System Transformation A View from the Field

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System TransformationA View from the Field

• UC Berkeley Petris Symposium
• April 18, 2008
• By Anne L. Bakar
• President and CEO, Telecare Corporation

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Telecare Who Are We?

• Provider with the greatest presence of adult
  mental health services across multiple CA
  counties (13)
• Operates spectrum of services from acute and
  sub-acute, to crisis, ACT, case management,
  residential, etc
• Last year, served over 18,000 individuals in 60
  programs focus on individuals with complex needs
  and long histories of institutionalization and/or
  hospitalization (high risk/high cost)
• Founded in 1965 by Morton Bakar, built on
  foundational belief in rehabilitation and
  recovery potential for persons with serious
  mental illness
• Employee- and family-owned passion for services
  and mission and legacy fuels the direction of
  Telecare today

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The Promise of Prop 63/MHSA

• The passage of Prop 63 (MHSA) was an exciting
  time for all of us who are committed to MH
  services
• From a provider perspective, it was a once in a
  lifetime opportunity to infuse the system with
  much-needed resources to expand and transform the
  system to one that is based on recovery and
  wellness
• This meant building on the past to more fully
  meet the needs of persons with SMI/SED and
  address the needs of the underserved

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The Clear and Present DangerHow Dangerous?

• The obvious challenge to the promise of Prop 63
  and what it could mean to a recovery-focused MH
  system is continuing fiscal constraint, despite
  new revenues. There are a number of variables
  converging to create this situation
• Elimination of AB2034 funding (1-time event?)
• Current state budget crises (will it stabilize?)
• Shortfall in realignment revenues (turnaround?)
• Emergence of Dual Systems of care
• MHSA population
• SMI/SED population
• (Will awareness of the issue break down silos?)

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Trends Experienced by Telecare
Funding mix for ACT, Homeless FSP programs
shown in millions. Overall, our service trends in
California support the conclusion that MHSA
revenue increases are being offset by reductions
in base funding.
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Transformation is Happening Recovery

• Despite the financial challenges, the vision and
  promise of the MHSA has stimulated profound
  changes in philosophy about service delivery,
  particularly in the area of recovery.
• Clinically, its changed the relationship clients
  and providers, as well as expectations around
  program approaches, outcomes and power sharing.
• Politically, the MHSA has created a system of
  care environment where consumers have become
  primary drivers, integral to the MHSA/county
  planning process.

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Recovery Success Factors
The following factors help to create a
recovery-enlivening environment ensure greater
effectiveness
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Recovery Transformation in Action
Telecare has had the privilege of working with
counties to implement innovative programs and
services, such as
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Recovery Tools Supports
The MHSA has created greater opportunity for the
use of innovative practices, such as Telecares
Recovery-Centered Clinical System (RCCS).

• Incorporates evidence-based innovation-based
  practices
• Engages individuals in the recovery journey,
  awakening hope, motivation and sense of self
  focuses on power with people vs. power over
  people
• Based on the foundational belief that recovery is
  possible and will happen for everyone

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Recovery A Clients Story

• A year ago, she was homeless, suffering from
  depression, poverty, and without hope
• I would sit in the dirty car that was my home
  and watched as people lived their lives. I had no
  belief that I would ever be a part of the life I
  was watching again.
• Today, as a result of MHSA and her involvement
  in an FSP program, she lives in her own
  apartment, has gone back to school, and works as
  an intern in a public service office
• They truly empowered me to help myself live well
  within the community, and I will always be
  grateful.

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Cultural Transformation in Action

• Although recruitment and training have been more
  challenging, our experience in counties that
  have emphasized ethnic parity between staff and
  clients has enhanced our ability to engage
  clients successfully.

Telecare LA Service Area Program
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In Summary

• Transformation underway
• Major progress on recovery
• Progress on ethnic disparities
• More supports are needed
• Leadership to support recovery and client
  choice-making
• Recovery systems, tools and training
• Housing/vocational opportunities
• Models that accommodate more people at different
  intensity levels
• Ensuring effectiveness
• Dialogue collaboration on challenges is still
  necessary
• How much risk?
• Who should be served given fiscal constraints?
• How do we integrate dual systems of care?
• Advocacy for funding and rebuilding foundation is
  crucial