Lassen County Behavioral Health

Barbara PiersonLCBH Director

Located in rural Northeastern California on the eastern slope of Sierra Nevada Mountain range

County is 4,547 square miles (8th largest in size) Estimated population: 34,248 (US Census data)

Inmates at three area prisons make up 10,173 of the total population

Susanville is the only incorporated town (8,000-10,000 residents)

Rest of county is made up of small communities ranging from 20-1,500 residents

Lassen County

Lassen has approximately 3,800 Veterans (one of the highest per capita in the state)

There are 1,448 children ages 0-5 (4.2% of population). Population shift: number of children is shrinking

while senior population continues to grow Racial/Ethnic Make-up:

Caucasian: 82.6% African American: 10.0% Native Americans/Alaska Natives: 3.7% Asian: 1.0% Native Hawaiian/Pacific Islanders: 0.5% Hispanic: 15.3%

Lassen County

While 79.6% of residents have graduated from high-school, only 10.7% have a bachelor’s degree

About 41.4% of Lassen County residents live below the 200% federal poverty limit

Unemployment rate holds steady at 17.1%

Lassen is one of the three lowest counties in California for economic well being

Lassen County

Majority of medical, social and behavioral health services are located in Susanville

County has established Family Resource Centers to serve three outlying areas

County is federally designated as a primary care, mental health and dental federal Health Professional Shortage Area (HPSA)

The is very limited public transportation throughout the county

Closest urban areas: Reno, Nevada which is 86 miles away or Redding, California which is 120 miles away

Lassen County

Alcohol and Drug and Mental Health Departments merged on July 1, 2012 to become Behavioral Health

5 locations – 2 Susanville, Herlong, Westwood, Bieber New focus is client centered care (vs. system centered)

using a holistic approach based on the 8 dimensions of wellness

Foundation is the Behavioral Health Home model – IHI chronic care model, Macoll, SAMHSA-HRSA

This model allows for better coordination of care since most clients have substance abuse, mental health issues, and physical conditions

Clients receive care through interdisciplinary teams

Behavioral Health

Services will be delivered by interdisciplinary teams All consumers will get to choose a care team. Teams consist of: therapists, case managers, rehab specialists,

AOD counselors, patient advocate, clerical. Teams huddle every morning to discuss new clients, emergencies,

expiring treatment plans, clients on the day’s schedule. Care is easier to coordinate with case managers, rehab

specialists, and AOD counselors working with the same therapist. Teams assures the consumer that staff are familiar with their

needs even if their provider is not there. Consumers receive care within the team. They can change the

people they receive services from but they stay within the team.

Interdisciplinary Teams

Behavioral Health DepartmentEffective July 1, 2012

Phase 1

Behavioral Health Director Medical Director

AdminSupport

Supervisor

ProgramSupport

Supervisor

Admin/ClericalSupport

Staff

ProgramsQA/AIGrants

InitiativesPrevention

TrainingWork studyWraparound

MHSA

Support

NursingStaff

Medical Services

Team 1Co-occurring

Diversion CourtPerinatal

FloatingParenting

Applied Behavioral Analyst

Team 2 Team 3

3 One Stop TeamsTherapistsCase Mgrs

AOD

Direct Services

Clinical MHSupervisor

Clinical MHSupervisor

Clinical AOD

Supervisor

Clinical Supervision Team

Co-dependency Education (AOD) Structured Outpatient Promises Day Rehab Socialization Relapse Prevention Trauma Anger Co-occurring

Parenting Adolescent life skills Peer Support WRAP Self-esteem Family Medication PTSD/Anxiety Depression DBT Group Summer Youth Group Friday Night Live Skillstreaming©

Groups

Common Holistic ApproachesIntegrated Care Planning

Multiple Life Domain FocusMultidisciplinary Teams

Natural and Peer SupportsTeam Facilitator/Designated Care Coordinator

Motivational InterviewingStages of Change

After Care Planning (WRAP)Outcome Monitoring

Adult System of CareAdults with multi-agency

involvement at risk of placement, incarceration,

or hospitalizationDual DiagnosisAdolescents and adults with co-

occurring disorders

Integrated WORKS

Adult welfare-to-work clients with AOD and MH risk

factors

Family SolutionsWraparound

Youth at risk of or returning from group

home placement

Children’s System of Care

Children and adolescents at risk of out-of-

home placement

Full Service Partnerships

SMI adults and children at risk of hospitalization,

homelessness, or incarceration

Integrated CPSFamilies with

children at risk of out-of-home placement

Health & Social ServicesCommon Elements ofIntegrated CareMarch 2012

8 dimensions of wellness

* Assuming that working in teams comes naturally to people* Eliminating silos and hierarchical thinking – physical and mental* Not allowing staff to fall back into old patterns* Change is difficult for most staff* Staff competencies* Learning what the other disciplines do and trusting them enough to delegate client responsibilities to* Staff turnover* Balancing between building a foundation and growing the program when opportunities arise

Challenges

Things that worked or didn’t Coffee hour every morning. Taking inventory: We created a

Dump/Keep/Don’t know list and went through it every morning at coffee hour and worked through each thing on the list.

Training staff – Netsmart, case manager meetings, webinars, time for people to meet.

EHR combining two ways of doing things – assessments, forms, progress notes, treatment plans.

-Staff competencies-Working within a larger bureaucracy – unions, personnel-Advisory boards-Limited local resources and their stability-Two sets of rules, regulations-Developing a common language

Organizational Level issues

Thank you!