the following intervention models: Aggression Replacement Training Functional Family Therapy Trauma Focused Cognitive Behavioral Therapy 5

6 2013 California Institute for Mental Health Evidence-Based Practices Symposium: Evidence-based Practices for Children and Adults in a Changing Health Care Environment Continued from page 5 Additionally, there will be many featured workshops for young children, youth, transition age youth and adults. Some of these workshops include: Children s Practices: Depression Treatment Quality Improvement (DTQI) Triple P (Positive Parenting Program) Parent-Child Interaction Therapy (PCIT) Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems (MATCH-ACTC) Transition Age Youth Practices: Early Detection and Intervention for the Prevention of Psychosis (EDIPP) Model Dialectic Behavioral Therapy (DBT) Evidence-based Interventions in the Treatment of Early Psychosis: The PREP Model Family Acceptance Project: Generating a Revolution in Prevention and Care for LGBT Children and Youth Adult Practices: Cognitive Enhancement Therapy (CET) SSI/SSDI Outreach, Access, and Recovery (SOAR) Model Moral Reconation Therapy Cognitive Behavioral Therapy for Adults You will also hear presentations on: Outcome Evaluation Data from Evidence-based Practice Implementations Supported by CiMH Implementation Science Troubleshooting Model Adherent Implementation The Business Case for Evidence-based Practices A Family Experience with Evidence-based Practices 6

7 CiMH HEALTH EQUITY LEADERSHIP INSTITUTE Kristee L. Haggins, Ph.D. Health equity is the realization by ALL people of the highest attainable level of health. Achieving health equity requires valuing all individuals and populations equally, and entails focused and ongoing societal efforts to address avoidable inequalities by assuring the conditions for optimal health for all groups, particularly for those who have experienced historical or contemporary injustices or socio-economic disadvantage. -Adewale Troutman, MD, MPH, MA President, APHA The California Institute for Mental Health (CiMH) is excited to be launching a new pilot project, the Health Equity Leadership Institute (HELI). HELI seeks to support the development of leadership skills to achieve health equity and reduce disparities, as well as to enhance the public behavioral health system s capacity to track and eliminate disparities at the local level. Through statewide and local learning communities, the Health Equity Leadership Institute will support small regional teams as they work collaboratively to address health disparities identified as priorities in the region. These local learning community teams will identify culturally relevant strategies to address the disparities and culturally appropriate methods for evaluating these efforts. The Health Equity Leadership Institute will include the formation of team-based learning communities. Each local learning community team will represent a county or regional collective comprised of various members including: a County Ethnic Services Manager, Evaluation/Data Expert, CBO Partner(s), Person(s) with Lived Experience, and Cultural Brokers (e.g., faith leaders, community advocates, etc.). We have gathered information from stakeholders regarding the development of the Health Equity Leadership Institute and continue to do so. The concept of the Institute was first introduced to the California Mental Health Directors Association (CHMDA) in July 2012, a Health Equity Leadership Institute Input Session with 22 attendees was held during the September 2012 California Mental Health and Substance Use Policy Forum, and an Expert Panel Meeting with 18 attendees was held in November 2012 at CiMH. In addition, HELI was introduced to the Southern Region Ethnic Services Managers in January 2013 and an overview of the project was provided at the Cultural Competency, Equity and Social Justice Coalition Meeting (CCESJC) in February Continued on page 8

8 CiMH Health Equity Leadership Instute Connued on page 9 Based upon feedback received thus far, the following objectives for and benefits of participation in the Health Equity Leadership Institute have been identified: Objectives: Empowerment Increase efficacy of county Ethnic Services Managers as change agents Expand the role of the community in the decision-making process; utilize bottom-up approaches Learning Enhance leadership skills necessary to achieve health equity Identify opportunities to advance health equity within health care reform Enhance effective communication skills Results Develop culturally appropriate indicators of success Identify culturally appropriate methods for measuring results/outcomes Align with existing efforts to produce effective results/outcomes Benefits of Participation Shared learning through statewide and local learning communities Team coaching at the local level Consensus building Small scale tests of change (PDSA cycles) Implementation and spread of learning Tracking and communicating results The kickoff for the Health Equity Leadership Institute will be on June 6-7, 2013 (location TBD). Mario Hernandez, Ph.D. and Tara Earl, Ph.D. are our expected keynote speakers and we are very pleased to have these national leaders participate in this project. After the kickoff in June 2013, the Health Equity Leadership Institute will continue through the fiscal year of It will include Quarterly Statewide Learning Community Meetings with presentations and discussions led by faculty who are experts in measuring and evaluating disparities, leadership, and strategies to reduce disparities and enhance health equity. In between these quarterly statewide meetings, faculty members will provide the local learning community teams with coaching and support on their collective project. The Institute will conclude with a Statewide Harvest of Learning Meeting in June However, before launching the Health Equity Leadership Institute in June 2013, we are continuing to seek stakeholder feedback through regional meetings. These meetings will provide an overview of the HELI program, so that attendees can learn more about the institute and what it has to offer. The regional meetings will also give participants an opportunity to provide input into the development of the Institute s curriculum - with the feedback being integrated into the overall plan for the Health Equity Leadership Institute. These regional meetings will include presentations and discussions about the following topics

9 CiMH Health Equity Leadership Institute Continued from page 8 by these presenters: Understanding Health Equity Kristee Haggins, CiMH, Leadership in the Context of Health Equity Ana Estrada, Kiely Group, and Measurement and Evaluation Steve Roussos, UC Merced. How Do You Get Involved in the Health Equity Leadership Institute? Attend one of the Health Equity Leadership Institute s regional meetings! They are open to ALL interested parties. We encourage HELI regional meeting attendees to begin the process of identifying individuals that may be included in your regional team should you decide to participate in the Institute. As mentioned previously, these teams should include: County Ethnic Services Managers, CBO Partner(s), Person(s) with Lived Experience, and Cultural Brokers (e.g., faith leaders, Promotoras, community advocates, etc.). Regional meeting participants may also include County Mental Health/Behavioral Health Directors, MHSA Coordinators, contract providers, and others working to achieve health equity in your region. Regional Meeting Schedule & Locations To register for the HELI Regional Meetings please click on the link below for the appropriate regional meeting or go to We are grateful to the following counties for hosting these regional meetings: San Bernardino, Contra Costa, Santa Barbara and Merced. April 5, 2013 from 8:30am San Bernardino Co. Dept. of Behavioral Health 1950 South Sunwest Lane, Suite 200, San Bernardino, CA April 26, 2013 from 8:30am Contra Costa County Health Services Behavioral Health Division, 50 Douglas Drive, 2nd Fl, Martinez, CA May 1, 2013 from 8:30am Santa Barbara County, Santa Maria Mental Health Clinic 500 West Foster Road, Santa Maria, CA May 10, 2013 from 8:30am Merced County Mental Health Department 1137 B Street, Merced, CA We look forward to your potential participation in one of our regional meetings and/or in the Institute. Once the details for the Health Equity Leadership Institute Kickoff scheduled for June 6-7, 2013 have been finalized, more information will be available on our website at For more information about the Health Equity Leadership Institute, please contact: Kristee Haggins, PhD, Senior Associate at khaggins@cimh.org or