Adult Services MHSA funded programs CSSA01 Adult FSP CSS A02 Adult BH OP Services Redesign 1
CSSA01: MHSA Adult FSP Goals To provide all of the mental health services and support to a persons wants and needs to reach his or her goals. To reach out to people who may need services but are not getting them (Unserved) To improve mental health services and supports for people who receive mental health services (under-served) *. 2
CSSA01: MHSA Adult FSP Key Strategies : 1. Develop a referral process through h DAD's for clients requiring substance abuse treatment 2. Create activities, group and individual therapy sessions to address mental health and substance related disorders to increase meaningful day activities. 3
CSSA01: MHSA Adult FSP 3. Continue & expand FSP for Adults, which is used to full capacity, emphasizing languages and specific populations such as Vietnamese speaking and Individuals with intellectual disabilities 4. Re structure the referral process for FSP 90 to focus on clients discharging gfrom IMD/Acute Hospitals back into the community. Thereby creating access to other FSP slots 5. Re direct Peninsular health FSP provider to serve clients in the North Region of Santa Clara County 4
Rationale 1. Lack of FSP capacity/slots to serve new Adult client with severe mental illness requiring intensive case management services. 2. Outreach and engagement of FSP clients is taking longer than 30 days for clients in the IMD s, thereby making it difficult to add new clients. 3. There are current 20 FSP slots to serve Vietnamese speaking clients, but due to the demand for FSP services for this ethnic population the current provider has 25 clients on their caseload 5
CSSA01: MHSA Adult FSP Key Achievements 1. For Fy14 year to date the FSP teams have served a total of 215 unduplicated clients. 2. Improved coordination between FSP providers and Inpatient units, EPS and Primary care physicians. 3. Developed a system for monitoring clients on Outreach and engagement gg to increase the accessibility to FSP services. 6
Key Priorities to guide Recommendations: Adult BHOS Redesign: modifylevel of care to appropriately meet the clients level of need by providing peer support, outpatient services etc MHSA Key Performance Measures Prioritization determined by Adult/Older providers system of care meeting on March h6th 2014 Reduction of subjective suffering from mental illness Increase meaningful use of time and capacities in schools, work and activity Reduce homelessness and increase safe and permanent housing 7
Key Priorities to guide Recommendations: Increase substance abuse treatment Increase natural network of supportive relationships Reduction in disparities in service access Reduction in self help and consumer/family involvement 8
A02 (1 4) Recommendations Goal of A02 Adult redesign: To create a recovery model program that incorporates consumer involvement, expand self-help and peer support services and create services to address clients with co-occurring mental health/ substance abuse and other co-occurring disorders such as mental health and intellectually developed consumers. Program Initial Recommendations Rationale Consumer wellness and recovery, MHSA Downtown Clinic MHSA Downtown 1.0 HSOS 1.0 FTE HCPM Move position 0.25 to administration Shift funding of 1.0 HSOS Funding from one-time to ongoing Maintain Current funding level through FY16-17 for HSOS and HCPM Client Impact as Result of Proposed Recommendation Increase capacity for new clients requiring i specialty MH services The Clerical Manager and Program Manager are very important for the day-to day operations of the clinic Provide Outpatient team for individuals living in the Downtown area, by reducing disparities in access to mental health services Funding these two positions will increase the guidance and supervision of caseloads and client services. Thereby improving the quality of services clients receive in the clinic. it will create additional capacity to refer clients living in the downtown area. Increase capacity to continue to serve 700 or more clients who otherwise will have to be referred to other outpatient sites for MH services. 9
A02 (1 4) Recommendations Goal of A02 Adult redesign: To create a recovery model program that incorporates consumer involvement, expand self-help and peer support services and create services to address clients with co-occurring mental health/ substance abuse and other co-occurring disorders such as mental health and intellectually developed consumers. Program Initial Recommendations Rationale Community Placement Team Staff 1. Maintain i Current funding level lthrough hfy16-17 2. Restructure team to include the task of coordinating all discharges from acute hospitals to address timely access to Outpatient services 3. Develop a coordinated referral process to increase access to residential substance abuse treatment with DAD s Client Impact as Result of Proposed Recommendation Provide the MH system a consolidated authorization unit to process all residential care request and decrease homelessness. The 24 Hour Care team processes close to 1000 referrals each month, which includes referrals to IMD, Crisis Residential, Transportation, Supplemental residential programs, shelters and acts as a liaison to all the acute hospitals for all Santa Clara County Residents Address timely access to Outpatient services to avoid and reduce re-hospitalization. Improve the referral tracking process from manual to a centralized data collection process 10
Recommendations Goal of A02 Adult redesign: To create a recovery model program that includes consumer involvement, expand self-help and peer support services and create services to address clients with co-occuring mental health/ substance abuse and other co- occuring disorders such as mental health and intellectually developed. Program Initial Recommendations Rationale Outpatient Clinic & FQHC staff Expand case management services to Alexian and Milpitas sites Maintain funding for Rehabilitation Counselors at the FQ clinics Client Impact as Result of Proposed Recommendation Increase capacity and access for clients requiring mild to moderate MH services Provide case management services for clients d to avoid decompensating and inpatient hospitalization Improving coordination i of care between the primary care and psychiatrist in one location and Clients can have access to one stop health care. Keep clients in one location, clients can see their psychiatrist and physician in the same building Currently only 5% of fthe clients in the FQHC are receiving case management service out of 6448 clients. Expanding CM services will allow clients to enjoy accessing both the primary care and psychiatrist or substance abuse treatment in one location Clients do not have to be transferred back to specialty MH if they need additional CM support. 11
Data for FQHC CM Currently only 312 clients out of 6448 are receiving case management support from an FQHC Current caseload is broken down to 184 at East Valley 52 at Gilroy 76 at Sunnyvale 12
Recommendations Goal of A02 Adult redesign: To create a recovery model program that includes consumer involvement, expand self-help and peer support services and create services to address clients with co-occuring mental health/ substance abuse and other co-occuring occuring disorders such as mental health and intellectually developed. Program Initial Recommendations Rationale MHSA Adult Outpatient Teams & Crisis Residential Programs Maintain funding for Adult Outpatient programs Increase Outpatient capacity for clients who speaking the following languages: Hindu, Korean, Spanish, Increase Outpatient capacity for Vietnamese etc. in order to reduce disparities in service clients who speaking the following access languages: Hindu, Korean, Client Impact as Result of fproposed Spanish, Vietnamese etc. in order Recommendation to reduce disparities in service Develop substance use & co-occurring treatment access and support services for clients with alcohol or Increase capacity for Crisis substance abuse issues Improve integration between medical and psychiatric in-patient and outpatient and communities Expand funding for Adult mental health contractors t to increase capacity for outpatient ti t services for clients seeking mental health services Residential lbdt Beds to meet the demands of the community. These structured sub acute residential homes serve as an alternative to IMD placement 13
A02 Recommendations Goal of A02 Adult redesign: To create a recovery model program that includes consumer involvement, expand self-help and peer support services and create services to address clients with co-occuring mental health/ substance abuse and other co-occuring disorders such as mental health and intellectually developed. Program Initial Recommendations Rationale MHSA 24 Hour Alternatives Consolidate t all JSI beds (DAD s, FSP, MH 24 Hour Care) make the 24 Hour Care team responsible for authorization process. Re-evaluate the services provided at the shelters for clients discharging from EPS/Acute hospitals. Continue funding all 24 Hour Alternative placements Client Impact as Result of Proposed Recommendation These step down programs provide a respite for clients who do not have an alternative placement and reduces homelessness. It provides a safe place for clients to stay instead of discharging them to the streets. These programs are used to support the stabilization of clients discharging from EPS and acute hospitals thereby reducing recidivism to hospitalization. Reduces the LOS in acute and Emergency psychiatric hospitals which otherwise reduces the overall cost of acute hospitalization or inpatient stay. 14
A02 (1 4) Recommendations Goal of A02 Adult redesign: To create a recovery model program that includes consumer involvement, expand self-help and peer support services and create services to address clients with co-occuring mental health/ substance abuse and other co-occuring disorders such as mental health and intellectually developed. Program Initial Recommendations Rationale MHSA IMD Alternatives ti Continue funding IMD Alternative placements for the next 3 years. Re-structure to reduce length of stay These programs are used to support the stabilization of clients discharging from, IMD, EPS and acute hospitals thereby reducing Client Impact as Result of fproposed Recommendation These programs EVP, Crossroads, Drake House, provide structured residential and day Rehabilitation services for individuals dvdu sdsc discharging gfrom IMD s and acute cueinpatient skilled nursing facility. hospitals. The programs work closely to provide structured placement for FSP clients who need meaningful day activities (such as groups, small jobs and going out on community activities) It provides a safe place for clients to stay instead of discharging them to the streets. recidivism Serves Adults & seniors with serious medical conditions who do not require a locked setting or If not funded adults/older adults with COPD, AWOL risk and other medical related issues will not have a place to live. 15
A02 (1 4) Recommendations Goal of A02 Adult redesign: To create a recovery model program that includes consumer involvement, expand self-help and peer support services and create services to address clients with co-occuring mental health/ substance abuse and other co-occuring disorders such as mental health and intellectually developed. Program Initial Recommendations Rationale MHSA ID Integrated & Adults with Autism Program Increase capacity to serve more Intellectually delayed clients. Create C a new level lof care to address higher h h id functioning clients Continue to contract for next 3 years Client Impact as Result of Proposed Recommendation This is a very specialized Outpatient team specialized in serving individuals who are intellectually delayed. Only one provider currently able to provide this service. Increase capacity for Intellectually delayed clients. Current provider has been closed to new referral for the last 6 months. MHSA Autism, offer INN Projecting serving individuals with autism and MH needed to continue to provide an array of services. In other to increase meaningful day activities for clients the program provides specialized staff with expertise in behavior modification and one to one prompting p for Intellectually delayed consumers. Currently cannot move the high functioning intellectually delayed to FQ or Primary Care b/c of the specialized needs 16