SAN DIEGO COUNTY: DATA NOTEBOOK 2014FOR CALIFORNIA

MENTAL HEALTH BOARDS AND COMMISSIONS

Prepared by California Mental Health Planning Council, in collaboration with: California Association of Mental Health Boards/Commissions, and APS Healthcare/EQRO

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Date: April 20, 2014

To: Chairpersons and/or Directors

Local Mental Health Boards and Commissions

From: California Mental Health Planning Council

Subject: Instructions for Data Notebook 2014

We ask that this report be prepared by the MH Board or Commission members. You are the most important resources for identifying program strengths and needs in your community.

On the first page , please fill in the requested information for your county websites:

Department of Behavioral Health/ Mental Health Public reports about your county’s MH services.

Please send a copy of the filled-in first page to the Planning Council along with your final report which contains your answers to the questions in the Data Notebook. Please submit your report within 60 days by email to:

DataNotebook@cmhpc.ca.gov.

Or, you may mail a printed copy of your report to:

Data Notebook Project California Mental Health Planning Council 1501 Capitol Avenue, MS 2706 P.O. Box 997413 Sacramento, CA 95899-7413

Please examine the enclosed information, which will help you discuss the questions in the Data Notebook. We provide examples of recent mental health data for your county. In some figures, the term “MHP” is used to refer to your county’s Mental Health Plan.

Some data comes from APS Healthcare/EQRO, which gave permission to use their figures and tables, prepared for review of each county’s Medi-Cal Specialty Mental Health services. Data in this packet came from the following review cycle:

Fiscal Year 2013 -- 2014: http://caeqro.com/webx/.ee85675/

X Fiscal Year 2012 -- 2013: http://caeqro.com/webx/.ee851c3/

For some questions, you will need to consult your local county Quality Improvement Coordinator, and/or Mental Health Director. If you are not able to address all of the questions, just answer the ones you can.

Thank you for your participation in the Data Notebook Project.

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SAN DIEGO COUNTY: DATA NOTEBOOK 2014FOR CALIFORNIA

MENTAL HEALTH BOARDS AND COMMISSIONSCounty Name: San Diego Population (2013): 3,182,072

Website for County Department of Mental Health (MH) or Behavioral Health:

http://www.sdcounty.ca.gov/hhsa

Website for Local County MH Data and Reports:

http://www.sdcounty.ca.gov/hhsa/programs/bhs/mental_health_services_act/tech nical_resource_library.html

Website for local MH Board/Commission Meeting Announcements and Reports:

sandiego.networkofcare.org/mh/content.aspx?id

Specialty MH Data from review Year 2013-2014: http://caeqro.com/webx/.ee85675

Total number of persons receiving Medi-Cal in your county (2012): 573,554

Average number Medi-Cal eligible persons per month: 455,828

Percent of Medi-Cal eligible persons who were:

Children, ages 0-17: 47.7 %

Adults, ages 18-59: 36.4 % Adults,

Ages 60 and Over: 15.9 %

Total persons with SMI1 or SED2 who received Specialty MH services (2012): 31,509

Percent of Specialty MH service recipients who were:

Children 0-17: 41.1 %

Adults 18-59: 50.9 %

Adults 60 and Over: 8.0 %

1 Serious Mental Illness, term used for adults 18 and older.

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2 Severe Emotional Disorder, term used for children 17 and under.

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INTRODUCTION: Purpose, Goals, and Data Resources

This Data Notebook has been developed for the use by the local mental health (MH) boards and commissions by a yearlong workgroup comprised of members from:

California Mental Health Planning Council (CMHPC) California Association of Local Mental Health Boards and Commissions

(CALMHB/C) APS Healthcare/ EQRO (External Quality Review Organization)

Our plan is for the Data Notebook to meet these goals:

assist local boards to meet their mandates to review the local county mental health systems, identify unmet needs, and recommend improvements.

provide a professional format for submitting reports to their local Board of Supervisors, and/or their county Director of Mental Health Services.

function as an educational tool for local boards, whose members have varying levels of skills, frequent turnover, and need ‘refresher’ training about using data.

help the CMHPC fulfill its mandates to review and report on the public mental health system in California, which also helps provide evidence for advocacy.

Data reporting drives policy, and policy drives funding for programs. But the data must be both recent and available to the public, or else it is not useful. So, the CMHPC will provide examples of local data from current public reports. We focus on two broad areas: (1) evaluation of program performance, and (2) indicators of client outcomes.

We recognize that each county has a unique population, resources, strengths, and needs. Thus, there is no single perfect data source to answer all the important questions one might ask about mental health services. However, the following data resources will help board members answer questions in this Data Notebook:

experience and opinions of the local mental health board members recent reports about county MH programs from APS Healthcare/EQRO data you request from your county QI Coordinator and/or Mental Health Director

(because CMHPC does not have that data, and it’s not in other public reports) client outcomes data provided by California Institute of Mental Health (CiMH) in

their analysis of the most recent Consumer Perception Survey.

Some of our data comes from APS Healthcare/EQRO, which kindly gave permission to use their figures and tables, prepared for review of each county’s Medi-Cal Specialty Mental Health services. Those reviews are at: www.CAEQRO.com. You may find the full-length EQRO reports helpful because they summarize key programs and quality improvement efforts for each county. They also describe strengths, opportunities for improvement, and changes in mental health programs since the last year.

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Understanding changes in local programs can help consumers because of the massive re-organization of mental health services statewide. Some changes have been confusing to clients. The old state Department of Mental Health was eliminated in 2012 and many functions were moved to the Department of Health Care Services. Other changes due to federal health care reform and the Affordable Care Act affect how mental health services are provided, funded, and linked to primary health care or substance use treatment. Also, local counties have adjusted to major challenges.

Remember, this report is about your community, and what you and your stakeholders choose to discuss. Examining the data can indeed “Tell a Human Story.” But quantitative data (numbers) provides only part of the picture, for example:

measures of whether the quality of program services improve over time whether more people from different groups are receiving services how many clients got physical healthcare or needed substance use treatment.

The other part of the story gives human context to the numbers. Such qualitative data (narrative, descriptions, or stories) tells more of the story, because we can:

describe special programs targeted for outreach to specific groups examine how the programs are actually implementing their goals list concrete steps that are taken to improve services, and tell what is being done to increase client engagement with continued treatment.

We hope this project contributes to ongoing quality improvement (QI) in mental health services. We seek constant improvement in our approach to quality because:

needs change over time, all human endeavors are by nature imperfect, creativity gives rise to new ideas, and we can share examples of successful programs to help other communities.

One question is whether local boards are permitted to provide additional information, besides that requested in this Notebook. We always welcome supplemental reports about successful projects, or which the county administration uses to inform the public. Any additional reports may be attached in an “Appendix,” with the website address (if available). However, we emphasize such extra reports are not required.

Thank you for participating in this project. We hope this Data Notebook serves as a springboard for your discussion about all areas of the mental health system, not just those topics highlighted by our questions.

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TREATING THE WHOLE PERSON:

Integrating Behavioral and Physical Health Care

Studies have shown that individuals with serious mental illness die, on average, 25 years earlier than the general population. This information makes improving the physical health of clients of great importance and should be a goal of county mental health departments along with providing effective and appropriate mental health services. Coordination of care for mental health, substance abuse and physical health is one way of accomplishing the goal.

The California Mental Health Planning Council does not have any data to provide to show how your county’s programs connect clients of mental health services with necessary physical health care. We ask that the local mental health board request information from your county mental health department for any data on numbers (or percent) of total mental health clients who are referred to, or connected with, physical health providers to assess, treat and monitor physical health issues.

If your county has data on numbers or percentages of clients who are also receiving physical health care, please include it in your Data Notebook you submit to the Council.

Check here if your county does not have such data or information.

1) Please describe any efforts in your county to improve the physical health of clients.

Programs refer discharged clients to Primary Care or other physical health clinics and report on this in their Monthly Wait Times Reports. See Attachment 1 - Adults Discharged Clients Referred to Primary Care Report.

In addition, San Diego County Health and Human Services Behavioral Health Division has put forth several initiatives focused on improving the health of San Diego County residents, such as:

Innovations Physical Health Integration Project – I-CARE is an integrated mental and physical health program implemented in San Diego. The focus of I-CARE is to enhance mental and physical wellness through a holistic and collaborative continuum of care between primary and mental health clinics.

Originally, three Family Health Centers of San Diego (FHC) were chosen as I-CARE program sites to serve as “person-centered medical homes” (PCMH) for persons with severe mental illness (SMI) who have reached a certain level of stability. Two additional FHC sites and one additional community mental health program were added later.Since the program’s implementation in March 2011, 125 participants have been enrolled

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in the I-CARE program across these five FHC sites. See Attachment 2 – Icare Innovations Report – January 13.

SAN DIEGO COUNTY INITIATIVES – UCSD’s Health Services Research Center (HSRC) conducted an evaluation of physical and mental health in San Diego County, focusing on barriers to physical health for adults and older adults.

With modifiable problems affecting this population so severely, San Diego County Behavioral Health Services is responding with two initiatives to address the problem:

Integrating mental health and physical health services Providing new program services to address physical health issues.

HSRC is working closely with SDBHS to evaluate the feasibility and effectiveness of these changes. See Attachment 3 – Evaluation of Physical and Mental Health in San Diego County.

Care Coordination – towards the end of Fiscal Year 12-13, BHS implemented the requirement for care coordination for all County and contracted providers.

Coordination of care between behavioral health care providers and physical health care providers is necessary to optimize the overall health of a client. Behavioral Health Services (BHS) values and expects coordination of care with health care providers, linkage of clients to medical homes, acquisition of primary care provider (PCP) information and the entry of all information into the client’s behavioral health record.With healthcare reform, BHS providers shall further strengthen integration efforts by improving care coordination with primary care providers. Requesting client/guardian authorization to exchange information with primary care providers is mandatory, and upon authorization, communicating with primary care providers is required. County providers shall utilize the Coordination and/or Referral of Physical & Behavioral Health Form & Update Form, while contracted providers may obtain legal counsel to determine the format to exchange the required information. See Attachment 4 – Care Coordination Form.

BHS also contracts with Council of Community Clinics. The Council is comprised of 16 member community clinics and health center corporations in more than 100 sites throughout San Diego, Imperial, and Riverside Counties, including 10 Federally Qualified Health Centers, Four Indian Health Centers, two other member clinic organizations (Planned Parenthood and Operation Samahan).

In 2012, the clinics served 719,585 patients and had more than two million encounters. More than half of the clients were between the ages of 20 and 64 (60.7%). While nearly three quarters of all clients were white (74.3%), 4.7% of the clients were African American.

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In Fiscal Year (FY) 2012-13, the Council of Community Clinics served 200 unique BHS clients. The clients were seen for two behavioral health conditions - Depression Disorders (60%) and Other Depression/Adjustment Disorders (40%). The African American client population comprised 5% (or 9 clients), but the majority of the clients served were Hispanic (55%). More than three quarters of the clients were between the ages of 25 and 59 (82%). Almost all clients (97%), with a total of 322 visits, received medication treatment along with case management, therapy, and rehabilitative services.

2) How does your county address wellness programs to engage and motivate clients to take charge of improving their physical health?

Examples:

Exercise Nutrition Healthy cooking Stress management Quitting smoking Managing chronic disease Maintaining social connectedness

On July 13, 2010 the County of San Diego Board of Supervisors adopted the “Live Well, San Diego!” Campaign, a 10 year strategy to improve the health and wellness of the San Diego Region. The ultimate goal of “Live Well, San Diego!” is to achieve the vision of a healthy, safe and thriving San Diego County. A primary goal of the campaign is to increase awareness and access to health-related services for San Diego Residents.

Why was the “Live Well, San Diego!” initiative needed? While San Diego County has many assets—a great climate, a diverse economy, and world renowned educational and research institutions—the region also faces significant challenges. A surge in chronic disease, rising health care costs and increased demands on healthcare delivery systems, coupled with a volatile economic climate, prompted the County of San Diego to take action through the Building Better Health agenda.

Achieving the vision of health, safety and well-being for all residents has required that the County go beyond what many would consider the typical scope of government. The County is re-thinking its approach to day-to-day work; redefining the role that the entire County enterprise plays as a steward of health, safety and well-being; and measuring how these new approaches and roles have been successful. “Live Well San Diego!” encompasses community engagement on all levels. It starts with individuals and families who are leading efforts to be healthy and safe and grows through County support of community action by convening community groups, programming activities, and leveraging funds. Collaborations with public service organizations and businesses give residents easier access to the services they need, and community partners help

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to

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expand Live Well San Diego’s impact throughout the county. See Attachment 5 – “Live Well, San Diego!” flyer and Attachment 6 – “Live Well, San Diego” Annual Report.

For more information on “Live Well, San Diego!” please use the link below:

http://www.sdcounty.ca.gov/hhsa/programs/sd/live_well_san_diego/index.html .

BHS also introduced two Mental Health Services Act Innovation Projects in 2013:

INN-01 Wellness and Self-Regulation for Children and Youth Evaluation and INN-03 Physical Health Integration Project Evaluation (ICARE) (see 1. above).

The Wellness and Self-Regulation for Children and Youth Innovations Project is an MHSA funded program. It was awarded to both New Alternatives Inc. for adolescents, ages 12 to 18 in the Residential Care Levels (RCLs) 12 and 14, and to San Diego Center for Children for children ages 6 to 13 years of age. The goal of this program was to address the specific physical, emotional, and relational challenges faced by these children and youth. Given their circumstances, these children and youth are more likely to face health challenges such as obesity, diabetes, depression, anxiety, post-traumatic stress, and other life challenges.

The Wellness and Self-Regulation Program offered these youth an array of alternative, holistic interventions to produce a positive impact on their mental and physical health. These alternative treatment strategies focused on teaching youth multiple ways to reregulate functioning in areas such as arousal level, mood, physical health, mental health, social functioning, sleeping patterns, eating habits, family wellness, frustration management, and sense of self. See Attachment 7 - Mental Health Services Act Innovations Projects - Evaluation 2013.

ICARE (Integrated Care Resources) is an innovation pilot designed to create person- centered medical homes for individuals with serious mental illness (SMI) in a primary care setting and is covered in detail in section 1. above.

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NEW CLIENTS: One Measure of Access

One way to evaluate the quality of mental health services outreach is to measure how many clients receive services who have never been part of the service system before (“brand new” clients). Another measure is how many clients return for services after a period of time with no services (“new” clients).

The California Mental Health Planning Council is exploring how each county mental health department defines “new” clients, and how a client is labelled when they returnfor additional services. This information is important in determining whether your county has a “revolving door,” that is, clients who are in and out of mental health services repeatedly. This data is one indicator of the success of your county’s programs in closing cases appropriately and providing adequate discharge planning to clients.

This data is not currently reported by the counties to the state. The Council does not have data to provide to you. This information should be requested from your county mental health department.

X Check here if your county does not have this information.

3. How does your county define 'new' client for those individuals who have previously received services, but who have not received services for a while? (e.g., 6 months, 12 months, 2 years)

Although San Diego County does not distinguish between new clients and brand new clients, BHS does track recidivism, penetration and retention.

4. Please provide any data your county has on the number of 'new' clients last year. And if you have it, how many of those new clients were brand new clients? You may need to ask your county mental health department forthis data.

# new children/youth (0-17 yrs) N/A

of these, how many (or %) are ‘brand new’ clients

# new adults (18-59 yrs)

of these, how many (or %) are ‘brand new’ clients

# new older adults (60+ yrs)

of these, how many (or %) are ‘brand new’ clients

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REDUCING RE-HOSPITALIZATION: Access to Follow-up Care

Sometimes, an individual experiences acute symptoms of mental illness or substance abuse which can result in a brief stay in an acute care hospital. Receiving follow-up services after discharge from a short-term (3-14 day) hospitalization can be critical to preventing a return to the hospital.

The chart below shows the percentage of people discharged in your county who received at least one service within 7 days of discharge. Also shown is the percentage of those same people who were readmitted to the hospital. The chart also shows the same information for receiving services and being readmitted to the hospital within 30 days. Red indicates the numbers for your county and the blue indicates the percentage for the state of California .

San Diego County:

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6. Looking at the chart, is your county doing better or worse than the state? Discuss why (e.g., your county has programming available that specifically ensures a warm handoff for follow-up services).

Looking at the provided chart, San Diego County is slightly higher at 43% than the State at 40% in Outpatient Services received within 7 days, and is equal to the State in Outpatient Services received within 30 days.

For readmission to inpatient, San Diego County’s percentage is slightly lower at 6% vs. the State’s 8% for readmission within 7 days, and at 17% vs. the State’s 18% for readmission within 30 days.

San Diego County has several programs in place to promote support and assistance to clients such as:

UCSD Bridge to Recovery – a co-occurring disorders program.

Bridge to Recovery is Prevention and Early Intervention (PEI) Program, funded for 5 years by MHSA dollars, administered through San Diego County Alcohol and Drug Services.

Staff consists of 8 full-time Masters-level Clinicians and 8 full-time Community Health Representatives (Peer/Recovery Specialists) certified in addiction counseling.

They provide SBIRT (Screening, Brief Intervention and Referral to Treatment) services to identify and assist those with substance use and/or other addiction problems. They also provide case management services to help stabilize the patient and link them with treatment when appropriate.

Bridge to Recovery’s goal is to target patients who come to SDCPH and have substance-related issues.

HOPE Connections - A Partnership: MHS, Inc., NAMI and Union of Pan Asian Communities (UPAC).

The program’s mission is to utilize Peer and Family Specialists to provide supportive services to reduce psychiatric hospitalizations, decrease stigma of mental illness, foster independence and decision making for clients as they navigate the system, educate and support clients, families, and the community to improve access to care and increase utilization of resources

Since the program began in the fall of 2011, HOPE Connections has served 6212clients.

HOPE Connections Staff consists of Peer Specialists, Family Specialists, Registered Nurses and Licensed Clinicians. They have Hospital Teams and Community Teams.

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Hospital Team - Staff includes Peer and Family Specialists, RNs, a Clinician and Agency Supervisors. A HOPE Specialist is present in SDCPH up to 16 hours a day 365 days/year, works in the Emergency Psychiatric Unit (EPU) and on the Crisis Recovery Units (CRUs) with clients and families.

Community Team - Staff include Peer and Family Specialists, Community RN and Agency Supervisors and they work with clients after discharge from SDCPH and accepts referrals from 3 county MH clinics (ECMH, SEMH, and NCMH).

Community Teams are stationed at 4 MH clinics during walk-in hours - East County, Southeast, North Central, and Heartland

7. Do you have any suggestions on how your county can improve follow-up and reduce re-hospitalizations?

This was the topic of last year’s (FY 13-14) Clinical Performance Improvement Project.

Stakeholders in the Readmissions Workgroup brainstormed unseen causes of readmission, data elements to consider, and “low-hanging fruit” (the simplest types of interventions that can have a positive effect on reducing readmissions). See Attachment 8 - Readmission Workgroup Themes Final Updated.

Stakeholders in the Readmissions Workgroup saw presentations by representatives of 6 programs that work to reduce readmissions and/or connect clients to services and facilitate their transition to living outside of inpatient care. See Attachment 9 - Readmission Article and Presentation Review Grid, and compiled a document summarizing best practices for reducing readmissions (see Best Practices below) and shared this document with the stakeholders in the Readmissions Workgroup.

Best Practices -- Commonalities Through Multiple Programs That Help Clients With Transitions / Bridges to Care:

Support From Peers With Lived Experience: Programs found that peer/family specialists could often engage with clients and influence them to change behaviors (such as improve self-care, and connect with services) in a way that some clinicians have failed to. This is because peer/family specialists can relate to clients, and provide a good example of someone who has experienced BH issues and recovered successfully.

Connection To Services: Programs help clients with scheduling follow-up appointments. This can include making the calls with the client, and explaining to providers of services that a long wait for a follow up appointment is not acceptable because the client needs to be seen within a week after discharge. Programs help clients with connecting to services for basic needs such as food, shelter, employment, education, medication, and socialization (such as clubhouses).

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Coaching and Social Support: Programs help clients by teaching wellness self- management skills. This can include knowledge of red flags that indicate it is important to seek BH services before a crisis begins or escalates. It can also include knowing how and when to take one's medication. Many programs have identified empowering clients as an important value. This can include helping the client to develop a Wellness Recovery Action Plan (WRAP) or similar goals and strategies for accomplishing these goals.

Engaging Support Systems: If the client consents, a program can interact with their family or other designated loved ones in order to coach them on how to be supportive during the period of transitioning from inpatient care to outpatient. This can include helping the client with medication compliance. Clubhouses and peer support coaches themselves can also be a helpful part of the client's social support system.

Connecting With Homeless Clients: It can be a challenge to remain in contact with a client who does not have a consistent address or telephone number. Programs work proactively to keep in touch with these clients so that they do not slip through the cracks. This can include going to the area where the client usually sleeps or spends time, and some programs have also found that giving clients cell phones helped with maintaining contact. Also, programs have helped clients to apply for housing services, or to connect with shelters or crisis residential facilities.

Connecting With Appropriate (and Less Expensive) Services: Programs aim to connect clients with outpatient services so that they can be stable and live successfully outside of inpatient care. This helps the client to recover more smoothly -- focusing on recovery rather than merely on responding to crises. A smooth recovery process with outpatient services reduces the incidence of crises and makes crises more manageable. In addition to serving the clients' recovery better, this model also saves money because less expensive services are being utilized.

In addition, we will continue to build close relationships with hospitals, and work on enhancing data tracking to identify trends.

Our focus in the upcoming fiscal year is on connecting to services – a new Performance Improvement Project (PIP).

8. What are the three most significant barriers to service access? Examples:

Transportation Child care Language barriers or lack of interpreters Specific cultural issues Too few child or adult therapists Lack of psychiatrists or tele-psychiatry services Delays in service Restrictive time window to schedule an appointment

Hours of interpreter services in FY 12-13164

542 4821,383

1,3367,726

2,310

3,975

Spanish *Arabic * Vietnamese * Cambodian LaotianFarsiTagalog *All Others (31 total)

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Language Barriers are present in the system as evidenced by use of interpreters. There is a shortage of bi-lingual staff in the workforce, thus BHS relies on interpreter services.

Any additional barriers to note?

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ACCESS BY UNSERVED AND UNDER-SERVED COMMUNITIES

One goal of the Mental Health Services Act (MHSA) is to reach unserved and underserved communities, especially communities of color. The MHSA promotes outreach to engage these communities in services. If individuals and families in these communities are not accessing services, then we may need to explore new ways of reaching them. Or, we may need to change our programs to meet their mental health needs in ways that better complement their culture.

From data the counties report to the state, we can see how many individuals living in your county are eligible for Medi-Cal, and of those individuals, how many received mental health services. Are you serving the Medi-Cal clients who need your services?

San Diego County Data:

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9. Is there a big difference between the race/ethnicity breakdown on the two charts? Do you feel that the group(s) that need services in your county are receiving services?

There isn’t a huge difference between the two charts. Looking at the table below it appears that for the most part the groups that need services in our county are receiving them, with the exception of Hispanic and Asian/Pacific Islander clients who are being underserved according to the data.

Unduplicated Eligibles Beneficiaries ServedWhite 20.72% 37.38%Hispanic 49.11% 34.05%African American 8.70% 12.97%Asian/Pacific Islander 9.00% 5.99%Native American 0.41% 0.76%Other 12.05% 8.85%

10. What outreach efforts are being made to reach minority groups in your community?

The Council of Community Clinics and its subsidiaries represent and support community clinics and health centers in their efforts to provide access to quality health care and related services for the diverse communities they serve with an emphasis on low income and uninsured populations.

Its 16-member community clinics provide care to 1 in 6 San Diegans. San Diego has the eighth largest Hispanic population in the nation, is home to 17 Indian tribes, as well as a distinct Vietnamese, Filipino, Korean, and Somali communities. The County of San Diego does not operate a public hospital or public clinics; therefore, the private, nonprofit community clinics and health centers are the safety net for primary care services for San Diego’s low-income and uninsured.

The Council of Community Clinics and its subsidiaries will be the common voice for community clinics and health centers by building and strengthening relationships with strategic public and private partners resulting in sustainable resources and healthier communities.

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11. Do you have suggestions for improving outreach to and/or programs for underserved groups?

Current strategies San Diego County is implementing to improve outreach to underserved communities include:

Revision of our wait times tracking methodology to include wait times information by ethnicity and language preference among other categories. This revision is currently underway and will be rolled out mid FY 14-15.

Outreach to faith based communities - A faith based initiative began in February 2013. A consultant was hired in April 2013 to help BHS reach the faith community and bring them to the table with planning two breakfast forums, one in the Central Region in October, 2013 and one in the North Inland Region in November, 2013.

Over 150 participants participated in each breakfast, which included individuals from faith based communities, BHS programs, advocates, consumer and family members, community stakeholders, advocates and non-profit organizations.

BHS will prepare an event compendium that will be released electronically and in hard copy. It will include information from the four themes identified at both breakfasts, and will be used as a road map for next steps.

Trauma Informed Care (source – EQRO Binder – MHP List of Significant Changes) – BHS contracted with Dr. Dawn Griffin as a consultant to facilitate the implementation of recommendations in BHS and across the Health and Human Services Agency.

BHS’ Southeast Mental Health Clinic is involved in the year-long pilot project with the National Council 2013 Trauma-Informed Care Learning Community.

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CLIENT ENGAGEMENT IN SERVICES

One MHSA goal is to connect individuals to services they need to be successful. Clients who stop services too soon may not achieve much improvement, nor is it likely to last. So it is important to measure not only who comes in for treatment, but also how long they stay in services. Here we are considering individuals with high service needs,not someone who just needs a ‘tune-up.’ Although not every individual needs the same amount of services, research shows that when someone with severe mental illness continues to receive services over time, their chances of recovery increase.

Engagement in services, also called ‘retention rate’, is important to review. If individuals come in, receive only one or two services and never come back, it may mean the services were not appropriate, or that the individual did not feel welcome, or some other reason that should be explored. Again, we recognize that some individuals only need minimal services, but here we are looking at those with severe mental illness.Ultimately, the goal is to ensure they are getting needed services and are on the road to recovery. But we would not know that unless we look at how many services individuals received over time.

The chart below shows the number of Medi-Cal beneficiaries in your county who received 1, or 2, or 3, or 4, or 5, or more than 15 mental health services during the year. For individuals experiencing severe mental illness, the more engaged they are in services, the greater the chance for lasting improvements in mental health.

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12. Do you think your county is doing a good job at keeping clients engaged in services? If yes, how? If not, why?

Based on the data provided, San Diego County’s MHP Medi-Cal Services retention rates are comparable to the State percentages. 70% of clients received 5 or more services, with 33% receiving more than 15 services.

13. For those clients receiving less than 5 services, what is your county doing to follow-up and re-engage those individuals for further mental health services?

This topic is included in one of the FY14-15 Performance Improvement Projects (PIP). The goal is to look at ways to expand efforts to provide effective follow up care after discharge of clients and adopting policies and procedures that best match clients to follow-up services that begin at or near the time of discharge

Pre-discharge assessment of risk at admission and risk acquired during treatment.

Risk assessment to inform the discharge decision

Identify sources of support and willingness and ability to provide support.

Give patient and family instruction on suicide risk at discharge and thereafter.

Give instruction on accessing crisis intervention and other sources of help.

Follow-up with patients after discharge

Supports and services in place after discharge

Other resources that will be discussed are:

Preparation of personal suicide prevention of safety plans at discharge.

The availability of peer-run warm lines for use by newly discharged consumers.

Access to therapies that have demonstrated suicide prevention potential (e.g., Cognitive Behavioral Therapy).

Peer-led or co-led support groups for those who have made suicide attempts or had an acute episode of suicidality.

Training peer specialists as “gatekeepers” to identify possible warning signs of suicide in other consumers.

14. Looking at the previous chart of who is being served by race/ethnicity in your county, do you have any thoughts or ideas to share regarding your county’s engagement of underserved communities?

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San Diego County BHS implements a multitude of programs targeted to ethnically diverse populations such as outreach to faith based communities, and Trauma Informed Care, as noted in item 11.

CLIENT OUTCOMES: Consumer Perception Survey (August 2013)

Ultimately, the reason we provide mental health services is to help individuals manage their mental illness and to lead productive lives. We have selected two questions from the Consumer Perception Survey which capture this intention. One question is geared toward adults of any age, and the other is for children and youth under 18.

Below is the data for the responses by clients in your county to these two questions.

The total numbers of surveys completed for Adults or Children/Youth in your county are shown separately in the tables below, under the heading “Total.”

No responses from your county for “Adults” were received by CiMH to this question. Therefore, we are supplying summary data for “Adults” for all “Large” counties, excluding L.A. county.

Q1. Adults. As a direct result of the services I received, I deal more effectively with daily problems.

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Total

Number of Responses

73 246 1,168 2,579 2,529 6,595

Percent of Responses

1.1 % 3.7 % 17.7 % 39.1 % 38.3 % 100.0 %

San Diego Results (Consumer Satisfaction Survey Results – Survey Period August 26- 30, 2013 attached):

Strongly Disagree

Strongly Agree

Number of ResponsesPercent of Responses

4.2% 79.8% 100%

For detailed survey results see Attachments 11 - CASRC_YSS Compliance August 2013 and Attachment 12 - HSRC_Overall State Survey Report – August 2013.

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Q2. Children/Youth. As a result of services my child and/or family received, my child is better at handling daily life.

The following data are from San Diego county.

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Total

Number of Responses

43 107 556 1216 755 2,677

Percent of Responses

1.6 % 4.0 % 20.8 % 45.4 % 28.2 % 100.0 %

15. Is the data consistent with your perception of the effectiveness of mental health services in your county?

Yes, as the survey demonstrates that 70% of clients agree or strongly agree that appropriate services are being provided.

16. Do you have any recommendations for improving effectiveness of services?

Recommendations for improving effectiveness of services are enhanced communication to BHS community stake holders, and enhanced collaboration with contractors to ensure seamless services for clients.

17. Many counties experience very low numbers of surveys completed. Do you have suggestions to increase the response rate?

We make an extensive effort to communicate with providers by sending out emails with detailed instructions ahead of the survey, providing training for programs and any technical assistance needed.

Nearly 4000 survey forms were submitted for the August 2013 Youth Services Survey (YSS) (2,659 forms from care givers and 1318 forms from youth). More than 2800 of the forms were completed and had useable data (1881 forms from caregivers and 989 forms from youth). Overall, 72% of the forms that were turned in were completed.Reasons for non-completion include refusals, care giver not available (i.e. for a child in out-of-home care) and caregiver or child not showing up for a scheduled appointment.

18.Lastly, overall, with respect to delivery of services, do you have suggestions regarding any of the following:

a.Specific unmet needs or gaps in services

b.Improvements to, or better coordination of, existing services

c. New programs that need to be implemented to serve individuals in your county

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Attachments:

Attachment 1 Adults Discharged Clients Referred to Primary Care Report

Attachment 2 ICare Innovations Report – January 13

Attachment 3 Adult Physical Health Report – November 13

Attachment 4 Coordination of Care Form

Attachment 5 “Live Well, San Diego!” One Sheet Summary

Attachment 6 “Live Well, San Diego!” Annual Report 2013

Attachment 7 INN1 – Wellness and Self-Regulation

Attachment 8 Hospital Readmission Workgroup Causal Factors: Brainstorming Exercise

Attachment 9 Reducing Hospital Readmission Article and Presentation Review

Attachment 10 Readmission Best Practices

Attachment 11 CYF Satisfaction Survey August 13

Attachment 12 A/OA Satisfaction Survey August 13

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REMINDER:

Thank you for your participation in completing your Data Notebook report.

Please feel free to provide feedback or recommendations you may have to improve this project for the following year. We welcome your input.

Please submit your Data Notebook report by email to:

DataNotebook@CMHPC.CA.GOV

Or, you may submit a printed copy by postal mail to:

Data Notebook Project California Mental Health Planning Council 1501 Capitol Avenue, MS 2706 P.O. Box 997413 Sacramento, CA 95899-7413

For information, you may contact either email address above, or telephone:

(916) 449-5249, or

(916) 323-4501