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CMHS Block Grant CMHS Block Grant Peer ReviewsPeer Reviews

Ann Arneill-Py, PhD, Executive OfficerAnn Arneill-Py, PhD, Executive OfficerCA Mental Health Planning CouncilCA Mental Health Planning Council

California Mental Health Planning California Mental Health Planning CouncilCouncilApril 21, 2010April 21, 2010

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CMHS Block GrantCMHS Block Grant

Community Mental Health Community Mental Health Services Block grant appropriated Services Block grant appropriated at approximately $400M annuallyat approximately $400M annually

CA receives approximately $54M CA receives approximately $54M annuallyannually

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CMHS Block GrantCMHS Block Grant

Type of AllocationType of Allocation AmountAmount

Base AllocationBase Allocation $36.6M$36.6M

Dual Diagnosis Set-asideDual Diagnosis Set-aside 8.1M8.1M

Children’s System of CareChildren’s System of Care 4.0M4.0M

Integrated Service Integrated Service AgencyAgency

2.0M2.0M

Human Resources ProjectHuman Resources Project 200,000200,000

Co-occurring DisordersCo-occurring Disorders 340,000340,000

Homeless ProgramsHomeless Programs 300,000300,000

COJAC SupportCOJAC Support 20,00020,000

DMH AdministrationDMH Administration 2.7M2.7M

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Planning Council Planning Council MandateMandate Review and comment on Block Grant Review and comment on Block Grant

application and implementation reportapplication and implementation report Advocate for persons with serious Advocate for persons with serious

mental illnesses and children with mental illnesses and children with serious emotional disturbancesserious emotional disturbances

Monitor, review, and evaluate not less Monitor, review, and evaluate not less than once each year, the allocation than once each year, the allocation and adequacy of mental health and adequacy of mental health services in the Stateservices in the State

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Peer Review MandatePeer Review Mandate

Title XIX, Part B, Subpart ITitle XIX, Part B, Subpart I Section 1943, Additional RequirementsSection 1943, Additional Requirements In general – A funding agreement for a grant In general – A funding agreement for a grant

under section 1911 or 1921 is that the State under section 1911 or 1921 is that the State involved will involved will – (A) For the fiscal year for which the grant involved (A) For the fiscal year for which the grant involved

is provided, provide for an independent peer is provided, provide for an independent peer review to assess the quality, appropriateness, and review to assess the quality, appropriateness, and efficacy of treatment services provided in the State efficacy of treatment services provided in the State to individuals under the program involved; andto individuals under the program involved; and

– (B) Ensure that, in the conduct of such peer review, (B) Ensure that, in the conduct of such peer review, not fewer than 5 percent of the entities providing not fewer than 5 percent of the entities providing services in the State under such program are services in the State under such program are reviewed (which 5 percent is representative of the reviewed (which 5 percent is representative of the total population of such entities);total population of such entities);

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Peer ReviewsPeer Reviews

Peer reviews have not been Peer reviews have not been conducted since 2004conducted since 2004

DMH has asked the Planning DMH has asked the Planning Council to conduct these reviewsCouncil to conduct these reviews

The Executive Committee The Executive Committee authorized the Quality authorized the Quality Improvement Committee to Improvement Committee to implement this projectimplement this project

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Memorandum of Memorandum of Understanding (MOU)Understanding (MOU) MOU being negotiated MOU being negotiated

with DMH regarding with DMH regarding the conduct of these the conduct of these peer reviewspeer reviews

DMH to provide DMH to provide applicationsapplications

Review written reports Review written reports and commentand comment

Develop corrective Develop corrective action plans, if neededaction plans, if needed

Provide travel fundsProvide travel funds

CMHPC to comply CMHPC to comply with federal statutewith federal statute

Develop protocolDevelop protocol Conduct site visitConduct site visit Provide written Provide written

report within 90 report within 90 daysdays

Have county make Have county make presentation at QIC presentation at QIC meetingmeeting

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Peer Review TeamPeer Review Team

One consumerOne consumer One family memberOne family member One provider/professional or One provider/professional or

consumer related advocateconsumer related advocate 2 Planning Council staff2 Planning Council staff 1 county mental health 1 county mental health

department quality improvement department quality improvement staff personstaff person

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Site Review AgendaSite Review Agenda

Team MeetingTeam Meeting Entrance Entrance

ConferenceConference One program One program

review in the review in the morningmorning

One program One program review in the review in the afternoonafternoon

Team meeting in Team meeting in the morning to the morning to develop findingsdevelop findings

Exit conferenceExit conference

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Review ProtocolReview Protocol

Have there been any revisions to the Have there been any revisions to the program description? If so please describe. program description? If so please describe.

What staff are providing services? Please What staff are providing services? Please specify in full time equivalent positions.specify in full time equivalent positions.

How does the program serve the target How does the program serve the target population; e.g., Children and Youth, population; e.g., Children and Youth, Transition Age Youth, Adults, and Older Transition Age Youth, Adults, and Older Adults.? Please specify the number of Adults.? Please specify the number of clients served.clients served.

What collaborative efforts with other What collaborative efforts with other County programs have been undertaken County programs have been undertaken with CMHS-funded services?with CMHS-funded services?

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Review ProtocolReview Protocol Are the approved measurable objectives being Are the approved measurable objectives being

met? What progress has there been towards met? What progress has there been towards meeting the approved program objectives? If meeting the approved program objectives? If there are problems, what has been or needs there are problems, what has been or needs to be done to resolve the issue?to be done to resolve the issue?

What are the results of the program What are the results of the program evaluation as described in the approved evaluation as described in the approved application? If a problem was identified, what application? If a problem was identified, what action was planned or taken to resolve it?action was planned or taken to resolve it?

Does this program have a role in reducing Does this program have a role in reducing racial/ethnic/cultural disparities in your racial/ethnic/cultural disparities in your county?county?

What barriers have you encountered? What What barriers have you encountered? What means have been used to eliminate any means have been used to eliminate any identified barriers?identified barriers?

What special gains or service reforms have What special gains or service reforms have occurred as a direct result of the County’s occurred as a direct result of the County’s SAMSHA grant program?SAMSHA grant program?

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Client Focus GroupClient Focus Group

What part of this program do you What part of this program do you think is the most helpful to you? think is the most helpful to you?

How involved are you in helping to How involved are you in helping to develop your treatment plan and develop your treatment plan and setting your goals?setting your goals?

What goals are most important for What goals are most important for you, and how do your services help you, and how do your services help you get there?you get there?

How is this program helping you How is this program helping you “recover” from the problems that “recover” from the problems that brought you here? brought you here?

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Client Focus GroupClient Focus Group

Do you consider yourself to be a part Do you consider yourself to be a part of a certain culture, such as ethnicity, of a certain culture, such as ethnicity, age, or religion? Is the staff respectful age, or religion? Is the staff respectful of this when they talk to you or assist of this when they talk to you or assist you in your plans?you in your plans?

Are you receiving community-Are you receiving community-supported services in preparing you supported services in preparing you for transition to independent living; for transition to independent living; e.g. employment, housing, education?e.g. employment, housing, education?

What do you recommend for What do you recommend for improving services here?improving services here?

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Staff Focus GroupStaff Focus Group Please tell us about the program.Please tell us about the program. How is the How is the

program staffed? Who is served? How are potential program staffed? Who is served? How are potential consumers identified? How is assessment consumers identified? How is assessment conducted? How do you develop treatment plans? conducted? How do you develop treatment plans? What services do you provide?What services do you provide?

What are the program’s strengths/successes and What are the program’s strengths/successes and what are the program’s challenges?what are the program’s challenges? From the From the perspective of management? Supervisor? Line staff?perspective of management? Supervisor? Line staff?

What interagency involvement is there?What interagency involvement is there? How How successful is collaboration? What strategies are successful is collaboration? What strategies are used to facilitate collaboration? Management? Line used to facilitate collaboration? Management? Line staff?staff?

How are staff trained?How are staff trained? Is there any training Is there any training regarding specific treatment approaches or regarding specific treatment approaches or treatment philosophy? What kind of training is treatment philosophy? What kind of training is provided regarding Cultural competency? How is provided regarding Cultural competency? How is Cultural Competency training incorporated into Cultural Competency training incorporated into service delivery? Do staff receive any specific service delivery? Do staff receive any specific training on Recovery principles? Describe. How are training on Recovery principles? Describe. How are Recovery principles incorporated into service Recovery principles incorporated into service delivery?delivery?

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Staff Focus GroupStaff Focus Group

What does success look like for the program’s What does success look like for the program’s consumers?consumers? Please provide some examples. Please provide some examples. What are the greatest challenges for obtaining What are the greatest challenges for obtaining this success? What are the programs greatest this success? What are the programs greatest strengths in helping consumers succeed?strengths in helping consumers succeed?

If we asked consumers what they thought If we asked consumers what they thought about the program, what would they tell us?about the program, what would they tell us? What would be the program’s greatest What would be the program’s greatest challenges from their perspective? What would challenges from their perspective? What would be the program’s greatest strengths? If we be the program’s greatest strengths? If we talked to consumers, what would they say talked to consumers, what would they say about cultural competency? About the focus on about cultural competency? About the focus on recovery?recovery?

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Assistance from Assistance from Planning Council Planning Council MembersMembers Peer reviews will be conducted in Peer reviews will be conducted in

February/March, August/September, February/March, August/September, November/DecemberNovember/December

Quality Improvement Committee does Quality Improvement Committee does not have sufficient members to staff all not have sufficient members to staff all the peer reviewsthe peer reviews

Will be asking for volunteers from Will be asking for volunteers from Planning Council to participate in Planning Council to participate in reviewsreviews