Transcript New Strategic Plan (6-10-10) Goals - Home

Challenging Behaviors in Challenging Times:
How We Can Best Serve Children through MultiAgency Collaboration
UNDERSTANDING OUR SYSTEMS
William Arroyo, M.D.
Regional Medical Director, Los Angeles County
Department of Mental Health
December 7, 2010
MISSION
Enriching lives
through partnership
designed to strengthen
the community’s
capacity to support
recovery and resiliency
New Strategic Plan (6-10-10)
Goals
 Enhance the quality and capacity of
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mental health services and supports
in partnership … within available
resources
Eliminate disparities … especially
those due to race, ethnicity and
culture
Enhance the community’s emotional
and social well-being…
…with a workforce capable of meeting
the needs of our diverse communities
Maximize fiscal strength…
Use of research and technological
advancements…
DMH Nos. At A Glance
 No. of outpatient clients: 209,386 (FY 08-09)
 No. of inpatients: 15,879 (FY 08-09)
 Avg. daily no. of clients in adult justice programs:
2300
 No. clients served in juvenile justice programs:
15,954 (FY 08-09)
 No. of clients with Public Guardian: 2800
 No. of calls received by ACCESS: 283,098
 Crisis field evaluations: 19,000 served
 4 Urgent Care Centers (24 hr): 11,000 served
At A Glance - 2
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47 directly-operated programs
130 contracted agencies
112 potential new contractor agencies
89 pharmacies
27 fee-for-service hospitals
3 indigent hospitals
338 fee-for-service individuals
4 contracts/MOU’s with veteran’s organizations
Budget of $1.58 billion (gross appropriation) (FY 09-10)
New Treatment Strategies
 Short term
 Focused (especially around crisis, trauma,
depression)
 Evidence based
 Expansion of community based approaches
 Expansion of in-home strategies
 Expansion of crisis resolution approaches
 Integration with primary care
Main Sources of Childrens MH Funding
 Realignment
 Medi-Cal Managed Care
 EPSDT (a Medi-Cal program) includes
Therapeutic Behavioral Services, Day Treatment,
Day Rehab, Outpatient
 Healthy Families: basic & SED MH benefit
 AB 3632
 Mental Health Services Act: FSP’s and PEI
 Specialized Foster Care
 Family Preservation
EPSDT (Medical Necessity Criteria)
 Below age 21
 Mental disorder results in at least one of following:
(1) significant deterioration in key domain
(2) probability of significant deterioration in key
domain or
(3) a probability of not progressing
developmentally
Medical Necessity Criteria - 2
 Condition is not responsive to general medical
interventions
 (Outpatient) Intervention would:
(1) significantly diminish impairment;
(2) prevent significant deterioration in key
domain; or
(3) allow child to progress developmentally
 Meets the criteria of one of the following Dx:
ELIGIBLE DIAGNOSES
 Pervasive Developmental
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Disorders (including
Aspergers D and excluding
Autistic D)
Disruptive Behavior D
Feeding/Eating D of
Infancy and Early
Childhood
Elimination D
Schizophrenia/Psychoses
 Mood D
 Anxiety D
 Somatoform D
 Factitious D
 Dissociative D
 Paraphilias
 Gender Identity D
 Eating D
ELIGIBLE DIAGNOSES -2
 Impulse Control D
 Adjustment D
 Personality D, exc. Antisocial Personality Disorder
Mental Health Services Act
 Proposition 63—a California voters’ ballot initiative—passed
in 2004
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Based on recovery/wellness
Stakeholder involvement
Focus on unserved and underserved
 1% tax on personal income in excess of $1 million intended to
expand mental health services
 5 components
 Community Services and Supports, Workforce Education
and Training, Capital/Technology, Prevention/Early
Intervention, Innovation
Outcomes – Increase:
 Likelihood of having a safe place to live
 Having meaningful use of time
(e.g., school, work, training).
 Having supportive relationships with family, friends,
and neighbors.
Outcomes – Reduction of:
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Suicide
Incarceration
School failure and dropout
Unemployment
Prolonged suffering
Homelessness
Removal of children from their homes
FULL SERVICE PARTNERSHIPS
 The FSP program is for children ages 0-15 or TAY ages
16 – 24 and their families who would benefit from a
program designed to address the total needs of a
family whose child or youth is experiencing significant
emotional, psychological or behavioral problems that
are interfering with their wellbeing.
 FSP programs are capable of providing a wide array of
services beyond the scope of traditional clinic-based
outpatient mental health services. Those participating
in a FSP program will have the support of a service
provider 24 hours a day, 7 days a week.
Children’s Programs (0-15)
 Full Service Partnership - (“high end
children”)
 Priority populations
(1) children removed or at risk of
removal from their families,
(2) children experiencing extreme
behaviors at school
(3) children involved with Probation
and families affected by substance
abuse
Transition Age Youth Programs (16-24)
 Full Service Partnerships – (“high end” youth)
 Priority Populations
(1) youth with substance abuse disorders,
(2) youth who are homeless or at risk of
becoming homeless,
(3) youth are emancipating from DCFS &
Probation,
(4) or youth leaving long term institutional
care, experiencing first psychotic break
FULL SERVICE PARTNERSHIP SERVICES (0-15, TAY)
 24/7 clinic/field-based/in-home that include
multi-discipinary teams for crisis intervention &
assess
 Culturally competent
 Individualized
 Social/recreational/faith-based
 Engagement with ethnic minorities through
schools/primary care clinics/shelters
 Wraparound
 Trauma specific services
 Community re-entry services (juvenile halls &
camps)
FSP Services (0-15, TAY) (cont’d)
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Transportation
Interagency collaboration
Respite Care
Probation halls/camps
GLBT specific
MH Services & Supports for
caregivers/parents, including
crisis family services
 Temporary/permanent
supportive housing
 Co-Occurring Disorders
Services
 Drop-in Center Services (TAY)
FSP – TAY only
 Peer partners
 Support for independent living
 Basic living skills
 Integrated MH with law enforcement agencies
Requirement of Full Service Partnership
(LACDMH)
 Programs may not discriminate against individuals
with a mental illness who have co-occurring
disorders, including individuals with physical
health problems, developmental delays, low
literacy issues, substance abuse issues, or other
issues. Rather, providers must demonstrate the
ability to collaborate with other Departments or
entities (e.g., Regional Center, DHS) in order to
ensure clients access the services most appropriate
for their needs and to which they are entitled.
MHSA Prevention and Early Intervention (PEI) Priority
Populations
 Underserved Cultural Populations
 Individuals Experiencing Onset of Serious Psychiatric
Illness
 Children/Youth in Stressed Families
 Trauma-Exposed Individuals
 Children/Youth at Risk for School Failure
 Children/Youth at Risk of Juvenile Justice Involvement
Priority Child/Youth Population (indigents)
multi-dimensional definition
 Severe emotional/behavioral crisis
 In or at risk for out of home placement
 Certain diagnostic categories
 Severe functional impairment
OPERATIONAL AGREEMENT BETWEEN L.A. CO.
and REGIONAL CENTERS (2005)
 Chief Administrative Officer
 Department of Mental Health
 Probation Department
 Department of Children and Family Services
 Seven Regional Centers (in L.A. County)
“AGREEMENT”
 State regulations indicate that “regional center
funds shall not be used to supplant the budget of
any agency which has a legal responsibility to serve
all members of the general public and is receiving
public funds for providing those services”
 Agreement is “…to meet the needs of persons with
developmental disabilities who are also mentally
ill”
GOALS OF AGREEMENT
(pertaining to LACRC’s and LACDMH)
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Increase leadership, communication…
To optimize utilization of agency resources…
To decrease costs and minimize fiscal risk…
To ensure continuity of services…
Improve quality outcomes…
Strive toward highest client functioning…in least
restrict setting
 Timely resolution of conflicts…
AGREEMENT - OUTPATIENT
 LACDMH and LACRC’s will develop and
implement…general plan for crisis
intervention…shall include after-hours
emergency response systems, interagency
notification guidelines and f/u
 If psychiatric care is warranted, both will
develop procedure for a client based on the
presenting dx and medical necessity, as defined
by State regulations. Once the client no longer
requires MH treatment, the client is referred to
LACRC for f/u
AGREEMENT - INPATIENT
RC clients admitted to psychiatric inpatient
facilities due to a mental disorder will be the
responsibility of LACDMH. LACDMH will
provide psychiatric treatment until there is no
further medical necessity for acute inpatient care.
Discharge shall occur when medical necessity
criteria are no longer met. If placement by RC is
delayed, the client is placed on administrative
days for which RC’s are responsible beginning on
the 5th administrative day.
CA CODE OF REGULATIONS
Title 9, Chpt 11, Section 1830.205
 Los Angeles County DMH will meet the needs of
Regional Center clients/consumers who meet
medical necessity criteria as in CA code
 Persons eligible for developmental disability
services referred to LACDMH for mental health
services will receive an evaluation and
assessment to determine the extent of their
need for services. LACDMH will provide
appropriate mental health services…
Critical Challenges & Issues
 Funding for indigent care
 Emergency response capacity given ER overcrowding &
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limited long-term care options
Katie A. lawsuit (children in foster care)
Implementation of MHSA components of PEI, WET and
Innovations
Needs of youth in juvenile justice system, i.e. halls & camps
AB 3632 funding
Healthcare reform
Workforce issues
Resources
Los Angeles County DMH website with MHSA info., list of mental health agencies, other MH links
http://dmh.lacounty.gov
Los Angeles County DMH Medi-Cal Network Providers (Psychiatrists and Psychologists)
http://dmh.lacounty.gov/cms1_054947.pdf
Los Angeles Network of Care provides an online service directory, i.e. addiction, disability insurance,
housing, emergency shelter (by zip code)
http://losangeles.networkofcare.org/mh/home/
Los Angeles County Guide to Medi-Cal MH Services
http://dmh.lacounty.gov/cms1_046410.pdf
Healthy Families
http://www.healthyfamilies.ca.gov/hfhome.asp
CA State DMH
www.dmh.ca.gov
Resources (cont’d)
CA Mental Health Planning Council’s Master Plan
http://www.dmh.ca.gov/MHPC/masterplan.asp
Characteristics of the uninsured:
http://covertheuninsured.org/media/research/brffs.pdf
Report from the President’s New Freedom Commission on Mental Health
http://www.mentalhealthcommission.gov/reports/reports.htm
Healthy People 2010 report – Mental Health Section
http://www.healthypeople.gov/Document/pdf/Volume2/18Mental.pdf
California Little Hoover Commission Report On Mental Health, Being There: Making
a Commitment to Mental Health Nov. 2000
http://www.lhc.ca.gov/lhcdir/report157.html