Merced County Behavioral Health and Recovery Services ...

Merced County Behavioral Health and Recovery Services Program Update to the FY 2019-2020 MHSA Annual Update FINAL Adopted by Merced County Board of Supervisors on 5-19-2020

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Program Update

to the

Fiscal Year 2019-2020

Mental Health Services Act

Annual Update

Merced County Behavioral Health and Recovery Services

P.O. Box 2087 Merced, CA 95344

(209) 381-6800

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Table of Contents Page 2 Background MHSA County Compliance Certification Page 4 MHSA County Fiscal Accountability Certification Page 5 Community Program Planning Process (CPPP) Page 6 Prevention and Early Intervention Page 8

Training, Technical Assistance and Capacity Building (CB) Expansion of Capacity Building-Prevention and Early Intervention

Services-One-Time Funds for Homeless Navigation Support Page 9

Program Changes for 2019-2020 Page 14

MHSA Funding Summary Page 15 Appendices Page 22 Appendix 1: MHSA Monthly Meetings Schedules 2018-2019 and

2019-2020 Page 22

Appendix 2: MHSA Stakeholder Feedback Survey Questions for the Program Update to the 2019-2020 Annual Update

Page 23

Appendix 3: Demographics of Responders to the MHSA Stakeholder Feedback Survey for the Program Update to the 2019-2020 Annual Update

Page 24

Appendix 4: MHSA Stakeholder Feedback from the Survey for the Program Update to the 2019-2020 Annual Update

Page 26

Appendix 5: Ongoing Planning Council Conference Call Meeting Review Summary March 26, 2020

Page 36

Appendix 6: 30-Day Public Comment Form Page 40 Appendix 7: 30-Day Public Review Substantive Comments, Other

Substantive Comments, MCBHRS Responses and Updates to the Program Update

Page 41

Appendix 8: Public Hearing Meeting Agenda April 24, 2020 Page 48 Appendix 9: Draft Minutes from the 04/24/2020 Public Hearing Via

Conference Call Including Substantive Comments Page 50

Table of Contents

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Background

On February 18, 2020 the Merced County Behavioral Health Board approved Merced County’s Fiscal Year 2019-2020 Mental Health Services Act (MHSA) Annual Update. This 2019-2020 Annual Update was adopted by the Merced County Board of Supervisors on March 31, 2020. The Update was submitted to both the Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission within 30 days of adoption. The department has since identified a necessary revision to the MHSA Annual Update that requires implementation before June 30, 2020. This proposed revision is detailed and set forth in this Program Update. This proposed Program Update provides Merced County stakeholders with the details of the proposed revision to Fiscal Year 2019-2020 MHSA Annual Update. The timeline for this Program Update is as follows:

• The draft Program Update was made available for review to stakeholders via an email

sent on March 20, 2020.

• Community Program Planning Process (CPPP) including: local stakeholder feedback, stakeholder survey, focus groups, and key informant interviews if possible, began on March 20, 2020.

• Pursuant to Welfare and Institutions Code (WIC) § 5848 the Program Update was posted for a 30-Day Public Comment and Review Period starting on March 20, 2020.

• The Program Update was presented to the MHSA Ongoing Planning Council at a Special Conference Call Meeting on March 26, 2020.

• The required Public Hearing was conducted, via Conference Call, on April 24, 2020, and

the Program Update was approved by the Behavioral Health Advisory Board. • The department plans to send the Program Update to the Merced County Board of

Supervisors for possible adoption on May 19, 2020.

• Submit the adopted Program Update to Department of Health Care Services and Mental Health Oversight and Accountability Commission by May 22, 2020.

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In Merced County the MHSA Community Program Planning Process (CPPP) adheres to the inclusive idea of “nothing about us without us”. For the past fourteen years, MCBHRS has built strength in stakeholder numbers through the involvement of diverse consumers, family members, agency partners, and community members, throughout the county; in the planning and implementation of MHSA programs and services. Each year Merced County’s annual CPPP strategy includes regular, ongoing meetings with stakeholders, community presentations, training on the CPPP, community focus groups, and key informant interviews. In addition, CPPP input may be submitted via email to MHSA staff members at [email protected] or by calling the toll free MHSA phone line at 1-888-626-6472.

Monthly Meetings There are two regularly scheduled CPPP meetings and both are open to the public. In order to ensure there is an accurate record, all meetings have agendas, a sign-in sheet, and minutes. MHSA Ongoing Planning Council (OPC)

o The monthly OPC meetings are held the third Thursday of every month from 9:00 a.m. to 10:00 a.m.

Cultural Competence Committee (CCC) o The monthly CCC meetings are held the third Thursday of every month from

10:00 a.m. to 11:00 a.m.

These monthly meetings provide year-round opportunities to address concerns, meet challenging needs, and communicate directly with the public in order to maintain stakeholder presence throughout the MHSA programs. There is an opportunity at the beginning of the meeting for members of the public to speak for up to three (3) minutes regarding any topic that is not already on the published agenda. In accordance with WIC § 5848 Merced County’s MHSA OPC includes representatives from many stakeholders groups and reflects Merced County’s consumers, family members of consumers, social services, education, law enforcement, health care including public and private, older adults, probation, housing and employment, mental health staff, faith based organizations, contract providers of mental health services and non-profit agencies. The OPC is also ethnically and culturally diverse. Community Focus Groups and Key Informant Interviews In addition to the ongoing meetings, Merced County utilizes focus groups and key informant interviews as the primary method for collection of community stakeholder input. The CPPP for the Program Update to the Fiscal Year 2019-2020 MHSA Annual Update has included outreach, through a Stakeholder Survey, to consumers, family members, community members, community based organizations, educational and health care providers. Due to COVID-19 the department had to make adjustments in the methods used to gather stakeholder feedback. See Appendices 2, 3 and 4 of this document for the survey questions, demographics of the survey respondents, survey feedback, and MCBHRS’ responses.

Community Program Planning Process (CPPP)

7 Merced County Behavioral Health and Recovery Services Program Update to the FY 2019-2020 MHSA Annual Update FINAL Adopted by Merced County Board of Supervisors on 5-19-2020

Public Review and Approval Process of MHSA Plans/Updates The Program Update to the Fiscal Year 2019-2020 MHSA Annual Update was posted by MCBHRS on the Merced County website at http://www.co.merced.ca.us/486/Mental-Health-Services-Act for a 30-day Public Review and Comment Period, from March 20, 2020 through April 20, 2020. The Program Update to the 2019-2020 MHSA Annual Update is available to be emailed and/or mailed to all MHSA stakeholders. In addition, copies are available, upon request, to all interested parties at the MCBHRS MHSA Office, located at 301 East 13th Street, Suite E, Merced, CA 95341. The public is able to provide input, recommendations, or comments through any of the following methods:

• Attend the Public Hearing via conference call on April 24, 2020 at 4:30 p.m.: Phone Dial-in numbers are: • 1.888.748.9073 (United States(Primary)) • 1.844.540.8065 (United States(Primary)) • 1.408.419.1715 (United States(San Jose)) • 1.408.915.6290 (United States(San Jose))

o Enter the Meeting ID: 209 381 6805 6805 (followed by the # sign)

• Email: Sharon Jones at [email protected] • Phone: (209) 381-6800, ext. 3611 • Write to or return Public Comment Form (Appendix 6) to: Merced County Behavioral Health and Recovery Services Attn: Sharon Jones, MHSA Coordinator P.O. Box 2087 Merced, CA 95344

http://www.co.merced.ca.us/486/Mental-Health-Services-Act

http://www.co.merced.ca.us/486/Mental-Health-Services-Act


Training, Technological Assistance and Capacity Building

Training, Technical Assistance and Capacity Building is the emphasis to increase capacity among PEI providers (outside the mental health system) to implement successful programs and interventions. Some methods may include expanding training capacity in specific systems, learning communities, materials development and dissemination, and other improvement approaches.

Prevention and Early Intervention (PEI)


Expansion of Capacity Building-Prevention and Early Intervention Services One-Time Funds for Homeless Navigation Support

Fiscal Year Total Funding

One-Time Funding for Fiscal Year 2019-2020

$4,000,000 in funding

BACKGROUND

Merced County is centrally located in the heart of the San Joaquin Valley of California. Per the 2010 United States Census, the population was 255,793, up from 210,554 at the 2000 census. As of July 1, 2018, the current estimated population is 274,765 making Merced County one of the fastest growing counties in California. The City of Merced is the County seat and the largest of six incorporated cities, which include Atwater, Livingston, Los Banos, Gustine, and Dos Palos. There are eight urban communities including, Castle, Delhi, Franklin/Beachwood, Hilmar, Le Grand, Planada, Santa Nella, and Winton.

County and City municipalities are a major source of employment along with agricultural related industries, retailing, manufacturing, food processing and tourism. Merced County has an excellent school system including a modern community college, Merced College. Merced is also the home to the University of California's tenth campus, University of California, Merced, which is the first research university built in the U.S. in the 21st century.

Over the course of the last twelve (12) months, much progress was made in addressing homelessness and those at risk of becoming homeless within the County of Merced. Areas of opportunity still exist to expand services to the Westside of the County; development of region-wide low-barrier shelters with the capacity to house the unsheltered; creation of much needed transitional housing; and the development of an array of affordable housing options for those with little or no income.

Merced County’s poverty rate rose to 27.4% according to the U.S. Census with the national average at 15.9%. The high cost of housing and the high unemployment rate in Merced County are two of the main reasons for increased homelessness and housing insecurity. The continued lack of affordable housing in this area coupled with the population growth and the disproportionate numbers of the county’s population living well below the federal poverty level put the homeless in Merced County at a very high risk.

COUNTY PERSPECTIVE

This region is designated by HUD as the Merced City and County Continuum of Care CA-520 (Merced CoC), which encompasses the entire County of Merced. The 2019 Merced CoC point-in-time count showed a total of 607 persons who were identified as meeting the HUD definition of homeless on January 24, 2019. Of those counted, 285 persons were unsheltered, with 71.6% (204) located in the City of Merced. Of the 285 unsheltered persons, 45.3% (129) were identified as chronically homeless. 322 individuals were considered sheltered in either transitional housing


or emergency shelter. This data is exclusive of individuals residing in substandard structures, forced to choose between habitability concerns and homelessness. According to the 2017 American Community Survey (ACS), 23% of Merced County residents are living below the federal poverty level, and therefore they are at increased risk of becoming homeless.

The County of Merced is developing a Homeless Navigation Center in the City of Merced, with a targeted opening date of October 2020. Service components of this Center will include: a 75-100 bed low-barrier shelter; supportive services, which include co-located service providers; referral assistance to help individuals and families at-risk of becoming homeless connect with available services; and an outreach and engagement team who will work in conjunction with other Outreach and Engagement providers (law enforcement, County behavioral health, etc.). A Low-Barrier Navigation Center is defined as a Housing First, service-enriched shelter focused on moving people into permanent housing.

Merced County’s Homeless Navigation Center will assist the homeless population transition to housing and help them work towards reentry into a more traditional living situation. The services provided at the Center will address basic needs such as healthy meals and the ability to maintain hygiene. The Center will also feature intensive case-management services designed to focus on how to rapidly resolve the homeless episode and regain housing. The Center will be staffed 24 hours a day, 7 days a week, and staff will be expected to facilitate a safe and welcoming facility, while focusing on resident well-being and reducing barriers to permanent housing.

PURPOSE

The purpose of Prevention and Early Intervention (PEI) is to focus on interventions and programs for individuals across the life span prior to the onset of a serious emotional/behavioral disorder or mental illness. Prevention in mental health involves reducing risk factors or stressors, building protective factors and skills, and increasing support. Prevention promotes positive cognitive, social, and emotional development and encourages a state of well-being.

Examples of Prevention:

• Outreach & Education about Mental Health • Providing information about Services, Programs • Providing resources (flyers, brochures, etc.) • Linkage to appropriate agencies and services • Initial engagement and explanation of services

Early Intervention includes services that are designed to address mild to moderate mental health problems in the early stages; thus preventing a problem from getting worse, and avoiding the need for more extensive treatment.

Examples of Early Intervention:

• Supportive services to address mild behavioral issues • Working on issues of: self-esteem, bullying, coping, grief and loss, financial issues, anger

management, stress management, housing instability, homelessness, and other issues


• Linkages to resources • Referrals to appropriate services

PEI Programs strive to meet the following goals:

• To prevent a mental health problem from getting worse and to avoid more extensive treatment

• To reduce stigma and discrimination • To improve access to services • To reduce risk factors and stressors for children • To support well-being and reduce suffering of children and families • Reduce psychosocial impacts of trauma • Increase support overall for help-seeking behaviors in natural settings (i.e., schools,

home, church, etc.) • Reduction and prevention of suicide risk

PROGRAM EXPANSION

The proposed expansion of PEI-Capacity Building Services is intended as a one-time opportunity to leverage PEI funds with other funding sources to implement the Homeless Navigation Center. The goal of this collaboration is to build capacity and infuse more Prevention and Early Intervention services into the community, with a focus on those who are homeless or at-risk of homelessness. Community capacity is defined as “the combined influence of a community’s commitment, resources, and skills that can be deployed to build on community strengths, identify common aspirations, and address community problems.” (Adapted from the work of Steven E. Mayer).

This use of PEI funds for this project will provide for capacity building through systems coordination and community collaboration to reduce and prevent homelessness; to increase access to shelters and housing; and to improve coordination of homelessness programs for individuals at risk and facing barriers and unique challenges in accessing shelter, housing, and supportive services. MCBHRS and the Homeless Navigation Center will coordinate Prevention and Early Intervention efforts designed to reduce the long-term problems for those individuals experiencing homelessness, and to mitigate the need for extensive mental health treatment.

The expansion of Capacity Building services will: support the operations of the Homeless Navigation Center; help identify and provides linkages for individuals who are suffering from mental health issues; and expand early intervention services and improved access to mental health care. Supportive Services will:

• Focus on Prevention and Early Intervention efforts for homeless individuals • Provide mental health and substance use disorder outreach services • Collect data on each individual contacted through outreach & for those who receive

ongoing services • Conduct outreach and engagement activities countywide


• Implement applicable screening tools, one at intake and at a secondary point in treatment, examples include: the GAD-7, PHQ-9, Beck Depression Scale, ASAM, and AUDIT-C for excessive drinking

• Track outcomes for housing status changes over time • Track behavioral health outcomes through pre and post surveys • Track satisfaction data and outcomes through surveys

By supporting the much needed Homeless Navigation Center with PEI funding and support, MCBHRS will be able to broaden the provision of community-based services by taking prevention and early intervention services to individuals where they are located, in their natural settings.

CULTURAL COMPETENCE

This PEI-Capacity Building expansion will provide outreach, engagement, referrals, and brief intervention services for our diverse community individuals who are homeless or at-risk of homelessness. The goals of the expansion will include recognition of early signs of mental illness and improvement of timely access and linkage to treatment, as well as to other supportive services.

All services will be culturally responsive, person-centered and rooted in evidence-based practices. Such practices include: critical time intervention, motivational interviewing, trauma informed care, and harm reduction principles. The service model includes diversion and target prevention strategies to maximize resources. The Navigation Center campus is intended to provide for the basic needs of adult individuals experiencing homelessness, while providing connection to supportive services that focus primarily on helping residents identify a pathway to housing.

PRIORITY POPULATION

The target populations will include adults, 18 years and older, residing at or receiving services through the Homeless Navigation Center and other shelters throughout the County.

COST

MCBHRS will leverage $4,000,000 dollars of MHSA Prevention and Early Intervention funds, in Fiscal Year 2019-2020, as one-time funds, directed to Merced County to support Capacity Building collaboration with the Homeless Navigation Center. In this effort to support the Homeless Navigation Center MCBHRS will utilize funds that would be subject to reversion to the State, pursuant to Welfare and Institutions (W&I) Code Section 5892(h).

Merced County will utilize the funds as follows: to support the operation of the Homeless Navigation Center; to identify homeless or at-risk individuals served at the Center who are experiencing behavioral health issues; to ensure timely linkage to appropriate services, interventions and treatment; and to provide support for the homeless by promoting wellness, recovery, and related functional outcomes for a mental illness early in its emergence. These services will be implemented with the goal to reduce the following:


• Homelessness • Incarcerations • School failure or dropout • Unemployment • Prolonged suffering • Hospitalizations and inpatient psychiatric care

PERFORMANCE MEASURES

Target Population • Adult Individuals who are experiencing homelessness or are At-Risk of Homelessness

PEI Performance Measures

• The number of individuals served at the Homeless Navigation Center

• The number of those individuals served who access prevention, early intervention and treatment services

• Percentage of individuals served who report improvement in their housing status

• Percentage of individuals served with reduced symptoms and/or improved functioning or support

• Percentage of individuals served who report increased wellbeing • Average time between referral and engagement to appropriate

mental health resource • Number and percentage of individuals linked to appropriate

mental health resource successfully • Percentage of individuals served reporting satisfaction with

housing services • Percentage of individuals served reporting satisfaction with PEI

supportive services Other Performance Measures

• The percentage of individuals sheltered at the Navigation Center who are MCBHRS clients with Severe Mental Illness (SMI)

• The total number of days MCBHRS clients are sheltered • The percentage of MCBHRS clients who access supportive

services • Average time from engagement to access to services

Services • Emergency shelter beds with a special accommodations space as needed

• Services will include direct early intervention services, such as individual brief intervention sessions and groups, in addition to navigating to appropriate PEI and treatment services and other supportive services.

Conclusion This proposed one-time PEI-Capacity Building Expansion is offered for review. Stakeholders are invited to provide comment. Substantive comments will be included in the final Program Update to the FY 2019-2020 Annual Update document.


The Program Update to the 2019-2020 MHSA Annual Update includes the following changes:

PEI Program Description Funding Change Yes/No? Amount of Change

Expansion of Capacity Building-Prevention and Early Intervention Services-One-Time Funds for Homeless Navigation Support

Leverage one-time use of PEI funds to support the Homeless Navigation Center in Merced, California.

Yes $4,000,000

PROGRAM CHANGES


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update

Funding Summary County: MERCED Date: 03/19/2020

MHSA Funding A B C D E F

Community Services and

Support

Prevention and Early

Intervention Innovation

Workforce Education

and Training

Capital Facilities and Technological

Needs

Prudent Reserve

A. Estimated FY2019/20 Funding

1. Estimated Unspent Funds from Prior Fiscal Years 15,559,392 CSS 7,803,665 PEI 4,926,423 INN 289,989 WET 402,013 CFTN

2. Estimated New FY2019/20 Funding 11,526,206 CSS 2,881,552 PEI 758,303 INN

3. Transfer in FY2019/20a/ (2,638,625) CSS 2,638,625 CFTN

4. Access Local Prudent Reserve in FY2019/20 835,786 PEI (835,786) PR

5. Estimated Available Funding for FY2019/20 24,446,973 CSS 11,521,003 PEI 5,684,726 INN 289,989 WET 3,040,638 CFTN

B. Estimated FY 2019/20 Expenditures 11,335,751 CSS 7,699,467 PEI 1,345,806 INN 226,141 WET 3,040,638 CFTN

C. Estimated FY 2019/20 Unspent Fund Balance 13,111,223 CSS 3,821,536 PEI 4,338,920 INN 63,848 WET 0 CFTN

D. Estimated Local Prudent Reserve Balance

1. Estimated Local Prudent Reserve Balance on June 30, 2019 3,821,367

2. Contributions to the Local Prudent Reserve in FY 2019/20 25,000

3. Distributions from the Local Prudent Reserve in FY 2019/20 (835,786)

4. Estimated Local Prudent Reserve Balance on June 30, 2020 3,010,581 a/ Pursuant to Welfare and Institutions Code Section 5892(b), Counties may use a portion of their CSS funds for WET, CFTN, and the Local Prudent Reserve. The total amount of CSS funding used for this purpose shall not exceed 20% of the total average amount of funds allocated to that County for the previous five years.

MHSA Funding Summary


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update Community Services and Support (CSS) Funding

County: MERCED Date: 03/19/2020

Column order:


A Estimated Total Mental Health Expenditures

B Estimated CSS

Funding

C Estimated

Medi-Cal FFP

D Estimated

1991 Realignment

E Estimated Behavioral

Health Subaccount

F Estimated

Other Funding

FSP Programs 1. CARE (Adult FSP) 1,748,983 Total 1,148,983 CSS 600,000 FFP 2. WECAN (Children FSP) 3,300,000 Total 1,800,000 CSS 1,500,000 FFP

Non-FSP Programs 1. Merced Adult Wellness Center (GSD) 1,239,021 Total 1,239,021 CSS

2. Dual Diagnosis Program Wellness Center (GSD) 582,431 Total 582,431 CSS

3. Westside Transitional Wellness Center (GSD) 346,431 Total 346,431 CSS

4. Transitional Age Youth Wellness Center-CUBE (GSD)

298,470 Total 298,470 CSS

5. Older Adult System of Care (OASOC) (GSD) 334,977 Total 334,977 CSS

6. Adult Behavioral Health Court (GSD) 501,685 Total 501,685 CSS

7. SEACAP (GSD) 347,339 Total 347,339 CSS

8. CSS in Schools and Communities (GSD) 444,956 Total 222,478 CSS 222,478 FFP 9. Juvenile Behavioral Health Court (GSD) 174,037 Total 174,037 CSS

10. Housing-CoC (GSD) 40,000 Total 40,000 CSS

11. Housing Supportive Services Program (GSD) 402,882 Total 402,882 CSS

12. Wellness and Recovery Team-NEW 500,000 Total 500,000 CSS

13. COPE (Outreach & Engagement) 63,634 Total 63,634 CSS

14. COPE-Central Intake (O&E) 552,054 Total 552,054 CSS

15. COPE-Crisis Stabilization Unit (O&E) 362,380 Total 362,380 CSS

16. COPE-Public Health (O&E) 330,835 Total 330,835 CSS 17. COPE-Mobile Crisis Response Team (O&E) 590,853 Total 590,853 CSS CSS Administration 1,824,145 Total 1,475,774 CSS 348,372 FFP CSS MHSA Housing Program Assigned Funds 21,487 Total 21,487 CSS Total CSS Program Estimated Expenditures 14,006,600 Total 11,335,751 CSS 2,670,850 FFP 0 0 0 FSP Programs as Percent of Total 44.5%


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update Prevention and Early Intervention (PEI) Funding


Column order:

Fiscal Year 2019-2020 A B C D E F

Estimated Total Mental

Health Expenditures

Estimated PEI Funding

Estimated Medi-Cal FFP

Estimated 1991

Realignment

Estimated Behavioral

Health Subaccount

Estimated Other

Funding

PEI Programs – Prevention

1. Merced County Office of Education-Caring Kids 164,000 Total 164,000 PEI 2. Sierra Vista Child and Family Services-Imatter 331,811 Total 331,811 PEI

3. MCBHRS-Youth to Youth Middle School Mentoring 100,000 Total 100,000 PEI

4. Golden Valley Health Centers -Integrated Primary Care in Latino Community 118,734 Total 118,734 PEI

5. Merced Lao Family Community, Inc.-Integrated Primary Care in Hmong Community 82,714 Total 82,714 PEI

6. Livingston Community Health Services -Integrated Primary Care in Latino Community 120,272 Total 120,272 PEI

7. Golden Valley Health Centers –Cultural Broker in Latino Community 86,691 Total 86,691 PEI

8. Merced Lao Family Community, Inc.- Cultural Broker in Hmong Community 59,913 Total 59,913 PEI

9. Livingston Community Health Services - Cultural Broker in Latino Community 56,485 Total 56,485 PEI

10. Merced County Human Services Agency-Cultural and Linguistic Outreach Veterans Program 100,000 Total 100,000 PEI

11. PEI-Strengthening Families Program 481,815 Total 481,815 PEI

12. Collaboration with National Alliance on Mental Illness (NAMI) 37,850 Total 37,850 PEI

13. Youth Leadership Institute (YLI)-Capacity Building of LGBTQQIA2-S Supportive Services 22,000 Total 22,000 PEI

14. Training, Capacity Building and Support for Program Evaluation 53,050 Total 53,050 PEI

15. CalMHSA-Central Valley Suicide Prevention Hotline 55,713 PEI 55,713 PEI 16. CalMHSA- Member Fee 3,693 PEI 3,693 PEI 17. Stigma and Discrimination Reduction Program 43,000 Total 43,000 PEI

18. Suicide Prevention Program 43,000 Total 43,000 PEI


PEI Programs – Early Intervention

1. Merced County Office of Education-Caring Kids 4,000 Total 4,000 PEI

2. Aspiranet-Transition to Independence Process Program (TIP) 262,360 Total 262,360 PEI

3. City of Livingston-Mental Health and Police in Schools (MAPS) Police Officer 94,500 Total 94,500 PEI

4. MCBHRS-Mental Health and Police in Schools (MAPS) Clinician 112,949 Total 112,949 PEI

5. Golden Valley Health Centers -Integrated Primary Care in Latino Community 58,481 Total 58,481 PEI

6. Merced Lao Family Community, Inc.-Integrated Primary Care in Hmong Community 40,739 Total 40,739 PEI

7. Livingston Community Health Services -Integrated Primary Care in Latino Community 59,239 Total 59,239 PEI

8. Golden Valley Health Centers –Cultural Broker in Latino Community 42,698 Total 42,698 PEI

9. Merced Lao Family Community, Inc.- Cultural Broker in Hmong Community 29,509 Total 29,509 PEI

10. Livingston Community Health Services - Cultural Broker in Latino Community 27,821 Total 27,821 PEI

11.

Merced County Human Services Agency-Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) 110,000 Total 110,000 PEI

12. MCBHRS-PEI-Strengthening Families Program 20,076 Total 20,076 PEI

13. MCBHRS-Capacity Building of PEI-Early Intervention Services 393,815 Total 393,815 PEI

14.

Expansion of Capacity Building-Prevention and Early Intervention Services-One-Time Funds for Homeless Navigation Support-One Time Support 4,000,000 Total 4,000,000 PEI

PEI Administration* 482,539 Total 482,539 PEI

PEI Assigned Funds 0 0

Total PEI Program Estimated Expenditures 7,699,467 Total 7,699,467 PEI

*PEI Administration Costs not calculated on One-Time Funds for Homeless Navigation Support


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update Innovation (INN) Funding


Column Order:



B Estimated INN

Funding

C Estimated

Medi-Cal FFP

D Estimated 1991

Realignment


Health Subaccount

F Estimated

Other Funding

INN Programs

1. Innovative Strategist Network-Service Integration Team (ISN-SIT)-Adults 973,533 Total 973,533 INN

2. Innovative Strategist Network-Youth (ISN-Y) 249,927 Total 249,927 INN

INN Administration 122,346 Total 122,346 INN

Total INN Program Estimated Expenditures 1,345,806 Total 1,345,806 INN


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update Workforce, Education and Training (WET) Funding


Column Order:


A Estimated

Total Mental Health

Expenditures

B Estimated

WET Funding

C Estimated

Medi-Cal FFP

D Estimated

1991 Realignment


Health Subaccount

F Estimated

Other Funding

WET Programs

1. Financial Incentives-California State University, Stanislaus-Master of Social Work Stipends 37,000 Total 37,000 WET

2.

Training and Technical Assistance-Trilogy Integrated Resources-Network of Care and E-Learning 25,096 Total 25,096 WET

3. Staff Development-Trainings and Consultants 92,948 Total 92,948 WET

4.

Mental Health Career Pathway Programs-Merced College-Psychosocial Rehabilitation Classes 41,600 Total 41,600 WET

WET Administration 29,497 Total 29,497 WET

Total WET Program Estimated Expenditures 226,141 Total 226,141 WET


Program Update to the Fiscal Year 2019-2020 Mental Health Services Act Annual Update Capital Facilities/Technological Needs (CFTN) Funding


Column order:



B Estimated CFTN

Funding

C Estimated Medi-Cal

FFP

D Estimated 1991

Realignment


Health Subaccount

F Estimated

Other Funding

CFTN Programs – Capital Facilities Projects

1. CF Project #4: Livingston Clinic New Facility 2,481,570 Total 2,481,570 CFTN

2. CF Project #5 CUBE Facility Improvements 100,000 Total 100,000 CFTN

CFTN Programs – Technological Needs Projects

3. TN Project #1 Electronic Health Record (EHR) 365,068 Total 365,068 CFTN

4. TN Project #2 EHR Support 94,000 Total 94,000 CFTN

CFTN Administration 0 Total 0 CFTN

Total CFTN Program Estimated Expenditures 3,040,638 Total 3,040,638 CFTN


Appendix 1:

MHSA Monthly Meeting Schedule Fiscal Years 2018- 2019 and 2019-2020

Mental Health Services Act (MHSA) Ongoing Planning Council Monthly Meeting Schedule

2018-2019 Schedule 2019-2020 Schedule

July 19, 2018

August 16, 2018

September 20, 2018

October 18, 2018

November 15, 2018

December 20, 2018

January 17, 2019

February 21, 2019

March 21, 2019

April 18, 2019

May 16, 2019

June 20, 2019

July 18, 2019

August 15, 2019

September 19, 2019

October 17, 2019 October 24, 2019 * Special Meeting

November 21, 2019

December 19, 2019

January 16, 2020

February 20, 2020

March 26, 2020*

April 16, 2020*

May 21, 2020*

June 18, 2020* *Meetings Held via Conference Call due to COVID-19

Location: 301 East 13th Street, Merced CA 95341

Time: 9:00 am-10:00 am

Appendices


Appendix 2: MHSA Stakeholder Feedback Survey Questions for the Program Update to the 2019-2020 Annual Update

Due to the COVID-19 crisis MCBHRS was not able to conduct in-person focus groups as part of the Community Program Planning Process (CPPP) for the Program Update to the 2019-2020 MHSA Annual Update. In order to gather valuable Stakeholder feedback, the department utilized Survey Monkey to release a Stakeholder Survey. The Survey gathered demographics and responses to the following questions: Stakeholder Feedback 1. Have you reviewed the Draft Program Update to the 2019-2020 MHSA Annual Update?

- Yes - No

If YES go to #2, then on to #4 2. What do you see as the strengths of the Draft Program Update to the 2019-2020 MHSA Annual Update? 3. If you have concerns about the Draft Program Update to the 2019-2020 MHSA Annual Update, please explain. If NO go to #4 4. In your opinion, what are the current needs regarding prevention and early intervention services for the homeless in Merced County? 5. Which part of the existing system serving homeless individuals in Merced County works best? 6. Which parts of the existing system serving homeless individuals in Merced County have the greatest need for expansion? 7. What are risk factors that contribute to homelessness in at-risk populations? 8. What protective factors help prevent homelessness in at-risk populations? 9. What protective factors help to prevent chronic homelessness among persons who are already homeless? 10. What two actions would you take to meet the most pressing needs of the subpopulation that you serve, or are most knowledgeable

about?


Appendix 3: Demographics of Responders to the MHSA Stakeholder Feedback Survey for the Program Update to the

2019-2020 Annual Update

Results from the survey indicate that thirty-five (35) individuals accessed the Stakeholder Feedback Survey, while only seventeen (17) of those individuals or 48.6%, completed the demographics section. 51.4% of those accessing the survey provided no demographics. The demographic detail is as follows:

The detail at left reflects the breakdown of the 17 demographic respondents based on their identified roles in the mental health community.

Respondents were able to choose more than one category; therefore, the total percentage is greater than 100%.

The detail at right reflects the breakdown of the 17 demographic respondents based on their identified Ethnicity.

Respondents were able to choose more than one category; therefore, the total percentage is greater than 100%.


The detail at left reflects the breakdown of the 17 demographic respondents based on their identified Age Category.

The detail at right reflects the breakdown of the 17 demographic respondents based on their identified Gender.

The detail at left reflects the breakdown of the 17 demographic respondents regarding Veteran status.


Appendix 4: MHSA Stakeholder Feedback from the Survey for the Program Update to the 2019-2020 Annual Update

MCBHRS shows that thirty-five (35) individuals accessed the Stakeholder Feedback Survey, but responses to the stated questions were optional; therefore the number of responses varied for each question. All Survey responses are included in the table below, along with MCBHRS’ responses.

Q1 Have you reviewed the Draft Program Update to the 2019-2020 MHSA Annual Update?

Yes – 80 % No – 20 %

Q2 What do you see as the strengths of the Program Update to the 2019-2020 MHSA Annual Update?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 It is easy to read 2 Survey Response received 03/23/2020 It highlights changes in bright green. 3 Survey Response received 03/23/2020 Increased funding.

4 Survey Response received 03/31/2020 The strength is identifying that action needs to taken from a help first approach and to intervene so things do not get worse and support is there early on.

5 Survey Response received 03/31/2020 Focus on Early Intervention to (hopefully) prevent need later on. 6 Survey Response received 03/31/2020 Includes programs/projects to serve many Merced Co. populations throughout the county 7 Survey Response received 04/01/2020 Transparency with scope of services offered and financial distribution to various programs. 8 Survey Response received 04/01/2020 Varied in its scope reaching many different groups.

9 Survey Response received 04/01/2020 That there will be a focus on youth experiencing homelessness that are heavily impacted by the symptoms that plague them.

10 Survey Response received 04/01/2020 The concrete performance measures 11 Survey Response received 04/02/2020 The addition of more preventative measures for homelessness

Q2 MCBHRS Response: Thank you for taking time to read the Program Update. All of your feedback is greatly appreciated. Each stakeholder approved Annual Update includes approved program amount, number to be served, estimated cost, program description, key


objectives, performance measures, satisfaction survey, success stories and pre/post outcomes. Public hearings are held to receive feedback, and feedback and information is shared when considered for adoption by the Merced County Board of Supervisors.

Q3 If you have any concerns about the Program Update to the 2019-2020 MHSA Annual Update, please explain.

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 The amount is concerning 2 Survey Response received 03/23/2020 None. 3 Survey Response received 03/23/2020 Proposed use of new PEI funds should be supported with evidence-based research program is effective. 4 Survey Response received 03/23/2020 The crisis workers still see people in person.

5 Survey Response received 03/26/2020 The fact that Merced Lao family received $8,000 for prevention and early intervention regarding LGBTQ+ people is not itemized correctly.

6 Survey Response received 03/31/2020 I believe this is needed to support the families in our community.

7 Survey Response received 03/31/2020

A great deal of the homeless population does not have any sort of support system in place. For many, their pets are their only source of love and shelters currently do not accept people with their pets. I would really like to see strides made in addressing this percentage of the homeless population. I know many refuse to give up their pets and therefore cannot receive or benefit many of the programs offered. I understand the liability issue and the red tape, but I have yet to see much progress for that demographic, which is considerable.

8 Survey Response received 03/31/2020 Could use more concrete objectives such as # of program participants who found permanent supportive housing, change in % of those requiring acute crisis services, etc.

9 Survey Response received 04/01/2020 Does not address High School aged youth. The resources they get in the schools is not enough. 10 Survey Response received 04/01/2020 The unknown of the funding moving forward into the new 20-21 year. 11 Survey Response received 04/01/2020 None.

12 Survey Response received 04/02/2020 There is little mentioned about children that are homeless and we have a large population of homeless mothers and children.

Q3 MCBHRS Response: Thank you all for your feedback.

• A 24-hour low barrier shelter is costly to operate. By leveraging Prevention and Early Intervention dollars this helps with Community Collaboration and increased health and wellness, linkage and timely services and support.

• Each MHSA funded program has a promising practice, evidence based practice or a community defined practice.


• The Southeast Asian community is identified as underserved in regards to LGBTQ+ awareness and support. MHSA funds are to support underserved and unserved communities, and the identified LGBTQ+ funding was awarded to Merced Lao Family as an expansion of their existing Cultural Broker Program.

• The County is in the process of establishing a Homeless Navigation Center, which will allow individuals with pets to access services. • The department also finds that resources for the TAY (Transitional Age Youth) population are essential. MHSA has funded several programs

provided services to the high school population including the iMatter program through Sierra Vista Child and Family Services, Youth to Youth Middle School Mentoring through BHRS, Aspiranet TIP (Transition to Independence Program), and the PEI Strengthening Families Program through BHRS.

• MHSA dollars are received each month. The funding received is determined by the California millionaires and the 1% Proposition 63 tax. • The Navigation Center will provide support or linkage to assist families experiencing homelessness or at-risk of homelessness.

Q4 In your opinion, what are the current needs regarding prevention and early intervention services for the homeless in Merced County?

Date Survey Response Received Comments/Responses

1 Survey Response received 03/23/2020 Consumers need basic needs met, ID, SS Cards, Medical cards, clean clothing and showers. Those that already have homes need help maintaining their current home.

2 Survey Response received 03/23/2020 How is Merced County serving homeless children and youth? 3 Survey Response received 03/23/2020 Evidence-based practices for identifying currently housed individual’s families at risk of becoming homeless. 4 Survey Response received 03/23/2020 We need more mental health and substance abuse assistance to those addicted who are on the streets. 5 Survey Response received 03/23/2020 Outreach is needed, going to meet them where they are. To make them aware of the available services.


Some studies show up to 40% of homeless youth are LGBTQ+. I do not see any strategies to address this specific population that include reportable LGBTQ+ contacts, accountability, or expert consultation of any kind.

7 Survey Response received 03/31/2020 All-inclusive. There are currently not enough resources to definitely say that any one area in prevention and early intervention does not require additional supports and resources.


A person working full time making minimum wage cannot afford to rent a studio apartment in Merced anymore. This was not the case a few years ago. Rising rents and stagnant wages forced many to become homeless, which begins a snowball effect of issues.

9 Survey Response received 03/31/2020 A simple process to navigate the system that is barrier free.

10 Survey Response received 04/01/2020 A bigger focus on the affects to K-12 kids and leveraging more funds/personnel to help support the students and families.



Transportation to get to appointments, linkages to open affordable housing (not just getting section 8), hygiene supplies/ enrollment into services to utilize laundry and shower. Different linkages or housing supportive services for those who did not meet medical necessity with BHRS/ PATH program-- (lower of level of care through beacon does not help with this).

12 Survey Response received 04/01/2020 The criminalization of the unsheltered. 13 Survey Response received 04/01/2020 More money for direct services in a creative manner

14 Survey Response received 04/02/2020 Most homeless are in need of mental health or substance abuse counseling but they have to be willing to participate

15 Survey Response received 04/02/2020 1) An increase in the quality and quantity of available units 2) More responsibility on the part of our clients (nothing much we can do about that though).

Q4 MCBHRS Response: Thank you for the valuable input.

• Case management services can assist with identifying if there are available supports in the community to assist individuals with maintaining their home and will identify effective practices for families at risk for homelessness.

• There has been an increase of outreach workers to assist the homeless. Merced County has established New Direction as a place for the homeless to get assistance or linkage.

• Overall, the department is dedicated to providing services to residents in Merced County who are underserved, as well as improving existing programs to better serve underserved populations. The department requires that all PEI funded programs identify priority populations, goals, objectives and measurement tools.

• Merced County continues to build resources in all areas. One approach that we use is capacity building and building relationships with collaborative partners.

• Other MHSA Programs also exist to provide services to various populations: o The Innovative Strategist Network is an approved program to assist adults and youth with removing barriers to services o Several MHSA programs provide support for students and families: iMatter Program, Strengthening Families Program, Middle

School Mentoring Program, and CSS in Schools o BHRS has an ending the stigma campaign to increase mental health awareness and end stigma and discrimination.

• One of the main goals of the County’s Navigation Center is to permanently house as many individuals as possible. To date, MHSA has developed and funded two housing projects: Gateway Terrace in Merced and Pacheco Place in Los Banos. The MHSA housing program at Gateway Terrace serves children and their family, transitional age youth age 18 and above, adults, and older adults who are homeless or at risk of homelessness and have a qualifying serious mental illness and be functionally impaired due to their illness or a co-occurring condition of mental illness and substance abuse. Pacheco Place serves adults and older adults who are chronically homeless and have a


qualifying serious mental illness and be functionally impaired due to their illness or a co-occurring condition of mental illness and substance abuse.

Q5 Which part of the existing system serving homeless individuals in Merced County works best?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 It doesn’t work. 2 Survey Response received 03/23/2020 New Direction is doing a great job at linking consumers to available services 3 Survey Response received 03/23/2020 More visible outreach and engagement is needed within the community. 4 Survey Response received 03/23/2020 Unknown. 5 Survey Response received 03/23/2020 Public, non-judgmental help. 6

Survey Response received 03/23/2020 The New Direction Center, as it is helpful to have a physical location to send/refer individuals who may need services.

7

Survey Response received 03/31/2020

Partner collaboration, decision to implement best practices in the areas of harm reduction and permanent supportive housing. Collaborative applicant through Co. HSA has provided huge advances in structure and effectiveness.

8 Survey Response received 03/31/2020 I have not had any direct experience with New Direction, but it sounds ideal. 9 Survey Response received 03/31/2020 The Innovative Strategist Network is a strong force towards this effort

10 Survey Response received 04/01/2020 Not sure. 11 Survey Response received 04/01/2020 The comprehensive plan with PEI Performance Measures. Gives some purpose and tangible things to judge. 12 Survey Response received 04/01/2020 Outreach. 13 Survey Response received 04/02/2020 The shelters are a good place for homeless to stay and meals are provided.

14 Survey Response received 04/02/2020 The crisis residential housing program is excellent (although I know that is not really a housing program per se).

Q5 MCBHRS Response: Response: Thank you for your suggestion and feedback.

• Ongoing outreach is conducted through the department throughout the year. The Navigation Center is expected to have the combination in flow and functionalities of a Low-Barrier Shelter that includes supportive and Outreach and Engagement services.

• The Navigation Center will be an expanded model of New Direction that will have the capability to serve more individuals and families with a broader community focus.


Q6 Which parts of the existing system serving homeless individuals in Merced County have the greatest need for expansion?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 Shelters we only have only one shelter!


Prevention helping those that have homes to keep them talking to them about behaviors that may be getting them into trouble, money management, how to communicate with management, and good boundaries to keep people away that maybe problems for consumers.

3 Survey Response received 03/23/2020 All. 4 Survey Response received 03/23/2020 Actual housing. 5 Survey Response received 03/23/2020 Mental health and substance abuse. 6 Survey Response received 03/23/2020 Supportive housing, temporary housing. 7 Survey Response received 03/26/2020 LGBTQ+ outreach 8 Survey Response received 03/31/2020 HMIS needs to be reworked and provided by a partner genuinely interested in coordinated entry.

9 Survey Response received 03/31/2020 The shelter is often full, and while they do the best they can, it is not an ideal situation nor often not the best solution for many people.

10 Survey Response received 03/31/2020 Across the continuum of care from Prevention-Early Intervention-Treatment 11 Survey Response received 04/01/2020 Not sure. 12 Survey Response received 04/01/2020 Financial security. A onetime lump sum is good, but will the money stay static or decrease in time?


Services provided for clients who are not open to services. Example: CUBE TAYS not open to services and needs access to showers-- because they are not open they cannot utilize wellness center facilities even if they are open to CUBE.

14 Survey Response received 04/01/2020 There needs to be a drop in shelter for young people. The shelter in place now is not a safe place for youth or young adults.

15 Survey Response received 04/02/2020 The need to care for families that are homeless separate from the single men and women. 16 Survey Response received 04/02/2020 A new shelter with more rooms and beds

Q6 MCBHRS Response: Thank you for your input.

• The Navigation Center will include 75-100 bed Low Barrier Shelter designed to expand shelter services, to help individuals and families at-risk of becoming homeless connect with available services, and an outreach and engagement team who will work in conjunction with other Outreach and Engagement providers


• The Center will provide all services in a culturally competent manner • All funding is contingent on MHSA funding and available resources.

Q7 What are risk factors that contribute to homelessness in at-risk populations?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 Health and they are not well informed about C virus [COVID-19] 2 Survey Response received 03/23/2020 Drugs and poverty. 3 Survey Response received 03/23/2020 Affordable housing. 4 Survey Response received 03/23/2020 Lack of affordable housing. Lack of no barrier, safe shelter. 5 Survey Response received 03/23/2020 Low educational levels. Substance abuse issues. Lack of employment opportunities. 6 Survey Response received 03/23/2020 Mental health issues, physical health issues. 7 Survey Response received 03/26/2020 Being LGBTQ+, often meaning reduced family support.


Lack of supports to obtain long term entitlements, such as SSI support, need for further integration of health, social service, CBO, and faith based coordination, lack of substance use/abuse support, esp. inpatient resources


Low wages and high rent are key components. Most people barely live paycheck to paycheck, and many are currently unemployed due to the Executive Order for COVID-19. Most will not "survive" the impact that it has.

10 Survey Response received 03/31/2020 Domestic violence, loss of employment, inability to find a job, lack of budgeting, substance use, health issues, rent going up, landlord decides to sell property.

11 Survey Response received 04/01/2020 Not sure.

12 Survey Response received 04/01/2020 Inaccuracy due to it being such a transient population. Longitudinal numbers will be skewed consistently as folks moved around so much.

13 Survey Response received 04/01/2020 Substance use. Violence in to home/ streets. Poor family support/dynamics. Poor boundaries. lack of knowledge of services

14 Survey Response received 04/01/2020 Drugs, crime, prostitution. Lack of mental health.

15 Survey Response received 04/02/2020 Mental health services and substance abuse

16 Survey Response received 04/02/2020 1) Mental Illness 2) Substance Use 3) Irresponsibility


Q7 MCBHRS Response: Thank you for your feedback.

• The role of the Navigation Center will be to provide safe shelter to people experiencing homelessness allowing them the opportunity to stabilize as they work on a plan to secure housing. Case management, supportive services and linkages will be important stabilizing factors for those served.

Q8 What protective factors help prevent homelessness in at-risk populations?

Date Survey Response Received Comments/Responses

1 Survey Response received 03/31/2020 family, friends, faith based supports, CBO that wrap services around those at risk, and employment/education opportunities

2 Survey Response received 03/31/2020 Working with property management and imposing rent control. Adopting pet friendly practices also helps a great deal.

3 Survey Response received 03/31/2020 Life skills groups Supportive services Positive social network

4 Survey Response received 03/26/2020 Increased LGBTQ+ specific mental health outreach in schools and foster youth programs, staff education from licensed experts in the field, peer-led support groups.

5 Survey Response received 03/23/2020 Having programs that both address Mental Health and drug and shelters at same time. 6 Survey Response received 03/23/2020 Help with supplemental income when a consumer loses a job or source of income help remedy the problem 7 Survey Response received 03/23/2020 Resources to assist with housing, rent, utilities. 8 Survey Response received 03/23/2020 Social supports; robust & accessible mental health services 9 Survey Response received 03/23/2020 Unemployment insurance.

10 Survey Response received 03/23/2020 Outreach, education, supportive services on the street and in the Navigation Center 11 Survey Response received 04/01/2020 Concrete supports

12 Survey Response received 04/01/2020 Education, opportunity and knowledge of resources in any given area. Built-in resentment of families toward "the system."

13 Survey Response received 04/01/2020 Drop in centers- laundry services/ kitchen services/ hygiene bags/ shower services at Wellness Center/ linkages to free phones

14 Survey Response received 04/02/2020 Support from family and the community or faith based organization that makes them feel connected 15 Survey Response received 04/02/2020 1) Stable employment 2) Healthy relationships

Q8 MCBHRS Response: Thank you for your help identifying protective factors in at-risk populations.


• An important part of the Navigation Center will be the Outreach and Engagement Services provided. The plan is to co-locate service providers at the Center in order to enhance effectiveness with outreach, improve coordination with the overall homeless services system, and more centrally assess, prioritize, and refer households to supportive service providers.

Q9 What protective factors help to prevent chronic homelessness among persons who are already homeless?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 Empower individuals to find a source of legal income 2 Survey Response received 03/23/2020 unknown 3 Survey Response received 03/23/2020 No barrier housing 4 Survey Response received 03/23/2020 Outreach. 5 Survey Response received 03/23/2020 Supportive services Linkages to resources 6

Survey Response received 03/31/2020 Creating low-income housing with assistance so that people can have a roof over their head and their basic needs met.

7 Survey Response received 03/31/2020 A barrier free network 8 Survey Response received 04/01/2020 Concrete supports. Positive social connections. 9 Survey Response received 04/01/2020 Federal/state programs Early recognition by stakeholders


Linkages to food, furniture, employment, and open housing. Need more programs similar to GATEWAY or PACHECO.

11 Survey Response received 04/02/2020 That need to belong to something bigger then ourselves and feel like you can contribute 12 Survey Response received 04/02/2020 1) Mental health treatment 2) Sobriety

Q9 MCBHRS Response: Thank you for your feedback.

• The Navigation Center model is designed as a low barrier, Housing First approach allowing individuals who enter to bring pets, partners, and possessions with them and without precondition to sobriety, mental health treatment, or participation in services.

Q10 What two actions would you take to meet the most pressing needs of the sub-population that you serve, or are most knowledgeable about?

Date Survey Response Received Comments/Responses 1 Survey Response received 03/23/2020 Having more shelters and having a transitional program (residential) with trainings for getting jobs too. 2 Survey Response received 03/23/2020 I am not sure. 3 Survey Response received 03/23/2020 Continue to assist with outreach and info sharing


4 Survey Response received 03/23/2020 Increase the collaboration between mental health providers and housing support; increase the number of mental health providers for all socio-economic groups.

5 Survey Response received 03/23/2020 Get outreach to addicts with help for their problem and valid job opportunities. 6 Survey Response received 03/23/2020 Distribute safety kits to homeless individuals Ensure linkages to resources.


Support existing community peer to peer LGBTQ support groups, consult with the Merced LGBTQ+ Alliance or other appropriate community organizations when making funding choices, LGBTQ+ representation at all levels of staff.


Develop a better HMIS that reports accurate data that is visible to those approved by the person to aid in care coordination/reduction in duplicative services. More housing options to promote rapid rehousing for those at risk.


As I mentioned numerous times, homeless people are sometimes even homeless because they refuse to give up their beloved pets, which are their family. I would love to see a pet-friendly option for housing and emergency shelter. Secondly, I would work with the city/county to create low income housing with a locked rent rate so that people can reliably continue to have a roof over their head and a reliable amount expected of them each month.

10 Survey Response received 03/31/2020 To have readily available a supportive team and a keepsake connections.


Meeting with community stakeholders so that their input can be felt on a particular schools LCAP funding plan. Community promotion and notification about any and all resources available to members. They can't get help if they don't know what's out there.

12 Survey Response received 04/01/2020 More housing and more outreach.

13 Survey Response received 04/01/2020 More implementation of Be Strong Families Parent Cafes More money for local MH services with licensed clinicians

14 Survey Response received 04/02/2020 More mental health services for families to help with the children in the home and at school with difficult behaviors and possible special needs.

15 Survey Response received 04/02/2020 1) Provide quality mental healthcare 2) Provide adequate resources Q10 MCBHRS Response: Thank you! We appreciate your ideas to help end homelessness and value your input in our Stakeholder process.


Appendix 5:

MHSA Ongoing Planning Council Review Summary from Conference Call Meeting on March 26, 2020

Merced County Behavioral Health and Recovery Services

Ongoing Planning Council March 26, 2020

9:00am Behavioral Health and Recovery Services-Adult Campus

301 East 13th Street, Merced, CA

Present on call: Monica Adrian, Norma Barragan, Clovia Barboza, Vong Chang, Fernando Granados, Leticia Guillen, Caitlin Haygood, Sharon Jones, Megan Lawson, Cindy Mattox, Rebecca McMullen, Marilyn Mochel, Ismael Munoz, Maria Nava, Jenna Nunes, Maria Orozco, Nancy Reding, Steve Roussos, Eli Sachse, Sandra Sandoval, Anna Santos, Ge Thao, Paul Thao, Griselda Vazquez, Tatiana Vizcaino Presentation and Discussion: All Members

1. Call to Order / Roll Call

2. Approval of Minutes The approval of minutes for February 20, 2020 was motioned/seconded (Nancy Reding/Jenna Nunes) and carried.

3. Update Planning Council Contact List Sharon Jones mentioned that this is an ongoing task, and will be updated as members join the meeting.

4. Notice to the Public

Jenna Nunes with Sierra Vista informed the group that their ISN-Y program is still taking referrals. Staff are still working and all their services are being done through telehealth. Tatiana Vizcaino with NAMI is working from home, but still responding to emails and phone calls. Their office is exploring options for doing meetings through zoom, in the coming weeks. Leticia Guillen with Livingston Community Health stated that her office is continuing the IPC program, so they are still taking referrals. The Cultural Broker outreach is at a halt at the moment. Monica Adrian with Caring Kids wanted to let everyone know that they are here to provide family support right now. They are looking into somehow having online play groups to help with social connections. Nancy Reding, on behalf of the Merced LGBTQ Alliance, announced that all upcoming events have been cancelled.

5. Director's Report Agenda item tabled. Sharon Jones reminded the group that the new Director, Genevieve Valentine, will be starting on Monday, March 30, 2020.


6. Discussion on MHSA Program Update 2019-2020

Sharon Jones gave a MHSA Program Update 2019-2020 PowerPoint presentation, which was previously sent out to the group. Sharon talked about our guiding principles for the Ongoing Planning Council. She mentioned that Merced County’s poverty rate increased to 27.4% according to the U.S. Census. The 2019 Merced CoC point-in-time count showed a total of 607 persons were identified as meeting the HUD definition of homeless on January 24, 2019. Of those counted, 285 persons were unsheltered. She talked about the purpose of prevention in mental health, and how it involves reducing risk factors or stressors, building protective factors and skills, and increasing support. Sharon mentioned that a part of capacity building was to leverage $4,000,000 in funds to help support the Homeless Navigation Center. The center is going to focus on prevention and early intervention efforts for homeless individuals and provide mental health and substance use disorder outreach services.

Monica Adrian asked if the funds are being used to actually pay for housing for individuals. Sharon Jones said it is going to be used for a combination of things. The CEO’s office will be implementing how the funds are spent. Monica Adrian wanted to know if families with children will be able to benefit from the services. Sharon Jones said she would have to get more information on that. Monica Adrian asked that it be noted that there is a need for services for families with children to be met with this new homeless navigation support system. Sharon Jones said she will have someone give a presentation on it, when the information is available. Anna Santos wanted to know what definition of homeless we are going to be encompassing or are we going to be creating our own definition of what homelessness looks like. Sharon Jones said if she had to guess, she believes it would be the HUD definition. Anna Santos asked if the center would be serving families that are doubled up or “couch surfing.” Sharon Jones responded that it would be individuals that are already homeless and individuals that are at risk of being homeless. Sharon Jones added that technically, when they are doubled up, they may still be at risk of being homeless.

Steve Roussos wanted to add to what Anna said, when we are looking at homelessness around the country, and people are looking at the disparities in homelessness related to culture and language, what we find not just in Merced, but all over the country is that in communities that are not English speaking, they are often missed as homeless because of the barriers of being afraid of being kicked out of their cultural system. He believes the HUD definition is lacking immensely on reaching that disparity and unless we formally do something in Merced County to add to the definition and clarify that, we wouldn’t actually be a part of the navigation center. He thinks we need to be a little more proactive and really put ourselves out on the line for that. Sharon Jones said that it is not 100%, but she knows that in the literature she has read, it was HUD and individuals that are at risk and it has to be culturally responsive.

Nancy Reding asked if we are first talking about homelessness and then going on, or are we just talking about prevention and early intervention methods. Sharon Jones said we are talking about a combination of both. In the priority population of individuals who are homeless, but looking through the lens of prevention and early intervention for individuals and families. Nancy added that when she reviewed the budget for prevention and early intervention, she was informed in 2019 that Merced Lao Family and the Youth Leadership Institute (YLI) received together $30,000, but when she looks at the budget, she does not see the $8,000 for Lao Family. First question, are they receiving this money for 2019-2020, and if they are, is it somewhere in the budget that she is not seeing. Sharon Jones said, yes they are receiving it.


Youth Leadership Institute received $22,000 and Merced Lao Family received $8,000, which is an expansion of their Cultural Broker program. Nancy Reding stated she does have some concerns about grouping it with their cultural broker money because she thinks it needs to be specified as to what is being done for the LGBTQ community. Nancy Reding also wanted to comment on the $4,000,000 budget, which almost $500,000 is going to administration. That leaves us with $3,500,000 to be used. It’s less than 75% being spent on the LGBTQ community in Merced. Nancy added that they have done focus groups and they want to see money for direct services and prevention for the LGBTQ community. Nancy Reding also has concern that the Merced LGBTQ Alliance was not consulted by any one of the programs. She recommends that for 2020-2021 that there is a LGBTQ Alliance board member on the selection and decision committee. Sharon Jones thanked Nancy for her feedback.

Eli Sachse wanted to add on to Nancy’s concerns. He understands that YLI and Merced Lao Family got this money set aside for LGBTQ outreach and prevention, but when he looks at the Annual Update, he sees that Merced Lao Family noted zero LGBTQ contacts. Sharon Jones explained that the work has just begun. The way that the Merced Lao community works is that it starts with engaging the leaders and providing training for the leaders. That was started successfully and then it will move on to further outreach in their communities and program system. They have already started training 40 or 50 community leaders. With local county government agencies, there is a process to get contracts to the Board of Supervisors. The work can’t begin until the Board of Supervisors signs off on it. The current data in the Annual Update is from 2018-2019. In the next Annual Update, which is the Three Year Plan, there should be widespread data to show what work has been done. Eli Sachse stated, so groups don’t have to prove that they have LGBTQ contacts in order to receive this money. Sharon Jones said the way it works is that when a MHSA contactor receives funding for a particular scope of work, the scope of work begins, and then there is a whole year of work and then we receive quarterly reports that are ongoing for that year. At the end of the year, all of that four quarters worth of data is reported out in the Annual Update. At that time you can see how many individuals were served. The work has just begun and we are going to see what the results are.

Eli Sachse asked if Sharon Jones has received one of the reports yet. Sharon Jones responded No, because it just began this year. Quarterly reports are due now. We are going to receive at least four quarterly reports and then it will go into the next Annual Update. Eli Sachse asked what kind of training has been provided to the elders and leaders. Paul Thao from Merced Lao Family said their program is designed to provide information to the community leaders. The Hmong parents aren’t that aware of the LGBTQ group, so they want to give them knowledge and to let them know in this community you have to respect and work together. They have helped setup workshops for the leaders. Dr. Sang is a psychologist that knows about the LGBTQ group. He provides information on how we talk to the people and how we approach them. This is where we started and this is the first round. We don’t have the experience to provide directly, but the information is provided to the community and family members, to respect the group. Eli Sachse asked if Dr. Sang is an expert in LGBTQ outreach. Sharon Jones asked Eli if they could talk offline and get his questions answered.

Fernando Granados reminded the group that today’s discussion was about the MHSA Program Update and we need to stay on task and discuss what is on the agenda.

Anna Santos wanted to add, in regards to the data collection for prevention and early intervention, for homelessness, has Sharon Jones been reaching out to the committee from the


CoC, and people that have already gathered data, in regards to Merced and are we partnering with any of those committees. Sharon Jones said that this is in conjunction with the county wide effort with the CEO’s office, Behavioral Health and Recovery Services, and other agencies. Monica Adrian asked if this was an expectation from the state, that these MHSA funds be used for this project. She wanted to know if this is something that every county is doing. Sharon Jones said she can’t speak for what other counties are doing, but every Mental Health Plan gets MHSA funding. This is a strategy that Merced County is trying to move forward.

Monica Adrian said she is curious as to where the $4,000,000 is coming from and if it’s available now, where has it been. Sharon Jones replied that most recently the state changed how they are doing their calculations for spending. For many years they have allowed MHSA to keep money in the coffers and hold onto it, now the state is not allowing that anymore, so they have activated their reversion. These are one time funds that are going to revert if an action is not m

7. Administrative Updates and Changes Sharon Jones said the big thing right now is getting our Fiscal Year 2019 Annual Update approved on March 31 with the Board of Supervisors meeting. Sharon Jones announced that our Innovative Strategist Network (ISN) is looking at opening up to the community more. The Program Update has been posted on the website for the 30 day public review. There is a comment form there, if you have further comments, please fill it out and send it to us.

8. Possibilities and Success Stories Leticia Guillen from Livingston Community Health said that still being able to access the community through telehealth is a big success.

9. Next Steps Sharon Jones said we will be arranging for a Public Hearing and sending out the information once the date is confirmed. Fernando Granados asked that we setup a meeting for how COVID-19 is affecting our programs. He also asked if we could get an update from the department as to what the plan is and how this might affect funding for our MHSA programs.

10. Adjourned Meeting adjourned at 9:55 a.m.


Appendix 6: 30-Day Public Comment Form

Merced County Behavioral Health and Recovery Services (MCBHRS) Mental Health Services Act (MHSA)

PUBLIC COMMENT FORM PROGRAM UPDATE TO THE FISCAL YEAR 2019-2020 MHSA ANNUAL UPDATE

30 Day Review Period: March 20, 2020 through April 20, 2020 Personal Information

Name: Phone Number:

Agency/Organization: Mailing Address:

Email Address: My Role in the Mental Health Community (check all that apply)

Client/Consumer Community Agency

Family Member Health Care Provider

MHSA Provider Law Enforcement/Criminal Justice

Mental Health/Behavioral Health Service Provider Other (specify):

County Employee Department:

What do you see as the strengths of the Program Update to the FY 2019-2020 MHSA Annual Update? If you have concerns about the Program Update to the FY 2019-2020 MHSA Annual Update, please explain. Please return completed forms to: Mailing Address:

Merced County Behavioral Health and Recovery Services Attn: Mental Health Services Act P.O. Box 2087, Merced, CA 95344

Physical Address:

Merced County Behavioral Health and Recovery Services Attn: Mental Health Services Act 301 East 13th Street, Merced, CA 95341

Email Submittal:

Sharon Jones, MHSA Coordinator at [email protected]

To request a copy of the Program Update to the FY 2019-2020 MHSA Annual Update, please contact: MHSA Coordinator at (209) 381-6800 Ext. 3611 or [email protected]

mailto:[email protected]


Appendix 7: 30-Day Public Review Substantive Comments, Other

Substantive Comments, MCBHRS Responses and Updates to the Program Update

Substantive Comments submitted via the Public Comment Form during the 30-day Public Comment and Review Period are included below. 1. Public Comment Form received on 03/26/2020 from:

• Nancy Reding, Family Member Merced LGBTQ+ Alliance, United Methodist Church, United Methodist Women, Elder/Senior population

WHAT DO YOU SEE AS THE STRENGTHS OF THE PLAN?

IF YOU HAVE CONCERNS ABOUT THE PLAN, PLEASE EXPLAIN:

I do not see adequate services to the LGBTQ+ population. The Merced LGBTQ+ Alliance is the most qualified to deliver services and/or consult with and monitor services provided by non-specific organizations or agencies.

MCBHRS Response:

MCBHRS is committed to empowering our diverse community with hope, recovery and wellness by providing comprehensive holistic care. Our core values are Humility, Integrity, Compassion, Innovation, Customer Service and Inclusion. The entire BHRS system provides behavioral health services to our LGBTQ population we have a continuum of programs from prevention to early intervention to treatment. Our Behavioral Health providers are required to have continuing education and staff development to facilitate individual plans of care. BHRS has a Cultural Competence Committee that meets each month to discuss service delivery, health equity and cultural humility. Most recently, BHRS funded several actions to provide increased support to our LGBTQ Community by contracting with Youth Leadership Institute and Merced Lao Family. Starting in fiscal year 2019-2020, Merced Lao Family received $8,000 additional funding annually to provide LGBTQQIA2-S Supportive Services to the SEA population. This expansion provides the opportunity to education community leaders and opens the discussion around the LGBTQQIA2-S community, as well as providing services to those who identify themselves as SEA and LGBTQQIA2-S. Youth Leadership Institute (YLI) received $22,000 dollars for LGBTQ+ supportive services. The Merced LGBTQ+ Alliance did not submit a proposal to provide LGBTQ+ Supportive Services when funding was available. All MHSA funded programs are for the community.

2. Public Comment Form received on 04/17/2020 from:

• Eli Sachse, Health Care Provider

WHAT DO YOU SEE AS THE STRENGTHS OF THE PLAN?



It is not clear how LGBTQ+ outreach ($30,000 - $22,000?) is to be achieved. I would love to meet personally sometime to discuss.

MCBHRS Response:

MCBHRS has developed a process for performance measurement which includes a demographic table with cost estimates, description of the program, key objectives, number of individuals served, demographics of individuals served, SMART goals and Pre/Post Outcomes, success stories and any needed changes. The overall strategy identified for both Merced Lao Family and YLI is to improve cultural awareness and support for LGBTQ+ communities through outreach, education and supportive services. The MSHA Coordinator is in the process of scheduling a meeting to hear your concerns. 3. Public Comment Form received on 04/20/2020 from:

• Rheena Pineda, PhD, Behavioral Health Director, Livingston Community Health Mental Health/Behavioral Health Service Provider, Community Agency

WHAT DO YOU SEE AS THE STRENGTHS OF THE PLAN? As Merced county struggles with homelessness, this one-time opportunity to leverage PEI funds with other funding sources to implement the Homeless Navigation Center appears to be an important step to help address this problem.


Given the business impact of COVID-19, LCH has made difficult work-force reductions. Within the MCBHRS policy, BH providers under MHSA grant funding have not been eligible to bill (despite billing-eligible). This has specifically made their positions more vulnerable to COVID-19 related work-force reductions. I began discussion with BHRS regarding this matter on 2018, the previous director has also worked to address this issue prior to 2018. To date, no decision or policy change has been made by BHRS administrator. I would like to use this public comment period as a means to address the county's policy on billing-eligible BH providers to Medi-Cal and MHSA. Can there be a better plan moving forward? For example, continuing to offer no-cost services to those without insurance, waiving copays for those who are under-insured and billing those with insurance. I hope this matter can be addressed soon as LCH continues to assess if further work-force reduction is necessary.

MCBHRS Response:

The State Department of Mental Health approved Merced County's Mental Health Services Act (MHSA) Prevention and Early lntervention (PEl) Plan on November 20, 2008. The goal of the PEl component of the MHSA is to help counties implement services that promote wellness, foster health, and prevent the suffering that can result from untreated mental illness. The PEI component requires collaboration with consumers and family members in the development of PEI projects and programs; and included with the collaboration is a component on cultural competency. The community stakeholders and Merced County Board of Supervisor’s approved


infrastructure designed for the PEI Programs, which was not established as a Medi-Cal billable system. Each PEI Program was provided funding to provide services and those services are paid by the MHSA funds allocated for that program. Each PEI Program has an approved funding amount. Each year there is a stakeholder community process that leads to an Annual Update or Three Year Plan where feedback is received and program changes can occur.

Substantive Comments submitted via the Public Comment Form and via email after the close of the 30-day Public Comment and Review Period are included below.

4. Public Comment Form received on 04/24/2020 from:

• Vince Ramos, Client/Consumer Mental Health Board Member of Merced County Behavioral Health and Recovery Services

WHAT DO YOU SEE AS THE STRENGTHS OF THE PLAN? The strengths I have notice is that this program is a duplicate of the programs that MCBHRS department have previously implemented with the same objectives. The City of Merced, along with other programs the community individuals has implemented to address the homeless dilemma. The community partners are in the county area giving aid and guidance to the homeless.


The waning concern is the method Merced County has to inform those concerns about the 2019-2020 MHSA Annual Update. The required Public Hearing will be conducted via Conference Call, but how will the public be aware of how to utilize this procedure? I question how effective and accurate this method will be? First how the public or board member will knows when to speak or ask questions without interrupting the speaker, disrupting the meeting or who is speaking?

During one board meeting the Director Manuel Jimenez asked for funds to procure a webinar, televised system that so that the psychiatrist could view and treat more of their clients, which was granted by the board. This system can be integrated with the home computer and be televised. So where is that webinar system or where the funds go? This system has an icon of a hand that tells the narrator when a question needs an answer and not be disruptive.

So I Believe this meeting should be postponed until we can find a better system than the teleconference that uses the phone.

Every time the Merced Mental Department has a One-Time Funding they get the funding, yet they receive funds from the previous MSHA update similar to the new program the MHSA coordinator creates and presents for the one time funding

Examples are Innovative Strategist Network (ISN), Workforce, Education and Training, Stigma and Discrimination Reduction Program and Suicide Prevention Program, PEI-Strengthening Families, Housing, $21,487.14 funded, Wellness and Recovery Team New Program for 2019-2020 ,$500,000 in funding objectives: • Reduce homelessness • Reduce


disparities in service access • Reduce subjective suffering from mental illness • Reduce hospitalizations • Reduce incarcerations • Reduce substance use/increase access to services.

There is more Mental Health department program that has the same objects such as the Expansion of Capacity Building-Prevention and Early Intervention Services One-Time Funds for Homeless Navigation Support that is asking for 4million more dollars. This program objective is to reduce the following • Reduce homelessness • Reduce disparities in service access • Reduce subjective suffering from mental illness • Reduce hospitalizations • Reduce incarcerations • Reduce substance use/increase access to services, are the same as other departmental program,

Merced County Behavioral Health and Recovery Services get an increased funding for their programs, whereas the community partners (stake holders) have not or have gotten a reduction in funding. This would be a good time to increase community partners funding from the 4 million dollars. They are in the county community trying to make a difference against mental health disparity. If Merced County Behavioral Health and Recovery Services get those funds, they will pass by referring those objectives to the community partners.

The Innovative Strategist Network (ISN) could add this service for the Homeless Navigation Support to their program since they have the same objectives. The INS should have funds left, since they were granted funds in 18 -19 MHSA update and received more funding after wards which ISN got implemented 2020.

There is the City of Merced and other organizations in the county that are doing the same services with the homeless. If you browse the internet there are organization that are addressing this dilemma such as; The city of Merced is planning to create an affordable housing facility along Childs and B Street that would include 30 units for supportive homeless housing.

To find out more about Homeless Assistance contact your Family Services Representative or visit your nearest Human Services Agency office at:

2115 West Wardrobe Ave. Merced CA 95340 Ph.: (209) 385-3000

The Merced County Community Action Agency that runs the existing D Street Shelter plans to build a navigation center in Merced, and significant new investment into a regional homeless strategy came in the form of welcome news when they were unveiled recently for a community seriously concerned about homelessness.

HOMELESS SHELTERS AND SUPPORTIVE HOUSING by Shelter Listings org. is dedicated to serving the homeless and low-income. We have listed out the shelters and low cost housing services we have in Merced, CA below. This list has homeless shelters, halfway houses, affordable housing, etc. The database consists of over 3,000 listings and includes emergency shelters, homeless shelters, day shelters, transitional housing, shared housing, residential drug alcohol rehabilitation programs and permanent affordable housing.


GracesList.org is an emergency services directory offering a list of local homeless shelters, churches, food banks and other emergency services.

These the community organizations that are implemented now along with others resources.

Will all these concerns by the public and board members be answered under the SPECIAL WIC UPDATE: Changes to CA Welfare & Institution Code 5604 and 5848 MHSA Duties from Code Section 5848?

MCBHRS Response:

MCBHRS Community Planning Process includes: Community Collaboration a process by which clients and/or families receiving services, other community members, agencies, organizations, and businesses work together to share information and resources in order to fulfill a shared vision and goals (Title 9, California Code of Regulations, §§3320 and 3200.060). Included in the process is a broad-based of stakeholders defined by Welfare and Institution Code Section 5848a as adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness. Also, included providers of services, law enforcement agencies, education, social services agencies, veterans, representatives from veterans organizations, providers of alcohol and drug services, health care organizations, and other important interests (WIC, § 5848a).

A special focus is given to underserved populations and participation from representatives of unserved and/or underserved populations and family members of unserved/underserved populations (CCR, 9 CA § 3300).

A special focus is given to the diversity of stakeholders that “reflect the diversity of the demographics of the County, including but not limited to, geographic location, age, gender, and race/ethnicity, and have the opportunity to participate in the Community Program Planning Process” (CCR, 9 CA § 3300).

The local review process:

• The draft Program Update was made available for review to stakeholders via an email sent on March 20, 2020.

• The Community Program Planning Process (CPPP) including local stakeholder feedback, stakeholder survey, focus groups and key informant interviews began on March 20, 2020.

• Pursuant to Welfare and Institutions Code (WIC) § 5848 the Program Update was posted for a 30-Day Public Comment and Review Period starting on March 20, 2020.

• The Program Update was presented to the MHSA Ongoing Planning Council at a Special Conference Call Meeting on March 26, 2020.

• The Behavioral Health Advisory Board conducted the required Public Hearing, via Conference Call on April 24, 2020.

• The department plans to send the Program Update to the Merced County Board of Supervisors for possible adoption on May 19, 2020.

• Submit the adopted Program Update to Department of Health Care Services and Mental Health Oversight and Accountability Commission by May 22, 2020


Prevention and Early Intervention

Prevention and Early Intervention Capacity Building is the emphasis to increase capacity among PEI providers (outside the mental health system) to implement successful programs and interventions. Some methods may include expanding training capacity in specific systems, learning communities, materials development and dissemination, and other improvement approaches.

The purpose of Prevention and Early Intervention (PEI) is to focus on interventions and programs for individuals across the life span prior to the onset of a serious emotional/behavioral disorder or mental illness. Prevention in mental health involves reducing risk factors or stressors, building protective factors and skills, and increasing support. Prevention promotes positive cognitive, social and emotional development and encourages a state of well-being.

The proposed expansion of Capacity Building-Prevention and Early Intervention (PEI) Services is a collaboration with the Human Services Agency. This is a one-time opportunity to leverage PEI funds with other funding sources to implement the Homeless Navigation Center. The goal of this collaboration is to build capacity and infuse more Prevention and Early Intervention services into the community, with a focus on those who are homeless or at-risk of homelessness. Community capacity is defined as “the combined influence of a community’s commitment, resources, and skills that can be deployed to build on community strengths, identify common aspirations, and address community problems. (Adapted from the work of Steven E. Mayer).

The Innovative Strategist Network

The ISN applies a promising community-driven practice or approach that has been to increase access to services and promote interagency collaboration.

The ISN focuses on timely care and uncomplicated entry into services. This ISN introduces a model that utilizes principles from the “ABC Innovative Framework Model” (Appreciative Inquiry, Building Capacity and Care Coordination) to open pathways to care and healing strategies. 5. Email to Sharon Jones received on 04/24/2020 from:

• Micki Archuleta

I would like somewhere included in the survey responses my own observation that there is a lack of secular programming at the Wellness Center, especially in terms of sobriety. How can I get that documented?

MCBHRS Response:

Thank you. MCBHRS is committed to empowering our diverse community with hope, recovery and wellness by providing comprehensive holistic care. One way this is accomplished is having a Recovery Vision for mental health consumers: To promote concepts key to the recovery for individuals who have mental illness -- hope, personal empowerment, respect, social connections, self-responsibility, and self-determination. To promote consumer-operated services as a way to support recovery.


To reflect the cultural, ethnic, and racial diversity of mental health consumers. To plan for each consumer’s individual needs.” (CA WIC Section 7, 5813.5 (d))

Updates to the Program Update since the start of the 30-day posting on 03/20/2020:

1. Minor spelling and grammatical corrections were made throughout the document. 2. Page 3: Revised the date of the Public Hearing from 5/5/2020 to 4/24/2020. 3. Pages 6: Revised and detailed how stakeholder feedback was obtained through a

Stakeholder Survey due to COVID-19. 4. Page 7: Updated the timeline with correct dates, changed the Public Hearing Date to

4/24/2020 and revised the Public Hearing from an in-person meeting to a conference call meeting with access phone numbers and code.

5. Page 9: corrected the percentage calculations regarding unsheltered individuals. 6. Updated Appendix 2 to show the questions from the Stakeholder Survey that was used

to obtain feedback and comments on the Program Update in lieu of in-person focus groups.

7. Updated Appendix 3 to detail the reported demographics of survey respondents. 8. Updated Appendix 4 to detail the responses to the Stakeholder Survey questions and

MCBHRS’ responses 9. Updated Appendix 5 with the minutes from the Special Meeting via Conference Call of

the MHSA Ongoing Planning Council on 3/26/2020. 10. Updated Appendix 7 with the Public Comments received both during and after the 30-

day Public Comment and Review period, including MCBHRS’ responses and any updates made to the Program Update since the start of the 30-day posting on 03/20/2020.

11. Updated Appendix 8 with the Public Hearing Agenda via Conference Call for April 24, 2020.

12. Updated Appendix 9 with the Draft Minutes form the Public Hearing Agenda via Conference Call for April 24, 2020.


Appendix 8: Public Hearing Agenda for April 24, 2020

Merced County Behavioral Health Board Public Hearing via Conference Call - DATE: April 24, 2020 TIME: 4:30 – 5:30pm

LOCATION: Merced County Behavioral Health Dept. 301 E. 13th Street – Conference Call

Merced, CA 95341 Mission Statement: The mission of the Merced County Behavioral Health Board is to ensure that the Agency provides integrated, culturally responsive mental health, substance use disorder and community-based services that promote wellness and recovery.

AGENDA

1. Call to Order / Roll Call (3 minutes) All

2. Mission Statement (1 minute) Board Member

3. Opportunity for public input. At this time any person may comment on any item which is not on the agenda. Please state your name and address for the record. Action will not be taken on an item that is not on the agenda. If it requires action, it will be referred to staff and/or it will be placed on a future agenda. To comment on an item which is on the agenda, please wait until the item is read for consideration. In order that all interested parties have an opportunity to speak, please limit comments to a maximum of three (3) minutes. PLEASE NOTE: Board Members can only listen to the public; they cannot engage the public in conversation. (10 minutes total)

Public Only

4. OPEN PUBLIC HEARING: Program Update to the FY 19/20 Mental Health Services Act (MHSA) Annual Update a. Close Public Hearing

(1) Approve Program Update to the FY 19/20 Mental Health Services Act Annual Update

Sharon Jones

(Board Action)

5. Announcements All

6. Adjournment


Conference Call-in Information:

Phone Dial-in

+1.888.748.9073 (United States (Primary))

+1.844.540.8065 (United States (Primary))

+1.408.419.1715 (United States (San Jose))

+1.408.915.6290 (United States (San Jose))

(Global Numbers)

Meeting ID: 209 381 6805 6805

Enter meeting ID number followed by the # sign.

Enter call as “Participant”.


Appendix 9:

Draft Minutes from the 04/20/2020 Public Hearing via Conference Call including Substantive Comments

Present: Sally Ragonut, Chair; Paula Mason, Vice-Chair; Bruce Metcalf, Secretary; Supervisor Lee Lor; Iris Mojica de Tatum; Keng Cha; Supervisor Lloyd Pareira; Mary Ellis; Vicki Humble; Emil Erreca; Micki Archuleta; Zachery Ramos

Absent: Brian Pena; Virginia Vega; Vince Ramos

Others Present: Genevieve Valentine; Sharon Jones; Jacqui Coulter; Nancy Reding; Adam Lane; Eli Sachse; Ye Thao; Araceli Sanchez; Steve Roussos; Sharon Mendonca; Zachery Coston; Jeffery; Carol Hulsizer, Recorder

Call to Order / Roll Call

Chair Sally Ragonut called the meeting to order at 4:32 p.m. Roll call was taken. Sally asked that before anyone makes a comment, to please state their name and then give their comment.

Mission Statement

The Mission Statement was read by Sally Ragonut.

Opportunity for public input. At this time any person may comment on any item which is not on the agenda.

Discussion/Conclusion: Adam Lane from the LGBTQ+ Alliance questioned why the $30K of the $8M (3% of $8M) is such a disproportionate amount. They are doing mental health there and the LGBTQ+ have a lot of extra mental health issues particularly depression and anxiety.

Eli Sachse commented that up to 40% of homeless youth are LGBTQ. This is a huge disparity. The mental illness and physical health that LGBTQ face and the reason these health measures like this are so crucial and should have a SMART goal. He hasn’t seen these come forth from the people with the funds, the cultural brokers. He continually asks for the SMART goals and to see how they can hold these programs accountable to address these health disparities. He thanked everyone for holding this meeting later at night; he appreciates that.

Recommendation/Action: Information only

4:36 p.m. – OPEN PUBLIC HEARING: Program Update to the FY 19/20 Mental Health Services Act (MHSA) Annual Update

a. Close Public Hearing

(1) Approve Program Update to the FY 19/20 Mental Health Services Act (MHSA) Annual Update


Discussion/Conclusion: Sharon Jones gave a brief presentation. This is a program update to the most recent Annual Update for FY 19/20. This update involves the homeless community, Prevention and Early Intervention (PEI) funds and also capacity building for our community.

Demographics – In January 2019 it was noted that 607 people were identified as meeting the HUD definition for homelessness in the County of Merced. About 285 were unsheltered in the City of Merced; 46.3% were identified as chronically homeless. 322 individuals were considered sheltered in either transitional housing or emergency shelter. The goal of having a Navigation Center campus means moving towards getting individuals into permanent housing. The Navigation Center will play a distinct role in homeless services and the homeless system that will be set up in Merced County. It will aid individuals in shelter, provide opportunities for food and other benefits and supports.

Supportive Services – Currently there is New Direction which has already started some of the work. The Navigation Center will replicate what New Direction started and expand. The priority population is individuals living with a mental illness or at risk of a mental illness that may be homeless or at risk of becoming homeless. The Mental Health Services Act (MHSA) is about disabling symptoms of mental illness; but there are many intersections (such as being homeless). It is about having healthy meals, helping with hygiene, and intensive case management. Some individuals need guidance or help facilitating a process to help them heal or get linked to services. The Navigation Center will have 24/7 staffing; there will be a safe and welcoming environment. It will help eliminate barriers to housing. It will be considered a low-barrier shelter with supportive outreach and engagement services. The definition of low-barrier Navigation Center is housing first and enriched with services where people can move on to receiving permanent housing. There will be linkages to employment, public benefits, and health services with the primary goal of having a permanent place to live. The Navigation Center will be a 75 to 100 bed low-barrier shelter. There will be co-located service providers, referral assistance and an outreach and engagement team that will work in conjunction with law enforcement and other providers in the community.

The action being discussed today is the use of Prevention and Early Intervention (PEI) funds. PEI focuses on interventions across the life span (meaning from zero up to 65+). PEI is about not having symptoms getting so severe where an intervention is needed. Prevention reduces risk factors, builds protective factors for individuals and promotes social, emotional and cognitive development that lead to a state of well-being. This action builds capacity in the community – linking those programs together to have a focus of community health. Prevention focuses on outreach and engagement, providing information about services and programs, providing resources, brochures and flyers, and linkage to appropriate agencies and services. Early intervention is about symptom reduction; avoiding the need for more intensive treatment.

Program Expansion – this is a one-time opportunity to leverage dollars for the homeless navigation center and building collaboration here in Merced County to help our homeless community. With this program expansion they are hoping to reduce homelessness, increase access to shelter and housing, improve coordination system with the different programs in the community, help those facing homelessness and may need supportive services. By leveraging dollars for the Navigation Center through the use of PEI funds, they will be able to broaden the provision of community-based services by taking prevention and early intervention services to individuals where they are located, in their natural settings. Again, this is one-time funding of $4M. This includes a blending of other funding sources. The person implementing this program


along with the collaboration of BHRS is the Human Services Agency (HSA). Sharon then asked for questions and comments.

-Iris questioned the oversite falling on HSA. Sharon reiterated the oversite will fall on HSA. They will have to provide what all other MHSA program provides which is a description of the work happening, their key objectives, how many people they will serve within the timeframe, the cost to serve each person, how they will measure it and any success stories. All MHSA programs have the same infrastructure – fiscal year, number of individuals served, amount that it will cost per participant, the amount of funding for the overall project, a description of the program, key objectives, SMART goals, performance measures, satisfaction surveys, and pre- and post-tests/evaluations as well as quarterly reporting.

-Public – where can this information be found? Sharon replied it is in the Annual Update.

-Public – has HSA permitted a breakdown as to what they will do, what their focus is, what percentage is going to deliverables? Sharon stated that the next phase would be to sit down with the PEI analysts working out the SMART goals, key objectives, and the number that can realistically be served. After it is approved, that is when the work begins. The deliverables are required.

-Public – could Sharon expand on the definition of low-barriers and what type of barriers has happened in the past? Sharon stated they are trying to build a system flow where individuals will be supported in a timely manner. Access will be easier. They will understand what is available to them and how to access it. They will have a plan established in a timely manner to determine what is needed for them individually. The goal is to have a faster access without barriers so that housing can come faster.

-Public – this sounds great and he suggests using LGBTQ+ as a resource and by consult, having a rainbow flag in there somewhere, having awareness of LGBTQ+ for the staff, using available resources in the community and knowing of the large amount of LGBTQ+ homeless in this town. Sharon stated this will definitely be passed on to HSA and thanked him for his offer.

-Sally – in the past having a pet was a barrier, could Sharon discuss if the homeless will be allowed to have a dog. Sharon stated there have been a lot of conversations regarding this; she will find out definitely and let everyone know. They are looking at building protective factors and a pet is definitely a protective factor for the homeless. Bruce commented that there will probably be some kennels outside and also be some small kennels inside. A number of ideas are being looked at.

-Public – low barrier ideas – she knows that Fresno County is doing a great job.

-Sally – she commented that in looking through the program there was a notice that said there would be other sites around Merced County somewhere down the line – like Delhi or Atwater – has there been any discussion around this? Bruce commented that the County has already contracted with The Mission to have ten bridging houses. They presently have four or five in the city of Merced. They are looking for two houses in Atwater, one in Livingston, one in Dos Palos and two in Los Banos. They already have one in Los Banos. A bridging house is a low-barrier house much like the Navigation Center except it is located in houses all over the county. The people in those bridging houses will have full access to the facilities at the Navigation Center.


-Public – with HSA taking over the $4M, will it be added to other funding? Sharon stated that the $4M will be leveraged with other funding. The cost of operating a 24/7 Navigation Center can be very costly. It can also be very impactful for the community.

-Sally – she read the plan and they planned to start build this October, but will this be hindered by COVID-19? Sharon stated that conversations are taking place with whatever can be done now. Of course, we are “sheltering in place” and there is no better time to get people out of the elements. Bruce commented that construction has already begun in southern California where the same developer is developing the same type of facility. Another location in California is already working on pre-fabbing; at some point in time they will be bringing all those pieces and putting them together on site. They have already begun the construction off-site.

-Public – how much of the $4M will be used for construction? Sharon replied that PEI dollars cannot be used for construction. They have to be used for preventive support services. The question was asked how long supportive services would last. Sharon stated that the goal is to have an individualized client care/housing plan for everyone so it will vary for everyone. The ultimate goal is to get everyone into permanent housing. The question was asked how long $4M can sustain such a program. Sharon stated that the program cost is over $4M. HSA has other funding to go along with this and that is how the sustainability will be created. They will also have a budget and will be monitoring the program. The hope is to continue building so this can be a center for our community.

-Emil – he questioned if there will be public meetings for other organizations, such as LGBTQ or 12-step programs, to come in and educate the population? Bruce stated there will be a classroom in the building. Sharon stated that the arranging of these trainings will fall under HSA; BHRS will definitely be a collaborative partner and they are hoping for many other collaborative partners as well.

-Iris – she questioned if the Navigation Center is still opening on schedule? Bruce stated he believes it is. Sally read it is to be open by October 2020. Bruce stated that the County is expecting to sign a contract for organizations to operate it by sometime in June. Iris asked if they are looking at a turnkey in Merced County – placing people in hotel rooms. Sharon stated there is a process right now. Jennifer Jones is assisting with securing hotel rooms for individuals. Iris then reported that she was listening to Governor Newsom’s daily briefing and he mentioned Merced County in terms that he was pleased with what is happening here in regards to homelessness. Bruce mentioned that Adam Gray is a strong proponent for our area and he has probably let the Governor know what is going on. Adam Gray has worked a lot with Merced County, the City and CoC Board. Bruce is very happy to see the collaboration taking place across private organizations, the city, the county, the state.

-Adam – he corrected the percentage he gave earlier in the meeting in regards to 3% of $8M – it is not 3%, it is .375% which is an incredibly disproportionate number. He just wanted to rectify this.

At 5:30 Sally closed the Public Hearing.

Recommendation/Action: M/S/C (Ellis / Archuleta) to approve a referral to the Board of Supervisors for the $4M for the Homeless Navigation support. Director Valentine commented that a roll-call vote must be taken. Carol will read each member’s name and they have to state “approve” or “nay”.


Supervisor Lor – Approve Virginia Vega – not present Iris Mojica de Tatum – Approve Brian Pena – not present Mary Ellis – Approve Vince Ramos – not present Keng Cha – Approve Sally Ragonut – Approve Bruce Metcalf – Approve Vicki Humble – Approve Emil Erreca – Approve Micki Archuleta – Approve Paula Mason – Approve

Sharon stated that the next step is the document being sent to the Board of Supervisor’s for their approval.

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