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MHSA Successes in LA: Perspectives on Recovery and Resiliency “Nurturing Hope, Promoting Wellness and Supporting Recovery” 1 Welcome Catherine Bond, MFT Vice Chair, Los Angeles County Client Coalition Dennis Murata, MSW Deputy Director, Program Support Bureau 2 MHSA Overview Proposition 63 – Mental Health Services Act • California ballot proposition • Passed November 2004 • Funding began January 1, 2005 How it is funded – 1% state tax on incomes of $1 million or more What it funds – Expansion of mental health services and programs Who it serves – All ages • Children (0-15) • Transitional Age Youths (16-25) • Adults (26-59) • Older Adults (60 and older) 3 MHSA Core Principles • • • • • Client / family driven Cultural competence Community collaboration Service integration Focus on recovery, wellness, and resilience 4 MHSA Components • Community Services and Support Plan February 14, 2006* • Workforce Education and Training Plan April 8, 2009* • Information Technology and Needs Plan May 8, 2009* • Prevention and Early Intervention Plan September 27, 2009* • Innovations Plan February 2, 2010* • Capital Facilities Plan April 19, 2010 (Submitted)* *Date of approval 5 County of Los Angeles MHSA Stakeholder Delegates CSS INN Ad Hoc Work Groups Ad Hoc Work Groups IT/CF WET Ad Hoc Work Groups Ad Hoc Work Groups PEI Service Area Level Planning Process Underrepresented Ethnic Populations Service Area Advisory Committees (SAAC) SAAC 1 SAAC 2 SAAC 3 SAAC 4 SAAC 5 SAAC 6 SAAC 7 SAAC 8 6 Contract Providers County Commissions & Councils Department of Mental Health System Leadership Team Other Government Agencies Advocacy Groups: Consumers, Family Member, Caregivers Community and Faith Based Organizations Healthcare & Hospitals Underrepresented Ethnic Populations 7 County of Los Angeles MHSA Stakeholder Process MHSA Stakeholder Delegates System Leadership Team Support Transformation of Overall Public Mental Health System Monitor Progress of MHSA Implementation Develop, Deliberate and Recommend NEW MHSA Plans for Los Angeles County CSS PEI INFORMATION WORFORCE TECHNOLOGY EDUCATION & CAPITAL &TRAINING FACILITIES INNOVATIONS 8 MHSA Stakeholder Delegates Comments: “The process reinforced how important it is to have consumers and family members involved throughout the process.” “It was amazing how people from very varied backgrounds were able to reach unanimous consensus on each plan.” “All voices were heard, and they were heard equally.” 9 Making a Difference in Consumers’ Quality of Life: Full-Service Partnerships Debbie Innes-Gomberg, Ph.D. District Chief, MHSA Implementation Unit Kara Taguchi, Psy.D. Program Head, MHSA Implementation Unit 10 Data Collection of Full Service Partnership (FSP) Outcomes in Los Angeles County Size limitations resulted in LA County’s inability to enter data directly into State DMH Data Collection and Reporting System • Outcomes Measures Application (OMA) developed in late 2005 • Data elements include state mandated elements and additional outcomes based on stakeholder feedback • Initiated provider training in September 2006 • Data entry initiated in November 2006 11 Outcomes Data Collection (continued) Our OMA is now used for 3 distinct programs: • Full Service Partnerships (2006) • Specialized Foster Care Intensive (2007) • Field Capable Clinical Services (FCCS) (2009) 12 Outcomes Data Collection (continued) Current total of 63,927 FSP outcome assessments in the OMA Data is also submitted electronically to LACDMH by third-party data collection systems (which yields an additional 10,835 outcome assessments) FSP outcomes uploaded to State DMH: First Upload to the state was on 12/30/08 for 13,135 records (2 years worth of data) As of 4/1/2010 a total of 50,137 records have been submitted to the state Data clean-up to enhance data submission to the state 13 Development of Reports • Utilized AB2034 methodology for reports, including initial focus on living arrangements • Data validity and reliability 14 Availability of Reports • Reports are accessible to Providers via the Internet • Reports are refreshed every Monday, so providers can view their own residential data on a regular basis without relying on DMH • New reports continue to refine data quality and to include additional domains 15 Annualized Living Arrangement Data and Graphs • Comparison of residential data for 12 months immediately prior to receiving FSP services and for 12 months of residential status while receiving FSP services • Data is adjusted (annualized) by a percentage based on average length of stay in the FSP program • Data must meet data quality standards to be included in the analysis 16 Annualized Living Arrangement Data and Graphs • 41 Unique Residential Types listed across 4 age groups • Residential types are grouped into 16 Living Arrangement Clusters: Residential Care Independent Living Psychiatric Institutional Settings Assisted Living Board and Care Group Home RCL011 Group Home RCL 12-14, CTF Justice Facilities Congregate Living Homeless Emergency Shelter Temporary Housing Acute Psychiatric Hospital/ Psychiatric Health Facility Living With Family Foster Homes Other/Unknown 17 Hospitalization Data (Measured by Number of Clients) Child Full Service Partnership Program 40% Reduction N=2,658 Transitional Age Youth Full Service Partnership Program 37% Reduction N=1,214 250 300 200 250 200 150 228 150 100 257 100 137 50 50 150 0 0 Pre-Partnership Clients Post-Partnership Clients Pre-Partnership Clients Adult Full Service Partnership Program 44% Reduction N=4,280 Post-Partnership Clients Older Adult Full Service Partnership Program 42% Reduction N=367 1400 90 1200 80 70 1000 60 800 600 50 1,204 910 400 85 65 40 30 20 200 10 0 0 Pre-Partnership Clients Post-Partnership Clients Pre-Partnership Clients Post-Partnership Clients 18 Hospitalization Data (Measured by Number of Days) Adult Full Service Partnership Program 16% Reduction N=4,280 62000 60000 58000 56000 60,489 54000 52000 50000 50,868 48000 46000 Pre-Partnership Days Post-Partnership Days Older Adult Full Service Partnership Program 17% Reduction N=367 8000 7000 6000 7,552 5000 6,251 4000 3000 2000 1000 0 Pre-Partnership Days Post-Partnership Days 19 Jail Data (Measured by Number of Clients) Older Adult Full Service Partnership Program 26% Reduction 25 Adult Full Service Partnership Program 26% Reduction 800 700 20 600 15 500 23 400 10 17 710 524 300 200 5 100 0 0 Pre-Partnership Clients Post-Partnership Clients Pre-Partnership Clients Post-Partnership Clients Transitional Age Youth Full Service Partnership Program 20% Reduction 100 90 80 70 60 95 50 40 76 30 20 10 0 Pre-Partnership Clients Post-Partnership Clients 20 Jail Data (Measured by Number of Days) Older Adult Full Service Partnership Program 30% Reduction N=367 4000 3500 3000 2500 2000 3,683 2,568 1500 1000 500 0 Pre-Partnership Days Post-Partnership Days Adult Full Service Partnership Program 38% Reduction N=4,280 90000 80000 70000 60000 50000 40000 79,243 30000 49,141 20000 10000 0 Pre-Partnership Days Post-Partnership Days 21 Decline in Homelessness (for All Age Groups) Transitional Age Youth 34% Reduction Child 24% Reduction 2000 1500 1,881 1,437 1000 500 0 Pre-Partnership Days 35000 30000 25000 20000 15000 10000 5000 0 30,221 20,082 Post-Partnership Days Pre-Partnership Days N=2,658 N=1,214 Adult 64% Reduction 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 Post-Partnership Days Older Adult 58% Reduction 25000 20000 421,597 15000 23,650 10000 150,085 10,018 5000 0 Pre-Partnership Days Post-Partnership Days N=4,280 Pre-Partnership Days Post-Partnership Days N=367 22 Homeless Data (Measured by Number of Clients) Transitional Age Youth Full Service Partnership Program 37% Reduction N=1,214 Older Adult Full Service Partnership Program 42% Reduction N=367 180 120 160 100 140 120 80 100 60 99 153 80 60 40 57 20 40 97 20 0 0 Pre-Partnership Clients Post-Partnership Clients Pre-Partnership Clients Post-Partnership Clients Adult Full Service Partnership Program 44% Reduction N=4,280 1800 1600 1400 1200 1000 1,705 800 600 951 400 200 0 Pre-Partnership Clients Post-Partnership Clients 23 What does the data tell us? Fewer clients are hospitalized in an acute psychiatric hospital while in FSP when compared to the 12 months immediately prior to FSP for all age groups 40% of Adult FSP clients experienced homelessness in the 12 months immediately prior to FSP, and on average, these clients were homeless for 8 out of those 12 months Transitional Age Youth, Adult, & Older Adult FSPs show reductions in the number of clients in jail when helped by FSP, compared to 12-month baseline data 24 What else does the data tell us? There is also a reduction in the number of jail days for Adults and Older Adults experienced while in FSP compared to the year prior The majority of Adult and Older Adult FSP clients are currently living independently in either an apartment or house where they pay rent, hold a lease, or pay mortgage, or in a Single Room Occupancy (SRO) where they hold the lease The majority of Child and TAY FSP clients are currently living with their families 25 Current Living Arrangement (by Cluster) Looks at last reported/current residential type status LACDMH can see this data broken down by provider site or FSP program At a quick glance you can see the distribution of where currently enrolled clients are living 26 Child Full Service Partnership Current Residential Status N= 1,629 Medical/ Physical Health Settings, 0.0018 No Cluster, 0.0141 Psychiatric Institutional Settings, 0.0012 Residential Care, 0.0061 Temporary Housing, 0.0043 Living with Family, 0.8281 Acute Psychiatric Hospital/PHF, 0.0147 Emergency Shelter, 0.0012 Foster Homes, 0.0933 Group Home RCL 0-11, 0.0037 Group Home RCL 12-14, CTF, 0.0037 Homeless, 0.0012 Independent Living, 0.019 Justice Facilities, 0.0074 27 Transitional Age Youth Full Service Partnership Current Residential Status N= 847 Medical/ Physical Health Settings, 0% No Cluster, 3% Residential Care, 6% Living with Family, 53% Temporary Housing, 3% Acute Psychiatric Hospital/PHF, 4% Assisted Living, 0% Board and Care, 4% Congregate Living, 2% Emergency Shelter, 2% Foster Homes, 3% Group Home RCL 0-11, 1% Justice Facilities, 3% Homeless, 4% Group Home RCL 12-14, CTF, 0% Independent Living, 9.28% 28 Adult Full Service Partnership Current Residential Status N= 3,111 Medical/ Physical Health Settings, 2% No Cluster, 3% Living with Family, 16% Psychiatric Institutional Settings, 1% Justice Facilities, 3% Residential Care, 8% Temporary Housing, 4% Acute Psychiatric Hospital/PHF, 3% Assisted Living, 1% Independent Living, 27% Board and Care, 17% Homeless, 7% Congregate Living, 6% Emergency Shelter, 4% 29 Older Adult Full Service Partnership Current Residential Status N= 284 Medical/ Physical Health Settings, 7.04% Living with Family, 7.04% Justice Facilities, 2.46% No Cluster, 5.28% Psychiatric Institutional Settings, 1.06% Residential Care, 6.69% Temporary Housing, 2.82% Acute Psychiatric Hospital/PHF, 3.87% Independent Living, 37.32% Assisted Living, 5.28% Board and Care, 12.32% Congregate Living, 2.82% Homeless, 4.58% Emergency Shelter, 1.41% 30 Adult FSP Program Cost Avoidance Hospitalizations ($523/day) • Pre-Partnership Days – 60,489 • Post-Partnership Days – 50,868 • Cost Avoidance of $5,031,783 Incarcerations ($1,093/day) • Pre-Partnership Days – 79,243 • Post-Partnership Days – 49,141 • Cost Avoidance of $32,901,486 31 Older Adult FSP Program Cost Avoidance Hospitalizations ($523/day) • Pre-Partnership Days – 7,552 • Post-Partnership Days – 6,251 • Cost Avoidance of $680,423 Incarcerations ($1,093/day) • Pre-Partnership Days – 3,683 • Post-Partnership Days – 2,568 • Cost Avoidance of $1,218,695 32 Roybal Mental Health Center Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach • Priority population is transition aged mothers ages 16 to 25 with children ages 0 to 5 years old • Program targets young mothers with mental illness • At risk of losing custody of their children • With a history or at risk of psychiatric hospitalization • Who are homeless or are about to become homeless 33 Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach The program addresses a comprehensive list of needs: • Educates the entire family on reasonable developmental • • • • expectations Provides education and role modeling for the mother and extended family Gives flex-funding to help with financial emergencies, including: food, housing and educational expenses Connects families to critical resources Staff available 24/7 34 Young Mothers & Babies FSP Program Using a “Whatever it Takes” Approach (continued) • In the past 28 months, the program has opened 67 cases • The program has reached more than 300 people by providing services to family members of enrolled clients • 12 mothers who enrolled in the program with existing Department of Children & Family Services cases, successfully saw their cases closed 35 Project 50 Mary Marx, LCSW District Chief, Countywide Resource Management 36 Project 50 Overview As a result of a motion introduced by Supervisor Zev Yaroslavsky, the Board of Supervisors committed to funding a pilot project to house and provide integrated supportive services for 50 most vulnerable chronically homeless people on Skid Row on November 20, 2007 Modeled on an approach used by Common Ground to dramatically reduce the number of people living on the streets in New York City’s Times Square The Board also specified that Project 50 should begin housing people within 100 days 37 Project 50 Project 50 Early Timeline: 12/7/2007 Project 50 launches with Skid Row Street Count 10/4/2007 Los Angeles County hosts Common Ground and US Interagency Council 12/20/2007 Presentation on Registry Creation October 2007 1/28/2008 First Participant is Housed! February 2008 12/10/2007 - 12/18/2007 Registry Creation 11/20/2007 Board of Supervisors pass Motion to Implement Project 50 within 100 days 1/17/2008 Outreach Begins 38 Project 50 Participating Partners: • Board of Supervisors • Los Angeles Mayor’s Office • Chief Executive Office • Los Angeles Police Department • Department of Mental Health • Skid Row Housing Trust • Department of Health Services • Didi Hirsch • Department of Public Health • JWCH • Department of Public Social Services • Volunteers of America • Sheriff’s Department • Courts • Probation Department • Public Defender • Alcohol Drug Program Administration • Public Counsel • Housing Authority City of Los Angeles • Los Angeles City Attorney’s Office • Los Angeles Homeless Services Authority • US Veteran’s Affairs Administration • CDC • Common Ground 39 Project 50 Phase I: Registry Creation 40 Project 50 Phase I: Registry Creation • Counted 471 homeless individuals (surveyed 350) • Identified the 50 most vulnerable persons who had a 40% likelihood of dying within the next seven years unless they could be successfully placed in housing and provided appropriate medical care • 25 Outreach personnel (with assistance from the Los Angeles Police Department) • 250 of the 350 allowed Outreach personnel to photograph them (used later during Phase II to identify prospective participants • Average length of homelessness: 9.6 years • 76% reported having Mental Health issues; 90% reported having Substance Abuse issues 41 Project 50 Phase II: Outreach Team • Maintain regular contact with identified individuals in efforts of establishing rapport and the goal of engaging these individuals in the services including transitional and permanent housing • Establish a trusting therapeutic relationship with identified individuals • Assess needs, define service goals, and reach agreement with the individual on a plan for service delivery • Connect and/or reconnect individuals to appropriate services and supports • Registry list was expanded to the top 140 individuals and was refreshed during the project 42 Project 50 Phase III: Integrated Supportive Services Team • Multi-disciplinary team (from different agencies) to provide housing, integrated health, mental health, and substance abuse services, and benefits establishment. Supportive Services include: 1. Physical health care, mental health and 6. Transportation services substance abuse treatment 7. Education opportunities 2. Money management 8. Community Reintegration services (museums, 3. 24 Hour/7 day crisis services 4. Recovery-based self-help and support fishing trips, Dodgers game, etc.) 9. Medication management groups 10. Benefits establishment 5. Employment services 43 Project 50 Phase III: Integrated Supportive Services Team (ISST) • Mental health services provided through a DMH Medi-Cal certified outpatient clinic and a contracted outpatient clinic • Physical health services provided through a Federally Qualified Health Center – – – – – – One record Daily team meetings Regular consultation Visits conducted together Shared office space Non-traditional contacts 44 Project 50 Data • Housed 67 participants since inception • 42 participants are currently housed with Project 50 • 11 participants are alternatively housed (appropriate levels of care – SNF; reunited/living with family) • Of the 42 participants currently housed: • • • • 67% recognized an increase in benefits since enrollment 33 successfully applied for and are currently receiving SSI benefits 100% are receiving benefits (77% receiving SSI) 100% are diagnosed with Mental Illness – 95% are participating with Mental Health treatment • 83% report a history of Substance Abuse – 80% of those reporting are participating with Substance Abuse treatment • 100% have Medical issues – 100% are participating with Physical Health treatment 45 Project 50 Data (continued) • Hospital Days: – Year prior to enrollment: approximately 750 hospital days at an estimated cost of $677,000 – Year after enrollment: less than 100 hospital days at an estimated cost of $185,000 • Incarceration: – Year prior to enrollment: approximately 750 jail days at an estimated cost of $79,000 – Year after enrollment: approximately 150 jail days at an estimated cost of $15,000 46 Project 50 Progression and Replication • Project 50 participants and the ISST are moving into the newly developed Cobb Apartment building. Project 50 is planning to expand services to 24 additional participants. • Project 50 replications in downtown: Cobb, Carver, Venice, Santa Monica, San Fernando Valley, Long Beach, and Hollywood (under development) • 1 participant moved into an independent apartment in Crenshaw with supportive services • 1 participant is actively seeking re-employment; recently passed his Merchant Marine examination 47 Project 50 Before: After: 48 Westside Urgent Care Center Karen J. Williams, PhD District Chief, Service Area 5 Mary Marx, LCSW District Chief, Countywide Resource Management Luana Murphy, CEO Exodus Recovery, Inc. 49 Alternative Crisis Services • Alternate Crisis Services (ACS) provides a comprehensive range of services and supports for mentally ill individuals that are designed to provide alternatives to emergency room care, acute inpatient hospitalization and institutional care, reduce homelessness, and prevent incarceration • ACS programs are funded by the Mental Health Services Act (MHSA) and operate in conjunction with MHSA’s recovery-based model of service delivery • Urgent Care Centers (UCCs) are a component of ACS 50 Westside UCC • Operated by Exodus Recovery, Inc. • Opened in December 2006 • Located in the 1st Supervisorial District – Service Area 5 (3828 Hughes Avenue, Culver City, CA 90232) • Open 365 days/year, 24 hours/day • Lanterman Petris-Short Designated (February 2007) • Located near Brotman Medical Center • Provide intensive crisis services to individuals who otherwise would be brought to emergency rooms • Provide up to 23 hours of immediate care and linkage to community-based solutions • Provide crisis intervention services, including integrated services for co-occurring substance abuse disorders • Focus on recovery and linkage to ongoing community services and supports that are designed to impact unnecessary and lengthy involuntary inpatient treatment 51 Westside UCC Three (3) Service Components: 1) Mental Health Crisis Program 1) Emergency Shelter Bed Program, providing short-term residential services to homeless individuals receiving services from the Mental Health Crisis Program (through partnership with Ocean Park Community center) 2) Transitional Residential Services Program, providing longer-term housing for individuals in need of ongoing support to live independently in the community (through partnership with Alcott) 52 Westside UCC Admission Source Centinela Hospital From Home 5150 Olympia Medical Center St. John’s Medical Center 5150 5150 Daniel Freeman Marina Brotman Medical Center Board & Cares 5150 Westside UCC 5150 5150 5150 PMRT (in lieu of Harbor/ UCLA) 5150 5150 LAPD Culver City PD Santa Monica PD (in lieu of Harbor/ UCLA) Jail Release Cedars Sinai Medical Center Santa Monica Medical Center Mental Health Clinics 53 UCC Data Reporting UCC Logic Model INPUTS Process/ Intervention Immediate Outcomes Intermediate/ Long Term Outcomes Decrease acute symptoms Mission Psychiatric Evaluation Prevent acute hospitalization Decrease ER Census Medication for stabilization Staffing Establish/ Reestablish MH treatment in community Decrease System Costs of Hospitalization Crisis Counseling Setting Medication support for clients unable to access outpatient care Client linked with substance abuse treatment, as applicable Client linked with housing, as applicable Target Population Community Integration/Linkage Activity Client linked with Wellness/Recovery Center, as applicable Increase Community Tenure of Client 54 Westside UCC Data Other Demographic Data: Since inception the Westside UCC has 13,198 unique monthly episodes of service (Average of 401 unique episodes per month during current Fiscal Year) Of the 13,198 Unique Episodes of Service: • 52.7% were male (n = 6,952); 47.3% were female (n = 6,246) • 46.2% reported having Substance Abuse issues (n = 6,101) • 14.5% reported being Homeless (n = 1,908) Age Group: • 0.4% ages 0-15 (n = 49) • 13.7% ages 16-25 (n = 1,816) • 78.9% ages 26-59 (n = 10,410) • 7.0% ages 60+ (n = 923) 55 Westside UCC Data Outcome Data Consumers with PMRT, Psychiatric ER, Inpatient Hospitalization, and Jail Mental Health episodes 30 days after receiving services from Westside UCC: *Westside UCC is able to admit consumers on involuntary holds (5150s). 56 Westside UCC Data Cost Avoidance Analysis The cost per day per client at Westside UCC has decreased from Fiscal Year 20072008 to Fiscal Year 2009-2010 Fiscal Year 2007-2008 Fiscal Year 2009-2010 Variance $690 $574 ($116) Cost/day/client Average Cost of a Psychiatric Inpatient Hospitalization (with a length of stay of 3 days – 5150) Fiscal Year 2009-2010 County Hospital $3,390 Short-Doyle/Medi-Cal Hospital $1,725 Fee-for-Service Hospital $1,569 57 Westside UCC Data Cost Avoidance Analysis Cost avoidance of utilizing Westside UCC services to manage clients and preventing involuntary inpatient psychiatric hospitalization: Cost Avoidance County Hospital $2,816 Short-Doyle/Medi-Cal Hospital $1,151 Fee-for-Service Hospital $995 58 UCC Expansion • DMH and Exodus Recovery, Inc. partnered to open a new psychiatric UCC in Los Angeles County • The new UCC is located on 1920 Marengo Street, directly across the street from LAC+USC Medical Center • Opened on April 15, 2010 and was LPS designated on 4/29/10 • The new UCC has the ability to provide Transitional Residential Services for consumers at Gateways Percy Village • Ability to provide consumers (up to 30 daily) with access to UCC services directly from LAC+USC Medical Center 59 Transformative Approaches Terri Boykins, LCSW District Chief, Transitional Age Youth 60 Drop-In Centers • Provide temporary safety & basic supports for seriously emotionally disturbed and severe and persistently mentally ill youth 16 – 25. • Low-demand, high-tolerance environments. • Served 4,405 clients from March 2008-2010 • Gender: 64% male, 29% female • Ethnicity: 33% African American 22% White 16% Other 25% Latino 3% Native American 1% Asian 61 Transformative Approaches Pacific Clinics TAY Drop-In Center Video 62 Transformative Approaches Northeast Wellness Center Maria Aguilar, MD Psychiatrist, Northeast Wellness Center 63 Northeast Wellness Center “Our dream is to help others achieve their dreams.” • Consumers created vision and mission • Vision: “Help consumers reach their hopes, dreams and goals.” • Mission: “Everybody working together for one purpose: to assist consumers to realize their skills, gifts and talents, and to support their brilliance as they find their place in the world.” 64 Northeast Wellness Center Person-Centered Approach • Social (family, community, friends) • Physical (medical, nutrition, exercise) • Basic needs (food, clothing, shelter) • Vocational (job, school, volunteering) • Psychological (emotional coping skills, harm reduction) • Spiritual (sense of purpose and belonging) 65 Northeast Wellness Center 1,800 Contact Services (FY July 2009-April 2010) Links to Services: • Vocational/Employment • Housing • Primary care health • Jail transition 66 Northeast Wellness Center Specific programs: • • • • • • Case management Individual medication support Housing Art groups Cooking class Daily Living Skills (balancing checkbooks) • Angels on call (peer to peer) • • • • • • • • Anger management Writing Healthy living class 12-Step Programs Tai Chi Family Education / Support Group Employment Support Group Empowerment (WRAP) 67 Prescription for the Whole Person 68 Lives Touched Kathleen Piché, LCSW Public Information Officer, LACDMH 69 Lives Touched Gary Gougis, Peer Advocate Video 70 Question & Answer 71