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MH Commission Packet February 26, 2015

Office: 3282 Adeline Street, Berkeley, CA 94703 • [email protected] (510) 981-7721 • (510) 981-5255 FAX

Health, Housing & Community Services Mental Health Commission

To: Mental Health Commissioners From: Carol Patterson, Commission Secretary Date: February 11, 2015

Documents Pertaining to 2/26/15 Agenda items: Agenda Item

Description Page

2.A.

February 26, 2015 Agenda

1

2.C.

January 22, 2015 Minutes

4

3.

Pages 23 -25 of Commissioners’ Manual on Election of Officers

7

5.

Review of Alternatives to AB1421

• Alternatives proposed in 2014 by Alameda County Behavioral Health

10

• Excerpt from February 25, 2014 Board of Supervisors Minutes

17 • Executive Summary, Report on AB 1421 Planning Process (pp 9 -

13)

18 5.A.

In-Home Outreach Team (I-HOT)

• I-HOT Program Brochure 24

• I-HOT Brief presentation 25

8.

Approval of Draft By-Laws

• Draft By-Laws 39

• Commission Enabling Resolution 43

• California WIC 5604- 5604.5 51

9.A.i.

Questions about FYC services

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A Vibrant and Healthy Berkeley for All

Office: 3282 Adeline St. • Berkeley, CA 94703 • (510) 981-7721 • (510) 981-5255 FAX

[email protected]

Health, Housing & Community Services Department Mental Health Commission

Berkeley/Albany Mental Health Commission

Regular Meeting Thursday, February 26, 2015

Time: 7:00 p.m. – 9:00 p.m. North Berkeley Senior Center

1901 Hearst Ave., Workshop B

AGENDA

All Agenda Items are for Discussion and Possible Action

Public Comment Policy: Members of the public may speak on any items on the Agenda and items not on the Agenda during the initial Public Comment period. Members of the public may also comment on any item listed on the agenda as the item is taken up. Members of the public may not speak more than once on any given item. The Chair may limit public comment to 3 minutes or less.

7:00 pm 1. Roll Call

2. PRELIMINARY MATTERS A. Agenda Approval B. Public Comment on items not on the agenda C. Approval of January 22, 2105 Minutes D. Staff Announcements/Updates

3. Action Item: Election of Officers 4. Presentation: Pool of Consumer Champions about AB 1421 implementation in the City of Berkeley

5. Discussion and Possible Action Item: A review of alternatives recommended by the Alameda County AB 1421 Task Force A. In-Home Outreach Team (I-HOT) voluntary, non-coercive model currently utilized in San Diego

6. Discussion, and possible action, regarding additional police statistics documentation to be maintained and released impacting on persons in mental health crisis

7. Report from Mental Health Division – Steve Grolnic-McClurg A. Action Item: Selection of Commission representative to Adult Clinic Redesign Committee

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3282 Adeline St. • Berkeley, CA 94703 • (510) 981-7721 • (510) 981-5255 FAX

[email protected]

8. Action Item: Approval of Commission By-Laws

9. Subcommittee Reports A. Family, Youth and Children Subcommittee

i. Questions about FYC services

10. Action Item: Select a representative to attend Peace and Justice Commission’s Subcommittee on the Convention on the Rights of Persons with Disabilities

11. Possible Action Item: Recommendations to City Council on improving services to persons in mental health crisis A. Expanding services to include people who currently aren’t eligible

12. Discussion on nature, and planning, of May is Mental Health Month 13. Mental Health Commission communication with City of Albany and Alameda County Behavioral Health Care Services 14. Brief discussion on the MHSA contract with BOSS for homeless outreach

15. Liaison Reports A. MHSA Advisory Committee B. City Council (Jesse) C. BMH Safety Committee D. Alameda County Mental Health Board Liaison E. Alameda County Crisis systems planning meeting

16. Possible Action Item: Response to Community Health Commission on HR 3717 Helping Families in Mental Health Crisis Act

17. Agenda Items for March meeting

A. Presentation from Homeless Taskforce B. MHSA 3-year plan Public Hearing 18. Announcements 9:00 pm 19. Adjournment Communications to Berkeley boards, commissions or committees are public record and will become part of the City’s electronic records, which are accessible through the City’s website. Please note: e-mail addresses, names, addresses, and other contact information are not required, but if included in any communication to a City board, commission or committee, will become part of the public record. If you do not want your e-mail address or any other contact information to be made public, you may deliver communications via U.S. Postal Service or in person to the secretary of the relevant board, commission or committee.

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3282 Adeline St. • Berkeley, CA 94703 • (510) 981-7721 • (510) 981-5255 FAX

[email protected]

If you do not want your contact information included in the public record, please do not include that information in your communication. Please contact the secretary to the relevant board, commission or committee for further information. The Health, Housing and Community Services Department does not take a position as to the content.

Contact person: Carol Patterson, Mental Health Commission Secretary at 981-7721 or [email protected].

Communication Access Information: This meeting is being held in a wheelchair accessible location. To request a disability-related accommodation(s) to participate in the meeting, including auxiliary aids or services, please contact the Disability Services specialist at 981-6342 (V) or 981-6345 (TDD) at least three business days before the meeting date. Please refrain from wearing scented products to this meeting. Attendees at trainings are reminded that other attendees may be sensitive to various scents, whether natural or manufactured, in products and materials. Please help the City respect these needs. Thank you. SB 343 Disclaimer Any writings or documents provided to a majority of the Commission regarding any item on this agenda will be made available for public inspection in the SB 343 Communications Binder located at the Family, Youth and Children’s Clinic at 3282 Adeline Street, Berkeley.

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A Vibrant and Healthy Berkeley for All

3282 Adeline St. Berkeley, CA 94704 Tel: 510.981-7721 Fax: 510.981-5255 TDD: 510.981-6903

Department of Health Services Mental Health Commission

Berkeley/Albany Mental Health Commission Unadopted Minutes

North Berkeley Senior Center Regular Meeting 1901 Hearst Ave. January 22, 2015 at 7:00 pm Workshop B Members of the Public Present: None. Staff Present: Steven Grolnic-McClurg, Cynthia Harris (BPD), Karen Klatt, Ofc. Jeff Shannon (BPD). 1. Call to Order at 7:00 pm

Commissioners Present: Jeffrey Davis, Jennifer Fazio (arrived at 8:05 pm), Bart Grossman, Shelby Heda, Paul Kealoha-Blake (Chair), Judy Kerr, Carole Marasovic, Jean Marie Hervé Michel, Jr, Shirley Posey (left at 8:47 pm). Commissioners Absent: Jesse Arreguin, Nadine Dixon, Cameron Silverberg (LOA).

2. Preliminary Matters A. Approval of January 22, 2015 Agenda

M/S/C (Kerr, Grossman) To extend the meeting to 9:15 pm due to tonight’s ambitious agenda. Ayes: Grossman, Heda, Kealoha-Blake, Kerr, Marasovic, Michel, Posey; Noes: None; Abstentions: Davis (hasn’t had a chance to look at the agenda); Absent: Arreguin, Dixon, Fazio (arrived after the vote.)

M/S/C (Kerr, Heda) Move to approve the January 22, 2015 Agenda. Ayes: Davis, Grossman, Heda, Kealoha-Blake, Kerr, Michel, Posey, Noes: None; Abstentions: Marasovic (believes that item #7 should have been discussion and possible action); Absent: Arreguin, Dixon, Fazio (arrived after the vote).

B. Public Comment – none.

C. Approval of the October 30, 2014 minutes M/S/C (Kerr, Marasovic) Move to approve the October 30, 3015 minutes

with the following amendment such that item 2.D.ii. should read: The Mental Health Commission’s report regarding suicide statistics was drafted for Council submission but has not left the Department as we are looking at the need for a Companion Report. Police department reps would like to attend next Commission meeting to find solutions to the Commission’s need for information. Ayes: Davis, Grossman, Heda, Kealoha-Blake, Kerr, Marasovic, Michel, Posey; Noes: None; Abstentions: None; Absent: Arreguin, Dixon, Fazio (arrived after the vote.)

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Mental Health Commission – January 22, 2015

D. Approval of December 18, 2014 minutes

M/S/C (Marasovic, Posey) Move to approve the December 18, 2012 minutes. Ayes: Grossman, Heda, Kealoha-Blake, Kerr, Marasovic, Michel, Posey; Noes: None; Abstentions: Davis (wasn’t at the meeting); Absent: Arreguin, Dixon, Fazio (arrived after vote.)

E. Staff Updates The February Mental Health First Aid training is full with a waiting list.

3. Presentation on collecting and reporting Suicide Statistics- Berkeley Police Dept.

Ofc. Jeff Shannon, Berkeley Police Department presented on suicide related calls to police and fielded questions from Commissioners. A. Action Item: Pertaining to collection of suicide statistics M/S/C (Grossman, Michel) Hold approved Council item on police reporting of 10-56’s for three months and request further input from Police department prior to further action. Ayes: Davis, Grossman, Heda, Kealoha-Blake, Kerr, Marasovic, Michel, Posey; Noes: None; Abstentions: None; Absent: Arreguin, Dixon, Fazio (arrived after the vote.)

4. Report from Mental Health Division – Steve Grolnic-McClurg

Mr. Grolnic-McClurg updated the Commission on the funding for the Adult Clinic redesign and a new wellness center offering peer-led services. A. MHSA 3-year Update Planning process – Karen Klatt

Ms. Klatt gave an overview of the planning process for Mental Health Services Act three-year plan and highlighted some new program ideas.

B. Action Item: Selection of Commission representative to Adult Clinic Redesign Committee Mr. Grolnic-McClurg described the purpose of the committee and will come back with more specifics as to meeting day and time.

5. Action item: Comments on Berkeley Housing Trust Fund Guidelines

M/S/C (Kerr, Marasovic) The Mental Health Commission recommends that the Housing Trust Fund should prioritize individuals and families dealing with mental health issues and that there be no geographic exclusions within the City. Ayes: Davis, Fazio, Grossman, Heda, Kealoha-Blake, Kerr, Marasovic, Michel, Posey; Noes: None; Abstentions: None; Absent: Arreguin, Dixon.

6. Action Item: Approval of Commission By-Laws Tabled to February meeting.

7. Action Item: Amendment of Commission mission statement M/S/W (Kerr , _________) The Mental Health Commission recommends to not amend the Commission Mission Statement, allowing it to become null and void and to continue to a develop appropriate communication channels with Albany City Council and Alameda County Behavioral Health Care Services.

8. Possible Action Item: Recommendations to City Council on Improving Services to

person in mental health crisis – Tabled due to lack of time.

9. Possible Action item: Response to Community Health Commission on HR 3717 Helping Families in Mental Health Crisis Act – Tabled due to lack of time.

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Mental Health Commission – January 22, 2015

10. Action Item: Select a representative to attend Peace and Justice Commission’s

Subcommittee on the Convention on the Rights of Persons with Disabilities – Tabled due to lack of time.

11. May is MH Month Planning – Tabled due to lack of time.

12. Subcommittee Reports – Tabled due to lack of time.

13. Agenda items for February meeting – Scope & Role of the Commission, getting

services for people who are not currently eligible, Statistics from the Berkeley Police Dept., By-Laws

14. Liaison Reports – Tabled due to lack of time.

15. Announcements – Tabled due to lack of time. 16. Adjournment at 9:17 pm. Minutes submitted by: ____________________________________ Carol Patterson, Commission Secretary

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ALAMEDA COUNTY

HEAL TH CARE SERVICES AGENCY

Alex Briscoe, Director

The Honorable Board of Supervisors Administration Building 1221 Oak Street Oakland, CA 94612

Dear Board Members:

AGENCY ADMIN. & FINANCE 1000 San Leandro Boulevard, Suite 300

San Leandro, CA 94577 Tel: (510) 618-3452 Fax: (510) 351-1367

Agenda: ____ February 25, 2014

February 5, 2014

SUBJECT: APPROVE THE IMPLEMENTATION OF TEN RECOMMENDATIONS DEVELOPED IN

RESPONSE TO AB 1421 {ALSO KNOWN AS LAURA'S LAW) THAT ADDRESS THE NEEDS OF

MENTAL HEAL TH CLIENTS/CONSUMERS WITH HISTORY OF NON-COMPLIANCE WITH

TREATMENT OR THOSE SERIOUSLY MENTALLY ILL CLIENTS/CONSUMERS WHO OUR

SYSTEM HAS BEEN UNABLE TO REACH AND ENGAGE IN ONGOING TREATMENT.

RECOMMENDATIONS:

Approve the plan of the Behavioral Health Care Services Department to proceed with the implementation of a set of recommendations developed in response to AB 1421, and reviewed by your Board's Health Committee, focused on voluntary programs and an assisted outpatient treatment pilot program which incorporate approaches to address the needs of clients/consumers with serious mental illness who have a history of noncompliance with treatment or who have not been engaged in treatment.

SUMMARY:

As requested at the March 18, 2013 Board of Supervisors Public Hearing on AB 1421, also known as Laura's Law, Health Care Services Agency/Behavioral Health Care Services (HCSA/BHCS) developed a set of recommendations focused on voluntary programs and an Assisted Outpatient Treatment (AOT) pilot to meet the needs of clients/consumers that are not engaged in services or are resistant to treatment, and their family members. This includes individuals that "fall through the cracks" of the system and may be in and out of psychiatric emergency rooms or the county jail or on and off5150's.

BHCS utilization data points to the high rates of involuntary treatment consumers already experience through over reliance on the 5150 and EMS system and the effective use of the bench in other

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The Honorable Board of Supervisors February 5, 2014 Page 2

collaborative models of bringing previously disconnected consumers into treatment. BHCS will include consumers in outreach and delivery of multiple models of voluntary treatment before referral to AOT would be considered.

BHCS Leadership is confident that these recommendations, when implemented as described, will expand and improve services for the clients/consumers identified in AB 1421. Outreach programs will assist clients and their families. Peer navigators will offer their lived experience and support to clients/consumers across the systems of care. Family members will receive more direct support and assistance. Clients/consumers that are experiencing early episodes of mental illness will receive intensive case management and step down into community programs with peer support. A pilot AB 1421/AOT program will be designed, implemented, and evaluated by a diverse stakeholder body that will carefully honor and reflect the voice of consumers.

DISCUSSION:

BHCS Leadership has worked closely with its existing provider and stakeholder groups, including multiple consumer and family member groups, the Mental Health Board, acute care clinical providers and our Criminal Justice Mental Health Program. We have had lengthy conversations with additional system partners including Patient Rights Advocates and the Social Services Agency Public Guardian/LPS Conservator. We have carefully and aggressively sought input from other jurisdictions that have wrestled with this issue.

Specifically we reviewed AB 1421 and other AOT initiatives at our monthly Greater Bay Area Mental Health Directors meeting, learning from our colleagues what they have put in place, what has worked well and what has not. Throughout these conversations, we have identified gaps in our system, clearly defined our needs, and considered many different service strategies.

To thoroughly understand the AB 1421 programs that are in place, BHCS worked directly with Nevada County's Mental Health Director to learn about their AB 1421 program, which is the only fully implemented program in California. We researched the details of voluntary AOT programs in Los Angeles, San Diego and San Francisco Counties and included San Diego's In Home Outreach Team model in our recommendations.

To ensure involvement of Alameda County stakeholders and interested community members, BHCS conducted two extensive public comment periods. More than 150 individuals, in all regions of the county, participated in this process. BHCS integrated stakeholder feedback into the final set of recommendations.

BHCS recognizes that sometimes people are not ready for treatment, and as a result may need repeated attempts for engagement and treatment. We also recognize that families experience significant frustration and disappointment at not being able to help their loved ones navigate the mental health system and get the help they need. Given the complex challenges faced by those living with a mental illness, we know that no single program or approach will meet the needs of every client. However, each of the program recommendations are based on practices that have been successful in engaging clients/consumers and family members and demonstrating improvement in client and family outcomes.

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The Honorable Board of Supervisors February 5, 2014 Page 3

The AB 1421 Recommendations are:

Outreach and Engage with Youth, Consumers and Families

1. Pilot San Diego County's In Home Outreach Team (IHOT) to provide home or community-based support and education to clients/consumers, family members and caregivers.

2. Pilot a Street Youth Outreach Team to meet and engage young people "where they're at" in the community and help link them to services and treatment.

3. Offer Multifamily Groups to support family members of youth who are not engaged or participating in their treatment.

Utilize Peer Navigators to Provide Peer Support to Clients/Consumers Receiving Services

4. Implement the Mentors on Discharge Program to support clients/consumers following their discharge from .John George Psychiatric Pavilion and possibly other local psychiatric hospitals. Funded by a BHCS MHSA Innovations Grant, this program demonstrated a 67% decrease in hospital recidivism rates for clients/consumers that had a peer mentor upon their discharge.

5. Develop and pilot a Peer Navigators Program to offer individual peer support to clients/consumers during care transitions and to provide linkages to primary and behavioral health care services and community resources.

Expand Hospital-Based Resources and Intensive Case Management Services

6. Hire an Acute Care Clinical Manager to work with staff at John George Psychiatric Pavilion and to identify BHCS services and community resources for clients/consumers in the Psychiatric Emergency Room or in the hospital.

7. Expand Intensive Case Management Services for Transition Age Youth who are difficult to engage, require assistance with maintaining their activities of daily living and would benefit from these services.

8. Expand capacity of the STEPS Adult Intensive Case Management Program to address a broader target population that includes clients/consumers experiencing early episodes of mental illness in the hospital.

9. Expand capacity of the Forensic Assertive Community Treatment (FACT) Team to address a broader target population that includes clients/consumers experiencing early episodes of mental illness while incarcerated.

Pilot an AB1421/Assisted Outpatient Treatment Program

10. Through a stakeholder planning and evaluation process, develop a one year pilot of AB1421/ Assisted Outpatient Treatment that will serve a maximum of 5 adjudicated clients/consumers. The planning process will include defining eligibility criteria for Alameda County and identifying outcomes for the pilot.

Please see Attachment A, which is a table summary of the proposed recommendations.

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The Honorable Board of Supervisors February 5, 2014 Page4

SELECTION CRITERIA AND PROCESS:

BHCS will obtain goods and/or services according to county procurement guidelines.

FINANCING:

The estimated annual program cost for the ten recommendations is $1.4 million. The Mental Health Services Act will fund the recommendations, including the AB 1421Pilot client services. Upon Board approval, BHCS will develop program implementation and procurement strategies for each recommendation and will return to the Board for final funding approval. The AB 1421 Pilot court processes will require a $50,000 increase in County General Funds, as involuntary services cannot be funded by MHSA or realignment.

AB:TT

cc: County Administrator County Counsel Auditor-Controller

13

SUMMARY ACTION MINUTES of Alameda County Board of Supervisors, February 25,

2014, excerpted from page 4

HE ALTH CARE SERVICES 3. Behavioral Health Care Services - Approve the plan of the Behavioral Health Care Services

Department to proceed with the implementation of a set of recommendations developed in response to

AB 1421, and reviewed by your Board's Health Committee, focused on voluntary programs and an

assisted outpatient treatment pilot program, which incorporate approaches to address the needs of

clients/consumers with serious mental illness who have a history of noncompliance with treatment or who

have not been engaged in treatment - CAO Recommends: Approve

Attachment 3

Approve as recommended 1 through 9

As to recommendation 10 the Board voted to direct staff to convene and use a working group of key

NA stakeholders over a 90-day period to conduct a comprehensive review of the programs that

could serve the population that is targeted by AB1421 for the purpose of considering alternatives to

AB1421 that are more compassionate options for accomplishing the goals of AB1421

and bring back recommendations.

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February 21, 2014 | 1

Alameda County Behavioral Health Care Services (BHCS) Report on the AB1421 Planning Process

18

Alameda County Behavioral Health Care Services Report on AB1421 Planning Process

October 2014 | 9

Executive Summary

In California and across the nation, communities have worked to create a continuum of mental health

services to foster recovery and to reduce the impact of mental health issues on communities. This

transformation has come hand in hand with an increasing understanding of the importance of consumers’

and their family members’ experience in directing the course of treatment. At the same time, public

systems grapple with how to consistently and effectively engage those who are most severely mentally

ill. Unawareness of illness, past and current trauma, and stigma can all contribute to a lack of engagement

in treatment; among this number, there are individuals whose resistance to treatment could pose a

danger to themselves and others.

A growing concern and frustration with California public mental health systems’ ability to engage this

segment of the consumer population led to the passage of Assembly Bill 1421 (AB1421), known as “Laura’s

Law,” which authorizes and provides guidelines to implement court-ordered intensive outpatient services

(called Assisted Outpatient Treatment, or AOT) for individuals with a recent history of recurrent

psychiatric emergency room visits and hospitalizations who are significantly deteriorating and

unwilling/unable to engage in voluntary services to support their recovery (AB1421 Service Goals are

summarized in Appendix 2). Local implementation of AOT requires a vote by the county board of

supervisors to enact the measure.

A coalition of family members in Alameda County brought AB1421 to the Board of Supervisors, requesting

that AOT be added to the range of available services. When this issue came before the Board in February

2014, it resulted in a lengthy meeting; those who support AOT see little alternative to effective

engagement, while many who oppose the measure express deep concerns with this move toward

involuntary services and the potential for mis- or over-use.

At the conclusion of this meeting, the Board adopted nine initiatives designed to engage this target

population (see Appendix 2), all of which are based on voluntary engagement, and requested that BHCS

initiate a stakeholder planning process to address the tenth recommendation, an AOT pilot project, and

return with recommendations. The BOS charge read:

“The Board voted to direct staff to convene and use a working group of key stakeholders

over a 90-day period to conduct a comprehensive review of the programs that could serve

the population that is targeted by AB1421 for the purpose of considering alternatives to

AB1421 that are more compassionate options for accomplishing the goals of AB1421 and

bring back recommendations.”

In May 2014, BHCS initiated a stakeholder planning process to explore and identify programs and services

that together would meet the mental health care needs of the target population, evidenced by a reduction

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October 2014 | 10

in unnecessary hospitalizations and an increase in engagement with mental health services. BHCS

identified stakeholders based on the stakeholder groups named in the AB1421 legislation, which provides

guidance to planning processes, and to reflect unique aspects of the County’s geography, population

demographics and service mix. The committee included twenty-four members, including consumers,

family members, and service providers, as well as representatives from the County’s Social Services

Agency, Sheriff’s Office, and Public Defender.

For the purposes of this planning process, BHCS defined the target population as adults with 4 or more

Psychiatric Emergency Services (PES) visits, with at least 2 resulting hospitalizations within a 12-month

period. BHCS used data on services for the fiscal year ending June 30, 2012, to identify 205 Alameda

residents in this target population. Of this group, 51% were male, and 79% fell between the ages of 25

and 59; 98 were African American and 64 were Caucasian, with 19 identified as Asian-Pacific Islander and

16 as Latino. Planning participants were provided with additional details about this population, which are

included in Appendix 5.

BHCS engaged Resource Development Associates (RDA) to design and implement this planning process.

RDA used a phased, consensus based facilitation approach designed to create a common foundation of

understanding about the current system; the target population, its size, level of engagement, and needs;

and participants’ hopes and concerns related to AOT. Throughout the process, the RDA team used

collaborative planning techniques to develop a set of program and service recommendations to address

the needs of the target population.

This process included five planning meetings and two workgroup meetings between April 23 and June 30,

2014. The recommendations were then submitted to BHCS to develop supporting budget and

implementation details prior to submission to the Board of Supervisors.

Recommendations

Committee workgroups brought recommendations forward at the fourth planning meeting (June 19,

2014), where there was uniform support for 10 recommendations, encompassing both system- and

program-level changes. These recommendations were confirmed at the final planning meeting (June 30,

2014), and are outlined below.

The committee reached consensus on five system-level recommendations.

1. Administrator for the “AB1421 Population”: This position will provide oversight and coordination

for the engagement and service of people with a recent history of recurrent psychiatric

emergency room visits and hospitalizations who are significantly deteriorating and

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October 2014 | 11

unwilling/unable to engage in voluntary services to support their recovery. This position will use

utilization and outcome data to drive individual and systems-level decision making.

2. Increased Data-Sharing Capacity: The workgroup recognizes the overlap of people with recurrent

psychiatric emergency room visits and hospitalizations and the criminal justice system, and

recommends working to increase capacity to share data between Behavioral Health Services, the

network of providers and the Sheriff for client care and systems-level evaluation. Recognizing

legal impediments to data-sharing must be addressed, this may include a centralized database,

data warehouse, or other mechanism to share data.

3. Staff Development: The workgroup recognizes the unique challenges in serving the “1421

population” and recommends staff development activities to support the entire system in serving

these individuals regardless of point of engagement:

a. Cognitive Behavioral Therapy for Psychosis

b. Dialectical Behavioral Therapy

c. Motivational Interviewing

d. Seeking Safety

e. Wellness Recovery Action Planning

f. Co-Occurring Disorders

4. Family Engagement: Family members serve as critical resources to their loved ones when

accessing services. The workgroup recommends looking for mechanisms, as permitted under 42

CFR, CMIA and HIPAA, to allow family members to support consumers to make appointments,

access services, and participate in their care.

5. Meaningful Involvement of Peers and Family Members: The workgroup recommends that the

County continue to seek ways to include peer and family support specialists throughout the

service system.

In addition, the committee reached consensus on five program-level recommendations.

6. Crisis Residential Treatment: A Crisis Residential Treatment (CRT) program will expand the

capacity of the existing system to provide alternatives to hospitalization for this population. The

current CRT is located in the Castro Valley/San Leandro area, and the workgroup recommends

siting the additional CRT beds in Northern Alameda County. This CRT will also develop the capacity

to accept referrals directly from Behavioral Health Services and divert PES utilization, as

permissible by Titles IX and XXII and when clinically appropriate. The CRT will also develop

increased co-occurring competency to serve individuals in dual recovery.

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October 2014 | 12

7. Peer Respite Program: The Peer Respite program will provide an additional alternative to

hospitalization with short-term residential services that consumers can access during times of

crisis in order to divert PES visits and hospitalization. Peer Respite is a peer-led model and may or

may not include a clinical consultant.

8. “Rapid Engagement Team” (RET): The RET is based on the fidelity model of Assertive Community

Treatment and is comprised of a multi-disciplinary, mobile staff that includes clinical, peer, and

family supports. The RET is designed to engage individuals while they are still in the hospital, sub-

acute facility, and/or jail to begin the relationship-building process and enroll them in the RET

team. The RET is also designed to “meet people where they’re at” and provide field-based,

flexible services to support individuals as they move through the stages of recovery.

9. Co-Occurring Disorders Full Service Partnership (FSP): This program will provide the full range of

FSP services targeted to people with co-occurring disorders to support the dual recovery process.

Every member of the team will have competency in working with people with co-occurring

disorders, and the team will include a certified substance abuse counselor.

10. “Bridges” System Navigation Team: Bridges is a multi-disciplinary team that would provide

outreach and engagement services as well as systems navigation support. This program would

engage those who are not currently receiving mental health services and maintain relationships

with these individuals as they move through the various levels of care. They would serve as a

consistent source of support regardless of how and where the person moves within the mental

health system.

In addition, one recommendation, the creation of a 24-hour Crisis Stabilization Unit, was referred to the

Crisis Planning effort that BHCS plans to undertake in Fall 2014.

However, the committee was unable to reach consensus on two alternatives, Community

Conservatorship and Assisted Outpatient Treatment (AOT). These recommendations became the focus

of the fifth planning meeting (June 30, 2014).

The RDA team modified the facilitation approach for the final planning meeting in order to enable further

exploration of the two remaining proposals before the committee adopted its recommendations. There

was no expectation that the group would reach consensus on these two programs. Instead, the group

engaged in an exercise to determine which, if either, had stronger overall support from stakeholders.

Individuals were asked to indicate their level of support using colored cards, with stronger support

indicated by green, opposition indicated by red, and concerns or questions indicated by yellow.

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October 2014 | 13

The committee found stronger consensus for a conservatorship model based on aspects of San Francisco’s

CIPP conservatorship and the San Mateo County Conservatorship Program, adapted to Alameda County’s

unique legal and service environment. With a show of cards and some discussion, the group moved to

request that BHCS develop a hybrid model of community conservatorship for implementation in Alameda

County. This model should include housing and connection to intensive recovery services, family member

involvement, conservatorship in the community, and an examination of recidivism. No stakeholders

present indicated opposition (red card) to this adaption.

For AOT, the group indicated 3 green cards, 6 yellow cards, and 4 red cards, and discussed their concerns

and questions. While participants expressed an understanding of the inherent challenges in engaging the

target population, there was a lack of consensus around the inclusion of AOT. Many participants expressed

concern about the involuntary nature of AOT services, and the desire to see the implementation of their

recommendations, designed to increase program linkages and consumer and family member involvement

in engagement efforts, prior to undertaking an AOT pilot. In addition, participants noted that the

upcoming crisis system planning process would provide further opportunities to address system linkages

and overall engagement efforts that would include this population. Ultimately, AOT did not receive the

level of support indicated for Community Conservatorship, and thus cannot be considered a consensus

recommendation.

Conclusion

Throughout the planning process, participants demonstrated commitment, curiosity, and a deep passion

for the health and wellbeing of those served by the mental health system in Alameda County. Participants

posed questions about the target population intended to create a better understanding of their needs,

including criminal justice involvement, presence of co-occurring disorders and the history of engagement

in treatment, that could not be answered within the planning timeframe with existing data (see Appendix

10).

However, participants shared a common view that in order to meet the needs of this target population

and others served by the public mental health system in Alameda County, energy should be invested in

strengthening the linkages across programs and services, as well as increasing coordination across

systems, to include the criminal justice system. At the conclusion of the process, most participants

expressed the hope that the recommended programs would create more timely “warm handoffs” to those

transitioning from the hospital or acute setting as well as those in treatment. Participants also expressed

a belief that the planning process, and the opportunity to work closely with peers with different

perspectives and opinions, would strengthen future planning and advocacy efforts in Alameda County.

This work and these relationships can be leveraged as BHCS undertakes an expanded planning process to

address its crisis system in the coming months, using the strengths and gaps identified through this

process as a starting point towards greater integration across services and providers.

23

In Home Outreach Team

(IHOT)

We exist to help people with mental impairments realize their full

potential.

Main Phone: (619) 961-2120

Fax: (619) 961-2138

1660 Hotel Circle North

Suite 314

San Diego, CA 92108

24

Telecare San Diego

In Home Outreach Team - IHOT

Presentation to:

California Association of Local Mental

Health Boards and Commissions

January 15, 2015January 15, 2015

Presenters

Roselyna Rosado, LCSW, Program Administrator

Shanna Talant, Personal Service Coordinator

Liz Heinz, Family Coach

25

History of IHOT

� San Diego County’s response to Laura’s Law initiative. Over a year in the planning stages and stakeholder process

� HHSA /SDBHS decided to pilot the In Home Outreach Team (IHOT) program using a voluntary approach of outreach and (IHOT) program using a voluntary approach of outreach and engagement to those resistant to mental health treatment

� Evaluative component conducted by UCSD to assess and measure program effectiveness

26

MHSA Innovation Funded Program

� Original contract was awarded Dec 23, 2011. Services started January 2nd, 2012 and served the Central, East and North Coastal regions.

� IHOT program was later awarded expansion and now carried out � IHOT program was later awarded expansion and now carried out by two contracts as of July 1, 2014:

� Telecare IHOT serves Central, East and South regions and is run by Telecare Corporation.

� IHOT North serves North Coastal, North Inland and North Central regions and is run by a collaboration of MHS, NAMI, UPAC

27

IHOT Program Mission and Structure

� Mission: To outreach and engage individuals that refuse or are resistant to treatment

� Goal: To connect individuals to mental health services,

community supports and other needed servicescommunity supports and other needed services

� Referrals can be made by family members, jails, PERT clinicians, hospitals and other mental health providers

� No prescribed time limits on services

� Strong family support component, including family support groups and psychoeducational workshops

28

Eligibility Criteria

� Adult individuals, 18 years and older

� Presence of serious mental illness with functional impairment

� Must reside in one of the Central, East or South HHSA regions of San Diego

� Not currently enrolled in mental health treatment and also resistant to mental health treatment

29

Program Services

� Outreach and engagement

� Support and empathic listening

� Short term intensive case management

� Needs assessment

� Individual and family goal planning and service coordination� Referrals and linkages to all types of community resources

� Psychoeducation

� Family outreach and support including family support groups

and workshops

� Participant wellness workshops

� Crisis intervention; 24-hour, on-call support

30

Service Phase Definitions

� Referral - This is the entry point into the program, the referral is received, further information gathered and assessed for eligibility

� Accepted - Individual has met eligibility � Accepted - Individual has met eligibility

� Outreach - Services begin to family and initial attempts are made to engage individual

� Engagement - Individual agrees to receive services

31

The IHOT Outreach and Engagement

Team

� Structure of IHOT Outreach Team:

� 4 Personal Service Coordinators (PSC II) – persons with educational and professional experience

� 3 Family Coaches – persons with personal “lived” family � 3 Family Coaches – persons with personal “lived” family experience; may or may not have formal training or work experience

� 3 Peer Support Specialists – persons with “lived” personal experience; may or may not have formal training or work experience

� Licensed Field Team Lead – licensed clinician supporting outreach team in their field work

32

Our Approach Philosophy

� Non judgmental, non threatening, and non coercive approach using Dr. Xavier Amador’s LEAP Principles:

� Listen

� Empathize

� Agree

� Partner

33

Our Approach

� Meet individuals where they are “at”

� Offer to hear and support their needs

� Assist with goals they have identified as important to them� Assist with goals they have identified as important to them

� Establish rapport and trust; ensure confidentiality

34

Services to Participant

� Respectful outreach

� Developing rapport, trust, relationship building

� Needs and Wants screening

� Reaching the Engaged Phase

� Individualized goal setting� Individualized goal setting

� Continued support and relationship building

� Referrals

� Linkage

35

Services to Family

� Support, guidance, empathic listening

� Psychoeducation on mental illness and mental health resources

� Referrals to other supportive community resources

� Family support planning

� Educational and supportive crisis intervention and proactive safety planning

� Coaching on improving boundary setting and communication

� Family Support groups

36

Successes

� Successful outcomes of IHOT participants and their families include:

� Accessing and maintaining treatment and medication

� Reconnecting with family or social supports� Reconnecting with family or social supports

� Obtaining safe and stable housing

� Obtaining employment assistance, medical care and benefits

� Enhanced boundary and limit setting

� Improved family communication skills

� Connecting to family support services (i.e. NAMI)

� Enhanced knowledge and ability to access emergency services (i.e. PERT)

37

CONTACT INFO:

Roselyna Rosado, LCSW, Program Administrator

[email protected]

(619) 961-2120 X113

Shanna Talant, Personal Services Coordinator

[email protected]

(619) 961-2120 X103

Liz Heinz, Family Coach

[email protected]

(619) 961-2120 X104

38

be appropriate.

5601. As used in this part:

(a) "Governing body" means the county board of supervisors or

boards of supervisors in the case of counties acting jointly; and in

the case of a city, the city council or city councils acting jointly.

(b) "Conference" means the California Mental Health Directors

Association as established under former Section 5757.

(c) Unless the context requires otherwise, "to the extent

resources are available" means to the extent that funds deposited in

the mental health account of the local health and welfare fund are

available to an entity qualified to use those funds.

(d) "Part 1" refers to the Lanterman-Petris-Short Act (Part 1

(commencing with Section 5000)).

(e) "Director of Health Care Services" or "director" means the

Director of the State Department of Health Care Services.

(f) "Institution" includes a general acute care hospital, a state

hospital, a psychiatric hospital, a psychiatric health facility, a

skilled nursing facility, including an institution for mental disease

as described in Chapter 1 (commencing with Section 5900) of Part 5,

an intermediate care facility, a community care facility or other

residential treatment facility, or a juvenile or criminal justice

institution.

(g) "Mental health service" means any service directed toward

early intervention in, or alleviation or prevention of, mental

disorder, including, but not limited to, diagnosis, evaluation,

treatment, personal care, day care, respite care, special living

arrangements, community skill training, sheltered employment,

socialization, case management, transportation, information,

referral, consultation, and community services.

5602. The board of supervisors of every county, or the boards of

supervisors of counties acting under the joint powers provisions of

Article 1 (commencing with Section 6500) of Chapter 5 of Division 7

of Title 1 of the Government Code shall establish a community mental

health service to cover the entire area of the county or counties.

Services of the State Department of Health Care Services shall be

provided to the county, or counties acting jointly, or, if both

parties agree, the state facilities may, in whole or in part, be

leased, rented or sold to the county or counties for county

operation, subject to terms and conditions approved by the Director

of General Services.

5604. (a) (1) Each community mental health service shall have a

mental health board consisting of 10 to 15 members, depending on the

preference of the county, appointed by the governing body, except

that boards in counties with a population of less than 80,000 may

have a minimum of five members. One member of the board shall be a

member of the local governing body. Any county with more than five

supervisors shall have at least the same number of members as the

size of its board of supervisors. Nothing in this section shall be

construed to limit the ability of the governing body to increase the

number of members above 15. Local mental health boards may recommend

appointees to the county supervisors. Counties are encouraged to

Page 7 of 14CA Codes (wic:5600-5623.5)

2/10/2015http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5...

51

appoint individuals who have experience and knowledge of the mental

health system. The board membership should reflect the ethnic

diversity of the client population in the county.

(2) Fifty percent of the board membership shall be consumers or

the parents, spouses, siblings, or adult children of consumers, who

are receiving or have received mental health services. At least 20

percent of the total membership shall be consumers, and at least 20

percent shall be families of consumers.

(3) (A) In counties under 80,000 population, at least one member

shall be a consumer, and at least one member shall be a parent,

spouse, sibling, or adult child of a consumer, who is receiving, or

has received, mental health services.

(B) Notwithstanding subparagraph (A), a board in a county with a

population under 80,000 that elects to have the board exceed the

five-member minimum permitted under paragraph (1) shall be required

to comply with paragraph (2).

(b) The term of each member of the board shall be for three years.

The governing body shall equitably stagger the appointments so that

approximately one-third of the appointments expire in each year.

(c) If two or more local agencies jointly establish a community

mental health service under Article 1 (commencing with Section 6500)

of Chapter 5 of Division 7 of Title 1 of the Government Code, the

mental health board for the community mental health service shall

consist of an additional two members for each additional agency, one

of whom shall be a consumer or a parent, spouse, sibling, or adult

child of a consumer who has received mental health services.

(d) No member of the board or his or her spouse shall be a

full-time or part-time county employee of a county mental health

service, an employee of the State Department of Health Care Services,

or an employee of, or a paid member of the governing body of, a

mental health contract agency.

(e) Members of the board shall abstain from voting on any issue in

which the member has a financial interest as defined in Section

87103 of the Government Code.

(f) If it is not possible to secure membership as specified from

among persons who reside in the county, the governing body may

substitute representatives of the public interest in mental health

who are not full-time or part-time employees of the county mental

health service, the State Department of Health Care Services, or on

the staff of, or a paid member of the governing body of, a mental

health contract agency.

(g) The mental health board may be established as an advisory

board or a commission, depending on the preference of the county.

5604.1. Local mental health advisory boards shall be subject to the

provisions of Chapter 9 (commencing with Section 54950) of Part 1 of

Division 2 of Title 5 of the Government Code, relating to meetings

of local agencies.

5604.2. (a) The local mental health board shall do all of the

following:

(1) Review and evaluate the community's mental health needs,

services, facilities, and special problems.

(2) Review any county agreements entered into pursuant to Section

5650.

(3) Advise the governing body and the local mental health director



52

as to any aspect of the local mental health program.

(4) Review and approve the procedures used to ensure citizen and

professional involvement at all stages of the planning process.

(5) Submit an annual report to the governing body on the needs and

performance of the county's mental health system.

(6) Review and make recommendations on applicants for the

appointment of a local director of mental health services. The board

shall be included in the selection process prior to the vote of the

governing body.

(7) Review and comment on the county's performance outcome data

and communicate its findings to the California Mental Health Planning

Council.

(8) Nothing in this part shall be construed to limit the ability

of the governing body to transfer additional duties or authority to a

mental health board.

(b) It is the intent of the Legislature that, as part of its

duties pursuant to subdivision (a), the board shall assess the impact

of the realignment of services from the state to the county, on

services delivered to clients and on the local community.

5604.3. The board of supervisors may pay from any available funds

the actual and necessary expenses of the members of the mental health

board of a community mental health service incurred incident to the

performance of their official duties and functions. The expenses may

include travel, lodging, child care, and meals for the members of an

advisory board while on official business as approved by the director

of the local mental health program.

5604.5. The local mental health board shall develop bylaws to be

approved by the governing body which shall:

(a) Establish the specific number of members on the mental health

board, consistent with subdivision (a) of Section 5604.

(b) Ensure that the composition of the mental health board

represents the demographics of the county as a whole, to the extent

feasible.

(c) Establish that a quorum be one person more than one-half of

the appointed members.

(d) Establish that the chairperson of the mental health board be

in consultation with the local mental health director.

(e) Establish that there may be an executive committee of the

mental health board.

5607. The local mental health services shall be administered by a

local director of mental health services to be appointed by the

governing body. He or she shall meet such standards of training and

experience as the State Department of Health Care Services, by

regulation, shall require. Applicants for these positions need not be

residents of the city, county, or state, and may be employed on a

full or part-time basis. If a county is unable to secure the services

of a person who meets the standards of the State Department of

Health Care Services, the county may select an alternate

administrator.



53

Berkeley Mental Health Commission January 22, 2015

Questions on Child Mental health Programs:

1. Especially in light of the surplus in MHSA funds why are so few resources devoted to serving Albany

and Berkeley Children?

2.

3. How many are on the waiting list for services?

4. What percentage of treatment funds are spent on children?

5. What other agencies besides Berkeley mental health have contracts to serve children in Albany and

Berkeley?

6. Why does the Berkeley mental Health division play no role in monitoring and coordinating these

services?

7. If TAY youth are seen by adult therapists, do these therapists have appropriate training?

8. How is the effectiveness of child and youth treatment services monitored and evaluated?

9. What mental health prevention is done in the schools including teacher training?

10. What is the policy regarding the use and monitoring of psychoactive drugs with children and youth?

Questions for the TAY program at BMH:

1. Is the program is compromised of one staff member and four interns?

2. If so, what percentage of the staff member's time is spent on administrative matters?

3. From where do these interns come?

4. What is their training?

5. How long are the internships?

6. What is the exact number of clients seen in a year?

7. For how long are the clients seen

8. How many times are the clients seen?

9. How do the clients reach persons after hours?

10. Is there family therapy with the clients and their families?

11. Does the program work with homeless TAY?

12. If so, how are homeless TAY referred to your program?

13., If so, what type of work do you do with homeless TAY?

14. If so, where do you work with homeless TAY?

15. Can you provide a break-down of the ages of the TAY which you serve?

54