MHSA Successes in LA: Perspectives on Recovery and Resiliency “Nurturing Hope, Promoting Wellness...

MHSA Successes in LA: Perspectives on Recovery and

Resiliency

“Nurturing Hope, Promoting Wellness and Supporting Recovery”

1

Welcome

Catherine Bond, MFTVice Chair, Los Angeles County Client Coalition

Dennis Murata, MSWDeputy Director, Program Support Bureau

2

MHSA Overview Proposition 63 – Mental Health Services Act

• California ballot proposition

• Passed November 2004

• Funding began January 1, 2005

How it is funded – 1% state tax on incomes of $1 million or more

What it funds – Expansion of mental health services and programs

Who it serves – All ages

• Children (0-15)

• Transitional Age Youths (16-25)

• Adults (26-59)

• Older Adults (60 and older)

3

MHSA Core Principles

• Client / family driven

• Cultural competence

• Community collaboration

• Service integration

• Focus on recovery, wellness, and resilience

4

MHSA Components

• Community Services and Support Plan February 14, 2006*

• Workforce Education and Training Plan April 8, 2009*

• Information Technology and Needs Plan May 8, 2009*

• Prevention and Early Intervention Plan September 27, 2009*

• Innovations Plan February 2, 2010*

• Capital Facilities Plan April 19, 2010 (Submitted)*

*Date of approval

5

IT/CFAd Hoc

Work Groups

PEIService Area LevelPlanning Process

SAAC 1

SAAC 2

SAAC 3

SAAC 4

SAAC 5

SAAC 6

SAAC 7

SAAC 8

WETAd Hoc

Work Groups

CSSAd Hoc

Work Groups

INNAd Hoc

Work Groups

Underrepresented Ethnic Populations

County of Los Angeles

MHSA Stakeholder Delegates

Service Area Advisory Committees (SAAC)

6

Department of Mental

Health

County Commissions &

Councils

Community and Faith Based

Organizations

Healthcare & Hospitals

Other Government

Agencies

Contract Providers

7

INFORMATION TECHNOLOGY

& CAPITALFACILITIES

WORFORCEEDUCATION &TRAINING

INNOVATIONS

PEI CSS

County of Los Angeles MHSA Stakeholder Process


Develop, Deliberate and Recommend NEW MHSA Plans for Los Angeles County

System Leadership Team

Monitor Progress of MHSA Implementation

Support Transformation of Overall Public Mental Health System

WORFORCEEDUCATION &TRAINING

INNOVATIONS

8


Comments:

“The process reinforced how important it is to have consumers and family members involved throughout the process.”

“It was amazing how people from very varied backgrounds were able to reach unanimous consensus on each plan.”

“All voices were heard, and they were heard equally.”

9

Making a Difference inConsumers’ Quality of Life: Full-Service Partnerships

Debbie Innes-Gomberg, Ph.D.District Chief, MHSA Implementation Unit

Kara Taguchi, Psy.D.Program Head, MHSA Implementation Unit

10

Data Collection of Full Service Partnership (FSP) Outcomes

in Los Angeles County

Size limitations resulted in LA County’s inability to enter data directly into State DMH Data Collection and Reporting System• Outcomes Measures Application (OMA) developed in late 2005

• Data elements include state mandated elements and additional outcomes based on stakeholder feedback

• Initiated provider training in September 2006

• Data entry initiated in November 2006

11

Outcomes Data Collection (continued)

Our OMA is now used for 3 distinct programs:

• Full Service Partnerships (2006)

• Specialized Foster Care Intensive (2007)

• Field Capable Clinical Services (FCCS) (2009)

12

Outcomes Data Collection (continued)

Current total of 63,927 FSP outcome assessments in the OMA

Data is also submitted electronically to LACDMH by third-party data collection systems (which yields an additional 10,835 outcome assessments)

FSP outcomes uploaded to State DMH: First Upload to the state was on 12/30/08 for 13,135

records (2 years worth of data) As of 4/1/2010 a total of 50,137 records have been

submitted to the state Data clean-up to enhance data submission to the

state

13

Development of Reports

• Utilized AB2034 methodology for reports, including initial focus on living arrangements

• Data validity and reliability

14

Availability of Reports

• Reports are accessible to Providers via the Internet

• Reports are refreshed every Monday, so providers can view their own residential data on a regular basis without relying on DMH

• New reports continue to refine data quality and to include additional domains

15

Annualized Living Arrangement Data and Graphs

• Comparison of residential data for 12 months immediately prior to receiving FSP services and for 12 months of residential status while receiving FSP services

• Data is adjusted (annualized) by a percentage based on average length of stay in the FSP program

• Data must meet data quality standards to be included in the analysis

16

Annualized Living Arrangement Data and Graphs

• 41 Unique Residential Types listed across 4 age groups

• Residential types are grouped into 16 Living Arrangement Clusters:

Residential CareIndependent

Living

Psychiatric Institutional

SettingsAssisted Living

Board and CareGroup Home RCL-

011Group Home RCL

12-14, CTFJustice Facilities

Congregate Living HomelessEmergency

ShelterTemporary

Housing

Acute Psychiatric Hospital/

Psychiatric Health Facility

Living With Family Foster Homes Other/Unknown

17

Hospitalization Data (Measured by Number of Clients)

18

Older Adult Full Service Partnership Program 42% Reduction

N=367

6585

0

10

20

30

40

50

60

70

80

90

Pre-Partnership Clients Post-Partnership Clients

Adult Full Service Partnership Program 44% Reduction

N=4,280

910

1,204

0

200

400

600

800

1000

1200

1400


Transitional Age Youth Full Service Partnership Program 37% Reduction

N=1,214

257

1500

50

100

150

200

250

300


Child Full Service Partnership Program 40% Reduction

N=2,658

228

137

0

50

100

150

200

250


Hospitalization Data (Measured by Number of Days)


N=4,280

60,489

50,868

46000

48000

50000

52000

54000

56000

58000

60000

62000

Pre-Partnership Days Post-Partnership Days


N=367

7,552

6,251

0

1000

2000

3000

4000

5000

6000

7000

8000


19

Jail Data (Measured by Number of Clients)


23

17

0

5

10

15

20

25



710

524

0

100

200

300

400

500

600

700

800



95

76

0

10

20

30

40

50

60

70

80

90

100

Pre-Partnership Clients Post-Partnership Clients 20

Jail Data (Measured by Number of Days)


N=367

3,683

2,568

0

500

1000

1500

2000

2500

3000

3500

4000



N=4,280

79,243

49,141

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Pre-Partnership Days Post-Partnership Days 21

Decline in Homelessness(for All Age Groups)

Older Adult 58% Reduction

10,018

23,650

0

5000

10000

15000

20000

25000

Pre-Partnership Days Post-Partnership DaysN=367

Adult 64% Reduction

421,597

150,085

050000

100000150000200000250000300000350000400000450000


N=4,280

Child24% Reduction

1,4371,881

0

500

1000

1500

2000


N=2,658

22

Transitional Age Youth34% Reduction

30,22120,082

05000

10000150002000025000

3000035000


N=1,214

Homeless Data (Measured by Number of Clients)


N=367

99

57

0

20

40

60

80

100

120



N=4,280

1,705

951

0

200

400

600

800

1000

1200

1400

1600

1800



N=1,214

153

970

20

40

60

80

100

120

140

160

180


23

What does the data tell us? Fewer clients are hospitalized in an acute psychiatric

hospital while in FSP when compared to the 12 months immediately prior to FSP for all age groups

40% of Adult FSP clients experienced homelessness in the 12 months immediately prior to FSP, and on average, these clients were homeless for 8 out of those 12 months

Transitional Age Youth, Adult, & Older Adult FSPs show reductions in the number of clients in jail when helped by FSP, compared to 12-month baseline data

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What else does the data tell us? There is also a reduction in the number of jail days for

Adults and Older Adults experienced while in FSP compared to the year prior

The majority of Adult and Older Adult FSP clients are currently living independently in either an apartment or house where they pay rent, hold a lease, or pay mortgage, or in a Single Room Occupancy (SRO) where they hold the lease

The majority of Child and TAY FSP clients are currently living with their families

25

Current Living Arrangement (by Cluster)

Looks at last reported/current residential type status

LACDMH can see this data broken down by provider site or FSP program

At a quick glance you can see the distribution of where currently enrolled clients are living

26

Child Full Service Partnership Current Residential Status

N= 1,629

Acute Psychiatric Hospital/PHF, 0.0147

Emergency Shelter, 0.0012Living with Family, 0.8281

Medical/ Physical Health Settings, 0.0018

No Cluster, 0.0141

Psychiatric Institutional Settings, 0.0012

Residential Care, 0.0061

Temporary Housing, 0.0043

Foster Homes, 0.0933

Independent Living, 0.019

Justice Facilities, 0.0074

Homeless, 0.0012

Group Home RCL 0-11, 0.0037Group Home RCL 12-14, CTF,

0.0037

27

Transitional Age Youth Full Service Partnership Current Residential Status

N= 847

Acute Psychiatric Hospital/PHF, 4%

Board and Care, 4%

Congregate Living, 2%

Living with Family, 53%

Medical/ Physical Health Settings, 0%

No Cluster, 3%

Residential Care, 6%

Temporary Housing, 3%

Group Home RCL 0-11, 1%

Homeless, 4% Group Home RCL 12-14, CTF, 0%

Assisted Living, 0%

Emergency Shelter, 2%Foster Homes, 3%

Independent Living, 9.28%

Justice Facilities, 3%

28

Adult Full Service Partnership Current Residential Status

N= 3,111

Acute Psychiatric Hospital/PHF, 3%

Assisted Living, 1%

Board and Care, 17%

Congregate Living, 6%Homeless, 7%

Independent Living, 27%

Justice Facilities, 3%

Living with Family, 16%

Medical/ Physical Health Settings, 2%

No Cluster, 3%

Psychiatric Institutional Settings, 1%

Residential Care, 8%

Temporary Housing, 4%

Emergency Shelter, 4% 29

Older Adult Full Service Partnership Current Residential Status

N= 284

Acute Psychiatric Hospital/PHF, 3.87%

Assisted Living, 5.28%

Board and Care, 12.32%

Independent Living, 37.32%

Justice Facilities, 2.46%

Living with Family, 7.04%

Medical/ Physical Health Settings, 7.04%

No Cluster, 5.28%

Psychiatric Institutional Settings, 1.06%

Residential Care, 6.69%

Temporary Housing, 2.82%

Congregate Living, 2.82%

Homeless, 4.58% Emergency Shelter, 1.41%

30

Adult FSP Program Cost Avoidance

Hospitalizations ($523/day)• Pre-Partnership Days – 60,489• Post-Partnership Days – 50,868• Cost Avoidance of $5,031,783

Incarcerations ($1,093/day)• Pre-Partnership Days – 79,243• Post-Partnership Days – 49,141• Cost Avoidance of $32,901,486

31

Older Adult FSP Program Cost Avoidance

Hospitalizations ($523/day)• Pre-Partnership Days – 7,552• Post-Partnership Days – 6,251• Cost Avoidance of $680,423

Incarcerations ($1,093/day)• Pre-Partnership Days – 3,683• Post-Partnership Days – 2,568• Cost Avoidance of $1,218,695

32

Roybal Mental Health Center Young Mothers & Babies FSP Program

Using a “Whatever it Takes” Approach

• Priority population is transition aged mothers ages 16 to 25 with children ages 0 to 5 years old

• Program targets young mothers with mental illness• At risk of losing custody of their children• With a history or at risk of psychiatric hospitalization• Who are homeless or are about to become homeless

33

Young Mothers & Babies FSP ProgramUsing a “Whatever it Takes” Approach

The program addresses a comprehensive list of needs:• Educates the entire family on reasonable developmental

expectations

• Provides education and role modeling for the mother and extended family

• Gives flex-funding to help with financial emergencies, including: food, housing and educational expenses

• Connects families to critical resources

• Staff available 24/7

34

Young Mothers & Babies FSP ProgramUsing a “Whatever it Takes” Approach

(continued)

• In the past 28 months, the program has opened 67 cases

• The program has reached more than 300 people by providing services to family members of enrolled clients

• 12 mothers who enrolled in the program with existing Department of Children & Family Services cases, successfully saw their cases closed

35

Project 50

Mary Marx, LCSW

District Chief, Countywide Resource Management

36

Project 50 Overview

As a result of a motion introduced by Supervisor Zev Yaroslavsky, the Board of Supervisors committed to funding a pilot project to house and provide integrated supportive services for 50 most vulnerable chronically homeless people on Skid Row on November 20, 2007

Modeled on an approach used by Common Ground to dramatically reduce the number of people living on the streets in New York City’s Times Square

The Board also specified that Project 50 should begin housing people within 100 days

37

Project 50

Project 50 Early Timeline:

October 2007 February 2008

11/20/2007Board of Supervisors pass Motion

to Implement Project 50 within 100 days

10/4/2007Los Angeles County hosts

Common Ground and US Interagency Council

12/7/2007Project 50 launches with Skid Row Street Count

12/10/2007 - 12/18/2007Registry Creation

12/20/2007Presentation on

Registry Creation

1/17/2008Outreach Begins

1/28/2008First Participant is Housed!

38

Project 50Participating Partners:

• Board of Supervisors

• Chief Executive Office

• Department of Mental Health

• Department of Health Services

• Department of Public Health

• Department of Public Social Services

• Sheriff’s Department

• Probation Department

• Alcohol Drug Program Administration

• Housing Authority City of Los Angeles

• Los Angeles Homeless Services Authority

• CDC

• Los Angeles Mayor’s Office

• Los Angeles Police Department

• Skid Row Housing Trust

• Didi Hirsch

• JWCH

• Volunteers of America

• Courts

• Public Defender

• Public Counsel

• Los Angeles City Attorney’s Office

• US Veteran’s Affairs Administration

• Common Ground

39

Project 50Phase I: Registry Creation

40

Project 50Phase I: Registry Creation

• Counted 471 homeless individuals (surveyed 350)

• Identified the 50 most vulnerable persons who had a 40% likelihood of dying within the next seven years unless they could be successfully placed in housing and provided appropriate medical care

• 25 Outreach personnel (with assistance from the Los Angeles Police Department)

• 250 of the 350 allowed Outreach personnel to photograph them (used later during Phase II to identify prospective participants

• Average length of homelessness: 9.6 years

• 76% reported having Mental Health issues; 90% reported having Substance Abuse issues

41

Project 50

Phase II: Outreach Team

• Maintain regular contact with identified individuals in efforts of establishing rapport and the goal of engaging these individuals in the services including transitional and permanent housing

• Establish a trusting therapeutic relationship with identified individuals

• Assess needs, define service goals, and reach agreement with the individual on a plan for service delivery

• Connect and/or reconnect individuals to appropriate services and supports

• Registry list was expanded to the top 140 individuals and was refreshed during the project

42

Project 50Phase III: Integrated Supportive Services Team

• Multi-disciplinary team (from different agencies) to provide housing, integrated health, mental health, and substance abuse services, and benefits establishment.

Supportive Services include:

1. Physical health care, mental health and substance abuse treatment

2. Money management

3. 24 Hour/7 day crisis services

4. Recovery-based self-help and support groups

5. Employment services

6. Transportation services

7. Education opportunities

8. Community Reintegration services (museums, fishing trips, Dodgers game, etc.)

9. Medication management

10. Benefits establishment

43

Project 50Phase III: Integrated Supportive Services Team (ISST)

• Mental health services provided through a DMH Medi-Cal certified outpatient clinic and a contracted outpatient clinic

• Physical health services provided through a Federally Qualified Health Center

– One record

– Daily team meetings

– Regular consultation

– Visits conducted together

– Shared office space

– Non-traditional contacts

44

Project 50 Data• Housed 67 participants since inception

• 42 participants are currently housed with Project 50

• 11 participants are alternatively housed (appropriate levels of care – SNF; reunited/living with family)

• Of the 42 participants currently housed:

• 67% recognized an increase in benefits since enrollment

• 33 successfully applied for and are currently receiving SSI benefits

• 100% are receiving benefits (77% receiving SSI)

• 100% are diagnosed with Mental Illness

– 95% are participating with Mental Health treatment

• 83% report a history of Substance Abuse

– 80% of those reporting are participating with Substance Abuse treatment

• 100% have Medical issues

– 100% are participating with Physical Health treatment

45

Project 50 Data(continued)

• Hospital Days:– Year prior to enrollment: approximately 750 hospital days at an

estimated cost of $677,000– Year after enrollment: less than 100 hospital days at an estimated

cost of $185,000

• Incarceration:– Year prior to enrollment: approximately 750 jail days at an

estimated cost of $79,000– Year after enrollment: approximately 150 jail days at an estimated

cost of $15,000

46

Project 50 Progression and Replication

• Project 50 participants and the ISST are moving into the newly developed Cobb Apartment building. Project 50 is planning to expand services to 24 additional participants.

• Project 50 replications in downtown: Cobb, Carver, Venice, Santa Monica, San Fernando Valley, Long Beach, and Hollywood (under development)

• 1 participant moved into an independent apartment in Crenshaw with supportive services

• 1 participant is actively seeking re-employment; recently passed his Merchant Marine examination

47

Project 50

Before: After:

48

Westside Urgent Care Center

Karen J. Williams, PhD

District Chief, Service Area 5

Mary Marx, LCSW

District Chief, Countywide Resource Management

Luana Murphy, CEO

Exodus Recovery, Inc.

49

Alternative Crisis Services

• Alternate Crisis Services (ACS) provides a comprehensive range of services and supports for mentally ill individuals that are designed to provide alternatives to emergency room care, acute inpatient hospitalization and institutional care, reduce homelessness, and prevent incarceration

• ACS programs are funded by the Mental Health Services Act (MHSA) and operate in conjunction with MHSA’s recovery-based model of service delivery

• Urgent Care Centers (UCCs) are a component of ACS

50

Westside UCC

• Operated by Exodus Recovery, Inc.

• Opened in December 2006

• Located in the 1st Supervisorial District – Service Area 5 (3828 Hughes Avenue, Culver City, CA 90232)

• Open 365 days/year, 24 hours/day

• Lanterman Petris-Short Designated (February 2007)

• Located near Brotman Medical Center

• Provide intensive crisis services to individuals who otherwise would be brought to emergency rooms

• Provide up to 23 hours of immediate care and linkage to community-based solutions

• Provide crisis intervention services, including integrated services for co-occurring substance abuse disorders

• Focus on recovery and linkage to ongoing community services and supports that are designed to impact unnecessary and lengthy involuntary inpatient treatment 51

Westside UCCThree (3) Service Components:

1) Mental Health Crisis Program

1) Emergency Shelter Bed Program, providing short-term residential services to homeless individuals receiving services from the Mental Health Crisis Program (through partnership with Ocean Park Community center)

2) Transitional Residential Services Program, providing longer-term housing for individuals in need of ongoing support to live independently in the community (through partnership with Alcott)

52

Westside UCCAdmission Source

WestsideUCC

OlympiaMedicalCenter

LAPDCulver City PD

Santa Monica PD(in lieu of Harbor/

UCLA)

Santa MonicaMedical Center

St. John’sMedicalCenter

Board & Cares

Mental HealthClinics

Cedars Sinai

Medical Center

CentinelaHospital

FromHome

BrotmanMedicalCenter

PMRT(in lieu of Harbor/UCLA)

Daniel FreemanMarina

Jail Release

5150

5150

5150

51505150

5150

5150

5150

5150

53

Mission

Staffing

Setting

Target Population

Psychiatric Evaluation

Medication for stabilization

Crisis Counseling

Medication support for clients unable

to access outpatient care

Community Integration/Linkage

Activity

Decrease acute symptoms

Prevent acute hospitalization

Establish/Reestablish MH

treatment in community

Client linked with substance abuse

treatment, as applicable

Client linked with housing, as applicable

Client linked with Wellness/Recovery

Center, as applicable

Decrease ER Census

Decrease System Costs of

Hospitalization

Increase Community Tenure

of Client

INPUTSProcess/

InterventionImmediate Outcomes

Intermediate/Long Term Outcomes

UCC Data ReportingUCC Logic Model

54

Westside UCC Data

Other Demographic Data:

Since inception the Westside UCC has 13,198 unique monthly episodes of service (Average of 401 unique episodes per month during current Fiscal Year)

Of the 13,198 Unique Episodes of Service:

• 52.7% were male (n = 6,952); 47.3% were female (n = 6,246)

• 46.2% reported having Substance Abuse issues (n = 6,101)

• 14.5% reported being Homeless (n = 1,908)

Age Group:

• 0.4% ages 0-15 (n = 49)

• 13.7% ages 16-25 (n = 1,816)

• 78.9% ages 26-59 (n = 10,410)

• 7.0% ages 60+ (n = 923)

55

Westside UCC DataOutcome Data

Consumers with PMRT, Psychiatric ER, Inpatient Hospitalization, and Jail Mental Health episodes 30 days after receiving services from Westside UCC:

*Westside UCC is able to admit consumers on involuntary holds (5150s). 56

Westside UCC Data

Fiscal Year2007-2008


Variance

Cost/day/client $690 $574 ($116)

Cost Avoidance Analysis

The cost per day per client at Westside UCC has decreased from Fiscal Year 2007-2008 to Fiscal Year 2009-2010

Average Cost of a Psychiatric Inpatient Hospitalization (with a length of stay of 3 days – 5150)


County Hospital $3,390

Short-Doyle/Medi-Cal Hospital $1,725

Fee-for-Service Hospital $1,569

57

Westside UCC Data

Cost Avoidance Analysis

Cost avoidance of utilizing Westside UCC services to manage clients and preventing involuntary inpatient psychiatric hospitalization:

Cost Avoidance

County Hospital $2,816

Short-Doyle/Medi-Cal Hospital $1,151

Fee-for-Service Hospital $995

58

UCC Expansion

• DMH and Exodus Recovery, Inc. partnered to open a new psychiatric UCC in Los Angeles County

• The new UCC is located on 1920 Marengo Street, directly across the street from LAC+USC Medical Center

• Opened on April 15, 2010 and was LPS designated on 4/29/10

• The new UCC has the ability to provide Transitional Residential Services for consumers at Gateways Percy Village

• Ability to provide consumers (up to 30 daily) with access to UCC services directly from LAC+USC Medical Center

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Transformative Approaches

Terri Boykins, LCSW

District Chief, Transitional Age Youth

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Drop-In Centers

• Provide temporary safety & basic supports for seriously emotionally disturbed and severe and persistently mentally ill youth 16 – 25.

• Low-demand, high-tolerance environments.

• Served 4,405 clients from March 2008-2010

• Gender: 64% male, 29% female

• Ethnicity: 33% African American

22% White 16% Other

25% Latino3% Native American

1% Asian

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Pacific Clinics

TAY Drop-In Center

Video

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Northeast Wellness Center

Maria Aguilar, MD

Psychiatrist, Northeast Wellness Center

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“Our dream is to help others achieve their dreams.”

• Consumers created vision and mission

• Vision: “Help consumers reach their hopes, dreams and goals.”

• Mission: “Everybody working together for one purpose: to assist consumers to realize their skills, gifts and talents, and to support their brilliance as they find their place in the world.”

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Person-Centered Approach

• Social (family, community, friends)

• Physical (medical, nutrition, exercise)

• Basic needs (food, clothing, shelter)

• Vocational (job, school, volunteering)

• Psychological (emotional coping skills, harm reduction)

• Spiritual (sense of purpose and belonging)

65


1,800 Contact Services (FY July 2009-April 2010)

Links to Services:

• Vocational/Employment

• Housing

• Primary care health

• Jail transition

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Prescription for the Whole Person

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Lives Touched

Kathleen Piché, LCSW

Public Information Officer, LACDMH

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Lives Touched

Gary Gougis, Peer Advocate

Video

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Question & Answer

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MHSA Successes in LA: Perspectives on Recovery and Resiliency “Nurturing Hope, Promoting Wellness...

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