MHSA Innovation Plan

8/9/2019 MHSA Innovation Plan

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Tuolumne County

Behavioral Health Department

Tuolumne County

Behavioral Healthwww.tcbehavioralhealth.com

Mailing Address:

2 South Green St.

Sonora, CA 95370

24 hour crisis line:

(209) 533-7000

Beatrice W. Readel, LCSW

Director

[email protected]

Sue McGuire, ASW, MSWQuality/Managed Care

Manager

[email protected].

Tracie Riggs

Fiscal Manager

[email protected]

Business locations and

contact information:

Behavioral Health Admin.105 Hospital Rd.

Sonora, CA 95370

Phone: (209) 533-6245Fax: (209) 588-9563

CAIP (Crisis Assessment &

Intervention Program)

105 Hospital Rd.

Sonora, CA 95370

Phone: (209) 533-7000(800) 630-1130

Fax: (209) 533-7007

Mono Clinic197 Mono WaySonora, CA 95370

Phone: (209) 533-5400

Fax: (209) 533-5411

Cabezut Clinic12801 Cabezut Rd.

Sonora, CA 95370

Phone: (209)-533-3553Fax: (209) 533-8259

Lambert Community Center

347 West Jackson St.

Sonora, CA 95370

Phone: (209) 533-6695(209) 533-4879

Fax: (209) 588-2781

March 29, 2010

NOTICE OF INITIATION OF 30-DAY PUBLIC REVIEW PERIOD

RE: MHSA INNOVATION COMPONENT PLAN

Dear Community Members and Stakeholders,

Tuolumne County Behavioral Health Department is holding a 30-day public review andcomment period for the Mental Health Services Act (MHSA) Innovation Component Plan.

This review period begins March 29, 2010 and ends April 30, 2010. A public hearing is

tentatively planned at our Behavioral Health Advisory Council Meeting of May 5, 2010.The meeting will take place at Tuolumne County Behavioral Health Departments

Conference Room at 105 Hospital Road, Sonora, California.

The Innovation Plan outlines a learning project that will contribute to the transformation

process of our mental health system of care. A Public Comment Form is available at the

end of this document. Please review our Plan and send comments, and/or questions to the

staff member noted below:

MHSA Innovation Plan: Public Comments submitted to:

Susan Sells, MHSA Coordinator

[email protected] Telephone: (209) 533-6245

Standard Mail: Tuolumne County Behavioral Health DepartmentAttn: MHSA Innovation

2 South Green Street

Sonora, California 95370

Sincerely,

Beatrice Readel

Beatrice Readel, LCSWExecutive Director


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EXHIBIT B

INNOVATION WORK PLANDescription of Community Program Planning and Local Review Processes

County Name: Tuolumne County

Work Plan Name: Building a Life at HomeInnovation Plan

Instructions: Utilizing the following format please provide a brief description of theCommunity Program Planning and Local Review Processes that were conducted aspart of this Annual Update.

1. Briefly describe the Community Program Planning Process for development of theInnovation Work Plan. It shall include the methods for obtaining stakeholder input.(suggested length one-half page)

The Community Program Planning Process consisted of a range of focus groups andkey informant interviews that generated valuable input specific to Tuolumne CountysMental Health Services Innovation Plan. Presentations to NAMI Chapter members,Tuolumne County Behavioral Health Advisory Board, and the Tuolumne County MentalHealth Leadership Council were held in February, and a focus group made up ofconsumers participating at the Peer Help Lambert Center occurred in March. Othercritical key stakeholders interviewed over this two month period includedrepresentatives from the Tuolumne County Adult Protective Services, Public Guardian,Probation, Children's Welfare Services, Omsbudsman, County Council, and SheriffDepartments. The Sonora Police Chief provided input for this plan, as well asrepresentatives that provide advocacy and outreach services to the Spanish-speaking

and Native American residents in our community. Because the Innovation component ofthe MHSA is different from other components of the Tuolumne County MHSA (CSS, PEIand WET) in that its primary focus is learning rather than service delivery, the MHSACoordinator made sure that the attendees of both focus groups and key informantinterviews were made aware of this novel approach to plan development.

Priorities and discussions generated between 2004 and 2008 and documented from theCSS, PEI and WET planning processes were revisited and shared when interviewingindividuals and groups in February, and March of this year. Input shared includedsummaries from both the PEI and WET planning processes in 2007 and 2008 - whichhad been obtained through a large community forum with 70 residents in attendance;

five community stakeholder meetings averaging a total of 50 participants each; 45 focusgroups and key informant interviews; and 375 surveys completed. Input from the CSScommunity planning process completed in 2004 and 2005 was also summarized andshared. The CSS planning strategy resulted in excess of 1,100 individuals participatingin the planning process and providing nearly 6,000 comments regarding mental healthneeds, impacts, and issues facing Tuolumne County.


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Enclosure 3

I

2. Identify the stakeholder entities involved in the Community Program PlanningProcess.

The following stakeholder entities were involved in Tuolumne Countys MHSA

Innovation Component Commmunity Planning Process:

Tuolumne County Mental Health Leadership Council,Tuolumne County Behavioral Health Advisory BoardTuolumne County NAMI Chapter Board and MembersNAMI Housing DirectorPeer Help Center staff and volunteersA focus group of consumers participating at the Peer Help Lambert CenterTuolumne County Behavioral Health staff and cliniciansOutreach and Engagement advocates/case managers representing both theSpanish-speaking and Native American residents

Representatives from Tuolumne County Sheriff Department, Public Guardian,Probation, Adult Protective Services, Children's Welfare Services, and CountyCouncilDirector of Ombudsman ProgramPolice Chief, Sonora Police Department

3. List the dates of the 30-day stakeholder review and public hearing. Attachsubstantive comments received during the stakeholder review and public hearingand responses to those comments. Indicate if none received.

The 30 day review was from March 29th to April 30th , 2010. The Public Hearing istentatively planned for May 5, 2010 at 4:00 pm at The Tuolumne County BehavioralHealth Department located at 105 Hospital Road, Sonora, CA in the CommunityConference Room.

Copies of the MHSA Innovation Plan were made available to all stakeholders throughthe following methods: Electronic format: the Tuolumne County Behavioral Health Department website:

www.tuolumnecounty.ca.gov Print format was available at the Tuolumne County Behavioral Health Department, the

Tuolumne County Peer Help Support Center, and the Tuolumne County Library The Tuolumne County MHSA Innovation Plan was e-mailed to Tuolumne County

Behavioral Health Advisory Council, and the MHSA Leadership Council Plans were e-mailed or mailed to all persons who requested a copy An informational flyer was sent to stakeholders regarding the Plans availability,including where to obtain it, where to make comments, and where/when the publichearing would be held


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2010/11 ANNUAL UPDATE EXHIBIT INN NEW PROGRAM DESCRIPTION

County: Tuolumne

Program Number/Name: Building a Life at Home Innovation Plan

Date: March 25, 2010

Select one of the following purposes that corresponds tothe Innovations key learning goal. Please note that whilethe program might embody all four purposes, a learninggoal cluster around a single Essential Purpose.

Increase access to underserved groupsIncrease the quality of services, including better outcomesPromote interagency collaborationIncrease access to services

1. Describe which of the four essential purposes of Innovation is most relevant to your learning goal and why isthis purpose a priority for your county.

Throughout both the MHSA Innovation and CSS community planning process, family members andpeers raised concerns and complaints about the high number of severely mentally ill residents thatare conserved and placed in out- of -county residential facilities. Family member and familiar peernetworks are unable to provide support and assistance to help persons with mental illness to beactive members in the community in which they themselves have chosen or desire to live.

Tuolumne County rates for LPS conservatorships have been consistently higher per capita thentwo thirds to three-fourths of the counties in California. Rates have stayed consistently high overthe years (34 in 2007/2008, 23 in 2008/2009, and 27 in this fiscal year). A major factor in the highconservatorship ratio is due to long term consecutively renewed LPS conservatorships forconsumers who have become dependent on residing in facilities outside our community inneighboring counties. These somewhat permanent relocations and renewed conservatorships are,in part, attributed to stigma and barriers associated with concerns and attitudes about personssuffering from severe mental illness and their ability to live successfully and independently in therural community setting. For Innovation planning, we have interviewed key stakeholdersrepresenting diverse organizations, systems, and representatives. The organizations representedincluded the Public Guardians Office, Adult Protective Services, Child Welfare Services, Law

Enforcement (Police and Sheriff Departments), Probation, Ombudsman, and Tuolumne CountyBehavioral Health Department staff. Additionally, outreach and engagement consultants thatrepresent the needs of both the Spanish-speaking and Native American residents, along with NAMIfamily members and consumers were included. These persons and organizations collectivelycontribute or embody the resources that would be necessary to prevent the need to conserveseverely mentally ill residents in long term residential facilities and provide collective support in thecommunity. It was discovered that there are strong, diverse and negative systemic cultural attitudesand beliefs that may affect our communitys decision makers about what is best for severelymentally ill peers. There are two core attitudes incorporated into this belief system. First is the viewthat severely mentally ill clients must be placed in long term residential placement as they areunable to meet their basic needs or develop independence from caretakers. Secondly, that keeping

persons suffering from severe mental illness in facilities will protect the community, based on vaguefears and stigma attributed to perceived dangerous behaviors arising from mental illness which hasoften been dramatically promoted in the media. One contributing factor for these communityattitudes and beliefs is the previous reliance on an acute locked psychiatric unit (as part of theTuolumne General Hospital) to stabilize severely mentally ill residents. Inpatient care has beensynonymous with appropriate treatment for the mentally ill since 1988. Our Board of Supervisorsclosed this unit on December 31, 2008 due to the prohibitive rising costs of inpatient serviceprovision. In response, Tuolumne County Behavioral Health Department developed a strengthenedoutpatient system including a 23 hour crisis stabilization program, and augmented after hours walk-in service, and crisis and assessment service integration with the new systems. This moreintensive outpatient model functions as the successor system from the involuntary locked inpatient


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treatment for acute psychiatric needs to a voluntary accessible crisis management system. Manyresidents and community agencies were concerned that closing the acute psychiatric unit reflecteda decline or weakening in our departments commitment to our peers and family members, when infact it reflected a move toward more efficient, less restrictive and ultimately more effective practicesto serve people in the community environment. Along with the 23-hour crisis stabilization and walk-in services, the Peer Help Center activities have been strengthened with MHSA funds and have

included the employment and contracting of peers as a powerful model in the recovery process. Inthe last six months, there has been a 31% increase in local peer participation in a range ofactivities, including six peer run support groups at the Center.

Despite these successful changes and enhancements, our communitys culture (attitudes andbeliefs) mitigates against bringing consumers home to live independently with family and peers whoare available for support and assistance. Overall, these core attitudes and beliefs need to beaddressed so that peers who have been institutionalized out of county can return home toparticipate successfully in the commitment to peer recovery, wellness and resilience activities andto benefit from families and friends who can be available to provide the community support networkneeded for healthy living.

For these reasons, we are proposing an Innovation strategy to develop an effective communitycollaborative partnership that will work together to improve and strengthen coordination andcollaboration and reduce stigma between mental health and the varied stakeholders. We areexcited to share that we have received agreement from all the key stakeholders who participated inour initial planning and interview to join in a Task Force, and will also include two case managerconsultants that provide outreach and engagement to both Spanish-speaking families and NativeAmerican residents. This is our essential purpose - to learn if better ways of collaborating with ourcommunity (who hold many diverse beliefs) can over time address cultural attitudes, improveservices for our mentally ill residents, reduce stigma, and create a more active communityengagement that supports mental health peer recovery, wellness and resilience strategies.Our Innovation Plan is titled Building a Life at Home. This Innovation Plan hopes to create newplanning processes across a range of social service agencies, new training and education practicesand approaches, and ultimately new treatment and recovery services or interventions that improvemental health services for our mentally ill residents in Tuolumne County. It is important to note thateffective community collaborations that have formed to address community concerns is not a newconcept to Tuolumne County, but the type of interagency collaboration we propose in this plan isinnovative related to the severely mentally ill population that has been viewed as the predominantlysole responsibility of the Tuolumne County Behavioral Health Department. For many years ourcommunity has collaborated on coalitions directed toward teen drug and alcohol abuse prevention, ansuicide prevention issues but the critical difference is that these community-wide collaborations havealways had common agreement across all the members from the start about how to work together toimpact and lessen a mutually agreed upon community issue and/or problem. Our proposed Task Forcdoes not necessarily agree on the nature of the problems or solutions specific to our severely mentallyill residents. The collaboration we propose will utilize the successful building strategies currently used the non-mental health focused community coalitions (Tuolumne County Suicide Prevention Task ForceYES Coalition supporting youth drug and alcohol prevention strategies). These strategies will beadopted for our current Innovation project. We plan to bring the community representatives and keystakeholders to the table including those who have expressed strong differences many who areadamantly opposed or skeptical of the peer recovery, wellness and resilience models. These keycommunity stakeholders representing strong and diverse beliefs have never met regularly to discussand reach census on how best to provide services and support our communitys severely mentally illclients. Key stakeholders have agreed to participate on this newly formed Task Force to discuss, listen


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to and evaluate the diverse range of community beliefs and perspectives specific to addressing theneeds of mentally ill residents in our community and reconsidering the practice of long term out ofcounty institutional placement and diversion. We hope to learn that, if successful, stigma can bereduced by directly addressing the cultural attitudes and beliefs through unifying key organizationaldecision makers with peers and family members and Behavioral Health staff on the Task Force. Also,we hope to demonstrate the Task Force members can work together over a three year period to

effectively assess, engage and substantiate that the interventions proposed will be effectivealternatives to residential housing out of county. Supportive interventions will be assessed by this TasForce to evaluate whether consumers can transition out of long term residential homes and return toour community to live successfully as members of the community over time. The Task Force will alsoassess the initiation of supportive intervention to reduce the number of first time and repeat placemenof mentally ill consumers currently living in the county who are at risk of higher or more restrictive leveof care. The Task Force will document and track what worked and did not work with this plan, includinassessing and documenting the community services that work well for people with mental healthdisabilities (i.e. are job training and placement activities effective, are public transportation opportunitieaccessible to peers?). What we learn by the end of the project will be shared with both our communityand other rural counties faced with similar issues and barriers throughout California.

2. Describe the INN Program, the issue and key learning goals it addresses, and the expected learning outcomesState specifically how the Innovation meets the definition of Innovation to create positive change; introduces new mental health practice; integrates practices/approaches that are developed within communities through aprocess that is inclusive and representative of unserved and underserved individuals; makes a specific changto an existing mental health practice; or introduces to the mental health system a community defined approacthat has been successful in a non-mental health context.

Innovation Project Description:The Building a Life at HomeProject proposes an innovative collaboration between our existingBehavioral Health Department, consumers and families, representatives of Spanish-speaking andNative American residents, and key and diverse stakeholders representing organizations andsystems (Public Guardian, Adult Protective Services, Law Enforcement, Probation and

Ombudsman programs) who all play a part in the decision to conserve severely mentally illresidents in long term residential in and out-of-county facilities or who would refer communitymembers for more restrictive services. Our Innovation Plan meets the definition of Innovation asthe project introduces our local mental health system to a community defined approach ofcollaboration that has been successful in a non-mental health context. We hope to ultimately createpositive change with a process that is inclusive and representative of unserved and underservedindividuals. We propose to form a Task Force that meets regularly to address community- issuesrelated to the mentally ill (addressing fears, concerns, and hopes) and alternatives to restrictivehigher level placements.. This type of collaboration has never existed before in our county specificto behavioral health issues for the conserved population, as the prevailing community attitudeshave been that mentally ill issues are the sole responsibility of Tuolumne County Behavioral Health

Department and its professionals.. The Building a Life at HomeTask Force will oversee thedevelopment, implementation, and assessment of best practice case management and peerrecovery and resiliency strategies that target mentally ill consumers currently living at home butrequiring a higher level of care, and mentally ill peers residing in residential facilities in and out ofcounty that need to return home to live safe and independent lives. While the clinical practices wepropose to pilot are not philosophically new, the composition, structure, diverse attitudes andbeliefs, and role of the newly formed community collaborative with regard to oversight andassessment to these practices is innovative to our community, and crucial to our goal to changecommunity attitudes, cohesion and engagement over time.


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Task Force members will create and engage in a process to explore and make a commitment toestablish alternatives to long-term institutionalization. Specific Task Force activities will include:

Developing a collaborative structure to guide the three year learning project, ensuring thatrelevant government agencies, consumers, and family members, and representatives ofSpanish-speaking and Native American residents are actively participating;

Developing formal collaborative agreements to guide the Task Force and three year

learning project (i.e. number of collaborative members who sign a Memorandum ofUnderstanding as a commitment to the collaborative process);

Guiding, assessing and selecting the learning projects relevant data needed for bothprocess and outcome evaluation to assess changes in attitudes of Task Force members andcommunity over time, and how to best communicate results specific to what works and doesnot work with the projects service model interventions (e.g. document anecdotal storiesspecific to personal experiences, successful service methods applied over three year period,peer recovery success stories, use of blogging, videotaping, and/or pictures to share projectactivities, Task Force participation in regular site visits?);

Offering ongoing training and outreach to Task Force members, as well as the staff frommembers organizations and advocacy groups and the community at large regarding stigma

and mental illness, as well as information about intensive case management and peerrecovery services implemented as part of this project.

The heart of our Innovation Project addresses the learning goal Can we change/shift culturalattitudes and beliefs in community systems over time in Tuolumne County from the currentstandard that institutionalization of severely mentally ill is best for the consumer and safest forcommunity - to the understanding that consumers can live at home independently and safely, withrecovery, wellness and resilience services available as needed, and that the consumers canbecome contributing members of our community?. What is the best way to organize and structurethe Task Force to produce this kind of significant change in understanding, attitude, engagement,and ultimately service delivery? Over time, can we reduce the high number of permanent

conservatorships by marshalling the cooperation, resources and expertise of consumers, familiesof consumers, and all county and community agencies that respond to or are involved with thenecessity and determination to place our severely mentally ill residents in long-term out-of-countyresidential facilities? And is there stigma related attitudes about severely mental ill clients thatcan be addressed through an ongoing Task Force?

Through the key informant interviews we have received agreement from all critical partners thatthey are willing to attend regular meetings as Task Force over the next three years.

The primary learning goals of this project are:

1. To determine the best way to develop a new approach to organizing, structuring andconvening a community Task Force to increase awareness, agreement, cooperation,collaboration, and implementation of a better way to deliver services in Tuolumne County forindividuals with serious mental illness and their families; and in the process successfullyaddress the understanding, attitudes and beliefs among members of the Task Force and ,the agencies and social networks they represent;

2. To determine if there is a corresponding change in community understanding, attitudes,collaboration, engagement, and cohesion regarding positive treatment options withinTuolumne County for people with serious mental illness and their families;

3. To determine if fewer mentally ill in crisis are placed in out of county residential facilities,and/or are allowed to return home more quickly with client-driven peer support services and


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case management assistance as a result of the projects development of increasedcooperation, collaboration and awareness through a Task Force,; and if the number ofpermanent conservatorships can be reduced over a three year period;

4. To determine if this innovative collaboration can be replicable in our community to addressother difficult cultural differences locally specific to mental health, and is this projectreplicable for other small rural counties in California if successful in aiding a transformation

of our local cultural beliefs about the abilities of the mentally ill to live at home.

A pilot of integrated case management and peer recovery services is proposed as part of thestrategy to change our understanding, culture and attitudes. This service component of the projectwill be implemented while forming and supporting the new Building a Life at HomeTask Force. Thisservice component of the Innovation Plan is not conceptually new, though innovative in the degreeof peer support integration planned and critical to our learning goal of changing cultural beliefs andattitudes. We know that change is difficult - as it contradicts well-developed views and the medicaland public health models currently in place. Change often questions the common practice ofprotection against anticipated negative effects of problems rather than empowerment to deal withthem; reversing these tendencies requires change from a focus on problems to a focus on human

growth and development. For this reason, and with support, buy-in and guidance from the newlyformed Task Force, we hope to demonstrate to our community that best practice case managementand peer support activities can be safe alternatives to out-of-county residential facilities andreduction of permanent conservatorships, in order to successfully affect change in our communityunderstanding over time. We have prepared members of the newly formed Task Force that our planmay not succeed by the end of the grant period.

The service component for this project , as currently envisioned, is as follows:Hire three new full time case management staff, including a nurse case manager and with apreference for peers. All three case managers will be trained in the Peer Recovery, Wellness andResilience model to ensure that peers are empowered with training and help as needed, as well

as assistance developing and/or strengthening current Peer Support Systems for individualstransitioning from crisis or short-term hospitalization and/or residential care (e.g. a community-based team to provide encouragement and support after crisis events with follow-up calls andreminders for appointments). The new staff will not be asked to impose a structure of support in thepeer community population, but instead would support these volunteers in leadership roles to helpstrengthen peer support systems already in place. Case managers will also work closely with theTuolumne County Behavioral HealthLPS Conservatorship Case Manager to bring conserved peersback into Tuolumne County, and coordinate closely with the Full Partnership Services (FSP) staff toensure effective continuum of care services and team support as needed to those peerstransitioning from a higher level of care. Funds would also be budgeted to help subsidize housingand transportation costs for consumers returning to live in the county from residential and acute

settings both in and out of county. Shared housing models could be developed, where four to sixconsumers share a home close to resources, with intensive case management support offered asneeded. Training in basic daily living skills (budgeting, shopping and preparing meals, managingmoney, doing housework, prioritizing daily tasks, accessing community resources, medicationusage, etc.) could be offered, with the goal for newly conserved consumers and peers at risk to beable to take care of their needs and be self-sustaining over time. This new case managementmodel will ensure that peers are assessed quickly during home visits in order to help identifysymptoms, implement early stabilization and avoid hospitalizations. The newly hired nurse casemanager would help educate peers in monitoring medication, and would selectively monitor andtrack medication usage All case managers would educate peers identified as at risk of a higherlevel of care by assessing/identifying warning symptoms of their disease and assisting with setting


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goals for the ongoing recovery process. They can also help peers to advocate and communicateclearly with their primary physicians about their medical needs. New services would be provided forthree years, with the goal of bringing home 6 consumers by the end of each year (saving the BHDbudget $135,000 each year for three years, totaling $405,000 by end of year three), with a total of18 of the 27 conservators stabilized and living independently (or in less restrictive environments) bythe end of year three. Funds saved from placements could help to sustain the new case

management staff positions over time, and provide ongoing transportation and housing funds toconsumers. This intensive case management model for consumers at risk of placement would alsoreduce future conservatorship costs. Additionally, it is anticipated that 30% of the new staffs timespecific to case management could be Medi-Cal billable ensuring additional funds to sustainthese activities.

As a result of developing and implementing and assessing this innovative, county-widecomprehensive Task Force and implementing best practice intensive case management andstrengthening our peer recovery, wellness and resiliency community - it is our hope that a numberof positive changes and learning outcomes will result:

1. The communitys understanding shifts over time, so that members believe that mentally illresidents can live safely and independently at home with ongoing case managementservices and strong peer community support,

2. Increased level of cooperation, confidence and mutual understanding will occur among TaskForce members regarding peer recovery, wellness and resiliency strategies, thereby building

3. community capacity to better support our mentally ill consumers,4. Changes may occur in administrative processes/organizational practices of Task Force

agencies specific to permanent conservatorships county-wide,5. There will be fewer severely mentally ill placed out of county in residential care, and more

consumers living safely and independently in our community with community-based peersupport and case management services available as needed,

6. As peers will be brought home from residential facilities out of county over a three yearperiod, there will be an increase in consumers involved in peer support community programsand activities, as well as an increase in families, friends, and Task Force members involvedand engaged with peers in our community,

7. Ongoing education and training will be available regarding stigma and mental illness, as wellas information about intensive case management and peer recovery services implementedas part of this project, and this will change the extent to and ways that Task Force membersand agencies they represent (as well as other community members) will engage withconsumers and families, which will lead to changes in information, attitudes and behaviorstoward mentally ill consumers in Tuolumne County.

If successful at the end of the three year plan period, the Building a Life at HomeTask Force willcontinue to meet and collaborate, and intensive case management and peer driven supportservices will continue and be self-sustaining, due to savings from cost of residential care.

2a. Include a description of how the project supports and is consistent with the applicable General Standards asset forth in CCR, Title 9, Section 3320.

This Innovation work plan incorporates the six standards applicable to all MHSA activities:#1 Community Collaboration Community Collaboration is a key to the development of this InnovationProject. The Building a Life at HomeTask Force represents an interagency collaboration betweenpeers, families of peers, agencies and organizations who all play a part in the decision to conserveseverely mentally ill residents in long term residential out-of-county facilities. This project initiates and


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strengthens collaboration and linkages in our community.#2 Cultural Competence This plan demonstrates cultural competency and capacity to improve overahealth outcomes for all residents of Tuolumne County with serious mental illness. An active Task Forcwith representatives of both the Spanish-speaking and Native American residents, as well as peers anfamilies of peers will assess and oversee culturally relevant intensive case management, and peersupport services as an alternative to long term residential placement for local consumers.

#3 and #4 Client and Family Driven Mental Health System This plan includes the ongoinginvolvement of consumers and family in roles such as, but not limited to, program development, taskforce participation, case management services, and peer recovery, wellness and resiliency services.Both peers and the local chapter of NAMI family members have agreed to participate on the Building aLife at HomeTask Force.#5 Wellness and Family Driven Mental Health System This plans intent is to increase resilience andpromote recovery and wellness for peers with serious mental illness who are currently in residentialfacilities by bringing them home safely over time, as well as peers who are currently at risk of higherlevels of care in our community. Our project will provide targeted peers with a continuum of careranging from specialty intensive case management mental health services with a focus on peerrecovery best practices, to peer support services and programs. This plan addresses overall health an

wellness for mentally ill residents in Tuolumne County.#6 Integrated Service Experience Through a stronger collaboration with interagency Task Forcemembers, this plan will encourage and provide support to help peers with access to a full range of peerecovery and support services that includes Peer Help Centers PRIDE Support Groups; BenefitsSpecialist; Senior Peer Counseling; Mother Lode Job Training; Food Bank; NAMI and MHSA Housingopportunities; Teen Center for transition age youth; Meals on Wheels; Lifeline; Energy andWeatherization Services; Catholic Charities outreach and engagement; and more. Engaging peers incommunity support services will help to ensure they receive the help and assistance needed to livesafely and independently when they return back into our community.2b. If applicable, describe the population to be served, number of clients to be served annually, and demographic

information including age, gender, race, ethnicity, language spoken, and situational characteristic(s) of thepopulation to be served.

Our target population to be served will be 60 or more severe mentally ill peers who have experienced least one hospitalization and/or psychiatric emergency visit and/or a placement in residential facilities and out of the county. Description of the population to be served is as follows: Age: 2% youth 17, 3% transitional age youth, 80% - adults, and 15% - older adults. Gender: 47% - male, and 53% - female.Race: 89% - white, 4% - Native American, 2% - Black, and 5%- unreported. Primary Language: 100%English, Ethnicity: 92% - non-Hispanic, 4% - Mexican/Mexican American and 4% - unreported.3. Describe the timeframe of the program. In your description include key actions of the time line and milestones

relatedto assessing your Innovation and communicating results significance and lessons learned. Provide abrief explanation of why this timeline will allow sufficient time for the desired learning to occur and todemonstrate the feasibility of replicating the Innovation.

June, 2010 Anticipated DMH/MHOAC approval

July, 2010 June, 2013 Innovation Project three year project periodJuly September 2010 Form Interagency Task Force, and with Task Force members set datesfor meetings, define purpose, role and level of oversight with InnovationProject; develop a collaborative structure to guide the three year learninProject; develop formal collaborative agreements; assess and select thelearning projects relevant data needed for both process and outcomeevaluation to assess changes in attitudes of Task Force members andcommunity over time, and how to best communicate results specific towhat works and does not work with the projects service modelinterventions.

July -September 2010 Initiate project service model, hire and train case managers, develop


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strategies with Peer Help Center staff and volunteers to support andstrengthen Peer Support/ Recovery services; and developtrainings for Task Force members, as well as the staff from membersorganizations and advocacy groups, regarding stigma and mental illnes

October- December 2010 With Task Force, provide a preliminary assessment and evaluation ofearly project implementation activity.

Sept., 2010 June, 2013 Full implementation of service component of Innovation Plan (Casemanagement and Peer Support/Recovery services in place).

July, 2011 Medi-Cal Feasibility Study completed for first year service activitiesJanuary, 2011 June, 2013 Make project adjustments as necessary based on Task Force process

evaluation assessments.January 2011 Mid year process evaluation of Task Force effectiveness and services

provided to date, and then evaluation of project every six months untilend of project.

May - July 2013 Full evaluation/assessment of Innovation Project, including effectivenesof Task Force, case management and peer recovery services, and ratesof permanent conservatorships and out of county residential facilities

placements determination of efficacy and feasibility or replication anddissemination of results.

We are confident that this three year timeline will allow sufficient time to learn if we change/shiftcultural attitudes and beliefs in community systems over time in Tuolumne County; and over timereduce the high number of permanent conservatorships. We also anticipate that the project periodwill allow us the time needed to provide a full evaluation/assessment of the Innovation Project todisseminate results, and determine the projects efficacy and feasibility for other small counties inCalifornia.4. Describe how you plan to measure the results, impacts, and lessons learned of your Innovation, with a focus

what is new or changed. Include in your description how the perspectives of stakeholders will be included inassessing and communicating results.

We hope to learn from this project if we can change/shift cultural attitudes and beliefs in communitysystems over time in Tuolumne County from the current standard that institutionalization ofseverely mentally ill is best for the consumer and safest for community - to the understanding thatconsumers can live at home independently and safely, with recovery, wellness and resilienceservices available as needed, and that the consumers can become contributing members of ourcommunity. Additionally, we hope to learn the best way to organize and structure the Task Force toproduce significant change in understanding, attitude, engagement, and ultimately service delivery;and if we can reduce the high number of permanent conservatorships by the end of our three yearproject.

To capture change in Task Force attitudes and beliefs, we will develop attitudinal pre and post

surveys prior to forming the Task Force to ensure we have baseline data from inception ofproject. Once the Building a Life atHomeTask Force is formed, the members and staff willtogether plan and design both process and outcome evaluation strategies in the first three monthsof project implementation to assess and communicate results of the projects short and long termgoals over time (see primary learning goals listed under question #2 above) - as part of acomprehensive evaluation to measure the results, impacts and lessons learned from this project.Data collection methods to assess both the ongoing involvement and support of Task Forcemembers, as well as the success of the projects service component could include (but are not belimited to): pre and post attitudinal surveys of Task Force members; documentation of Task Forcemembers participation at regular meetings, peer recovery activities and site visits; documentation


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of trainings provided to agencies and organizations; and anecdotal stories collected of peerrecovery successes, possible use of blogging, videotaping, and/or pictures to share projectimplementation strategies. The data collected will be analyzed on an ongoing basis to evaluate andmodify the implementation, as needed.

Ultimately, the Task Forces engaged and active review, assessment and direct involvement of the

projects service component; attitudinal surveys indicating a shift in cultural attitudes and beliefstoward peer recovery, wellness and resilience models; as well as the overall reduction of conservedmentally ill residents institutionalized out of the county but living successfully at home willdetermine the success of this project, and whether this project can be replicated in other ruralcounties in California.

Data, outcomes, and the experience in learning during the course of implementation will be sharedregularly at the Task Force meetings, as well as on a minimum of an annual basis with a diversegroup of stakeholders to gather their input and feedback and make changes to projectimplementation. The Building a Life at HomeTask Force members will also provide feedbackregularly to the Tuolumne County Behavioral Health Department Advisory Board, MHSA

Leadership Council, on our Tuolumne County Behavioral Health and Network of Care websites,and finally through the Board of Supervisors at the end of the three years. A full evaluation reportwill be completed during the final year of the Build a Life at Homeproject using the measurementsdesigned in the first three months of project implementation. The results will be shared with TaskForce members, stakeholders, and throughout the community to share learning and gather inputregarding efficacy of the project and long term funding strategies.

5. Please provide a Budget Narrative that includes the entire budget for each Innovation Program, and alsoprovide for each Innovation Program projected expenditure dollar amount by each fiscal year during theprogram time frame. (For Example, Program 01-XXXX, the entire project is $1,000,000. The first year projectedamount will be $250,000, the second year projected amount is $250,000, the third year is $250,000 and the fourth yeais $250,000.) Please also describe briefly the logic for this budget; how your proposed expenditures will allow

you to test your model and meet your learning and communication goals. Please also describe briefly the logfor this budget; how your proposed expenditures will allow you to test your model and meet your learning andcommunications goals.

The Innovation budget will include support a portion of the MHSA Coordinator (10% FTE) tooversee the project process and outcome evaluation and facilitate the Task Force meetingsand strategies, and a Clinical Program Manager (20% FTE) to supervise the project's servicecomponent staff as well as provide support and assistance with the Building a Life at HomeTask Force.

In addition to these two positions, the department will also budget for two Recovery Counselorand one Nurse Case Manager, for a total of $195,000 each year. Travel expenses are anothe

important component of the Innovation budget, as half of the target population currently residein residential facilities primarily outside the county, and staff will be required to travelextensively in county to provide support to peers in crisis. Mileage is estimated using thecounty mileage per diem rate of $.50 per mile. Transportation subsidies will also be providedas needed for clients, estimated at $50 per client, per month.

The department estimates that 20-30% of the case manager time will be billable to Medi-Cal.The first year will be at a much lower rate as we collaborate with other county agencies to brinour conserved clients home, once they are home they each will receive intensive casemanagement from the individuals listed above. The three case managers will also provide


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crisis services to clients who require a higher level of care, therefore negating the need forplacement within a residential care facility.

As the clients are brought home, the placement costs will decrease, the savings from bringingthese clients home will allow us to continue with the program beyond the first three years. It isestimated we will bring home six clients in the first year, estimated savings as a result ofbringing these clients home is $135,000. For each year we bring clients back home, we reducthe cost of out of county placement, resulting in additional resources for services to be providewithin the county. The department will budget to provide housing subsidies out of the savingsrecognized from the reduced level of care to independent housing; subsidies have beenestimated at $250 per client, per month.

Year One:Case Managers $ 194,000MHSA Coordinator 9,279Clinical Program Mgr 18,679

Housing Subsidies 18,000Travel 39,000Transportation Subsidies 3,600Administration 42,384Total Annual Estimate $ 324,942

Year Two:Case Managers $ 194,000MHSA Coordinator 9,279Clinical Program Mgr 18,679Housing Subsidies 36,000

Travel 39,000Transportation Subsidies 7,200Administration 45,624Total Annual Estimate $ 349,782

Year ThreeCase Managers $ 194,000MHSA Coordinator 9,279Clinical Program Mgr 18,679Housing Subsidies 54,000Travel 39,000

Transportation Subsidies 10,800Administration 48,864Total Annual Estimate $ 374,622

6. If applicable, provide a list of resources to be leveraged.

Tuolumne County Behavioral Health Department will provide an estimated cash match of $135,000each year for three years to support the Innovation Project, with funds from the placement reductionand Medi-Cal match. Additionally, by the end of the first year of case management services, a feasibilstudy will be generated to estimate the amount of Medi-Cal revenue that could be generated if Medi-Cal is billed for appropriate case management services, and this will be included as leveraged


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resources to continue supporting this project in years two and three, and beyond. We anticipatebetween 20 to 30% of the three case managers time will be Medi-Cal billable. If successful, fundssaved from the ongoing residential placement costs will be made available to continue the ongoingTask Force and service component of this project once the three year project comes to an end.


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EXHIBIT D

Innovation Work Plan Description(For Posting on DMH Website)

County Name

Tuolumne County

Work Plan Name

Building a Life at Home Innovation Project

Annual Number of Clients to Be

Served (If Applicable)60 Total

Population to Be Served (if applicable):

Our target population to be served will be severe mentally ill peers who haveexperienced at least one hospitalization and/or psychiatric emergency visit and/or aplacement in residential facilities in and out of the county.

Project Description (suggested length - one-half page): Provide a concise overalldescription of the proposed Innovation.

The Building a Life at Home Project proposes to change cultural attitudes and beliefsthrough an innovative collaboration between our existing Behavioral Health Department,consumers and families, representatives of Spanish-speaking and Native American

residents, and key and diverse stakeholders representing organizations and systems(Public Guardian, Adult Protective Services, Law Enforcement, Probation andOmbudsman programs) who all play a part in the decision to conserve severelymentally ill residents in long term residential in and out-of-county facilities or who wouldrefer community members for more restrictive services. Our Innovation Plan meets thedefinition of Innovation as the project introduces our local mental health system to acommunity defined approach of collaboration that has been successful in a non-mentalhealth context. We hope to ultimately create positive change with a process that isinclusive and representative of unserved and underserved individuals. We propose toform a Task Force that meets regularly to address community- issues related to thementally ill (addressing fears, concerns, and hopes) and alternatives to restrictive higher

level placements.This type of collaboration has never existed before in our countyspecific to behavioral health issues for the conserved population, as the prevailingcommunity attitudes have been that mentally ill issues are the sole responsibility ofTuolumne County Behavioral Health Department and its professionals. The Building aLife at Home Task Force will oversee the development, implementation, andassessment of best practice case management and peer recovery and resiliencystrategies that target mentally ill consumers currently living at home but requiring ahigher level of care, and mentally ill peers residing in residential facilities in and out of


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county that need to return home to live safe and independent lives. While the clinicalpractices we propose to pilot are not philosophically new, the composition, structure,diverse attitudes and beliefs, and role of the newly formed community collaborative withregard to oversight and assessment to these practices is innovative to our community,and crucial to our goal to change community attitudes, and create cohesion and

engagement over time.


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EXHIBIT E

Adult Older Adult

1 435100 348080 65265

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26 $435,100 $348,080 $65,265

27

28

29 $435,100

24-Mar-10

Innovation Work Plans

Estimated Funds by Age Group

(if applicable)

County: Tuolumne Date:

No. NameChildren,

Youth,

Transition

Age Youth

FY 09/10

Required

MHSA

Funding

Building a Life at Home 8702 13053

Total MHSA Funds Required for Innovation

Subtotal: Work Plans $8,702 $13,053

Plus County Administration

Mental Health Services Act

Innovation Funding Request

Plus Optional 10% Operating Reserve


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EXHIBIT F

County: Tuolumne 2009/10

Work Plan #:Work Plan Name: Building a Life at

New Work Plan

Expansion

Months of Operation: 07/10-06/13MM/YY - MM/YY

County

Mental HealthDepartment

Other

GovernmentalAgencies

Community

Mental Health

ContractProviders Total

802,746 $802,746

246,600 $246,600

$0

$0

$0

$1,049,346 $0 $0 #########

$0

200,000 $200,000

414,246 $414,246

$0$614,246 $0 $0 $614,246

$614,246 $0 $0 $614,246

$435,100 $0 $0 $435,100

Prepared by: 3/24/2010

Telephone Number:

b. FFP

c. (insert source of revenue)

B. Revenues1. Existing Revenues

Innovation Projected Revenues and Expenditures

Tracie M. Riggs Date:

C. Total Funding Requirements

3. Total New Revenue

4. Total Revenues

2. Additional Revenues

a. Realignment

Fiscal Year:

(209) 533-6265

A. Expenditures

1. Personnel Expenditures

4. Training Consultant Contracts

5. Work Plan Management

6. Total Proposed Work Plan Expenditures

2. Operating Expenditures

3. Non-recurring expenditures


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Tuolumne County Behavioral HealthMental Health Services Act

INNOVATION COMPONENT PLAN

30 Day Public Comment FormMarch 29, 2010 to April 30, 2010

PERSONAL INFORMATION (optional)

Name: ________________________________

Agency/Organization: ________________________________

Phone Number: ____________ Email address______________

Mailing address:______________________________________________________

MY ROLE IN THE MENTAL HEALTH COMMUNITY

__ Client/Consumer__ Family Member__ Education__ Social Services__ Service Provider

__ Law Enforcement/ Criminal Justice__ Probation__ Other (specify) _________________

WHAT DO YOU SEE AS THE STRENGTHS OF THE PLAN?IF YOU HAVE CONCERNS ABOUT THE PLAN, PLEASE EXPLAIN.

_____________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________

Tuolumne County Administration Center (Mailing Address:) 2 South Green Street Sonora, CA

95370 Phone: 209/533-6245 Fax: 209/588-9563

MHSA Innovation Plan

Documents

Transcript of MHSA Innovation Plan