MHSA Steering Committee

1
MHSASteering Committee
Health Care Agency/Behavioral Health Services

• April 6, 2009
• 1 p.m. 4 p.m.

2
Sharon Browning

• Welcome

3
Consumer Perspective

• Report on the CNMHC Client Forum February 20-22
• Theresa Boyd
• William Gonzalez

4
Mark Refowitz

• Local/State Updates

5
Technology Update

• Orange County Behavioral Health Service's path to
  an Electronic Health Record (EHR) has begun to
  be defined
• It is a two prong process
• Clinical Content Design and Definition of
  Methodology.
• Upgrade Network and System Infrastructure to
  support an EHR application.

6
Clinical Content Design

• We are performing our due diligence to design the
  best and most efficient clinical content and
  execution methodology to reflect Recovery
  oriented services and support compliance with
  Medi-Cal and Medicare billing standards
• An additional design consideration is to allow
  for outcome measures to be gathered from our
  clinical documentation
• To assist us in this effort we have hired an EHR
  Project Coordinator
• We are also part of a Statewide Coalition that is
  coming together to identify the best practices
  for treatment plans and other clinical
  documentation

7
Upgrade Network and System Infrastructure to
support an EHR application

• Existing systems and supporting applications are
  old and past end-of-life, and need to be upgraded
  to better support current technologies and to
  sustain the development and deployment of an
  integrated EHR system.
• MHSA funds will be needed to pay the Mental
  Health Plans proportional share of the servers
  and other hardware peripherals required for this
  upgrade.
• We will be back before the end of this Fiscal
  Year with a specific infrastructure upgrade plan.

8
Technology Stakeholder Process

• We will be forming two Advisory Committees to
  assist us with our efforts
• EHR Design Advisory Committee
• Its purpose will be to ensure our content is
  recovery oriented and that any IT expenditures
  support MHSA goals
• Outcome Measures Advisory Committee
• Its purpose will be to assist us in identifying
  meaningful outcome measures using the data
  currently available and data from the EHR in the
  future
• If you would like to participate in either of
  these Advisory committees, please provide your
  contact information to Kate Pavich at the break
  or after todays meeting

9
Rochelle Pierre

• MHSA Housing

10
Jenny Qian

• Prevention and Early Intervention (PEI) Update

11
PEI Plan Update

• PEI Plan approved unanimously by Oversight and
  Accountability Commission (OAC) on 3/26/09
• Orange County will fund 8 projects which includes
  a total of 33 programs

12
PEI Plan Update

• Current Procurement Plan
• Provider Preparation for PEI
• Principles and Trainings for PEI SIQ/RFP
• Prevention vs. Treatment

13
Kate Pavich

• MHSA Updates

14
MHSA Updates

• Spirituality Initiative
• California Conference on Mental Health and
  Spirituality - June 4, 2009
• To increase awareness of spirituality as a
  potential resource
• To encourage collaboration among
  faith-based/mental health groups, consumer and
  families in combating stigma and reducing
  disparities in access

15
California Strategic Plan on Reducing Mental
Health Stigma Discrimination - Public Workshop
- March 19, 2009

• Workshop was co-sponsored by the California
  Department of Mental Health and Orange County
  Health Care Agency
• Total of 92 attendees
• Solicited input on the draft
• Vision,
• Core Principles,
• Strategic Directions, and
• Recommended Actions for the 10-year California
  Strategic Plan on Reducing Mental Health Stigma
  and Discrimination

16
Recovery Arts Program

• April 16 MHSA Coordinators Regional Meeting
• May 21 Art Fair and Calendar Contest
• July 11 - August 23 Arts Festival

Such Great Heights by Theresa Boyd
17
Innovation Component

• Received notice of funding approval for
  2,893,800
• Funds will be used for community program
  planning.
• Information regarding stakeholder meetings will
  be released in April.

18
Capital FacilitiesProject Proposal

• The Capital Facilities Project Proposal was
  approved on March 12, 2009 by the Department of
  Mental Health for 18,300,125.
• These funds will be used for developing the
  Crisis Residential, Wellness/Peer Support Center,
  and the Education and Training Program at 401
  S. Tustin St., Orange CA.

19
401 S. Tustin Street
20
401 S. Tustin St. (Front View)
Education and Training Center
Crisis Residential
Wellness/Peer Support Center
21
401 S. Tustin St. (Rear View)
Education and Training Center
Wellness/Peer Support Center
Crisis Residential
22
Crate and Barrel Furniture

• Crate and Barrel has been featuring renewable
  woods and sustainable materials for a number of
  years.
• The majority of the upholstered sofas and chair
  frames are now certified sustainable by the
  Forest Stewardship Council (FSC).
• Since 2005, Crate and Barrel has worked closely
  with the Tropical Forest Trust (TFT) to ensure
  that certain hardwoods selected for furniture are
  from plantations that are responsibly and
  socially managed.

23
Crisis Residential Furniture
24
Maureen Robles

• Veteran Services

25
BUILDING BRIDGESFOR OUR VETERANS

• OC Health Care Agency
• Behavioral Health Services
• Caring for Orange County Veterans
• and their Families

26
How Many Vets Are We Talking About?

• Total US veteran (all wars) population as of
  September 2008
• Approx. 23.4 million
• Total Orange County veteran (all wars) population
  September 2008
• Approx. 148,915
• 5 of OCs population are veterans

27
How Many Female VetsAre We Talking About?

• US female veterans (all wars) number 1,802,491
• California has the highest number of female vets
  (all wars) at 166,984
• Orange County has the second highest
  female veteran (all wars) population at 9,638
  (Los Angeles has 30,590)
• Total registered female vets at Long Beach
  Veterans Administration (including LA vets)
  1,000

28
Now That You Are Home

• POST COMBAT ISSUES
• Transition combat stress
• PTSD
• Anger
• Depression
• Anxiety
• Self-medication with substances such as
  alcohol, medications and illegal drugs

29
Symptoms/Behaviors

• Symptoms can lead to behaviors such as
• Inability to concentrate at work/jobs
• Marital problems, domestic abuse, child abuse
• Substance abuse
• Legal problems (DUI, tickets, etc.)
• Inability to sleep
• Reckless driving
• Civil disturbances (bar fights, etc.)
• Apathy, inability to keep appointments

30
Symptoms/Behaviors

• Multiple deployments equals more depression,
  PTSD, alcohol use, etc.
• Army Reserve/National Guard and Marines have seen
  more combat in the current conflicts(OIF/OEF)
  and have more behavioral health issues
• Operation Iraqi Freedom/Operation Enduring
  Freedom (Afghanistan)

31
Whats the Problem?

• In 2007, 300,000 vets self-disclosed
  moderate levels of depression and anxiety
  at the 90-day PDHRA (post deployment health
  readiness assessment)
• Only 60 of those veterans registered at the
  Veterans Administration
• (PDHRA started in 2005. There are no stats on
  previous combat veterans)

32
Final Outcome

• Broken marriages
• Job loss
• Incarceration
• Homelessness
• Repeated hospitalizations
• Reliance on county/state/federal social-support
  programs
• Suicide
• Accidental death or severe medical issues

33
Final Outcome

• Veterans lose
• Families lose
• Society loses

34
Proposed Veterans Plan for BHS Primary Premise

• The Veterans Administration healthcare
  system is priority positioned to provide
  superior mental health outcomes for veterans to
  seek and complete treatment
• Orange County should not be the primary provider
  of mental health care to the American veteran

35
Core Issues

• Many Veterans do not seek services for behavioral
  health issues
• Many Veterans will not seek help at the VA
• Veterans will show up in their community for
  symptoms related to their combat issues
• Increasing number of veterans are involved in the
  legal system (domestic violence, drug related
  charges, etc.)

36
Do You Knowthe Way to the VA?

• Why dont vets seek care at the VA?
• Not eligible
• Dont trust the VA or government
• Transportation issues
• Co-pays and wait times
• Unaware of benefits and VA capabilities
• Dont know how to access
• Privacy concerns

37
Barriers to SeekingBehavioral Health Care

• Warrior mentality
• Stigma
• Lack of insight (symptoms recognition vs.
  cognitive dysfunction from traumatic brain injury
  TBI)
• Lack of eligibility or lack of knowledge about
  benefits
• Military career concerns

38
Million Dollar Question

• How to get the Veterans to intersect with
  Behavioral Health Care Provider?
• And, how to overcome barriers for the Veteran to
  receive definitive mental health care preferably
  at the VA?

39
Recommendation Conceptual Framework For Veterans
Behavioral Health Care

• VA has skilled, up-to-date, trained behavioral
  health clinicians and integrated veterans
  programs
• There are many effective community groups that
  wish to positively intervene to assist veterans
• The OC Community wants veterans and families to
  be healthy
• Case finding and overcoming reluctance to seek
  care at the VA is a primary barrier to positive
  outcomes

40
Conceptual Framework ForVeterans Behavioral
Health Care

• OC should primarily assist with case finding and
  providing a
• warm hand-off to the VA
• OC should provide follow-up to insure that
  veterans continue to seek treatment at the VA
• Some situations may require OC intervention for
  short term bridging care
• OC will treat veterans who request treatment by
  OC BHS
• rather than VA. Some veterans may complete
  entire course of care with OC BHS.
• We will respect our clients choice of provider
• There are many effective community groups that
• wish to positively intervene to assist
  veterans

41
Treatment Modality for Combat Stress and
PTSD

• There is recent evidence from many sources that
  early treatment results in better outcomes.
• Ongoing research supports first line treatments
  such as
• Cognitive Behavioral Therapy
• Eye Movement Desensitization and Reprocessing
  (EMDR) Therapy
• Exposure Therapy
• Pharmacological Therapy

42
Cornerstones

• All approaches should include
• Cultural competency
• Evidence-based practices
• Performance outcome measurements
• Consumer involvement
• Recovery philosophy
• Integration of co-occurring treatment

43
Successful Outcomes

• Keys to successful outcomes are
• Early recognition and intervention
• Evidence-based practice
• Multi-agency, community and family collaboration

44
Orange County Veterans/Behavioral Health
Services Plan
45
Early Interceptors

• Train early interceptors
• Early interceptors are contacts at places
  where the veteran or family may first present
  with problems/issues

46
Early Interceptors

• Healthcare
• Primary providers
• Emergency rooms/urgent care
• Emergency behavioral health teams
• Colleges
• Classroom instructors
• Guidance counselors
• Student health
• Student Veteran Associations

47
Early Interceptors

• Law enforcement
• Public defenders
• Courts
• Emergency response
• Probation
• Substance abuse
• Primary provider
• Substance abuse clinics/groups

48
Early Interceptors

• Community organizations (NAMI, etc.)
• Veterans organizationsnon-government
• Faith-based organizations
• Social service agencies
• Employment Development Department

49
Early Interceptors

• Community behavioral health providers
• Governmental
• Private

50
OC VA MilitaryCollaboration

• Veterans in LA/Orange Counties are recognized by
  DOD as the most underserved in the nation
• One of the largest veteran communities and
  largest geographic area
• OC does not have an active military post
• OC does not have a VA Medical Center

51
Collaboration

• OC has vested interest in positive treatment
  outcomes for OC vets
• Positive outcomes require active collaboration
  between VA, military and OC

52
Collaboration

• Work with VA, military bases (Los Alamitos, Camp
  Pendleton) to find solutions to veterans
  behavioral health problems and to support their
  families
• Avoid duplication of effort
• Evaluate performance outcomes and alter programs
  as needed

53
Build a FortifiedBridge to VA
FACTS

• Many veterans distrust government and VA
• Many vets are concerned about privacy and
  military career
• Best clinical treatment will be provided at VA,
  as their clinicians are more familiar with
  treatment and are provided up-to-date research

54
Build a FortifiedBridge to VA
Need for short-term intervention with vet to
reduce barriers to seeking care at VA

• 1-3 sessions with OC case manager
• Warm handoff to VA with follow-up

55
OC/BHS Current ProgramsThat Serve Vets

• Another Kind of Valor
• Training days, using the videos (three) to
  discuss issues that impact returning combat
  veterans and providing therapeutic approaches
  that maximize success for the veteran/family

56
OC/BHS Current ProgramsThat Serve Vets

• OC Behavioral Health Clinics provide direct
  clinical care for vets with serious mental
  illness who do not qualify or refuse care at VA
• Program for Assertive Community Treatment
  provides intensive care in the field
• Direct care for veteran families with serious
  mental illness
• Integrated Veterans/families into BHS Cultural
  Competency program and Stigma Task Force

57
OC/BHS Current ProgramsThat Serve Vets

• BHS Programs
• Homeless Outreach
• Older Adults Services
• Alcohol Drug Services
• Full Service Partnerships
• Veterans Court
• VA Jail Outreach

58
Programs In Development

• Early Interceptors
• Fortified Bridges to VA
• Collaboration with Military and VA
• Peer to Peer (consumer) training and group
  facilitation
• Veteran operated enterprises
• Community/volunteer activities

59
Resources

• Network of Care for Behavioral Health
• Network of Care for Veterans
• BHS subject matter experts
• BHS Veterans Services Coordinator
• Continuing educational seminars, training
  workshops on issues related to vets PTSD, TBI,
  etc.

60
Community Involvement
Community groups

• NAMI Frontline quarterly educational
  conference
• Veteran service groups(AmVet, American Legion,
  VFW, Vietnamese Vets, DAV, etc.)
• Veteran Service Office
• Veterans Centers
• Service organizations

61
Veteran As Locus of Control

• Recruit Veterans to Provide Consumer Input
• Develop Peer to Peer Groups
• Integrate Community Businesses to Support
  Veterans (Hire a Vet)

62
Unique Community

• Unique veteran population
• Largest Vietnamese community outside of Vietnam
• Third largest demographic in OC
• Many of the same issues as other veterans
• Not eligible for VA benefits

63
Unique Community

• Isolation due to poor acculturation and language
  barriers
• High rate of trauma from re-education camp post
  1975
• Families impacted by veterans status and by
  cultural mores
• Potential for major impact on OC resources

64
Unique Bridges for Unique Populations
Develop programs to include

• Community stakeholders
• Needs assessment that is culturally competent
• Outreach program that is designed to mitigate
  cultural reluctance

65
Unique Bridges for Unique Populations

• Intervention program based on evidence-based
  practice
• Integrate approach into BHS clinical practice
  framework as much as practical
• Reach out to other counties with Vietnamese
  communities

66
Performance Outcomes

• The key to success is to continually evaluate
  outcomes as they impact

• Veterans
• Families
• Communities

67
Next Steering Committee Meeting

• May 11, 2009
• 1 p.m. 4 p.m.
• Delhi Community Center
• 505 East Central
• Santa Ana, CA 92707