HomeMy WebLinkAboutMINUTES - 07231996 - P2 P.2
THE BOARD OF SUPERVISORS
OF CONTRA COSTA COUNTY CALIFORNIA
Adopted this Order on July 23 , 1996 by the following vote:
AYES: Supervisors Rogers, Bishop, DeSaulnier, Torlakson, Smith
NOES: None
ABSENT: None
ABSTAIN: None
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SUBJECT: Mental Health Commission Annual.. Report
Annual Report To The Board of Supervisors
IT IS BY THE BOARD ORDERED that the report from the Mental Health
Commission is ACCEPTED.
I hereby certify that this is a true
and correct copy of an action taken and
entered on the minutes of the Board of
Supervisors on the date shown.
ATTESTED: July 23, 1996
PHIL BATCHELOR, Clerk of the Board
of Supervisors and County Administrator
By �. ,Deputy
cc: Mental Health
Health Services Department
%`• MENTAL HEALTH DIVISION
• .f ;w 595 Center Avenue, Suite 200
Martinez, California 94553
Mental Health Director (51.0)313-6411
Medical Director (510)370-5720
Director,Planning/Mgmt:Support (510)313-6414
Adult/OlderAdult Program Chief ,(510)370-5460
r`4`�OiJIz" Children/Adolescent Program Chief ''(510)313-6408
May 30, 1996
California Mental Health Planning Council
Department of Mental Health
1600 Ninth Street, Room 100
Sacramento, CA 95814
Dear Council Members:
Enclosed, please find Contra Costa County's' report regarding
"Interpreting Adult Performance Outcome Measures: Wave 1 to Wave 3 . "
The report was developed jointly by the Mental Health Commission and
the Mental Health .Division in a committee format. The draft report
from the committee contained a brief .summary of the .background of the
survey (summarized from the workbook) , and an analysis of the
significant domains for our county. A public hearing to review the
report was held on May 23, 1996. The suggestions .and recommendations
from the public hearing were incorporated into the final report.
Also, the Commission voted to send the report to the Board of
Supervisors as part of their Annual Report.
If you have any questions about the report, please call Nancy Brewster
at (510) 313-6423 .
Sinc ly,
Lorna Bastian, Director .
Mental Health Division
Tck /6v4*IZ4-111-1
Ralph. Hoffmann, Chair
Mental Health Commission
pr
Enclosure
A-371 (7/94) Contra Costa County
�r
CONTRA COSTA COUNTY
ADULT PERFORMANCE OUTCOME DATA REPORT
FISCAL YEAR 1993-94
By the
ADULT PERFORMANCE OUTCOME REVIEW COMMITTEE
Contributors:
Mental Health Commissioners and Other Participants
Herb Putnam, Commissioner, Chair
Wayne Simpson, Commissioner
Kathy Simpson, Family Member
Marika Urso, Commissioner
Mental Health Division Staff
Robert P. Moody, Ph.D. , Adult/Older Adult Program Chief
Nancy Brewster, M.S.W. , Adult Services Support
CONTRA COSTA COUNTY
ADULT PERFORMANCE OUTCOME DATA REPORT
Table of Contents
Section I: Adult Performance Outcome Data Report
Section II: Summary of Adult Performance Outcome Data Workbook.
Required Information
Appendix: Fiscal Year 1993/94 Mental Health Program Listing
by Type and Service
CONTRA COSTA COUNTY
ADULT PERFORMANCE OUTCOME DATA REPORT
Background
Realignment gave local mental health departments greater
flexibility over their resources and greater autonomy to develop
mental health systems that respond to their unique local needs. In
addition, realignment incorporated many aspects of system reform
advocated by the California Mental Health Master Plan. "`These
system reform proposals aimed to create a mental health system that
is more responsive to the needs and desires of persons with serious
mental illness and their family members.
Performance outcome measures were established in statute as a
counterbalance to greater local flexibility and autonomy and to
gauge' the system's progress toward accomplishing system reform. In
addition, performance outcome measures are designed to make. the
accomplishments of the mental health system , more tangible to
policymakers in the Legislature and on county governing bodies.
Specifically, performance outcome measures are intended to quantify
for each county measurable changes in the lives . of clients to
determine if mental health services are improving basic aspects of
clients' quality of life. Additionally, performance outcome
measures can be used to identify the strengths and weaknesses in a
county's adult system of care.
Sampling and Data Collection
The Department of Mental Health (DMH) established parameters to
select clients to be included..for sampling. One hundred and seven
(107) clients were selected to be included in the Contra Costa
County sampling. A client had to possess the following
characteristics:
• a diagnosed major mental disorder;
• be at least 18 years of age; and
• have had at least five contacts with a county's mental health
system in the three-month period sampled.
A contact was defined as one unit of service, for example, one
outpatient visit, one medication visit, one contact with a .case
manager, or one day of hospitalization.
Strengths and Limitations of Performance Outcome Data
This project for developing and using performance outcome data is
a first step in developing a method of accountability for local
mental health programs in a realigned mental health system. It may
be a step toward developing a useful tool that can help counties
analyze what aspects of their adult system of care are working well
for clients and what aspects need more attention..
However, use of the data needs to be tempered by a realization of
their limitations. The method of constructing the sample, the
validity of the client data base from which the sample was drawn,
how the surveys were administered, etc. , could all affect the
Adult Performance Outcome Data Report pt
Page 2 .
outcomes. One effect of the sampling criteria is that some mental
health clients were screened out of the sample. For example, some
clients who do not need to use services frequently, clients with
geographical barriers to accessing services, or homeless clients
who are mentally ill and avoid the service system, , were less likely
to have been included in the sample.
It should be noted that a 12-month study of the effects of-,mental
health services on individual clients is not likely to reveal
significant change or improvement. Change in the results of system
outcome measures for clients with serious mental illnesses
typically does not show up until services have been provided for at
least two to three years. Another important characteristic of
serious and persistent mental illness is its cyclical nature in
which clients can make significant gains and then have setbacks.-
Linear
etbacks.Linear progress cannot necessarily be expected.
Caution needs to be exercised in using the data for making
comparisons. These data cannot be used to evaluate -or compare
individual programs within a county because the sample is only
valid for generalizing at the county level. to clients who meet the
sampling criteria. Interpreting the differences when comparing the
results among counties is difficult because different socio-
econom ic,. political, and demographic conditions in each county and
varying. levels of resources influence the results. Comparisons
with statewide data averages have. more validity, but are limited by
the individual county differences mentioned above.
Explanation of Terms
This project collected data on six domains: living situation,
financial, engaging in productive activity, avoiding legal
problems, physical health, and social support network. A domain is
a cluster of performance concerns all related to one aspect of a
client's life. Data were collected on 21 performance outcome
measures across the six domains. It was determined that the
performance of local mental health programs in each domain could be
most accurately analyzed by using it of the 21 performance outcome
measures. The 11 performance outcome measures used in this
analysis are called "key indicators." Each domain has two key
indicators except for the financial domain, which has only one.
Analyging the Performance Outcome Measures by Domain for . Contra
Costa County
An original sample size of 107 was estimated for Contra Costa
County in order to achieve a 95 percent confidence level so that
the differences occurring were not due to random chance. The
survey was sent to the primary clinician assigned to the
individual. This may have been, for example, a case manager,
conservator, or psychiatrist. The survey included a mixture of
clients in county-operated and contract-operated programs. Wave 1
produced 76 completed surveys. In Wave 3 , only 51 completed
surveys were returned, which is substantially lower than the
required number.
Adult Performance Outcome Data Report
Page
Of the six domains, only two (2) showed statistically significant
results from the statewide average: Living Situation (below) and
Engaging in Productive Daily Activity (above) . A third domain,
Social Support Network, deviated 7 percent (below) .
Domain: Living situation (Significantly below statewide average)
ti 5
Key Indicator: "Living in House or Apartment Without Supervision"
The.percentage who met. the criterion for this key 'indicator went
from 32 percent (Wave 1) to 19 percent (Wave 3) . The County"s
result was below the statewide average for this. indicator.
However, because of the small sample, the number of clients
involved in Wave 1 was 15, which went down to 9 in Wave 3 , this
may not be a sufficient number 'to indicate any significance.
Also, it is difficult to define what would be called "support"
versus what would be interpreted as "supervision" in various
residential settings.
Key Indicator: "Satisfied with Living Situation"
This indicator went from 55 percent (Wave 1) to 82 percent (Wave
. 3) . As the statewide average was 83 in Wave 3, this result is
not statistically significant.
Domain: Financial.
Key Indicator: "Income Above Poverty Level"
This result is not statistically different from the statewide
average.
Domain: Productive Daily Activities (Significantly above statewide
average)
Key Indicator: ::Engaging in Productive Daily Activity"
The County's outcome was substantially and significantly above
the statewide average in both Wave 1 and Wave- 3 .
Key Indicator: "Working .One or More Hours Per Week"
This result is not statistically different from the .statewide
average.
Domain: Avoid Legal Problems
Key Indicator: "Not Arrested in the Last Six Months"
Key Indicator: "Not Crime Victim in Last Six Months"
These results were not significantly different from the
statewide average.
Adult Performance outcome Data Report ^ '
Page 4
i
Domain: Physical Health
Key Indicator: "Received Physical Health Care From Nurse or
Physician in Last Two Years"
Key Indicator: "Received Dental Care in Last Two Years"
These results were not statistically different from the
statewide average.
Domain: Social Support Network
Key Indicator: "Using Social Support Network for Material Help"
In Wave 1, this indicator was within 1 percent of the statewide
average. However, by Wave 3, the statewide average slipped to.
68 percent, County slipped to 61 percent, creating a -7 percent
. spread. This was not considered significant.
Key Indicator: "Doing Activities With Friends"
In Wave 1 for this indicator, the County was 11 percent below
the statewide. average, but by Wave 3 had come up to within 2
percent of the statewide average, not considered statistically
significant.
Adult Performance Outcome Data Report
Page 5
Recommendations
Perhaps, more important than the validity of the survey or the
significance, or lack of significance, of the findings is that the
outcomes collaborate our County's understanding of the needs and
priorities which still desperately need to be addressed. Planning
efforts over the last several years, including prior to FY 1993/.94,
have strongly highlighted the weakest areas of our system. ,, ,It is
the opinion of the Performance Outcome Review Committee that Contra
Costa's performance outcomes would be significantly improved if. the
. Mental Health Division were to establish an array of housing and
vocational options/alternatives with appropriate supports ranging
from:
• an IND within the County
• non-hospital crisis beds as an alternative to hospitalization as
well as step down beds for those discharged from the hospital,
• an enhanced, supported, open ended board and ..;care home
contracted for/funded by the county _(not owner-operated
facilities)
• group homes supported by county staff; medical technicians to
provide medication twice daily when needed; a cook to provide a
hot meal daily; single rooms for privacy and independence.
• sufficient Section 8 certificates to enable those consumers who
wish to live in private housing with appropriate supports to be
able to do so.
• increase innovative employment and vocational opportunities in
the community, both in the private and public sectors: pre-
vocational/job readiness program, job developers, job coaches,
etc.
Funds for establishing these alternatives could partially come from
future state hospital and inpatient savings. During the year that
this performance outcome data was sampled, Contra Costa County
phased out of. 34 Napa beds (from 71 down to 37) . With this phase
down, state hospital costswere reduced to $4.7 million in FY
1993/94, compared to $7.5 million previously spent in FY 1992/93 .
Of this $2.8 million savings, approximately $800,000 was used for
alternatives to state hospitals (i.e. , Telecare and Highview) ,. and
the remaining $2.0 million became' a reduction in the County Mental
Health budget. The Mental Health Division must protect any future
savings in order to develop community alternatives.
The addition of the two psychiatric wards in the new county
hospital will provide a cheerful, modern facility for those
consumers who require inpatient facilities. We commend the Board
of Supervisors for taking this action.
Let us keep in mind as we use this data for planning for service
improvement that many of the mentally ill can take responsibility
for the treatment of their illnesses, and the family can be a
valuable resource in treatment and advocacy. Mental illness is not
a life sentence. Healing is possible. Life can be meaningful.
There is hope. The mentally ill have valuable contributions to
make given proper treatment, opportunity and respect.
The Adult Performance Outcome Review Committee, May, 1996
ADULT PERFORMANCE OUTCOME DATA WORKBOOK
REQUIRED INFORMATION SUMMARY
Representativeness of Your County's Sample and Survey Administration
I. Is the sample used for your county representative of your adult target population?
If not, why?
For the most part, the Wave I sample of 107 individuals was representative of the
adult.target population,with the exception of the high`percentage that was sampled
from clients residing in IMDs and/ormere under conservatorship. While the 1994
Housing Report showed approximately 1.5 percent of clients spent some time in
state hospitals and IMDs during FY 1993-94,* the sample included 15 clients (or
20 percent of Wave 1 actual sample size) who were residing in IMDs. Based on
computer compilation of billable cases for the period May 1, 1993, through April
30, 1994, only 4 percent were being ,served by the county's Conservatorship
program, whereas the sample included 17 individuals, or 22 percent of Wave 1
actual sample size.**
II. Who administered the instruments for each wave: mental health staff, direct
consumers, family members,or others?
Mental Health clinical staff administered the instruments.
Process for Completing the Workbook
I. _ Describe the process used,by the MHB/C and the local mental.health department
and the roles played by each entity and their contribution to the,finished product.
A small committee of Mental Health Commission members and County Adult
Services support staff held several meetings to discuss the findings and the response
to findings where there was significant deviation. The three domains which showed
deviation from the statewide average were.: Living Situation, Productive Activities,
and Social Support Network. The finished product was submitted to the Mental
Health Director and the Mental Health Commission.
H. Describe the public review process used for completing the workbook.
A public hearing was held at the regular meeting of the Mental Health Commission
on May 23, 1996. The draft Adult Performance Outcome Data Report was
presented,with overhead displays of the significant domains addressed in the report.
A discussion and question/answer period followed, with public attendees and
Mental Health Commissioner participation. The input and feedback from this
discussion was incorporated in the final report.
*Housing Report of the CCC Mental Health Commission, June 28, 1994, page IV
"Ibid., page 12
Description of Adult System of Care
I. Description of your overall resource base
Total funds and revenues for fiscal year ending June 30, 1994 were $42,197,311.
Sixty-seven percent (67%) or $28,272,198 represented resources spent on mental
health services for adults.
. yy
II. Description of your adult system of care in fiscal year 1993-94
Overview
With a shift in the target population, the goal for Fiscal Year 1993-94 was to further develop
a community support model of service delivery providing the most intense level of services
to individuals with the highest degree,of functional impairment who were at risk of costly,
often unnecessary, hospitalization or institutionalization. Concurrently, it was our goal to
return to a lower level of care .those individuals with serious mental illness who were
institutionalized and were appropriate and ready.for a lower level of care.
In keeping with the principles of the State. Plan, PL 99-660, PL 102-321 and AB 1288,
services were delivered in a framework of an integrated system of care designed to include
all major mental health providers within the current system--county and contract programs--
and other county,services such as Conservatorship, Substance Abuse, forensic and inpatient
services. Commencing in the third quarter_of Fiscal Year 1993-94, adult services began
implementation of Coordinated Services, which provided a new structure to ensure better
coordination,and integration of services to adults with SMI.
PROGRAM DESCRIPTION
• Target Population
The adult system of care target population included adults with SMI who are 18 and over
who are functionally disabled. Special consideration was given to homeless clients with SMI.
Pursuant to Section 1912(c) of the Public Mental Health Services Act; as amended by Public
Law 102-321, "adults with a serious mental illness" are persons:
- age 18 and over -
- who currently or at any time during the past year
- have had a diagnosable mental, behavioral, or emotional disorder of sufficient
duration to meet diagnostic criteria specified within DSM-I11-R
- that has resulted in functional impairment which subsequently interferes with or
limits one or more major life activities.
Functional impairment is defined as difficulties that substantially interfere with or limit role
functioning in one or more major life activities, including basic daily living skills (e.g., eating,
bathing, dressing);instrumental living skills(e.g.,maintaining a household,managing money,
getting around the community, taking prescribed medication); and functioning in social,
family, and vocational/education contexts.
Adult Performance Outcome Data Workbook 3
SERVICES OFFERED
In addition to our regular services (see attached program listings by type of service in the
Appendix) the following projects were undertaken during FY 1993-94:
(1) Assessment/Monitoring of Clients With SMI Residing in Institutions/Facilities
A 1.0 FTE Clinical Nurse Specialist provided assessment and ongoing monitoring
and case management services to individuals residing in Napa State Hospital and
the IMDs; attended monthly and quarterly treatment meetings at each facility;
minimum once a month face-to-face contact with each individual and written
summary of individual's. status; participate in discharge planning efforts by
presenting information for discharge to the Bed Review Committee; and facilitated
linkage with conservators and .outpatient case management assignment upon
discharge.
(2) Training of.Community Support Worker staff
Contra Costa County Mental Health Division developed a.contract with Mental
Health Consumer Concerns, Office For Family Involvement and Client
Empowerment (O.F.F.I.C.E) to .establish a training program for consumers
interested in securing volunteer and/or paid positions in County or contract mental
health.programs. (See Page 7, "Domain: Productive Daily Activities".)
(3) Housing for Adults With S]yII
(a) A housing consultant was hiredto evaluate existing housing programs,establish
the need, and.to mai imine .our housing resources to best meet the needs of our
target population. Funding opportunities were also explored to develop, and thus
increase, the overallsupply of community-based housing alternatives for the adult
population with SMI.
(b) Contracted_with Housing for. Independent People, Inc., to operate Semi
Supervised Living Residential Treatment Programs for adults with SMI at two
locations: Santa Fe in Pittsburg and Clayton Way in Concord. This supportive
housing program provided affordable housing for adults with SMI who,for the most
part, never maintained a successful living arrangement.
Other Information
(1) Circle the number of this 5-point scale that approximates the degree to which your
county had implemented the Rehabilitation Option in fiscal year 1993-94.
1 2 X 3 4 5
Clinic Rehabilitation
Option Option
Adult Performance Outcome Data Workbook 4
(2) Proportion of services county-operated versus contracted out
Thirty-nine percent (39%) of the services for adults were contracted out, and sixty-
one percent (61%) were county operated.
(3) Efforts to provide culturally competent services
An Ethnic Services Committee was formed that is addressing(on an on-going basis)
the service needs of our various ethnic populations and assuring that our services
are culturally competent.
Analysis of Domains with Sign'if'icant Endings.
DOMAIN: LIVING SITUATION
General Discussion of Domain
The Ad Hoc Planning Committee of the Contra Costa County Mental Health Advisory
Commission was formed in.early 1993 to provide a vehicle through which a broad array of
mental health constituencies could provide input into planning and developing the County's
Mental Health Services. The focus of the recommendations proposed in this report was a
"measured:movement away from institutional.care and toward a community support services
system". The report identified some urgently needed supports in the community:
• Support people in their own housing,using 24-hour services only when a person
needs a more structured. situation that cannot be provided in his/her own home.
Develop a range of services which can be used to help a person stay in his/her own
living situation, with family, or with friends during a time of crisis. .Expand
supported housing services, so that more emphasis can be placed on prevention of
crises. Establish a fund for housing and utility deposits. .
Develop strategies to maintain a person's regular living situation during times when
they may need to use 24-hour services. Loss of community housing makes it
extremely difficult to discharge people as soon as they are ready.
• Seek funds for housing. Revisit and update the Mental Health Division Special
User Housing Plan, November, 1988. Develop a joint Housing, Community
Development and Mental Health Task Force to take the lead in developing housing
in Contra Costa County for people with mental disabilities.
• Explore the possibility of negotiating Section 8 vouchers from the Housing
Authority to be set aside for people with mental disabilities.
• Designate a County staff person with responsibility for coordination of housing
activities.
Adult Performance Outcome Data Workbook 5
As a follow-up to Ad Hoc Planning Committee report,which was adopted on June 24, 1993,
an Adult Committee of the Mental Health Commission undertook a study of existing and
needed housing within Contra Costa County during FY 1993-94. Members of the
Commission, family members, consumers,. and staff members from the County Division of
Mental Health participated in the study.
This report recommended an in-depth housing plan which was adopted by the Mental
Health Commission on June 28, 1994. The Mental Health Division was committed to
implementing the plan by reallocating savings resulting through the decreased use of higher
levels of care, i.e., state hospitals and IMDs.
Through this planning effort, as well as Special User Plans developed in 1988 and 1989, the
following residential programs were developed, or were in the process of being developed,
during FY 93/94.
PROGRAM/PROVIDER REGION CAPACITY TYPE
Clayton Way, HIP C 6 beds Residential Treatment
Sante Fe, HIP E 8 beds Supported Independent
Living
Kirker Court, HIP C 25 beds Supported Independent
Living .
River House, HIP/Eden C 25-30 rooms Single Room Occupancy
for mentally
disabled
Pine House, Phoenix W 5 beds Transitional
Maple House, Phoenix C 5 beds Transitional
San Joaquin, Rubicon W 9 beds Transitional
Conclusions Regarding Outcome of Key Indicators
While the percentage who met the criteria of "Living in House or Apartment Without
Supervision' went from 32 percent (Wave I) to 19 percent (Wave 3), the number of clients
(15 down to 9) is not sufficient enough to indicate a significant decrease in the County's
performance in this domain. It is difficult to define what would be called "support" versus
what would be interpreted as "supervision" in various settings.
O
Adult Performance Outcome Data Workbook 6
Given the 33 percent decrease in returned surveys between Wave 1 (76) and Wave 3 (51),
there may have been a higher percentage of clients living in IMDs in Wave 3 because they
were easier to locate and survey within the given timeframe period.
The Housing Report (June 28, 1994) found that "nearly 2,250 (almost 32 percent) of the
County's clients are currently living on their.own, without any formal supervision and, most
often, without any housing related support (other than that provided by their families)".
Recommendations for Improvement in this Domain
The recommendations that were made in the 1994 Housing Report are still as relevant, and
as crucial, today.
0. Survey consumers to ascertain their preferences and needs.
• Develop alternative housing options for adult clients living at home.
• Collaborate with cities, planning commissions, and housing developers to
urge/encourage the development of affordable housing.
• Increase access to existing community housing.
• Provide a full range of support services, on site when necessary, to help maintain
people in their own homes.
0 Include more consumers as housing support staff members.
• Help Board and Care operators to upgrade their services and encourage/prepare
clients to move on to independent living situation.
• Provide supportive services.to persons residing in SROs.
• Retain and expand transitional housing and residential treatment programs.
0 Place emphasis on preserving permanent residences and preventing homelessness.
• Focus on upgrading programming at INIDs and continue to develop alternative
placements.
• Strengthen the provision of mental health services to homeless people.
Together, these recommendations will provide. measured movement toward our .goal
increasing and maintaining a diverse supply of safe, affordable, permanent community
housing, together with the supportive services which are needed to maintain clients in the
housing of their choice.
These recommendations will also serve to strengthen and improve those special residential
services which are, and will continue to be,needed until both the clients and the system are
fully prepared for independent living.
Adult Performance Outcome Data Workbook 7
DOMAIN: PRODUCTIVE DAILY ACTIVITIES
General Discussion of Domain
Contra Costa County was fortunate to have three nationally accredited vocational VKograms
which provide services to persons with severe mental disabilities. These programs, operated
by non-profit contract agencies (Rubicon, Phoenix, and Many Hands), are located in West,
Central, and East County. They provided sheltered employment, vocational counseling,
work service and adjustment, job placement and supported employment or follow-up
maintenance services for those placed in community jobs.
These programs were funded by a combination of revenues from County Mental Health,
California State Department of Rehabilitation and revenues generated by agencies. . TWO
of the programs provided employment via Javitts, Wagner, and O'Day set aside contracts
at federal government installations. Contra Costa County has funded vocational services on
a consistent basis in the Central and East regions. West County funding has been negligible
for several years. All three organizations, to a greater or lesser extent, rely on agency
businesses to help support their vocational services.
Although the California State Department of Rehabilitation funded job placement programs
at the three agencies, there was not enough money in these contracts to provide the long-
term follow-along services needed by many persons with severe mental disabilities.
The County also offers several day treatment programs,both intensive(partial hospital)-and
rehabilitative, in all three regions; These programs, both county-operated and -contract-
operated (Rubicon Day Center, Synthesis Day Center, Phoenix Center, and, at that time,
Many Hands) has a total service capacity of approximately 75 - 100 individuals at any one
time. Approximately 20 percent of the individuals in the Wave 1 sample were enrolled in
day treatment programs.
In FY 1993-94, utilizing SAMHSA funds, Contra Costa County Mental Health Division
contracted with Mental Health Consumer Concerns/O.F.F.I.C.E. to establish a training
program for consumers interested in.securing volunteer and/or paid positions in County or
contract mental health programs. While consumers were not hired until FY 1994-95, many
participated in on-the-job training as part of this program. Graduates of the first training
are working and volunteering throughout the county in a variety of settings. Four graduates
were selected to work as paid Community Support Workers at county programs and clinics;
two graduates returned to paid positions at Mental Health Consumer Concerns and Many
Hands; and one graduate was hired in a paid non-mental health job. In addition, a number
of graduates are now volunteering on the inpatient wards at Merrithew Memorial Hospital,
with Mental Health Consumer Concerns, with O.F.F.I.C.E., and with Many Hands.
Conclusions Reizarding Outcome of Key Indicators.
Contra Costa County's performance on this outcome measure is significantly above the
statewide average. While the percentage seems high, and this was a very pleasant
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performance outcome, there is still much to be accomplished and developed in this area.
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ADULT MENTAL HEALTH SERVICES
INPATIENT HEALTH SERVICES
The provision of diagnostic and .treatment services, under the direction of a physician, in
An acute hospital setting. Limited to persons who are suffering an acute episode of
illness, i.e., posing a substantial danger to self or society or exhibiting "confusion,
impaired judgment or uncooperative behavior" to the extent that diagnosis and treatment
cannot be ensured at a lower level of care.
_[
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Merrithew, I Ward Psychiatric Ward in County Hospital for 18 beds C
2500 Alhambra Avenue adults (18-65), with or without E
Martinez, CA 94553 insurance. Admission through Psychiatric W
370-5740 Emergency Services.
Merrithew, J Ward Same as above 17 beds C
2500 Alhambra Avenue E
Martinez, CA 94553 W
370-4730
East Bay Hospital Private psychiatric hospital for persons N/A
820 - 23rd Street over age 18, who have Medi-Cal, Medicare,-
Richmond,
edicare;Richmond, CA 94804 or other insurance.
234-2525
Walnut Creek Hospital Private psychiatric hospital with N/A
175 LaCasa Via separate wards for children, teens, and
Walnut Creek, CA 94598 adults. Require Medicare or other
933-7990 insurance not Medi-Cal alone).
First Hospital Vallejo Same As Walnut Creek Hospital N/A
525 Oregon Street
Vallejo, CA ' 94590
= 707 648-2200
Napa State Hospital State Hospital Bed categories include: 25 beds* N/A
2100 Napa Vallejo Continuing Medical (SNF)
Highway 'ICF/Acute
Napa, CA 94558-6293 Alternate Care (ICF)
(707) 253-5000
* We have 5 Youth beds at Napa State Hospital,
for a total of 30 beds.
1
ADULT MENTAL HEALTH SERVICES
CRISIS STABILIZATION
URGENT CARE:
This is an immediate face-to-face response lasting less than 24 hours, to or on behalf of
an individual exhibiting acute psychiatric symptoms, provided at a certified Mental Health
Rehabilitation provider site. The goal is to avoid the need for Inpatient Services by
alleviating problems and symptoms which, if not treated, present an imminent threat to the
individual or others' safety or substantially increase the risk of the individual becoming
gravely disabled. Services provided to individuals in a Crisis Stabilization - Urgent
Care program are not based in 24 hour health care facilities or hospital based outpatient
programs. Services shall be available 24 hours per day.
EMERGENCY ROOM:
This is an immediate face-to-face response lasting less than 24 hours, to or on behalf of
an individual exhibiting acute psychiatric symptoms, provided in a 24. hour health facility
or hospital based outpatient program. The goal is to avoid the need for Inpatient
Services by alleviating problems and symptoms which, if not treated, .present an imminent
threat to the individual or others' safety or substantially increase the risk of the
individual becoming gravely disabled. Services provided to individuals in a Crisis
Stabilization - Emergency Room program must be separate and distinct from services
provided to individuals in an Inpatient facility or 24 hour health care facility.
Services shall be available 24 hours per day.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
West County URGENT CARE: Services include but are W
Psychiatric Emergency not limited to crisis intervention,
256 24th St. assessment, evaluation, collateral,
Richmond, CA 94804 medication support and therapy.
374-3420
Merrithew, E Ward URGENT CARE: Services include but are C
2500 Alhambra Avenue not limited to crisis intervention,
Martinez, CA 94553 assessment, evaluation, collateral,
370-5700 medication support and therapy.
EMERGENCY ROOM: Same as above, except
provided in a 24 hour health facility or
hospital based outpatient program.
2
ADULT MENTAL HEALTH SERVICES
MENTAL HEALTH SERVICES
COLLATERAL contact with significant support person(s) in the client's life.
ASSESSMENT of the client's mental and emotional history and current status (including
diagnosis and testing procedures, as needed) and community functioning evaluation.
BRIEF THERAPY to reduce symptoms and functional impairments, delivered to a client or
group of clients (including families).
CRISIS INTERVENTION — emergency services to enable the client to cope with a crisis,
provided by telephone or face-to,-face, anywhere in the community.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
East County CMHC Provides mental health services, as E
550 School St. defined above, for the SPMI population
Pittsburg who qualify for SD/MC.
427-8110 Hours 8-5 P.M., M-F. N*
West County CMHC Same as above. W
3900 Bissell Ave.
Room 2400
Richmond
374-3061
Central County CMHC Same as above. C•
1026 Oak Grove Road
Suite 12, Concord
646-5480
Desarrollo Familiar; Provides mental health services for the W
Familias Unidas** Spanish-speaking population as defined
205 39th St. above. Staff is bilingual-bicultural.
Richmond Hours 9-5:30 P.M., M-Th.;
412-5930 1-5 P.M., Friday. N*
Crisis and Suicide Provides 24 hour, 7 days/week crisis C
.Intervention of intervention, suicide prevention and E
Contra Costa mental health rehabilitative services. W
P.O. Box 4852
Walnut Creek, CA 94596
939-1916
Community Living See Page 8 ic
-Program**
Pine House** See Page 8 W.
Nevin House** See Page 8 W
Nierika House** See Page 7 C
Phoenix Center** See Page 6 C
Rubicon Independent See Page 8 W
Living Services**
Many Hands** See Page 11 E
Maple House** See Page 8 C
* N = Spanish-speaking capability
** These services are rendered only to clients enrolled in this program.
3
ADULT MENTAL HEALTH SERVICES
MEDICATION SUPPORT SERVICES
Includes prescribing, administering, dispensing and monitoring psychiatric medications
necessary to alleviate the 'symptoms of mental illness--provided by a staff person within
the scope of practice of his/her profession. Includes: evaluation of need, effective-
ness and side effects of medication, obtaining informed consent, medication education,
and plan development.
yS
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
East County CMHC Provides medication support services, as E
550 School St. defined above, for the SPMI population
Pittsburg who qualify for SD/MC.
427-8110 Hours 8-5 P.M., M-F.
West County CMHC Same as above. W
.3900 Bissell Ave.
Room 2400
Richmond
374-3061
West County Partial Same as above. W
Hospital**
256 24th St.
Richmond
374-3467
Central County CMHC Same as above. N* C
1026 Oak Grove Road
Suite 12, Concord
646-5480
, a Desarrollo Familiar; See Page .3 W
Familias Unidas**
Nierika House**. See Page 7 C
Phoenix Center** See Page 6 C
Rubicon Independent See Page 8 W
Living Services**
* N = Spanish-speaking capacity
** These services are rendered only to clients enrolled in this program.
4
ADULT MENTAL HEALTH SERVICES
CASE MANAGEMENT/BROKERAGE SERVICES
Case management/brokerage services are activities provided to access medical, educational,
social, prevocational, vocational, rehabilitative or other needed community services for
eligible clients.
The case management/brokerage billing category includes:
(1) Linkage and Consultation
(2) Placement Services
(3) Plan Development
Other case management activities include:
(4) Evaluation and Re-evalution (to be billed as Mental Health Services)
(5) Assistance with Daily Living (to be billed as Mental Health Services)
(6) Emergency Intervention (to be billed as Crisis Intervention)
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
East County CMHC Provides case management/brokerage E
550 School St. services, as defined above, for the
Pittsburg SPMI population. Hours 8-5 P.M., M-F.
427-8110 N*
West County CMHC Same as above. W
3900 Bissell Ave.
Room 2400
Richmond
374-3061
Central County CMHC Same as above. C
1026 Oak Grove Road
Suite 12, Concord
646-5480
Desarrollo Familiar; See Page 3 W
Familias Unidas**
Community Living See Page 8 C
Program**
Pine House** See Page 8 W
Nevin House** See Page 8 W
Nierika House** See Page 7 C
Phoenix Center** See Page 6 C
* N = Spanish-speaking capacity
** These services are rendered only to clients enrolled in this program.
5
ADULT MENTAL HEALTH SERVICES
DAY TREATMENT
A packaged program of activities, provided to a distinct group of individuals, in an
organized and structured setting at a clearly established site. Services are to be
available at least three hours and less than .24 hours each day the program is open.
DAY TREATMENT INTENSIVE provides a multi-disciplinary treatment program as an alternative
to hospitalization to avoid placement in a more restrictive setting or to maigtain the
individual in a community setting. Staff:client ratio is 1:8.
DAY REHABILITATION provides evaluation,. rehabilitation and therapy to maintain or restore
personal independence and functioning consistent with requirements for learning and
development. Staff:client ration is 1:10.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Many Hands, Inc. REHABILITATION (half day) : Serves adults 30 _-. 35 E
1231 Loveridge Road who are in the process of recovering from
Pittsburg, CA 94565 a psychiatric episode which may have
432-1171 included hospitalization.
Partial Hospital INTENSIVE: The morning program (9 a.m. - AM 20-25 W
Program 2 p.m.) serves a less acute population,
256 24th St. while the afternoon.program (1:30 p.m. - PM 10-15
Richmond, CA 94804 5:30 p.m.) is targeted to clients in
374-3467 crisis and/or risk of immediate
hospitalization. N*
Rubicon Day Center REHABILITATION (FULL DAY): Serves adults 25 W.
2500 Bissell Ave. who are recovering from.an acute episode
Richmond, CA 94804 and who are interested in pre-vocational
234-2204 training.
9:00 a.m. ' ' 2:00 .m., M-F
Synthesis Day Center REHABILITATION (FULL DAY): Serves adults 25 W
169 6th St. who have histories of long-term
Richmond, CA 94801 psychiatric hospitalization and high
236-0796 levels of functional impairment.
(9:00 a.m. - 2:00 p.m., M-F)
Phoenix Center REHABILITATION (FULL DAY) : Serves adults 45-50 C
2290 Willow Pass Rd. who are in the. process of recovering from
Concord, CA 94520 a psychiatric episode which may have
680-0222 included hospitalization.
(9:00 a.m. - 2:30 p.m., M, T, Th, F;
9:00 a.m. - 4:30 p.m., W)
* N = Spanish-speaking capacity
6
ADULT MENTAL HEALTH SERVICES
CRISIS RESIDENTIAL
Therapeutic and/or rehabilitation services provided in a 24-hour.residential treatment
program as an alternative to hospitalization for individuals experiencing an acute
psychiatric episode or crisis, and who do not present medical complications requiring
nursing care. Individuals are supported in their efforts torestore, maintain and apply
interpersonal and independent living skills, and access community support systems.
Interventions which focus on symptom reduction shall also be available. This is a
structured, packaged program with services available day and night, seven day$ a week.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Nierika House Serves clients at risk for a psychiatric 12 C
1959/1967 Solano Way emergency visit and/or hospitalization.
Concord, CA 94520 The referral should be made as early in
676-9768 the crisis episode as possible. Case
management referral and participaton in
treatment is strongly encouraged. Brief
length of stay until crisis situation is
stabilized and client can. return to the
community.
7
ADULT MENTAL HEALTH SERVICES
RESIDENTIAL SERVICES
Rehabilitation services provided in a non-institutional residential setting where
individuals are supported in their efforts to restore, maintain and apply interpersonal
and independent living skills, and community support systems.
Program. Brief Program Description/Comments Capacity Region
(Identifying Info)
Nevin House (Phoenix) Services include but are not limited to 12 W
3215/3221 Nevin Ave. instruction in basic living skills,
Richmond, CA medication compliance/education, social/
232-7633. communication skills, money management
and community living skills.
Pine House (Phoenix) Semi-supervised living situation 5 W
especially ,for adults with a dual
(Contact Nevin House - diagnosis leaving Nevin House, who need
see above. ) additional structured living situation
while increasing their use of community
resources.
Community Living Semi-supervised living consisting of 5 C
Program (Phoenix) satellite housing, assisted independent
3720 Clayton Rd., Ill living, to increase participant's ability
Concord, CA 94521 to live as independently as possible, and
827-3683 'to develop appropriate social support
networks.
Maple House (Phoenix) Open to clients who do not require a high 5 C
level of structure and who have
(Contact CLP - see demonstrated a capacity to function in a
above. ) semi-independent setting, but lack
necessary skills and/or experience .in
community living.
Rubicon Independent Rubicon Housing Counseling Services W
Living Services Provide mental health services and case
2500 Bissell Ave. management brokerage to assist clients in
Richmond, CA 94804 living independently in the community.
235-1516
Rubicon Transitional Housing Services 9 W
Provides housing at an apartment site for
9 clients for a maximum stay of 18
months.
Rubicon Permanent Housing Services
Provides 20 permanent housing units. 20 W
River House Community-based permanent housing for 75 rooms C
700 Alhambra Ave. seniors and disabled adults. E
Martinez, CA 94553 W
229-9093
Kirker Court A HUD project - applicants must have 25 beds C
1732-D Kirker Pass Rd. "Federal preference" to apply for E
Clayton, CA 94517 apartments designated for chronically W
673-9557 mentally ill.
8
ADULT MENTAL HEALTH SERVICES
c
INSTITUTIONS FOR MENTAL DISEASE
Higher level of residential care is provided in safe and secure environments. Through
evaluation, treatment and focused rehabilitation, residents are assisted in reducing
psychiatric symptoms, improving quality of life and returning to a more independent living
setting.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Crestwood Hospitals Provides basic subacute psychiatric and 52 C
4635 Georgetown Pl. special treatment services based on the E
Stockton, CA 95207 specific needs of each client, including W
(209) 478-5291 life skill training, money management,
training on accessing community services
and transitional programs.
Westwood Manor Same as above. 23 C
4303 Stevenson Blvd. E
Fremont, CA 94538 W
657-6000
Telecare Corporation Same as above. C
1100 Marina Village E
Parkway 1100 Morton .Bakar Center 2 W
Alameda, CA 94501
337-7950 Provides gero-psychiatric treatment and
skilled nursing services for clients 65
and over.
Villa Fairmont Health Center 5
Gladman Psych iatric Health_Eggility 5
Highview Regional Provides skilled nursing services for 11 C
Neurobehavioral Care clients with Organic Brain Syndrome E
Program (OBS), traumatic brain injuries and other W
1301 31st Street medical disabilities.
Oakland, CA 94602
535-2245
9
ADULT MENTAL HEALTH SERVICES
HOMELESS PROGRAMS
A range of services for persons with mental disabilities who are homeless or at risk of
becoming homeless. Multi-service centers provide showers, locked storage facilities, a
message center and other amenities, as well as assistance in securing benefits and linking
to other needed services. A shelter, with 20 beds, is available to homeless persons with
mental disabilities for periods up to 30 days. Shelters which are not specifically
designated for special needs populations also frequently house mental health clients who
are homeless.
Program Brief Program Description/Comments Capacity Region_
(Identifying Info)
Phoenix Programs, Inc. Benefits/housing and mental health 12 ADA W
West County Multi- advocacy for people with a mental
Service Center disability who are homeless or at risk of
1515 Market Street being homeless.
San Pablo, CA 94806 8:30 a.m. - 5:OO p.m., M-F
232-7571
Phoenix Programs, Inc. Same as above. 30 ADA C
Central County Multi-
service Center
1121 Detroit Avenue
Concord, CA 94520
685-7613
Phoenix Programs, Inc. Same as above. 12 ADA E
East County Multi-
Service Center
1401 4th Street
Antioch, CA 94509
778-3750
Phoenix Programs, Inc. Shelter for people with a mental 20 beds E
East County Shelter disability, who are homeless (up to 30
1401 4th Street days) .
Antioch, CA 94509
778-3720
10
ADULT MENTAL HEALTH SERVICES � O
VOCATIONAL REHABILITATION PROGRAMS
Programs designed to enhance work-related skills of persons with mental disabilities and
to overcome barriers to their employment. Activities include counseling, pre-employment
preparation, on-the-job training, job placement and supportive activities.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Many Hands, Inc. Assists clients in learning to function 25 E
1231 Loveridge .Road in a work setting with their disability
Pittsburg, CA .94565 and provides training for remunerative
432-1171 work in the community. Length of service
ranges between six months to two years.
8:00 a.m. - 4:00 .m. , M-F
Rubicon Programs, Inc. Clients receive a wide variety of W
Vocational Services employment preparation services
2500 Bissell Ave. including: job readiness services, direct
Richmond, CA 94804 placement, work experience/job skills
235-1516 training and supported work
opportunities.
Phoenix Enterprises Assists adults through graduated levels 25-30 C
5056 Commercial Circle of activity designed to identify. and
E/F, Concord, CA eliminate barriers to employment.
674-9610 Services include work adjustment, job
development, and supported employment,
with particular emphasis on serving high
user population.
Phoenix Enterprises Hires and trains adults to perform 10 C
Concord Naval Weapons custodial work for service contract with
Station/Janitorial Concord Naval Weapons Station.
Port Chicago Highway
Concord, CA
674--9610
Phoenix Enterprises Hires and trains adults to perform 5 C
Concord Naval Weapons grounds maintenance work for service
Station/Grounds contract with Concord Naval Weapons
Maintenance Station.
or Chicago Highway
Concord, CA
674-9610
11
ADULT MENTAL HEALTH SERVICES n
PATIENTS' RIGHTS
Advocacy to protect the rights of hospitalized patients and other consumers of mental
health services, to represent clients at certification and capacity hearings, and to
empower clients and ensure their involvement in all aspects of the mental health system
--as participants in planning their own services, as staff members, and as members of key
mental health organizations.
Program Brief Program Description/Comments Capacity Region
(Identifying Info)
Mental Health Consumer Parent organization for the five programs NA C
Concerns, Inc. described below:
716 Alhambra Avenue
Martinez, CA 94553 (1) Patients' Rights Advocacy
646-4220
Monitor psychiatric inpatient hospitals
to ensure that patients are fully
informed of their rights. Advocacy
services are provided at Merrithew, CPC
Walnut Creek, East Bay and Mt. Diablo
Hospitals.
(2) Riese and Certification Hearings
Represent clients at involuntary commit-
ment and capacity hearings at the above-
named hospitals.
(3) Network of Mental Health Clients
Self-help and peer support group develop-
ment; .representation in planning groups,
task forces and other community
organizations; public information and
referral—
(4)
eferral—(4) O.F.F.I.C.E. (Office on Family
Involvement and Consumer
Empowerment)
Joint client-family planning group
working to increase employment of clients
within the local mental health system.
(5) Community Center
Operates the Contra Costa Network
Community Center located at 718 Alhambra
Avenue, Martinez. The Center provides
social and recreational activities and
space for convening self-help/peer
support groups.
12
ADULT MENTAL HEALTH SERVICES D
1 c�
SPECIALIZED SERVICES
The following specialized services are available to improve client access to the mental
health system.
Program Brief Program Description/Comments Capacity. Region
(Identifying Info)
Asian Community Mental Provides translation/interpretation, W
Health Services group therapy, and case management
3900 Bissell brokerage services to Southeast Asian
Room 2400 clients.
Richmond, CA 94804
374-3061
Center for New Provides multilingual mental health C
Americans interpretation services for non-English E
1776 Ygnacio Valley speaking clients. W
Rd. , 1105
Walnut Creek, CA 94598
939-3442
Desarrollo Familiar, See page 3. W
Inc.
205 39th St.
Richmond, CA 94805
412-5930
Hands On Services Provides sign language interpretation C
P.O. Box 3376 services for hearing impaired clients. E
Fremont, CA 94538 W
1-800-900-9478.
Crisis and Suicide See page 3 C
Intervention of E
Contra Costa W
P.O. Box 4852
Walnut Creek, CA 94596
939-1916
.3
13
CONTRA COSTA COUNTY '
MENTAL HEALTH COMMISSION
595 CENTER AVENUE,SUITE 200
MARTINEZ,CALIFORNIA 94553-4639
O. =m1111 Y Phone(510)313-6414
,ST'q_COUIy�
Mental Health Commission
Annual Report
to the
Contra Costa County
Board of Supervisors
July 23, 1996
Packet Contents:
Commission Presentation to Board of Supervisors
Performance Outcome Report
Status Report: Children's Mental Health System of Care
Mental Health Commission Roster
Mental Health Commission Mission Statement
A351 (6/93)
sEaL CONTRA COSTA COUNTY "
MENTAL HEALTH COMMISSION
595 CENTER AVENUE,SUITE 200
MARTINEZ,CALIFORNIA 94553-4639
Phone(510)313-6414
ST'9 COUI3"�
To: Contra Costa County Board of Supervisors
From: Ralph Hoffmann, Cha
Contra Costa County a al HA14 ilk'
Date: July 16, 1996
Subject: Commission Annual Report to Board of Supervisors
Attached please find the text to the Mental Health Commission's
Annual Report to the Board of Supervisors. This report will be
given at the July 23, 1996 meeting.
Thank you.
ck
A351 (6/93)
sEat CONTRA COSTA COUNTY
MENTAL HEALTH COMMISSION
- 595 CENTER AVENUE,SUITE 200
' = MARTINEZ,CALIFORNIA 94553-4639
a 3 niiip t Z Phone(510)313-6414
COUK
To: Contra Costa County Board of Supervisors
From: Mental Health Commission
Date: July 23, 1996
Subject: Commission's Annual Report to the Board of Supervisors
(I. Overview - Ralph)
Mr. Chairman and members of thb Board of Supervisors, Good Morning.
I am Ralph Hoffmann, Chair of the Contra Costa County Mental Health
Commission. On behalf of the Commission, I thank you for this
opportunity to present our Annual Report.
First of all, I would like to give you brief background of the
purpose and composition of the MHC. The State of California,
through the Welfare and Institutions Code 5604, mandates the
formation of a mental health commission in each county so that
consumers, family members, and interested citizens will have an
opportunity to be involved in the planning and implementation of
the public mental health delivery system. W and I Code 5604
outlines the structure of the Commission in terms of membership and
activities.
Our membership is unique. This Code requires at least 50% of the
membership be comprised of consumers of mental health services and
family members of consumers. The balance may be comprised of
interested citizens. Currently, our Commission is comprised of 7
family members, 3 consumers, and 3 interested citizens, including
the appointment you will be making today in District 5. There are
2 vacancies. Let me introduce the Commissioners who are in
attendance today. . . . . .
The full Commission meets 11 times a year and each of our 4
committees meets monthly. As the W and I Code mandates 8 specific
Commission duties, our overall mission is dedicated towards
ensuring that the County's mental health system delivers
responsive, quality, and culturally relevant services to those
suffering with a serious and persistent mental illness.
We have had a busy year. Our Children's Committee has completed an
exemplary report on the status of mental health services for
children, adolescents and their families. Our Performance Outcome
A351 (6/93)
Mental Health Commission Annual Report
July 23 , 1996
Page 2
Committee has completed their report on the status of adult
services. The newly formed Speakers Bureau is up and running. And
our Adult Services Committee continues its focus on the need for
affordable housing with appropriate supports for mental health
clients. I am proud to turn over this podium to the Commission
Committee Chairs who will briefly report on committee activities of
the past year.
First, I am pleased to introduce Linda Trowsdale, Chair of the
Children's Committee.
(II. Children's Report - Linda)
Mr. Chair and members of the Board of Supervisors. Hello. It is
a pleasure to see you again. On behalf of the Children's
Committee, I thank you for meeting with us over the past several
weeks, at which time we delivered to you our report about
Children's Mental Health Services in Contra Costa County. A copy
of that report titled "Status Report: Children's Mental Health
System of Care" is also included in your packet today.
In the mid 19701s, a State Department of Mental Health Program
Audit Team concluded that ,Contra Costa County "had no children's
mental health services". In the 20 years since, we together with
you, have developed a service system so comprehensive and
necessarily complex that it took the Children's Committee 2 1/2
years to study, analyze, and document the system.
A major part of that time was spent being certain that all the
groups in the community that are interested in children's mental
health could come forward to present information. A great amount
of time was spent studying and analyzing the programs that exist.
We looked at funding issues and focused on retrieving the data
you'll find throughout the report. Last, but certainly not least,
with dedication and drive, a great number of your constituents
volunteered hundreds of hours in the editing and completion of this
document.
Our Committee wanted this report to reflect the Children's Mental
Health System of Care by identifying the good parts of the system
as well as the gaps in service. We were very careful not to only
say "we need more money. "
I would like to briefly draw attention to the format of the report.
It begins with an introduction. During our analysis, we discovered
many recurring themes that may be of interest to policy makers and
Mental Health Commission Annual Report
July 23, 1996
Page 3
planners. Next, you will see a description of the children and
adolescents served. There are three very helpful color charts
reflecting an overview of the various categories or levels of care
provided. The charts are followed by a description of each of the
11 categories or levels of care, beginning with the state
hospitals. In each section, please note the vignette describing a
young person who is typical of those served at that level of care.
All of the vignettes were drawn from real cases. Each of the 11
sections concludes with a paragraph entitled "Critical Issues for
Policy Makers and Planners. " We had you in mind while writing
these sections with the hope that they will assist you in
identifying gaps and need. Next, you will find several lavender
pages which highlight the Major Issues we identified during our
analysis. The report concludes with a glossary of terms and
several appendices that provide supporting documentation. We did
not format this report on a regional basis because we wanted to
focus attention on the service continuum or System of Care. We did
identify regional availability when we discussed specific program
components.
All who participated in the development of this report hope that it
will contribute to a continuing dialogue among parents, service
providers, advocates, planners, and policy makers about improving
services for children and their families in CCC. Until now, no
document nor any series of documents has been available to guide
someone through the Children's Mental Health System. It is our
hope that this report will become an educational document for you,
for families, new mental health system employees, and for the
community.
(Brief Pause]
Over the past two decades, CCC Boards of Supervisors have supported
the efforts of Children's advocates, parents, mental health
services administration and staff, and independent nonprofit
agencies to create a system of mental health services for children
and adolescents. Today's system is more comprehensive than the
systems in place in many other California counties where the
community and political will have been less united on behalf of
children.
Historic forces and emerging community needs, coupled with
thoughtful planning, have produced a range of services distributed
across the county. Efforts have been made to develop programs that
serve children and families from -the earliest ages through
adolescence. We found that today's system contains all the
categories of service required in a full, quality continuum of care
Mental Health Commission Annual Report
July 23 , 1996
Page 4
including, but not limited to, prevention; outpatient, crisis, day,
and residential treatment; state hospitals, etc. There remain,
however, significant gaps in services. The administrative
framework of the Children's Mental Health system is sound. Future
efforts should be directed not toward redesigning this framework,
but toward increasing service availability.
As you know so well, there are a number of new children's programs
starting in the County. The AB 3015 contract with the State, which
you have heard about, will begin to fill in some of the service
gaps we identified for court wards and will provide intensive,
intermittent, in-home intervention for certain Social Services
families and AB 3632 pupils. What you may not have heard about is
the new one million dollars for EPSDT service augmentation. This
money establishes six new program strategies. Since the funding is
50% State and 50% Federal money, this significant expansion in
services comes at no expense to the County. Exciting things are
happening.
Back to the report. Completion of this document has been a labor
of love. I can truly say that it was a pleasure working with so
many individuals dedicated to the provision of and advocating for
quality mental health services to the children and adolescents of
our County.
Thank you.
I am now pleased to introduce Herbert Putnam, Chair of the
Performance Outcomes Committee.
(III. Performance Outcomes - Herb)
Mr. Chair and members of the Board of Supervisors. Good Morning.
As you are aware, recent Realignment legislation gave local mental
health departments greater flexibility over their resources and
greater autonomy to develop mental health systems that respond to
unique local needs. This system reform was aimed towards creating
a mental health system that. is more responsive to the needs and
desires of persons with serious mental illnesses and their
families.
Performance outcome measures were established in statute as a
counterbalance to this new greater local flexibility and autonomy.
These measures are set to gauge the system's progress toward
accomplishing system reform. These measures are also designed to
make the accomplishments of the mental health system more tangible
as well as to be used to identify the strengths and weaknesses in
! V
Mental Health Commission Annual Report
July 23 , 1996
Page 5
a county's System of Care. Lastly, the outcome measures are
intended to determine changes in the lives of the clients served
and assist in determining if the services are improving a client's
quality of life.
We invite you to review our entire report, as we collected data on
six domains with 11 performance outcome measures. Of those six
domains, only two showed statistically significant results from the
statewide average. The living situation domain ranked below the
state average and the domain of engaging in productive activity
ranked above the statewide average.
The fact that CCC was below the average in living situations
underscored the need for increased access to affordable housing
with adequate supports for our persons with mental disabilities.
It is the opinion of the Performance Outcome Committee that CCC
performance outcomes would be significantly improved if there was
an array of housing with appropriate supports ranging from having
an IMD located in our County, to the availability of non-hospital
crisis beds as an alternative to hospitalization, to having
sufficient subsidized housing certificates to enable consumers to
live in independent housing with adequate supports.
Thank you. I am now pleased to introduce Marika Urso, Chair of the
Speakers Bureau.
(IV. Speakers Bureau - Marika)
Mr. Chair and members of the Board of Supervisors. Good Morning.
The Speakers Bureau Committee was added to the Commission this
year.
In July 1994, the Commission presented a Housing Report to this
Board that identified the lack of adequate, affordable community
housing opportunities within our County for mental health
consumers. This report also identified the stigma consumers face
when searching for housing, which makes the search for housing all
the more difficult. At the time of the presentation, this Board
requested assistance from the Commission in educating the public
with a goal of decreasing stigma towards persons with mental
disabilities. The Speakers Bureau was born from that request. And
it has been a busy year.
We began the year by applying for and receiving a grant from Contra
Mental Health Commission Annual Report
July 23 , 1996
Page 6
Costa Television to create a public information video entitled "The
Way It is: Mental Health Clients Speak Out. " You may remember the
5 minute clip we shared with you last October during Mental Health
Awareness Week. We are greatly appreciative to the wonderfully
kind and talented staff at CCTV in completing this project. They
dedicated many, many hours to filming and editing and treated this
project with great dignity and respect. We are finding this video
to be an effective tool in our presentations.
Presently, the Bureau has a current membership of 30 persons,
including consumers, family members, and mental health service
providers. For each presentation, a member from each of these
groups takes part. The speakers attended personalized training
sessions funded through the Zellerbach Foundation in preparation
for beginning our public presentations.
Since February, we have presented to approximately 300 people. We
welcome any referrals to community groups that you might have for
US.
Thank you.
I am now pleased to present Maria Puente, Chair of the Adult
Services Committee.
(V. Housing Report Update - Maria)
Mr. Chair and members of the Board of Supervisors. Hello. The
Adult Committee of the MHC has been continuing focus on the needs
for affordable housing with adequate supports for the mentally
disabled residents of CCC. When mental health clients are asked
what they most want out of life, the majority respond that they
would like a safe place to live independently and an opportunity to
contribute to their community. There continues to be limited
housing opportunities for these clients. Currently, County Mental
Health is developing enhancement of board and cares which will be
designed to serve our most gravely disabled persons who have been
recently taken out. of hospitals and IMDs. "Enhanced" means the
County will provide extra supports to clients in these homes.
But, as you heard previously from the Performance Outcome Report,
an array of housing opportunities with a variety of supports
continues to -be needed.
The Adult Services Committee will continue to focus efforts on
housing as a high priority. We look to your assistance with the
continued examination of ways to create affordable housing with
appropriate supports services not only for the homeless mentally
Mental Health Commission Annual Report
July 23, 1996
Page 7
disabled, but for those in sub-standard rooming houses or living
with their parents. An increase in the affordable housing stock in
this County, integrated with market rate housing so as not to look
like public housing, would serve a broad population including the
mentally disabled.
Thank you. I now present Ralph Hoffmann.
(VI. Closing - Ralph)
This Fall, the Commission, the Mental Health Division, and the
Alliance for the Mentally Ili are co-sponsoring an informative
workshop with Dr. Chris Amenson, a well-known educator in the field
of mental health. This workshop will take place during Mental
Health Awareness Week on October 4th. We are looking forward to
providing an excellent educational opportunity to 300 family
members, consumers, and service providers in our county. I
cordially invite all of you to join us.
On behalf of the MHC, I thank you for your attention today and your
continued support. It is greatly appreciated.
MISSION STATEMENT
OF THE
CONTRA COSTA COUNTY MENTAL HEALTH COMMISSION
INTRODUCTION:
The State of California has mandated the development of Mental
Health Commissions in each County so that consumers, family
members, and other citizens will have an opportunity to be involved
and influential in the planning and implementation of the public
mental health services delivery system.
MISSION:
The Mental Health Commission has a dual mission: First to
influence the County's.mental health system to ensure the delivery
of quality services which are effective, efficient, culturally
relevant and responsive to the needs and desires of the clients it
serves; ands second, to advocate with the Board of Supervisors, the
Mental Health Division, and the community on behalf of all Contra
Costa County residents with mental disabilities.
ACTIVITIES:
To this end, the Contra Costa County Mental Health Commission will
review and assess the County'.s mental health services system,
report on the performance of the mental health system to the Board
of Supervisors, provide a forum for public input regarding the
concerns and needs of persons with mental disabilities, participate
in relevant planning activities, and advocate for appropriate and
needed services and the rights of persons with disabilities.
Revised by the Mental Health Commission
September 10, 1994
MENTAL HEALTH COMMISSION
595 Center Avenue, Suite 200
Martinez, CA 94553
NAME PHONE POSITION APPTD. TERM END
District I
Joan Bartulovich H: 232-1136 Family Member 6/22/93 6/30/97
7102 Donal Avenue
El Cerrito, CA 94530
Taalia Hasan H: 234-7590 Family Member 6/22/93 6/30/98
1300 Amador St. 118 0: 215-4670
Richmond, CA 94804
Michele Jackson H: 724-4459 At Large 07/16/96 6/30/98
2454 Mahan Way 0: 235-9780
San Pablo, CA 94806
District 2
Marie Goodman H: 372-0545 Family Member 6/22/93 6/30/98
3331 Brookside Dr.
Martinez, CA 94553
Cynthia Miller H: 372-7678 At Large 6/22/93 6/30/97
105 Jose Lane 0:
Martinez, CA 94553
Vacancy (Risser) H: Consumer 6/30/99
District 3
Ralph Hoffmann H: 837-4498 Consumer 6/22/93 6/30/99
60 St. Timothy Court
Danville, CA 94526
Wayne Simpson H: 820-2163 Family Member 6/22/93 6/30/97
897 Dolphin Court
Danville, CA 94526
Vera Abate H: 736-2966 At Large 9/19/95 6/30/98
3551 Shadow Creek Dr. 0: (408) 294-0500 X-12
Danville, CA 94506
District 4
Herb Putnam H: 686-3071 At Large 6/30/97
1747 Bishop Drive
Concord, CA 94521
Joan Sorisio H: 672-2292 Family Member 6/22/93 6/30/98
P.O. Box 612 0: 825-1921
Clayton, CA 94517
Marika Urso H: 687-4707 Consumer 1/24/95 6/30/96
2025 Parkside Drive
Concord, CA 94519
District 5
VACANCY (McLaurin) H: Consumer 6/22/93 6/30/97
0:
Marlos Hicks H: At Large 07/23/96 6/30/99
2401 E. Cypress Road 0:
Oakley., CA 94561
Linda Trowsdale . H: 7+4-1199 Consumer/ 6/221/93 6/30/98
2824 Honeysuckle Circle Child Advocate
Antioch, CA 94509
Supervisor Representative
Jeff Smith H: 646-2080 Bd. of Supes 6/22/93 6/30/96
651 Pine St. #108A
Martinez, CA 94553
The Mental Health Commission meets on the Fourth Tuesday of the month, from 4:30-6:30
at 595 Center Avenue Suite 200 Martinez.
07/02/96
STATUS REPORT:
CHILDREN'S MENTAL HEALTH SYSTEM OF CARE
BY CHILDREN'S COMMITTEE
OF THE
CONTRA COSTA COUNTY
MENTAL HEALTH COMMISSION
FEBRUARY, 1996
TABLE OF CONTENTS
I. Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . 2
H. Children and Adolescents Served . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Eligibility Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
B. Demographic Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
III. Services
i. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
ii. System of Care Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
A. State Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
B. Acute Inpatient Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . 20
C. Diversion Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
D. Residential Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
E. Crisis Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
F. AB 3632 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
G. Intensive Day Treatment Programs . . . . . . . . . . . . . . . . . . . . . 39
H. YIACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
I. Outpatient Treatment Programs . . . . . . . . . . . . . . . . . . . . . . . 48
J. Early Intervention Programs . . . . . . . . . . . . . . . . . . . . . . . . . 56
K. Prevention Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
IV. Major Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
V. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
VI. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Children's Report Subcommittee . . . . . . . . . . . . . . . . . . . . . . 71
B. Presenters and Contributors . . . . . . . . . . . . . . . . . . . . . . . . . 72
C. History of Children's Mental Health System . . . . . . . . . . . . . . . 73
D. Children's Mental Health Services Mission and Goals . . . . . . . . . 76
E. Children/Adolescent Medical Necessity Criteria . . . . . . . . . . . . . 78
F. Legislation Applicable to Children's Mental Health . . . . . . . . . . . 80
G. Children's Mental Health Services . . . . . . . . . . . . . . . . . . . . . 83
EXECUTIVE SUNEYMY
This is a report about the current status of Contra Costa County's mental health system
of care for children and their families. It is the product of a two-year process undertaken
by the Contra Costa County Children's Committee of the Mental,Health Commission.
Committee members included Commissioners, County Children's Mental Health
Administration, personnel of county-operated children's mental health programs, contract
providers, and children's advocates.
The children's mental health system of care is a changing, evolving system.
Over the past two decades, Contra Costa County Boards of Supervisors have supported
the efforts of children's advocates, parents, mental health services administration and
staff, and independent nonprofit agencies to create a system of mental health services for
children and adolescents. Today's system is more comprehensive than the systems in
place in many other California counties.
Historic forces and emerging community needs, coupled with thoughtful planning, have
produced a range of services distributed across the county. Efforts have been made to
develop programs that serve children and families from the earliest ages through
adolescence. There remain, however, significant gaps as well as insufficiencies in this
system. These will be discussed in more detail in the Major Issues chapter and in the
Critical Issues for Policy Makers and Planners section at the end of each section of
Chapter III.
To understand the Major Issues Chapter, one must read Section III which describes the.
elements of the system today.
The framework described here is sound, but many service gaps exist. Future efforts
should be directed not toward redesigning this framework, but toward filling in these
significant gaps.
All who participated in the development of this report hope that it will contribute to a
continuing dialogue among parents, service providers, advocates, planners, and policy
makers about improving services for children and families.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 1
INTRODUCTION
The California Mental Health Master Plan. (1991) defines the goals of Children's
Mental Health Services as "to enable children with serious emotional disturbance to
remain at home, succeed in school and avoid involvement with the juvenile justice
system." There is broad agreement in Contra Costa County that, to avoid
fragmentation and inefficiency, and to be humane, these services must be part of a
comprehensive and integrated system. The services must also be family centered,
provided in the least restrictive setting possible, be culturally relevant, and be
responsive to the unique needs of each child and family.
Recurring Themes:
As the committee began to gather information for this report, we discovered that some
themes recurred. Some may be familiar to you, others may not. We describe them here.
The Children's Mental Health system is complicated in many ways. Some of these
complications have implications for policy makers.and planners. A few are:
• Children and adolescents experience as great a range of severity in mental illness
as do adults, but serious disturbance may be unrecognized in older children
because it is masked as school failure or delinquent behavior, and may be
unrecognized in very young children because they have not come to the attention
of the public systems.
• Children need many of the same services adults need, but their different
developmental levels complicate service planning. That is, a program for severely
emotionally disturbed toddlers must be very different from a program for severely
emotionally disturbed 16 year olds.
• The systems that serve children in the United States are a fiscal and programmatic
tangle. The educational system, the developmental disability system, the juvenile
justice system, the child protection system, the foster care system, and the mental
health system were all created at different times, have different histories, and are
funded in different ways. A single child and family may have contact with several
of these systems, either simultaneously or serially. Planning and implementing
effective programs to serve families across the systems requires extraordinary
teamwork.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 2
Introduction
• Data collection for this report was complicated by the lack of a comprehensive
management information system (MIS) within the Mental Health Division. As an
example, some of the tables in this report contain.data from FY 1993-94 and some
from FY 1994-95. In each instance the information presented is the most recent
available. But consistency of presentation and comparability is not possible given
the inadequacy of the current information system.
Due to changes in how mental health services can be funded, the Children's Mental
Health system in Contra Costa County has changed dramatically in recent years:
• The "local" cost of many children's services has declined. Most mental health
services for children and adolescents which used to require a substantial local
match are now certified for Medi-Cal and generate substantial Federal Financial
Participation (FFP) dollars for the County. This has made it possible to continue
some services and, in some cases, to provide more and better services. However,
the dependence on FFP creates service vulnerability because of probable cuts in
Federal Medicaid funding.
• Fewer children are served in the state hospital than were served there a decade
ago. The Children's Mental Health system has developed community alternatives
that are less costly and closer to home. Though these alternatives provide needed
services for many children and families, they are not suitable for all children.
There will always be a need for this level of intensive and restrictive care for some
children for at least some period of time.
Some little known facts about Children's Mental Health services provide special
challenges for policy makers and planners:
• Some adults are treated in the children's mental health system because children can
be treated more effectively in the context of their families. Sometimes the family
members are themselves emotionally disturbed. This means that some parents
receive their primary mental health treatment from the children's mental health
system. Though this is appropriate, it is a challenge to the resources of the
children's system.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 3
1 '
Introduction
• Medi-Cal usually does not fund prevention or early intervention programs and it
is difficult to identify other sources of funding. Yet these programs. could help
some children who are troubled or at risk for emotional disturbance avoid
prolonged treatment later in life. This is a fiscal and programmatic "catch-22."
• A child who has a dual diagnosis may receive insufficient services. This applies
to a child or adolescent with emotional disturbance AND a developmental
disability or with emotional disturbance AND drug addiction or alcoholism.
The reality of dual or overlapping problem areas is usually ignored in the
regulations which govern the use of most governmental funds. Funding is
restricted to the one problem area identified as "primary". Funding sources also
require that any other funding source be accessed first. Which of the dual
problems is "primary" and which service system is responsible for care becomes
problematic. Because of their history (including federal, state, and local policy
decisions) each service system has developed different types of services and each
operates from a different philosophical viewpoint. All of the service systems
involved are underfunded. Each of the above factors impacts service delivery
across problem areas and funding boundaries.
Current Responses To These Challenges:
Although the framework of services described in this report is a sound one, many service
gaps exist. Future efforts should be directed not toward redesigning this framework, but
toward filling in those significant gaps.
This year, Contra Costa County has received several grants to fill in some of these
identified gaps by providing additional special programs to the most seriously troubled
children, youth, and families.
The long-term future of these programs is not assured because funding is dependent upon
public policy decisions and the appropriate allocation of dollars at every level of
government.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 4
L
CHAPTER H: THE CHILDREN AND ADOLESCENTS WHO ARE SERVED
A. Eligibility Definition
Eligibility for services in the public mental health system is determined by various pieces
of state and federal legislation which govern the use of or access to funds. That
legislation (enacted over many decades) has been modified by local choice, mostly fiscal.
The local criteria for eligibility have become more restrictive as funding has become less
available.
By legislative mandate, services are primarily directed toward children and adolescents
who are identified as seriously emotionally disturbed. These are children and adolescents
under age 18 who have as their primary problem a clinically diagnosed mental disorder
which results in behavior and functioning inappropriate to the individual's age according
to expected developmental norms.
To be eligible for most mental health services, a child or adolescent must have a mental
health diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM),
accepted worldwide, , nod meet criterion 1, 2, 3, or 4 below.
1. Individual exhibits substantial impairment in at least one of the following:
- Child/adolescent lives in the home and complies with community rules.
- Child/adolescent is involved in age appropriate daily activities (may include
involvement in household chores, scheduled programs, education and training).
r - Child/adolescent demonstrates the ability to establish and maintain age
appropriate social and family relationships.
- Child/adolescent experiences maximum physical and mental well-being, with
symptoms minimized and good access to health care services.
2. Individual exhibits repeated presence of psychotic symptoms, OR suicidal ideas or
acts, OR violent ideas or acts toward persons or property.
3. Individual has a psychiatric history of recurring substantial impairment or
symptoms which indicates that without mental health service there is a high risk
of recurrence of the functional impairment or symptoms.
4. Individual is eligible for mental health services under Chapter 26.5 of the
California Government Code (AB 3632), the only state-mandated program within
the mental health system for any age group (See Chapter III, Section F).
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 5
i
Children and Adolescents Served
In addition, to be eligible for Medi-Cal funding, counties must establish specific criteria
which define the "medical and service necessity" for mental health treatment. Contra
Costa County Children's Mental Health Services has fulfilled this requirement by creating
the document entitled "Children/Adolescent Medical Necessity Criteria" which is included
in this report as Appendix E.
Throughout the county-operated service system, individuals and families who request
service are triaged and those with the most urgent need are served first. Some clinicians
use the following "Priority Rating Scale" as an informal guideline. On this five-point
priority rating scale, with Level 5 indicating the most seriously disturbed group of
children/adolescents and Level 1 indicating minimal impairment, those in Levels 5, 4, and
as many 3's as possible receive services.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 6
Children and Adolescents Served
PRIORITY RATING SCALE
Level 5
Most seriously affected group of children and adolescents showing:
♦ history of past hospitalization with risk of re-hospitalization.
♦ persistent danger of hurting self and others.
♦ serious suicide act/rumination/plan, with clear expectations of death.
♦ behavior influenced by delusions or hallucinations.
Level 4
♦ behaviors threatening or dangerous to self or others within the past three months.
♦ failure to meet role expectations at home, school, or community.
♦ threat of/or recent removal from home or placement.
♦ recent release from psychiatric inpatient care.
♦ history of past hospitalization with risk of re-hospitalization.
♦ unreliable psychosocial support.
Level 3
♦ history of dangerous behavior to self or others in the past year.
♦ history of runaway, extended truancy.
♦ acting out behaviors at school and community.
♦ at high risk for higher levels of care.
♦ history of hospitalization or placement out-of-home.
♦ fair psychosocial support.
Level 2
♦ infrequent history of runaway or truancy.
♦ no dangerous behaviors in past year.
♦ acting out behaviors in home, school, or community.
♦ history of removal from home in past.
♦ fair to good psychosocial support.
♦ history of substance abuse.
Level 1
♦ temporary acting out behaviors at home, school, or community in response to stress.
♦ anxiety before exams and temporary falling behind in school work.
♦ occasional arguments with family.
♦ drug/alcohol involvement without regular patterns of abuse.
Due to inadequate resources and the high numbers needing services, the system cannot
serve all the children/adolescents who meet the Priority Rating Scale's criteria for service.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 7
Children and Adolescents Served
B. Demographic Profile of Children and Adolescents Served
Ethnic Distribution
Table 3 shows the ethnicity of the children and adolescents receiving mental health
services, compared with the general population of children and adolescents in Contra
Costa County.
Table 3: Ethnicity
ETHNICITY % OF CLIENTS % OF ALL CHILDREN
White 50% 54%
African American 33% 12%
Latino/other 11% 16%
Spanish
Asian 2% 12%
Native American < 1% < 1%
Other/Unknown 3% 6%
(Sources: County computer system for client population, 1993 - Census data for gene
population, 19%)
Gender Distribution
The general population of children and adolescents in Contra Costa County is
approximately 52 percent male and 48 percent female (1990 Census). For children and
adolescents receiving mental health services, gender distribution is 65% male and 35%
female.
Age Distribution
The age distribution for children and adolescents who receive mental health services is
as follows: Age 0-5 = 1.5%; age 6 - 12 = 7.08%; age 13 - 17 =8.12%. Together,
ages 0 - 17 total about 16.7% of the total individuals served. (Adult 18 - 59 = 77.5%
and seniors about 5.8%).
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 8
Children and Adolescents Served
Departmental Cross-overs
Children and adolescents served by Children's Mental Health Services are usually also
receiving services from other public agencies. [NOTE: The following percentages are not from
unduplicated counts. Children may be represented in more than one category.]
♦ Some 60% are court dependents and/or are known to Child Protective Services
(Social Service Department).
♦ Some 15% are wards of the Juvenile Justice System (Probation Department).
♦ Some 25% are special education students receiving services from the three
SELPA's in Contra Costa County. (SELPA = Special Education Local Planning
Area.)
♦ Some 15% are solely served by mental health.
♦ Most of the children and adolescents served are also receiving educational services
from their local public school.
[The percentages above regarding gender, age, and departmental cross-overs are
all from 1993-94 but remain relevant.]
Socio-Economic Situation
County-wide, there were more than 57,000 residents of Contra Costa (including 22,000
children) living in poverty in 1990, and there was a 20% increase in the number of
children living in extreme poverty between 1980 and 1990. Most of the children and
families served by our county's mental health system are poor because that is the
population for which the public system is primarily responsible.
Living Situations
Children and adolescents who are served in the mental health system are less likely to be
living with their own families than the children in the general population. See Table 4.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 9
Children and Adolescents Served
Table 4: Living Situations
LIVING SITUATION % OF CHILDREN % OF ALL CCC
SERVED CHILDREN
Living with immediate family 518% 91%
Not living with immediate family,
-- Extended family 13% 6
-- Non-relatives 13% 2%
-- Group home,institutions 5% < 1%
-- Other/lives alone/unknown 10% --
TOTAL, NOT LIVING WITH 41% 8%
IMMEDIATE FAMILY
(Sources: County computer system for client population, 3. Census data for genera
population, 1990)
Family Life and Environmental Factors
The extent of disruption in the family life of the client population is illustrated in data
collected from a survey conducted in 1993 at the three County Mental Health Outpatient
Clinics in Richmond, Concord, and Antioch. Though this survey is not the work of this
committee, the information obtained still is relevant.
The 1993 study showed that, of the child and adolescent clients who were seen in the
clinics:
♦ At least 55% had experienced the absence of or death of a parent,
♦ At least 63% had parents with alcohol or drug abuse problems, ote: Clients with
known or probable prenatal drug exposure = 55% Central; 34% East; and 50% West.)
♦ At least 54% had been neglected and at least 37% had been abused.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 10
�l V
Children and Adolescents Served
♦ At least 71% had experienced, witnessed, or been personally impacted by violence
within their home or immediate community. (Note: This survey category defined
three levels of violence: extreme, substantial, moderate. The percentage stated here
collapses the three categories into one total.)
[Each of the above percentages is the lowest of the three totals for that question from the three
clinics.]
The survey demonstrates that most, but not all, children and adolescents served in county
outpatient clinics come from disrupted or adverse living situations.
The family and community exposure to violence experienced by many children and
adolescents has significantly contributed to their mental health problems. Although
violence is a public safety issue, the increasing level of violence in the community and
within families has a significant impact on the mental health system at all levels.
This chapter has focused on children and adolescents as the recipients of mental health
services. .In practice, it is more generally true that the entire family unit is the recipient
of services, since the children do not/cannot/should not function in isolation from their
families.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 11
CHAPTER III: SERVICES
i. Overview
Children's Mental Health Services has established a System of Care (SOC) or continuum
of services to meet the varied mental health needs of children, adolescents, and their
families. The SOC continuum contains various "types" of mental health programs and
services from the most restrictive, institutionally based services (e.g., Napa State
Hospital) to the least restrictive, community-based services, (i.e., early intervention and
prevention programs). Because the mandate of the State is for public mental health
dollars to be expended for services to seriously emotionally disturbed children,
adolescents and their families, and those individuals and families have the most urgent
needs, the SOC is heavily weighted toward serving that population.
The SOC contains programs that are county operated, i.e., staffed by county employees,
and programs provided through contracts with community-based organizations. The goal
is to provide one seamless, coordinated and collaborative system for delivery of mental
health services countywide.
The current SOC for Children's Mental Health Services consists of 5 county-operated
programs and 16 contract programs. Six of the contracts are for residential or hospital-
based services and 10 are for less intensive community-based services. Of the 5 county-
operated programs, 3 are regional outpatient clinics in Central, East, and West County
and 2 (YIACT and AB 3632) are interagency programs which are based in Central
County but serve the whole county. This system functions under the administrative
leadership of the Child and Adolescent Services Program Chief supported by a Lead Staff
Group composed of a Children's Services Medical Director, 5 Mental Health Children's
Program Supervisors, and a Children's Program Specialist.
The Children's Mental Health SOC does not stand alone. It is inextricably linked with
the other public child-serving entities, i.e., schools, probation, social services, and health
care providers. There is usually one or more of these other entities also involved with
each child and family mental health serves. Interagency collaboration is a necessary and
important part of service delivery.
When new program elements are added to the SOC, they are designed to fill gaps in the
SOC continuum and to reinforce the system's ability to maintain children in their own
home and community, or, if a child is already in out-of-home placement, to enable such
children to return to a less restrictive environment.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 12
r
ii. System of Care Chart
The SOC chart, i.e., the 3 following pages, arrays services by "type" from the most
restrictive, institutionally based services (e.g., Napa State Hospital) to the least
restrictive, community-based early intervention and prevention programs. Columns
designate "age eligibility" for services, service capacity and mental health gross and net
cost. An asterisk (*) indicates case management services provided by YIACT (Youth
Interagency Assessment and Consultation Team) and the "diamond" shows case
management services by AB 3632. Eligibility for programs is represented by color
coding: blue for seriously emotionally disturbed (SED) Probation wards (602s); pink for
SED Social Service dependents (300s); green for SED AB 3632 special education pupils;
and brown/orange for other at-risk SED individuals. The color coding graphically
illustrates each agency subset SOC. Proposed programs are highlighted by yellow. A
purple frame surrounds alternatives to inpatient services.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 13
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CHAPTER III A: STATE HOSPITALS
Charles, 15, is hospitalized at Napa State Hospital for extreme aggression
and assaultive behavior. He has been in the mental health system since age
8. His mother, a single parent, is a battered woman. His father has been
absent most of his life. Charles'family and extended family have a history
of violence, substance abuse, mental illness, and criminal justice
involvement.
Hospitalization occurred only after failure at several high level residential
placements and after incarceration at juvenile hall on a restrictive unit. At
the Hall, both Charles and his mother refused to accept medications for him
that may have decreased his aggressiveness, suspiciousness, anxiety, and
paranoia.
Currently his mother is engaged in a treatment program and maintains full-
time employment. Charles' incidents of aggressiveness have markedly
decreased.
Definition and Descn
State hospitals are long-term, locked psychiatric institutions for patients with symptoms
too severe for them to be cared for in unlocked or less restrictive community settings.
This level of care is used as a last resort usually after numerous failed placements and
local hospitalizations.
State hospitals provide total care, including room and board, 24-hour supervision,
psychiatric and medical treatment, and on-site schooling. Napa State Hospital, located
approximately 30 miles from Martinez, is the main state hospital used for Contra Costa
County residents.
Population Served
State hospitals serve children and adolescents, age 5 through 17 years old, who exhibit
uncontrollable aggression, violence, or sexually acting out behavior, have major
personality disorders, are severely depressed, are suicidal or homicidal, or are otherwise
severely impaired. The four youths who are currently in Napa State Hospital range from
15 to 17 years of age.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 17
. O
State Hospitals
Utilization and Costs
Beginning in the 1960's, a growing belief in the clinical desirability of placing children
and adolescents in the least restrictive environment coincided with cost cutting efforts by
state government and produced a progressive decline in the utilization of state hospital
services.
Children's Mental Health Services has long striven to decrease state hospital utilization
and create community-based programs to prevent or shorten long-term hospital stays. In
consequence, between fiscal year(FY) 82-83 and FY 92-93, the number of Contra Costa
children placed in state hospitals declined from 24 to 12 annually.
However, during that same period there was limited fiscal incentive for removing patients
from state hospitals. Funds for state hospital beds were transferred from the County's
allocation directly to the state hospitals based on the County's projected need for beds
each year. Thus, money was lost to the County if the beds were not used.
The implementation of Realignment legislation (see Appendix F) in FY 92-93 changed
this situation. It placed the funding for state hospital beds directly under county control.
Consequently, an opportunity was created to redirect these funds to local alternatives.
The cost for children and adolescents in state hospitals is approximately $150,000 per bed
per year. The length of stay ranges from 3 months to 3 years, with an average of 12-18
months. Since Realignment, the number of contracted state hospital beds for children and
adolescents has been reduced from 12 to 6.
The cost for 12 beds would have been $1,800,000. The reduction from 12 to 6 beds a
year meant a saving of $900,000 for the County. In reality, $400,000 of that amount
went toward reducing the county deficit. Fortunately, $500,000 remained in Children's
Services. This portion has been used to create the Oak Grove Program which consists
of a crisis residential unit and a day treatment program at Oak Grove in Concord and to
augment other long-term residential treatment programs.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 18
V
State Hospitals
Critical Issues for Policy Makers and Planners
• Unfortunately, not all funds saved by reducing use of state hospitals have been
made available for local program development. Instead, savings have been used
to decrease the County deficit. All funds saved are needed by Children's Mental
Health Services to continue to provide programming for this difficult population.
• Presently, there are no SPECIALIZED programs available at the state hospitals for
violent, fire-setting, sexually offending, or dually diagnosed children and
adolescents. Efforts must continue across counties to create treatment programs
for these special population groups either at the state hospitals or as community-
based state hospital alternatives.
• There will always be children who will need the level of care provided by the state
hospital system. At this time, we are at minimal bed level for those children.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 19
O
CHAPTER III B: ACUTE INPATIENT HOSPITALIZATION
Carol, 14, is in her fifth hospitalization after a near fatal suicide attempt;
she ingested 150 Tylenol tablets. She is withdrawn, maintains no eye
contact, and has monotone speech. She has been in 12 foster homes in the
past 8 months. Her history includes parental drug abuse, early childhood
sexual abuse by her father, and severe deprivation emotionally and
economically.
Definition and Description
Acute inpatient hospitalization is short-term hospital care provided under the direction of
a physician who is a psychiatrist. This level of care is limited to children and adolescents
who are experiencing a psychiatric episode so severe as to require close, continuous, and
skilled medical observation and treatment in a secure environment. The primary'purpose
of hospitalization is to stabilize the child.
The hospital may provide management of assaultive or self-destructive behaviors by
means of one-on-one observation; isolation; or, if necessary, restraints, which can only
be used in the hospital setting. Services include diagnostic evaluation; individual, group,
and family therapy; psychotropic medication trials and monitoring; and educational
services.
Contra Costa County does not operate its own children's inpatient unit. It contracts with
private hospitals to provide acute inpatient services as needed or refers to private
psychiatric hospitals using other payor sources. Hospitalization in a particular facility
depends upon the child's age and particular needs, services offered, space available, and
insurance coverage. (See Table 6 for information on the private hospitals.)
Population Served
Most of the children and adolescents who are hospitalized meet the criteria for
involuntary hospitalization under Section 5150 of the Welfare and Institutions Code (See
Appendix F). They are suffering an acute phase of a psychiatric illness which causes
them to be a danger to themselves or others, or gravely disabled. Hospitalized children
and adolescents range in age from 5-18 years old, with adolescents outnumbering children
by a ratio of 6:1. Children under the age of 8 are seldom hospitalized.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 20
Acute Inpatient Hospitalization
Utilization
On average, there are approximately 20 Contra Costa County children and adolescents
in acute hospitals at any given time. This includes minors whose hospitalizations are
funded by private insurance and who are not part of the public-sector system of care.
During 1994, 170 children and adolescents were hospitalized under Medi-Cal--the
primary payment source for public funded hospitalizations. The average length of stay
was 9.88 days. Of these children and adolescents:
♦ 42 had more than one admission in the course of a year
♦ 24 were readmitted within 30 days of discharge
Table 6 provides data, from the Managed Care Plan of December 1994, on the private
hospitals used during 1993-94.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 21
f
Acute Inpatient Hospitalization
Table 6: Contra Costa Children and Adolescents in Inpatient Hospitals, under Medi-Cal, i
1993-94.
HOSPITAL LOCATION # OF TOTAL CCC AVERAGE TOTAL
BEDS CHILDREN LENGTH DAYS
IN SERVED OF STAY
UNIT (DAYS)
Langley- San Francisco 3 1 15 15
Porter
CPC Sacramento . 18 2, 29.5 59
Heritage
Oaks
Sutter Sacramento 32 2 14 28
Ross Kentfield 18 8 13.6 109
Herrick Berkeley 14 11 6.8 75
St. Mary's' San Francisco 27 13 12.6 164
(McAuley)
CPC Walnut 22 43 6.3 270
Walnut Creek
Creek
First Vallejo 22 89 10.6 943
Hospital
TOTAL 156 1.70 9.88 1679
Costs
In 1993-94, child and adolescent usage of inpatient services accounted for only 5 % of
all Medi-Cal inpatient days while adult services utilized the remaining 95%.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 22
Acute Inpatient Hospitalization
Children and adolescents are hospitalized in one of three ways:
1. The County has contracts with CPC Walnut Creek and First Hospital Vallejo, each
with a payment limit of $50,000 a year, to serve children and adolescents for
whom there are no other payor sources such as private insurance or Medi-Cal.
2. CPC Walnut Creek provides two "free beds"* for Contra Costa County's
medically indigent children; that is, the hospital covers the bed costs while County
Mental Health pays the doctor's fees and some incidentals for these children. The
hospital's obligation to provide "free beds" will continue until the year 2003.
3. Through calendar year 1993-94, private hospitals listed in Table 6 provided
inpatient hospitalization services under private insurance and the fee-for-service
Medi-Cal system.
As of January 1, 1995, the inpatient fee-for-service Medi-Cal system ceased to
exist. The County assumed responsibility for management of Medi-Cal inpatient
hospitalization as Phase I of Medi-Cal Managed Care implementation in
California.
Under Medi-Cal Managed care, psychiatric inpatient hospitalization of Medi-Cal
children and adolescents is limited to hospitals with County Managed Care
contracts and inpatient stays must be authorized and funded by the County. The
current rate is $450 per bed per day with a projected usage of 1200 days for the
year.
Critical Issues for Policy Makers and Planners
• Expanded home-based diversion programs might reduce the need for acute
hospitalization or shorten the length of stay.
• At times, hospital discharge may be delayed because there is not an appropriate
community placement for a particular child and/or a funding stream for placement
is not available.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 23
O
CHAPTER III C: DIVERSION PROGRAMS
Sara, 14, was sexually molested at age 3 by her great uncle. She has a
history of extreme oppositional behavior with explosive combative episodes.
Her academic performance is limited due to behavior management problems
and severe learning disabilities. At age 13, Sara became pregnant and 4
months after the birth of her infant she became psychotic and suicidal and
made homicidal attempts on her infant and her mother. After several local
hospitalizations, she was admitted to Napa State Hospital.
Because this family's problems are so complicated and chronic, a FP
worker has been assigned to help. Sara's mom, now homeless, must find
housing, re-establish her AFDC status and apply for job training through
the GAIN program,work toward decreasing the family's social isolation,
and develop parenting skills while monitoring Sara and the family's safety.
Definition and Description
Two recently established programs funded by the County are specifically designed to
divert children and adolescents who are at risk of hospitalization or out-of-home
placement. They are the Family Preservation Program and the Intensive Intermittent
Intervention Program (PP, pronounced "triple eye p").
♦ The Family Preservation Program is provided by FamiliesFirst, a contract agency.
It offers intensive in-home services to the entire family. Services to the family
include therapeutic interventions; education in crisis and anger management;
communication and parenting skills development;practical help with household and
financial management; case management services to link family members with
other needed services; and advocacy with schools, doctors, and county agencies.
The defining characteristic of family preservation programs is that a case
worker/therapist is in the home with the family from 8-20 hours per week and
available by pager 24 hours/day, 7 days/week, for a period of 6-8 weeks.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 24
Diversion Programs
♦ The VP is provided by two County contract staff members, one assigned to the AB
3632 Program and one to YIACT. It offers intensive services like those of family
preservation programs but differs in that workers each carry a caseload of 8
families and services are provided for a longer period of time, usually six months
to a year. Many of the families served by this program experience chronic
intermittent crises and need an intensive intervention for a longer time than those
families served by the family preservation program.
Population Served
These programs are used to divert children and adolescents from hospitalization or out
of home placements or to shorten the length of stay at those facilities.
Utilization and Cost
Utilization and cost,of the mental health programs are described in Table 7 below.
Table 7: Diversion Programs and Utilization and Costs 1993-94
PROGRAM # OF # SERVED CCC TOTAL
SLOTS MENTAL MENTAL
HEALTH HEALTH
COSTS COSTS
Intensive
Intermittent 16 24 $64,000 $9651000
Intervention
Program
FamiliesFirst $58,000 $68,000
Family 2 18
Preservation
Program*
*Contra Costa Social Services Department has a contract with FamiliesFirst for approximately
$700,000 to provide family preservation services to children and youth in the Probation and Social
Services Departments.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 25
Diversion Programs
Critical Issues for olicy Makers and Planners
for olicy Makers and Planners
• The balance of allocations to these programs compared to other programs will be
determined by analysis of client outcomes and cost avoidance data.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 26
CHAPTER III D: RESIDENTIAL TREATMENT
Brian, 11, a highly intelligent and artistic boy, hospitalized several times
for suicide attempts, was kicked out of his prior residential treatment
program when he threatened a staffperson person with a butcher knife. Brian is
responding well to the high level of structure in his current program. He
has worked hard over the past two years at learning to stop manipulating
others, to trust adults, and to control his impulses to hurt himself and
others. Meanwhile, his parents are attending weekly family therapy
sessions and learning how to live with and manage such a seriously
emotionally disturbed child. With the excellent progress they are all
making, and with the planned assistance of an in-home support counselor,
Brian will be able to return home to live with his family and attend a local
school before the year is up.
Definition and Description
Residential treatment programs provide long-term therapeutic care in unlocked community
facilities for seriously emotionally disturbed children and adolescents who require 24 hour
intensive care. Children and adolescents must be wards of the court or dependents of the
court or eligible for AB 3632 residential services. Children and adolescents who do not
fit one of these three funding categories are not eligible for out-of-home placement in
California unless they have private insurance which pays these costs.
Most children and adolescents who require residential placement need intensive levels
of care. Residential programs are licensed by Community Care Licensing and assigned
a Rate Classification Level (RCL) by the California Rate Setting Board/Bureau. Ranging
from RCL-1 to RCL-14, levels are based upon the intensity of services provided, staff
education and training, and staff to resident ratios. There are few facilities in California
rated lower than RCL-8.
All residential treatment programs used by Children's Mental Health Services offer 24-
hour supervision; medication support; education in an on-site certified non-public school;
day treatment; crisis intervention; and individual, group and family therapies as needed.
All of them provide some services of a psychiatrist and nurse.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 27
r
Residential Treatment
Children's Mental Health Services places children and adolescents in three community-
based RCL-14 agencies:
♦ La Cheim Residential Treatment Center operates two 6-bed facilities in Contra
Costa County serving adolescents, primarily boys, from 13.5 - 18 years old. Half
of the children and adolescents in'this program are "Napa-flagged," in other
words, are being specifically diverted from the state hospital.
♦ Seneca Center, operates a 30-bed sub-acute, residential program for latency-aged
children (6 - 12 years old) in Alameda County. Ten of its 30 beds are contracted
for Contra Costa children. Seneca Center also provides "wrap-around" services
and a "step-down" or transition foster care program. Contra Costa children and
adolescents placed in Seneca may receive some or all of these services. (See
Glossary for "sub-acute", "wrap-around" and "step-down.")
♦ Willow Creek in Santa Rosa has 32 beds in five homes for ages 13-18. Contra
Costa County contracts with Willow Creek for four beds.
Children's Mental Health Services provides case managers through YIACT or AB 3632
to support Contra Costa children in these programs.
Population Served
Seriously emotionally disturbed children and adolescents become eligible for County
placement in residential programs only in the following ways:
1. They may be removed from their homes by the Department of Social Services due
to abuse and/or neglect, pursuant to Welfare and Institutions (W&I) Code 300.
2. They may be removed from their homes by the Probation Department for law
violations. These minors are made wards of the Juvenile Court pursuant to W&I
Code 602.
3. They may be placed through the AB 3632 Program if they are eligible for school
district special education programs but cannot benefit from their education without
residential care. Unlike placement in categories 1 and 2, placement in this
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 28
r
Residential Treatment
category is voluntary, not court mandated. Placement is handled in cooperation
with school districts if agreed to by the parent or guardian.
By law, children and adolescents can be placed in the highest level of care (RCL 14) only
if certified by the Interagency Placement Committee (IPC), which meets monthly to
review all children under consideration (See Glossary .for IPC). Children and
adolescents placed in the highest level have been hospitalized in the recent past, have
repeatedly failed in prior placements, and/or have displayed aggressive and self-
destructive acting out behaviors associated with mental disorders.
Most children return to their families following placement and those without primary
family or extended family may be placed in specialized foster care or group homes.
Utilization and Costs
The following table provides an overview of the number of children and adolescents who
were served by mental health residential treatment programs and the cost of these services
in Contra Costa County for 1993-94.
Table 8: Utilization and Cost of Sub-Acute and Residential Treatment Programs, 1993-94
PROGRAM TOTAL CCC # LENGTH CCC TOTAL
BEDS BEDS SERVED OF MENTAL MENTAL
STAY HEALTH HEALTH
COSTS COSTS
La Cheim 12 12 20 1-1 1/2 131,000 131,000
yrs
Seneca 30 10 12 1-2 yrs 126,000 228,000
Willow 32 4 5 1-1 129,000 139,000
Creek 1/2 yrs .
Supplemental n/a n/a n/a n/a 25,000 25,000
Patches
TOTAL 74 26 37 411,000 5235,000
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 29
Residential Treatment
Most of the cost of residential treatment programs is paid by non-mental health sources
including AFDC-FC and the public schools. (See Glossary for AFDC-FC.) The total
cost of the most intensive level of residential treatment (RCL-14) ranges from
approximately $9,500 to $11,000 a month per resident, substantially less than the cost of
inpatient hospitalization.
For example, AFDC-FC pays approximately $5,000 per bed per month for 24 hour care
at the RCL-14 rate. Public school systems pay a non-public school (NPS) allotment of
approximately $2,000 to $3,000 a month per student. These costs are not included in the
chart above.
County Mental Health provides supplementary "patches" of approximately$900 to$2,000
a month per resident to other facilities which are not listed here. The word "patch" is
used to describe the money given to residential programs to provide day treatment
services as well as other mental health services, usually to children who are AB 3632
eligible.
Critical Issues for Policy Makers and Planners
0 A significant amount of funding for these programs comes from several different
departments, therefore, effective interdepartmental coordinating mechanisms are
particularly important to produce effective client outcomes.
• Children who need services at this level but who are not wards or dependents of .
the court or AB 3632 eligible cannot receive these services even if their families
are low income unless they have private insurance which pays for residential
treatment. This is one of the significant gaps in the service continuum.
• There are not enough residential treatment facilities appropriate for youth 17.5 -
22 years of age in Contra Costa County. There is one 6-bed facility, but it is not
available exclusively to Contra Costa County residents.
• Children's Mental Health services has been working to contain the number of out-
of-home placements and placement costs, but some children and adolescents will
continue to need this level of care. Programs which intervene earlier may reduce
the need for some, but not all, of these higher level services.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 ' Page 30
Residential Treatment
• There is a need for specialized, high-level, intensive programs for the violent,
firesetting, sexually offending, or dually diagnosed (that is, mental health and
substance abuse or mental health and developmentally disabled) children and
adolescents.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 31
CHAPTER III E: CRISIS SERVICES
Anna, a 17.5 year old born in El Salvador was referred to Crisis
Residential Services due to aggressive and dangerous behavior related to
psychotic symptoms and drug addiction. Her childhood was characterized
by the chaos and trauma of war as well as sexual abuse by her stepfather
and physical abuse by a relative. She has been using heroin and other
drugs for the past five years. Anna hears,- voices that command her to kill
herself or harm her family, she shot her stepfather. She has been
hospitalized in psychiatric facilities many times and has been served by
multiple county systems: Probation, Mental Health, Social Services,
Education. She achieved stability in the program and has been referred
to a residential treatment program.
Definition and Description
According to the 1991 State of California Mental Health Master Plan, "the primary focus
of crisis services is stabilization, crisis resolution, assessment of precipitating and
attending factors, and recommendations for meeting identified needs."
The most common crisis behaviors include suicidal gestures or attempts (usually drug
overdoses); assaultive or other out-of-control behaviors or the onset or re-emergence of
a major mental disorder, including schizophrenia or severe depression. Crises are often
precipitated by family or peer conflict.
The crisis services available in Contra Costa County fall into three major categories, as
follows:
♦ Crisis stabilization is defined as an immediate face-to-face response in a 24-hour
health facility for a period of less than 24 hours to individuals exhibiting acute
psychiatric symptoms to avoid the need for hospitalization.
Crisis stabilization services for adults, adolescents and children are available only
at Mental Health Crisis Services (MRCS), located in E Ward at Merrithew
Memorial Hospital in Martinez.
♦ Crisis intervention is a service offered face-to-face or by telephone at any location,
to enable the individual to cope with crisis while continuing to function within the
community.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 32
Crisis Services
Face-to-face, walk-in crisis intervention services are available at MHOS, at
Merrithew Memorial Hospital in Martinez on a 24-hour basis and at all clinics and
at the West County Crisis Service during weekday hours.
Telephone crisis intervention services are available, around the clock, at MHCS
and under contract from Crisis and Suicide Intervention of Contra Costa County
(CSI). CSI hotlines include crisis and suicide lines, child abuse lines, and a
runaway line. Children and adolescents often call these services.
♦ Crisis residential treatment services are therapeutic services provided in a
structured 24 hour residential program.
Since February 1995, Contra Costa County has provided crisis residential
treatment services to children and adolescents, 8 through 17 years of age, at the
Oak Grove Crisis Residential Program in Concord. This is an eight bed facility
operated by FamiliesFirst, a community-based organization. The program includes
24 hour-supervision; psychiatric evaluation and medication services; intensive day
treatment; an on-site school program provided by Mt. Diablo Unified School
District; and recreational activities. This is an RCL-14 residential treatment
center with a staff-to-resident ratio of 1:2. The average length of stay is expected
to be two weeks. Three beds are subcontracted to other counties.
Population Served
♦ Crisis Stabilization: Mental Health Crisis Services (MHCS) sees children and
adolescents who are brought in voluntarily or involuntarily or who walk in as
"self-referrals". They may be brought in by parents, police, or other caregivers.
MHCS is a designated "5150" site, a reference to the Welfare and Institutions
Code 5150 which authorizes involuntary holds for persons who are a danger to
themselves or others or who are gravely disabled. Approximately 40% of the
children and adolescents seen by MHCS are brought in under this Code provision.
♦ Crisis Intervention: Telephone crisis hotlines are called by children and
adolescents who are acutely distressed, suicidal, victims of abuse, or runaways.
Sometimes their caregivers or friends call.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 33
Crisis Services
♦ Crisis Residential Treatment Services: These services are used as an alternative
to hospitalization and/or to stabilize the child while assessing the current living
situation for individuals experiencing acute emotional or family problems which
require intensive short-term care.
Utilization and Costs
Table 9 summarizes the utilization and costs of the various kinds of crisis services. Since
these services vary so much, cost comparisons should be made with caution.
Table 9: Child and Adolescent Crisis Services Utilization and Costs 1993 - 94.
PROGRAM NUMBER UNIT OF CCC TOTAL
SERVED SERVICE MENTAL MENTAL
PER HEALTH HEALTH
YEAR COSTS COSTS
Mental Health 345 < 24 hour 33,833 79,609
Crisis Services day
(E Ward)
West County 41 Outpatient 29028 4,055
Crisis visit
Crisis and 59534 Phone 26,286 26,286
Suicide call
Intervention
Oak Grove 60 Per 91,000 182,000
Crisis (projected) bed/day
Residential (5
beds)*
TOTALS n/a 1153,860 1292,663
*
AnnuaGed budget.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 34
O
Crisis Services
Mental Health Crisis Services, the West County Crisis Center, and Crisis and Suicide
Intervention (CSI) provide most of their service to adults, therefore the County funds
which help support these programs come out of the Adult Mental Health Services budget.
Children and adolescents placed in crisis residential programs usually have placement
orders (authorizing AFDC-FC funding), and/or qualify under AB 3632, or are subsidized
by Children's Mental Health Services on a per diem basis.
Crisis and Suicide Intervention, a community-based organization, is partially funded under
contract by County Mental Health Services. The balance of their budget is through other
non-county sources.
Critical Issues for Policy Makers and Planners
• Mental Health Crisis Services is essentially an adult program with little special
provision for children. In the crisis unit, a single bed in an office, with a nurse
designated to provide one-to-one observation, is available for children and
adolescents who need to stay overnight. During the day, children are managed in
the crisis unit along with the general adult population. No separate area is
available. This situation needs to be addressed in the final planning process for
the new Merrithew Memorial Hospital.
• Additional training for designated staff on the crisis unit, regarding children and
adolescent treatment issues, should be made available for those staff not generally
in contact with children and adolescent clients.
• Crisis services for children and adolescents are not easily accessible to residents
outside Central County after regular working hours (Monday-Friday 9:00-6:00).
• New approaches are needed to respond to mental health crises in the community.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 35
CHAPTER III F: AB 3632
Kyle, 15, an outcast at school, is constantly insulted and threatened by his
classmates. He is failing several classes because he just sits in his seat and
never turns in any work. At home, he spends much of his time alone in his
room playing video games. Mom is cooperative, but she is a single parent
who must work long hours. The AB 3632 Program psychiatrist recently
prescribed anti-depressant medication for Kyle, and he is now expressing
interest in learning how to develop relationships with other people and how
to be successful at school. He will continue working on these issues with
his individual therapist.
Definition and Description
Assembly Bill 3632 (AB 3632) is the only state mandated program within the mental
health system for any age group. AB 3632 provides a structure and process for the local
school districts and County Mental Health Services to collaborate in serving the mental
health needs of special education students. It is also the only program that provides a
continuum of services from consultation to intensive residential treatment for a defined
group of clients, that is, special education students who are assessed as needing mental
health services to be able to benefit from their education.
Services provided by the AB 3632 program include:
♦ Assessment to determine whether the child is eligible for AB 3632 services;
outpatient therapy, including family, group, and individual therapy.
♦ Consultation with the school, either in conjunction with outpatient therapy or as
a separate service, in order to deal with specific problems, issues or questions
regarding the youth's mental condition, behaviors and treatment strategies.
♦ "Gatekeeping" (See Glossary) for other services provided by community-based
organizations under contract to the County, including intensive day treatment and
residential services (See Chapter III, Sections D and G).
♦ Case Management including monitoring placement and treatment of each child in
residential and day treatment programs; discharge planning.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 36
AB 3632
♦ I3P consisting of intermittent in-home services for families in crisis. (See Chapter
III Section C.)
Population Served
The referral of a child or adolescent must come from the school district, with the consent
of the parent, from an Individualized Education Plan team. This team consists of the
school personnel, AB 3632 mental health staff, and parents/caregivers. The decision to
offer mental health services is based upon a mental health assessment performed by a
clinically licensed member of the County's AB 3632 staff. Team members, including the
parents, bring their individual ideas and recommendations to the team meeting where a
plan is formulated. Parents have the right to accept or refuse any or all services for their
child and may seek outside services at their own expense or with school district funding.
Only special education students with identified emotional or mental health needs are
eligible to be served by this program and then only after they have received a minimum
of six months of school counseling services, which are called Designated Instructional
Services, provided by their home school district.
Utilization and Cost
The County contracts with community-based organizations for day treatment and
residential services for AB 3632 children and adolescents. The descriptions of these
programs and their costs are included in other sections of this report. Table 10 shows
only the utilization and cost of the services provided by AB 3632 County staff members.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 37
AB 3632
Table 10: AB 3632 Program: Unduplicated Count of Children and Adolescents and
Costs, 1993-94.
SERVICES NUMBER NUMBER CCC TOTAL
PROVIDED BY SERVED AT SERVED MENTAL MENTAL
COUNTY ONE TIME PER YEAR HEALTH ]HEALTH
AB 3632 COSTS COSTS
STAFF
Psychotherapy, 300 450 $355,000 $1,122,000*
Assessment,
Case
Management,
Consultation
This figure includes annual State funding of$472,000,identified specially by the State for AB 3632 services.
AB 3632 employs 13.6 FTE (Full-Time Equivalent) clinical staff, one supervisor, and 1.8
FTE clerical staff.
Critical Issues for Policy Makers and Planners
• Utilization of the AB 3632 Program varies by school districts. The requirement for
children and adolescents to be designated as special education to be eligible for AB
3632 is perceived as a barrier by some school districts. The legal requirements
for completion of significant amounts of paperwork is also seen as a barrier.
Some school districts refer many children and adolescents to AB 3632. Others
refer fewer. West County, which is a large district, refers noticeably fewer
students. Therefore, fewer children and adolescents in West County are served
by AB 3632 programs and contract agencies because of the lower number of
referrals.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 38
. V
CHAPTER III G: DAY TREATMENT INTENSIVE PROGRAMS
Shawn, 4, is a strong, naturally athletic boy who has been rejected from
nine foster homes because he is angry, violent, and out-of-control. He is
permanently disabled from a severe beating he received when he was 2112.
He has bonded with his current foster mother, but she is not sure she can
keep him because he is threatening to her younger children. In the
program, he is making progress toward expressing his anger in more
acceptable ways and his foster mother is learning how to help him control
himself while showing him her love. With continued progress, he may be
able to stay in this stable home and even to enter public school at the
appropriate age.
David, 17, has attended day treatment for 16 months. He was referred
because of his explosive rages and paranoia. When agitated, he became
hysterical and seemed to lose touch with reality. He had been hospitalized
twice because of suicidal thoughts. In the program, he has made
tremendous progress in controlling his temper and has learned to focus
more on his skills and resourcefulness. He is planning on graduating from
the day treatment program by year's end.
Definition and and Descries
Intensive day treatment is the highest level of care available outside a hospital or
residential treatment setting for seriously emotionally disturbed children and adolescents.
Intensive day treatment provides highly structured and comprehensive services in a center
or school five days a week. Services include therapeutic classroom interventions;
individual, group, and family therapy; special education; and age-appropriate skill
development. Some programs.also provide psychiatric evaluation and medication support.
In Contra Costa County, intensive day treatment programs serving children and
adolescents are provided by non-profit community-based organizations under contract with
the Mental Health Division. There are three programs for preschool children and two
programs for school-aged children and adolescents. All programs are Medi-Cal certified
and are staffed to meet State regulations. The programs designed for each of the age
groups are in separate sections below.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 39
1
r
Day Treatment Intensive Programs
I. Intensive Day Treatment for Preschoolers
Intensive day treatment for preschoolers provides highly structured therapeutic programs
in nursery-school settings to children who have serious emotional problems. Programs
vary in focus, but all use some combination of behavioral, developmental, and
psychodynamic interventions with children. All also require participation by family
members and provide parent education and counseling.
Programs operate between 3 and 4.5 hours a day, 5 days a week. Program entry is based
upon an assessment of the child's and family's special needs. Children continue in day
treatment from six months to three years, depending on their age at enrollment and
severity of diagnosis. Children are discharged when they become eligible for another
program or can return to a less structured and supervised setting.
The three private non-profit programs providing preschool day treatment programs are:
♦ Lynn Center, a program of the Association for Retarded Citizens (ARC), located
in Pittsburg, serving East and Central County.
♦ Therapeutic Nursery School (TNS), of Early Childhood Mental Health Program,
located in Richmond, serving West County.
♦ Barbara Milliff Center (formerly known as the We Care Treatment Center),
located in Concord, serving Central and East County.
All three programs are certified by the State of California Department of Education as
State Certified Non-Public Schools which can serve special education students. Two of
the programs (Lynn Center and Barbara Milliff Center) also serve, under separate
contract funded by the Regional Centers, additional children who are developmentally
delayed or disabled.
Population Served
Children enrolled in these three programs are seriously emotionally disturbed and are
often functionally delayed. To be served under County mental health contracts, they must
be ineligible for other funding sources (e.g., Education, Head Start, Regional Center).
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 40
Day Treatment Intensive Programs
Some referrals come from County agencies: Child Protective Services, Mental Health
Clinics, Public Health Nursing. Others come from Children's Hospital, U.C. San
Francisco Medical Center, and other Bay Area hospitals; private agencies; Regional
Center of the East Bay; day care providers; and private physicians. Some families are
self-referred.
Many of the children live in, or have been removed from, homes where parents have
been unable to provide the nurturance, stability, and safety children need. Many have
been abused or neglected. Some have been exposed to parental substance abuse and
family violence. Some are dependents of the court.
Utilization and Cost
Total capacity for the classroom component of these three programs at any given time is
46 children. A total of 91 children were served in FY 1994 - 95.
Table 12 provides an overview of children served in preschool day treatment programs.
Table 12: Utilization and Costs of Preschool Treatment programs, FY 1994 - 95.
PROGRAM # OF # # CCC TOTAL
SLOTS SERVED** DAYS MENTAL MENTAL
HEALTH HEALTH
COSTS COSTS
Lynn Center 13 20 2,809 146,000 224,000
Therapeutic 9 18 1,724 66,898 129,371
Nursery
School
Transition* n/a 7 89500 169467
Barbara Milliff 24 46 4,118 219,000 3849620
Center'
TOTAL 46 1 91 1 8,651 1440,398 754,458
41 Transition is a separate follow-up program for children isc arg rom into sc oo s or o er
programs.
** Number served represents unduplicated count.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 41
Day Treatment Intensive Programs
Critical Issues for Policy Makers and Planners
• There is no county-wide continuum of services for preschoolers. Such a
continuum that extends from intensive services to early intervention would provide
service options before day treatment as well as step-down options when a child is
ready to be discharged from day treatment.
• The public schools are legally resporaiW t provide special:education services to
an individual, age 0-22, who has any of 14 handicapping conditions given that the
person's learning is sufficiently impaired; i.e., the individual meets the State's
criteria for special educations services. Serious emotional disturbance is one of
the 14 handicapping conditions. Though public schools serve some young
seriously emotionally disturbed children, the reality is that it is extremely difficult
to get these preschoolers enrolled in an appropriate public school special education
program.
Barriers include the following: Given their short life span and developmental
level, it is difficult for preschoolers to meet the State's criteria for special
education services. Schools are reluctant to ,lel, young children as seriously
emotionally disturbed. In addition, schools are only required to fund educational
services while the emotionally disturbed preschooler and family need additional
treatment interventions. Unless special services (beyond special education
placement) are provided by the schools, AB 3632 referral is not possible. In
consequence, Children's Mental Health and the contracting day treatment providers
too often underwrite the full cost of both education and treatment components for
preschool-age children who are seriously emotionally disturbed.
• Services which would help children discharged from preschool intensive day
treatment programs make the transition to regular schools are limited. They do
not exist at all in most parts of the County.
H. Intensive Day Treatment for School-Age Children and Adolescents
School-based day treatment provides individualized educational and therapeutic services
in special classrooms, either in State Certified Non-Public Schools or specialized
educational units for children and adolescents between the ages of 6 and 18 who are too
disturbed to function in mainstream classrooms. Mental health services provided by
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 42
Day Treatment Intensive Programs
clinical staff include individual,,group, and family therapy; assessment and consultation;
milieu support; and crisis intervention. If needed, medication support and monitoring is
provided by psychiatrists and registered nurses. Parental and family involvement is a
critical part of each child's treatment. Educational services are paid for by the child's
school district.
The two private non-profit programs providing day treatment programs for school-age
children and adolescents are:
♦ La Cheim operates two intensive day treatment programs for children and
adolescents, one in Richmond and one in Pleasant Hill. Both programs serve
children and adolescents from 6 through 19 years of age. All children are referred
and case managed by AB 3632. La Cheim Schools are State-Certified Non-Public
Schools.
♦ Oak Grove Day Treatment, a new intensive day treatment program for youths
from 12 - 17 years of age, opened in February 1995. It is operated by
FamiliesFirst at the Oak Grove facility in Concord. This program primarily serves
adolescents who are not eligible for the AB 3632 program. The educational
component is provided by Mt. Diablo Unified School District.
Population Served
Intensive day treatment is for children and adolescents with acute psychiatric symptoms
who are unable to function in a less intensive educational environment. They may lack
impulse control, may be depressed, violent, or suicidal and, therefore, require daily
therapeutic interventions and/or treatment services.
Most children and adolescents live at home or,in foster care. Some children and
adolescents reside in the most restrictive residential settings. Families are expected to
participate in treatment.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 43
Day Treatment Intensive Programs
Utilization and Cots
Table 13: Day Treatment for School-Age Children and Adolescents Utilization and
Costs, 1994 - 95.
PROGRAM # OF # # OF CCC TOTAL
SLOTS SERVED DAYS MENTAL MENTAL
HEALTH HEALTH
COSTS COSTS
La Cheim 51 72 10,1.96 550,300 918,000
Oak Grove 24 24* 431200* 249,000** 498,000**
TOTAL 75 96 14,396 799,300 19416,000
um r ery .n um r Days reflect usage from February 1995 throughJune 30, 1995.
** Figures annualized based on five months performance.
Critical Issues for Policy Makers and Planners
• Children and adolescents referred to intensive day treatment programs often
require treatment for prolonged periods of time. Discharges to lesser levels of
care are delayed because few "step-down" resources exist either within a day
treatment program or in public school special education programs. Length of stay
at higher levels could be reduced if "step-down" services are developed.
• Access to day treatment for latency age children, not identified as special
education, is not available through Children's Mental Health Services in Contra
Costa County.
• The public schools are legally responsible to provide educational services for
seriously emotionally disturbed (SED) children, age 0-22, whose learning is
significantly impaired; i.e., who meet the State's criteria for special education
services. In,addition, schools are only required to fund educational services while
the emotionally disturbed child needs additional treatment interventions. Unless
special education services and school-based intervention are provided, AB 3632
assessment and referral is not possible, therefore limiting access to day treatment.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 44
r0
CHAPTER III H: YOUTH INTERAGENCY ASSESSMENT AND
CONSULTATION TEAM (YIACT)
Stacey, 16, was removed from her home at age 8 because of severe sexual
and physical abuse. She has lived in several foster homes. At age 14, her
teacher caught her stealing at school whereupon she assaulted the teacher,
was charged, and sent to juvenile hall. She bounced from placement to
placement due to a pattern of running away, returning to Juvenile Hall
between each placement where she required crisis counseling frequently.
Over the past 2 years, she's been hospitalized 3 times for suicide attempts
and is now placed in a level 14 facility. In summary, Stacey was evaluated
for return home by YIACT, received crisis counseling in juvenile hall by
YIACT, was tracked and supported through her hospitalizations by YIACT,
and is now being case managed in placement by YIACT. If her current
placement fails, the next step will be hospitalization at Napa State Hospital,
where she will be case managed by YIACT.
Definition and Description
The Youth Interagency Assessment and Consultation Team (YIACT) was created
originally to centralize assessments and recommend placement options for high-risk,
multi-problem youths who are served by several agencies.
YIACT services now include:
♦ Assessments and evaluations of emotionally troubled children and adolescents in
the Probation, Social Services, and Education Departments. Limited psychological
testing is available to Social Services;
♦ Case and program consultation, both clinical and educational, to professionals who
deal with these children and adolescents;
♦ Mental health crisis counseling, consultation, psychiatric and medication services
to residents at Juvenile Hall;
♦ Mental health crisis counseling,. consultation, individual and group therapy,
coordination with Healthy Start programs, aftercare referrals, and community
treatment to residents at Orin Allen Rehabilitation Center (formerly Byron's Boys
Ranch);
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 45
/ V
YIACT
♦ Monitoring hospital admissions for to all Medi-Cal eligible youngsters and case
management for those in the "free beds" at CPC Walnut Creek Hospital
throughout hospitalization and collaboration in discharge planning;
♦ "Gatekeeping" (see Glossary) and case management for County's children at Napa
State Hospital and for non-AB 3632 children and adolescents at La Cheim
Residential Treatment, Seneca Center, Willow Creek, and FamiliesFirst;
♦ 13P Services (see Chapter III Section C);
♦ Case management and crisis intervention for certain young adults age 18-21
previously served by YIACT who are moving into the County's Adult Mental
Health Services system.
Population Served
YIACT serves children and adolescents ages 4 through 17 who are candidates for out-of-
home placement or have been unable to succeed in one or more treatment programs.
YIACT also provides transition services for a few former YIACT clients ages 18 through
22 who are moving into the County's Adult Mental Health.Services system.
Utilization and Costs
Table 14: YIACT Utilization and Costs for 1994 - 95.
SERVICE NUMBER COUNTY TOTAL
SERVED MENTAL MENTAL
HEALTH COST HEALTH COST*
Assessments 1090 358,000 592,000
Case Management
There are no cash conte utions from other County departments at the present time, but an Educatioi L
Specialist from the County Office of Education is assigned to YIACT part time.
YIACT employs 11.25 FTE (full-time equivalent) staff including the following: 6.3 FTE
clinicians, 1 FTE clinical intern, 1 FTE VP clinician (on contract), 1 FTE (program)
supervisor, .5 FTE psychiatrist, .25 education specialist, and 1.2 FTE clerical staff.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 46
I
YIACT
Critical Issues for Policy Makers and Planners
• YIACT's case management and referral functions are hampered,by the lack of
needed services within the community, particularly the lack of specific programs
for violent youth and juvenile sex offenders.
• It is often difficult for YIACT staff to terminate services to young adults age 18
through 22 years due to the lack of appropriate services in the adult system.
t
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 47
CHAPTER III I: OUTPATIENT TREATMENT
Laura, 7, has been sexually abused by her father. She is frightened, easily
startled, wets her bed, and has nightmares. In treatment, Laura is dealing
with her confusion, self-blame, and fears of abandonment as a result of the
abuse. Initially, Laura's mother, Jane, had difficulty accepting Laura's
report of abuse. In her own therapy, Jane is dealing with self-blame,
resentment of Laura for breaking up the family, and her own inability to
protect her child.
Yolanda, 11, lived with her mom and stepdad (both abusing drugs) and her
three younger siblings until a year ago. She was the primary caregiver for
the younger children. During one of many domestic altercations, with all
four children in the next room, mom shot and killed her husband. The
younger children were placed in foster homes, mom went to jail for
manslaughter, and Yolanda moved to grandma's.
She was brought to counseling by her grandmother because she refused to
do chores, had temper tantrums, cried easily, had nightmares and was
jealous that the other grandchildren received grandma's attention when they
came to visit.
Yolanda feels responsible for mom's drug use and the breakup of the family.
She is terrified that the younger children, to whom she is very attached, will
never be a part of the family again. The counselor is helping Yolanda to
identify, express, and deal with her feelings and fears. She is learning
about addiction and that she is not to blame. Grandma is just beginning to
understand Yolanda, deal with her behavior, and meet her needs.
Contra Costa County offers a broad range of regionally-based outpatient treatment
services, for seriously emotionally disturbed children and their families or caretakers.
There are three regional clinics operated by the Mental Health Division and four private,
non-profit contract providers.
The roles of the clinics and non-profit providers will be separately described in the
sections which follow.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 48
Outpatient Treatment
Regional Clinics
Definition and Description
There are three regional mental health clinics that provide outpatient services to low-
income, seriously emotionally disturbed children and adolescents. Services include:
assessment of mental, emotional and behavioral disorders; support for family members
and others involved with the child; short and long-term individual, group, and family
therapy; case management; medication support; and specialized programs. Currently, two
of the clinics have intern programs. The average length of outpatient treatment is
approximately one year.
Regional clinic staff also provide consultation and training to the Early Mental Health
Initiative (EMHI) programs operated by various school districts and located on site at
some elementary schools throughout the county. In the EMHI program, children in
grades K-3 who display early school adjustment problems are paired with trained
paraprofessionals for 12 - 15 weekly one-on-one play sessions. The goal is to prevent
mild school adjustment difficulties from becoming more severe. The paraprofessional
staff is recruited from each local community and reflects, as much as possible, the ethnic
and cultural mix of the school population.
In 1993-1994, County Mental Health provided consultation/training to 20 schools
countywide. Approximately 1,000 children a year are served in the EMHI program
countywide. No Mental Health charts are opened on these 1,000 children and they are
not included in the totals reflected in Table 15.
The characteristics and special programs of each regional clinic (1994-95) are briefly
described below.
Central County Clinic, located in Concord, offers
• outpatient therapy
• step-parent and caretaker groups
• intern training program (four interns 1994 - 95)
• 4 FTE staff, 1 supervisor, 1 full time clerk.
• 5 EMHI programs sites (1 school district)
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 49
i
Outpatient Treatment
East County Clinic, located in Antioch, offers:
• outpatient therapy
• Parkside Healthy Start program (participate as part of the program team)
• Ambrose Service Integration Team (participate as part of the program team)
• intern training program ( 4 interns 1994-95)
• four EMHI program sites (1 school district)
• 5.5 FTE staff, 1 supervisor, 1 FTE clerk
West County Clinic, located in Richmond, offers:
• outpatient therapy
• adolescent sex offenders group
• battered women group
• parent support groups
• 13 EMHI program sites (2 school districts)
• 7.825 FTE staff, 1 supervisor, 2 FTE clerks, 1 FTE medical records technician,
1 FTE clerical supervisor
Population Served
Without treatment, the children and adolescents served by the regional clinics are at high
risk for school failure,juvenile delinquency, hospitalization, and out-of-home placement.
Most of the children and adolescents served by the regional clinics are diagnosed with
post traumatic stress disorder, depression, or one of the disruptive behavior disorders.
About a third of the children and adolescents are receiving some type of special
education, and many more struggle academically.
According to a survey conducted by the three regional clinics in 1993, almost half of the
children served are living either with extended family or in a foster or group home. The
majority of the remaining children live with only one biological parent. More than half
of the biological parents of these children are alcohol and/or drug impaired.
Additionally, more than half of the children have experienced some form of abuse or
neglect.
A majority of the sample children, from all regions of the County, have experienced or
have been exposed to violence in the form of battering of family members, gang violence,
and/or murders in their neighborhood. About one-third have family members who have
died by violence or the child has personally witnessed murders, shootings, or stabbings.
Exposure to violence is especially prevalent in West County.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 50
Outpatient Treatment
Utilization and Costs
The following table provides an overview of children and adolescents served through the
three regional clinics. This table reflects only clients served with open charts. It does
not reflect EMHI children nor other short term interventions.
Table 15: Children and Adolescent Utilization and Costs at the Regional Clinics, 1994 -
95.
REGIONAL NUMBER CCC TOTAL
CLINIC SERVED MENTAL MENTAL
HEALTH HEALTH
COSTS COSTS*
Central County 157 4131247 606,000
East County 320 366,206 570,000
West County `286 685,734 925,000
TOTALS 763 1314655,187 --F2,101,000
e difference between total costs and County mental health costs reflects Federal Financialarticipation
and other revenue.
Critical Issues for Policy Makers and Planners
• Although families who cannot be served immediately are referred to other
resources whenever possible, each of the clinics has a waiting list of 20 - 30
children and adolescents at any given time. Many children and adolescents wait
three to six months for treatment. There are insufficient clinic staff to meet the
need.
• EMHI programs are often started with three year state grants which decrease each
year. School districts are hard pressed to replace those dollars with other funding
resources needed to maintain the EMHI programs. In 1995, two school districts
discontinued their EMHI programs (five sites).
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 51
Outpatient Treatment
• The parents of the troubled children served are often seriously disturbed
themselves and in need of services. These services could best be provided through
children's mental health. Currently, there are few resources to do so.
• The number of ethnic minority staff at the professional level needs to be increased.
rivate., Community-Based Outpatient Programs
Definition and Description
The County contracts with four private, non-profit providers for specialty outpatient
services. Each organization provides a different type of service, as described below.
Child and Family Therapy Center (CFTC), now a part of East Bay Agency for
Children (EBAC), serves youth under age 18 who have been sexually molested
and/or physically abused. Treatment is also provided for parents, siblings, and
other adults who were molested as children. Services include: information and
referral; assessment; individual, family, and group therapy; parent training; and
psychological testing. Services are provided at locations throughout the county.
The length of treatment averages 11 - 12 months. There are 85-100 on-going
treatment slots.
The county Mental Health contract provides partial funding to this agency for
information and referral and intake activities only.
Early Childhood Mental Health Program: Infant-Parent Program provides in-home
support and intervention for parents with children under four years of age in West
Contra Costa County. Services are provided to infants/young children and their
families where the parent-child relationship is troubled and/or where past parenting
history places the infant or child at risk. Services available include: in-home
assessments; psychotherapy; parent education; and child development guidance.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 52
Outpatient Treatment
The Y Team, operating under the YMCA of the East Bay, provides counseling to
adolescents attending five junior high/middle schools in the West Contra Costa
Unified School District. Special education students are not included because other
programs are available. Services are provided on campus and include:
assessments, therapy, and crisis intervention. Both individual and family therapy
are available at the Y Team Clinic. Most services are provided by graduate
clinical interns supervised by licensed clinicians. The length of treatment generally
averages six to nine months.
Many of the children served have family histories of violence, neglect, and
physical/sexual abuse. Many are also exposed to, or involved in, gangs and gang
violence.
Familias Unidas,of Desarrollo Familiar, provides bicultural and bilingual services
to Latino families in West Contra Costa County. Services provided with County
mental health funds include:
♦ Outpatient therapy for individuals and families
♦ Consultation, education, and information regarding community resources
and advocacy for members of the Raza community
♦ Consultation and technical assistance to professionals and human service
providers regarding mental health issues, especially those relevant to Latino
clients
Population Served
These four agencies serve similar populations. One of the consistent characteristics is the
high degree of loss-suffered by family members. Violence has played a major role in the
lives of a majority of these families.
The children and families served experience seriously troubled family relationships, post
traumatic stress disorder, depression, acting out, and suicidal behavior. Referrals come
from various sources such as health and human service agencies, schools, other
community-based organizations, and self-referrals.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 53
Outpatient Treatment
Utilization and Costs
The following table provides an overview of the utilization and costs of outpatient
services provided by non-profit contractors.
Table 16: Utilization and Costs of Outpatient Services Provided by Non-Profit
Contractors, 1994 - 95.
NON-PROFIT NUMBER NUMBER CCC TOTAL.
CONTRACTORS SERVED HOURS MENTAL MENTAL
HEALTH HEALTH
COSTS COSTS
Child/Family 135* 595 40,373 40,373
Therapy Center
Early Childhood 50 1,81.3 79,000 155,636
Mental Health -
Infant-Parent
Program
Y Team 122 19410 98,000 129,000
Familias Unidas** 36 326 34,243 34,951
minors
TOTAL 343 3,793 1251,616 1 359,960
Source: PSP data tracking system fora programs except Child and Family Therapy,which provided its own
figures.)
* Child and Family Therapy Center: There were 135 individuals assessed face-to-face and 2,167 persons
provided information and referral by phone; 307 hours were spent in assessment services and 288 hours were
spent on information and referrals.
** Familias Unidas has a contract with Adult Mental Health Services with a total mental health cost of
$233,007. The above numbers estimate the cost of services to children and adolescents under this contract.
r
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 54
Outpatient Treatment
Critical Issues for Policy Makers and Planners
• The issue of waiting lists is generally as critical for the contract providers of
outpatient services as it is for the county clinics. There are insufficient resources
to meet the need.
• All of the non-profit contract agencies attempt to leverage their county mental
health dollars by seeking funds from other sources. In recent years, each of these
programs has experienced program cuts due to decreased governmental and United
Way funding. This places additional pressure on the agencies to maintain service
levels while searching for additional funding.
• The above specialized outpatient programs are not available in every part of the
county.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 55
�
CHAPTER III J: EARLY INTEI.tVENTION PROGRAMS
Victor, 4, was referred by his day care provider because he was attacking
other children and deliberately injuring himself. If he could not be kept in
the program, it would be Victor's third expulsion from a day care program,
a disaster for the family. Victor's,mother must work full time outside the
home because his father sustained a serious head injury in an accident and
is permanently disabled. He cannot care for Victor at home. Victor is
expressing all the buried anger and frustration of his parents in his own
behavior. The Preschool Consultant is helping redirect Victor's anger.
Because Victor can't improved very much until his home situation improves,
the Consultant also is helping the parents, who are proud and independent,
to acknowledge their need for help and she has found an appropriate
referral for counseling for them.
Definition and Description
Early intervention programs provide screening and/or assessments to identify children
with early adjustment problems and provide sufficient intervention to resolve or
ameliorate those problems before more intensive mental health treatment becomes
necessary.
Early Childhood Mental Health Program (ECMHP) is the only non-profit agency which
has a contract with Children's Mental Health Services to provide an early intervention
service. That service is Preschool Mental Health Consultation Teams.
There is one part-time Preschool Mental Health Consultation Team in East and one part-
time team in West County. Staffed by professionals, these two teams assess the treatment
needs of young children enrolled in preschool and day care settings who are displaying
signs of emotional disturbance. Referrals come from preschools and day care providers
with parent consent.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page.56
Early Intervention Programs
Team members provide:
♦ assessment of children referred by preschools and day care centers
♦ short-term counseling (a maximum of 6 visits) to parents
♦ linkage between parents and appropriate resources
♦ consultation to preschool and day care staff
♦ training for preschool.and day care staff in intervention techniques
♦ parent education and guidance in early childhood development
Population Served
The children served are identified by caregivers as functioning below capacity due to
social/emotional difficulties or as "difficult to manage" or as children for whom family
stress is creating difficulties. (Another early intervention effort, the Early Mental Health
Initiatives (EMHI) program, is described in Chapter III Section I. State Department of
Mental Health three-year grants often provide the start-up money for this school-based
school-funded program. County Children's Mental Health Services clinic staff provide
regular training and consultation to many of these programs.)
Utilization and Cost
Utilization data collected is in two categories: individuals served and agencies served.
The individuals include children(one child counted per family),individual parents served,
and the staff members in the program where each referred child is enrolled. The agency
category includes preschool and day care centers of different capacities. Each agency is
counted once regardless of the number of children referred from there.
The Preschool Consultation Teams tallies children served (one child counted per family),
individual parents served, individual preschool teachers and day care providers served and
agencies served (with a breakdown by licensed capacity). This data is shown in Table
18.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 57
Early Intervention Programs
Table 18: Utilization of Preschool Mental Health Consultation Teams, 1993-94.
POPULATION NUMBER NUMBER TOTAL
SERVED SERVED SERVED SERVED
EAST COUNTY WEST COUNTY
INDIVIDUALS
Children 57 69 126
Parents 98 83 181
Agency Staff 117 86 203
TOTAL 272 238 510
INDIVIDUALS
AGENCIES
(by capacity)
1 - 12 children 7 23 30
13 - 48 children 21 13 34
48 + children 8 11 19
TOTAL 36 47 83
AGENCIES
e County Mental Health cost for FY 1993-94 for this program was$129,958. T-Fe total cost of this program
identified in the contract, from all sources, is $133,949.
Critical Issues for Policy Makers and Planners
• Service need is greater than the program's current capacity in both East and West
County.
• Children in Central County also need these services, but no team currently exists
there.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 58
' O
CHAP'T'ER III K: PREVENTION PROGRAMS
Annette, 15, bright and outgoing, eagerly participated in North
Richmond Community Initiatives (NRCI) activities, volunteered in the
office and helped care for younger kids. "Jumped" by a gang, her world
fell apart. She took a gun to school for 'protection" and was sent to
Juvenile Hall. Probation and County Day School followed. Throughout,
NRCI staff and volunteers maintained contact with Annette and supported
her goal to return to regular school. Following a summer job at NRCI,
she did so this FALL. Her grades are now A's and B's.
Definition and Description
Prevention programs provide education, skill development and support to a generally
non-symptomatic population to prevent specific problems.
One non-profit agency has a contract with Children's Mental Health Services to
provide two prevention programs. That agency is the Center for Human
Development.
1. The Parent Educator Program (PEP) is offered throughout the County. Paid
staff train volunteers to deliver health promotion lessons about issues of mental
health and substance abuse to students in K - 6. The adult volunteers work in
teams to promote resiliency in the children and to serve as positive role models.
PEP is active in 26% of the county's public schools. In the 1993 - 94 contract
year, 287 adults volunteered in PEP in Contra Costa County. PEP also offers a
12 hour workshop for parents called Strengthening Family Ties.
2. North Richmond Community Initiatives (NRCI) is located at Shields Reed
Community Center in North Richmond and primarily serves that community.
Paid staff and approximately fifty volunteers provide:
♦ an after school program for elementary school students (called "Kids Are
Fun") which includes tutoring, recreation, and educational support
♦ a year-round after-school hours program for high school youth which
includes Teen Rap, New Youth Leadership Group, and Neighborhood
Youth Corps (NYC) activities
♦ a summer day camp for elementary school children in which NYC
participants work as paid peer counselors
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 59
Prevention Programs
♦ a workshop, similar to Strengthening Family Ties, for parents who
choose to participate
Population Served
All students in a participating K - 6 school are eligible to be served in the Parent
Educator Program and all community residents are eligible for North Richmond
Community Initiatives.
Utilization and Cost
The contract with Center for Human Development (one contract for two programs) is
jointly funded by Children's Mental Health and the Substance Abuse Division as
shown in Table 17 below.
Table 17: Utilization and Costs of Center for Human Development Prevention
Programs, 1994 -95.
PROGRAM NUMBER NUMBER CCC CCC TOTAL
CHILDREN PARENTS MENTAL SUBSTANCE COUNTY
SERVED SERVED HEALTH ABUSE COSTS
COSTS COSTS
Parent 5,735 400 17,631 62,990 80,621
Educator
Program
North 555* 119 21,275 849424 105,999
Richmond
Community
Initiatives
TOTAL 69290 1 519 38,906 1479414 186,620
* Based on year round participation, about 50% are elementary school students and 50% high school
students.
The cost to train volunteers in the Parent Educator Program is $175 per person. Typically,
that cost is paid by the school districts or parent clubs; it is not paid with County dollars.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 60
Prevention Programs
Critical Issues for Policy Makers and Planners
The Parent Educator Program can only be provided where and when a school is
willing to incorporate the program into the school's curriculum.
• Both the Parent Educator Program and North Richmond Community Initiatives
depend on the availability of volunteers and the funding to train them. In order
to be effective, both programs require volunteers and staff from the local
community, but it is difficult to recruit volunteers from low income areas.
Funding for stipends or scholarships would help resolve this problem.
• North Richmond Community Initiatives need to expand to serve the middle
school age range which is currently an unserved population. All of NRCI's
programs are appropriate for and needed by middle schoolers.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 61
1
CHAPTER IV: MAJOR ISSUES
One cannot understand the Children's Mental Health system in Contra Costa County
without knowing that the State and Federal mandate is to focus most of the resources on
seriously emotionally disturbed children and adolescents. These individuals reach the
system at various points of entry and at various ages with differing levels of need. The
challenge is to devise effective ways to respond to them and their families.
Each of the following issues affects the lives of thousands of County children and their
families. The issues have been grouped into six categories.
I. ACCESS TO SERVICE
♦ There are waiting lists for almost all services.
♦ The resources to intervene in the early phases of crisis, emotional distress and
social dysfunction are limited.
♦ There are limited resources available to treat dually diagnosed children and
adolescents. (This applies to a child with an emotional disturbance and a
developmental disability or with an emotional disturbance and drug addiction or
alcoholism.)
♦ The availability of day treatment for children and adolescents of all ages is limited.
For example, there is none at Juvenile Hall.
♦ The availability of intensive in-home services is limited.
♦ Not all services are available in all regions of the County. This creates unequal
access to the system.
♦ Children with no identified funding sources, in other words, those who are not
wards or dependents of the courts or are not eligible for AB 3632 residential
services, have no access to residential treatment services.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 62
I
Major Issues
II. SERVICE CONTINUUM DEFICIENCIES
♦ New approaches are needed to respond to mental health crises in the
community.
♦ "Wrap-around" services are limited. These services provide individualized non-
clinical resources to support positive treatment outcomes.
♦ There are few transition programs for young adults, ages 17 -22, who are ill
equipped to function in the adult community and are often ineligible for the adult
mental health system.
♦ Some parents of troubled children are seriously disturbed and in need of services
themselves. These services could be best provided through Children's Mental
Health. Currently, there are few resources to do so.
♦ There are no specialized high level, intensive programs available for violent, fire-
setting, or sexually offending youths. State hospitals or locked regional facilities
could address this issue cost-effectively.
♦ " There are no specialized, high level, intensive programs for dually diagnosed
children and adolescents. (This applies to a child with an emotional disturbance
and a developmental disability or with an emotional disturbance and drug addiction
or alcoholism.)
III. COORDINATION AND COLLABORATION
♦ Although there are multiple children's services available, they are provided
through different agencies/departments and funding sources. The complexity of
funding sources and regulations leads to jurisdictional problems. Innovative ways
to pool funding across division/department/agency boundaries needs to be
explored.
♦ There are philosophical, fiscal, and regulatory barriers to coordination and
collaboration among agencies and departments. It is difficult to overcome these
obstacles.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 63
Major Issues
IV. REVENUE ISSUES
♦ Monies saved and revenues generated by Children's Mental Health programs are
not now fully reinvested in the Children's Mental Health system. For example,
see Chapter III, Section A, State Hospitals.
♦ Because funding for mental health services is primarily limited to Medi-Cal and
State Realignment dollars, services for the uninsured working poor are limited.
♦ Mental health's reliance on the federal dollar makes local services vulnerable to
decisions made in Washington, D.C. The role of the State in determining policies
that govern distribution of federal and state dollars creates an additional
vulnerability for local mental health programs.
V. CULTURAL COMPETENCE
♦ It has been difficult to achieve culturally and ethnically appropriate staffing and
programming for the county's changing demographics.
♦ The growing and more diverse immigrant population presents cultural issues for
which staff are not adequately prepared.
VI. CHANGING CONTEXT
♦ In the past decade, there has been a steady and alarming escalation in the severity
of the problems displayed by the children and adolescents seen in Children's
Mental Health.
♦ The complete implementation of Mental Health Managed Care will have a
significant impact on the delivery of mental health services in Contra Costa
County. The Mental Health Division will be responsible for the entire mental
health Medi-Cal system and must provide an adequate array of services for all
Medi-Cal recipients in a cost-effective manner. Under Mental Health Managed
Care, Contra Costa will have more flexibility in deciding what programs to offer,
but because fiscal risk will be increased, careful planning and continuous
evaluation will be more important than ever.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 64
Major Issues
♦ Planning is complicated by the current uncertainty surrounding federal Medicaid,
both the amount of funding that will be made available to the states and how
California will allocate its share.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 65
GLOSSARY
i
AB 3632 is a state law signed in 1984 which mandates that County Mental Health provide
a full continuum of services for special education students with emotional and behavioral
difficulties which impair their ability to benefit from their education.
Acute Inpatient Hospitalization - [See Chapter III Section B].
AFDC - FC is Aid to Families with Dependent Children - Foster Care. It is the funding
stream for a child legally placed in any kind of foster care, i.e., relative's home, licensed
foster home, group home, or residential facility. Local, state, and governments are
responsible for a set share of this cost for children placed with AFDC -FC funds.
Age Categories
0 - 5 years old are called preschool children
6 - 12 years old are called latency age children
13 - 17 years old are called adolescents
18 - 22 years old are called young adults
Assessment includes comprehensive evaluations that consider genetic, developmental,
familial, cultural, and other ecological factors. An assessment determines the individual's
current and potential strengths, weaknesses and needs. Assessments include a clinical .
analysis of the history and current status of the individual's mental, emotional, and or
behavioral problems. Assessments often include diagnosis and may include the use of
testing procedures.
Case Management is the coordination of all the resources employed in the treatment and
care of an individual and/or family. The Case Manager is responsible for overseeing the
individual treatment plan.
Collateral Contact is contact with one or more significant persons in the life of the
individual receiving mental health services. Significant persons may include family
members, social workers, school personnel, or others.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 66
Y v
Glossary
Coordinated Services is the name of one of two quality management systems currently
required by the State Department of Mental Health. This is the one adopted by Contra
Costa County. It establishes a single point of coordination of services for each person
served longer than 60 days, sets requirements for assessment and timelines for treatment
planning and treatment review.
Crisis Intervention Services - [See Chapter III Section E]
Culturally Comyetent describes services which recognize cultural and ethnicity as
predominant forces in shaping behaviors, values, and decision making so that the child/
adolescent and family are viewed within the context of their culture and racial group.
Cultural competence must be addressed in program planning, policy, training, and direct
services.
DSM IV is a diagnostic and statistical manual developed by the American Psychiatric
Association to define and assign numerical codes to the various mental disorders.
Day Treatment - [See Chapter III Section G]
Early Intervention - [See Chapter III Section J]
Early Mental Health Initiative (EMHI) - [See Chapter III Section I]
Evaluation is an appraisal of an individual's ability to function in one or more areas.
Cultural factors are addressed where appropriate. Evaluation is also the appraisal of an
activity or program to determine its outcome, e.g., its effectiveness.
Family Preservation/Hospital Diversion -[See Chapter III Section C]
Fee-For-Service is a payment arrangement by which a private provider is paid for a
service based upon an established rate for that service. Fee-for-Service Medi-Cal refers
to health/mental health services provided by private providers and reimbursed directly by
the State using Medi-Cal funds.
FTE is the acronym for "full time equivalent" employees and is used when discussing the
number of personnel positions.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 67
e
Glossary
Gateke=r/Gatekeeping/Gatekept refers to a situation where access to a program or
service is controlled by someone outside that service.
Individualized Education Plan (IEP) is the name given the written plan required for
children receiving special education services. This plan specifies goals and activities
aimed at enhancing a child's ability to learn.
Inpatient is an individual who is admitted to a hospital for at least one day, receiving
room, board, medical and nursing care.
Inpatient Hospitalization - [See Chapter III Sections A and B]
Intensive Day Treatment - [See Chapter III, Section G]
Linkage/Linldng is the process of actively assisting individuals to connect with services
in the formal and informal caregiving systems.
Managed Care is a way of providing health care to an organization's membership while
controlling access to services. Usually a primary care provider is assigned and
preauthorization of services is required. The goal is to control costs and provide quality
care but only the level of care required.
Mental Health Augmentation(a "patch")is a pre-established monthly supplement to RCL
14 residential treatment programs to enable them to provide additional mental health
services to residents.
Medicaid - is the nation's major public health care financing program. It provides health
and long-term care coverage to millions of low income persons. Authorized by Title XIX
of the Social Security Act, Medicaid is currently an entitlement program governed by
Federal regulations which state the criteria for service eligibility and the types of benefits
funded. The program is financed by State and Federal monies and is administered by the
State. In California the Federal share is 50%. California's Medicaid program is called
Medi-Cat.
Out-of-Home Placement is the term used when a child is assigned a living situation away
from home by an official agent. The word "placement" is used to describe the activities
connected with moving a child from one living situation to another.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 68
O
Glossary
Outpatient Treatment - [See Chapter III Sec6ion 1]
"Patch" - [See Mental Health Augmentation]
Prevention - [See Chapter III Section K]
RCL means Rate Classification Level. The RCL signifies the level of care a state-
licensed facility says it provides to residents. By use of a State formula, providers are
given "points" for their staffing pattern and how many hours are worked by persons with
professional degrees. Levels 13 and 14 are the two levels considered to be mental health
treatment facilities. A provider's level determines the cost of care covered by AFDC -
FC.
Realignment is the informal name of the legislation that transferred certain fiscal and
program responsibilities for health, mental health, and social service programs from the
State to the Counties. It also established a defined but fluctuating structure for funding
health and human services programs locally. This change occurred in 1991. [See
Appendix F - Legislation].
Residential Treatment - [See Chapter III Secdon D].
Short-Doyle Act - [See Appendix F - Legislation].
Short-Doyle edi-Cal refers to a funding mechanism for mental health services where
reimbursement is based on 'a 50 - 50 match of federal dollars with local and state funds.
State Hospitalization - [See Chapter III Section A].
Subacute - is the label given a residential program that provides children in crisis an
alternate to psychiatric hospitalization. Such programs have a higher staff-to-child
staffing ratio than even RCL 13 and RCL 14 programs, both residential and day treatment
components are highly structured, placement is longer term than Crisis Residential
services (often six months plus) and the usual multiple funding sources are augmented by
a mental health "patch".
Substance Abuse is a term used for alcohol and drug abuse and/or dependency.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 69
Glossary
Ste own is the term used to describe a less restrictive or less intensive alternative mental
health service than the child and/or family are currently receiving.
UMDAP means Uniform Method of Determining Ability to Pay. It is a State-mandated
process by which the annual cost or liability for a family who is requesting mental health
services is determined.
"Ventura Model" - [See Appendix F - Legislation].
Welfare and Institutions Code 5150 (commonly known as "5150") authorizes short-term
involuntary psychiatric "holds" for persons who are a danger to themselves or others, or
are gravely disabled.
Wrap-Around is the name of a service element that brings together specific additional
resources that in all likelihood will foster the success of an individual's mental health
treatment plan.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 70
Appendix A
WRITERS AND EDITORS
Children's Report Subcommittee of the Children's Committee of the Contra Costa County
Mental Health Commission
Committee members contributed countless hours to reviewing and discussing Children's
Mental Health Services, sharing observations and experiences, and finally writing and
editing the chapters of this document. Each participant came to this project with one
purpose: a deep commitment and dedication toward the provision of quality mental health
services for children and adolescents.
Terri Basile
Migs Carter
Bonita Granlund
Taalia Hasan
Arlette Merritt
Cynthia Miller
Ruth Ormsby
Wes Robinson
Vi Smith
Suzanne Strisower
Linda Trowsdale
Chris Koch, Staff
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 71
A
V
Appendix B
PRESENTERS AND CONTRIBUTORS
The Children's Committee of the Mental Health Commission would like to thank and
acknowledge the following people who spent many hours educating our committee about
their programs and services.
Mental Health Division
Children and Adolescent Mental Health Service,
David Bergesen, MFCC - Mental Health Clinical Specialist
Bonita Granlund, LCSW - Mental Health Clinical Specialist
Larry Hanover, PhD - Supervisor, YIACT
Rick Melny, MD - Medical Director
Butler Nelson, PhD - Supervisor, East County Children' Services
Ray Neuman, MFCC - Supervisor, West County Children's Services
Ruth Ormsby, LCSW - Program Chief
David Shaw, MFCC - Mental Health Clinical Specialist
Rich Weisgal, MFCC - Supervisor, AB 3632
Grant Wyborny, PhD - Supervisor, Central County Childrens Services
Acute Services
Linda Kirkhorn, LCSW - Supervisor, Acute Services
Community-Based Organizations
Christine Stoner-Mertz, LCSW - Executive Director, Seneca.Center
Frank Camargo, LCSW - Executive Director, Familias Unidas
Migs Carter, BA - Mental Health Program Director, La Cheim
Pat Chambers, PhD - (Former)Executive Director, Child and Family Therapy
Antoinette Harris, MSW - Supervisor, FamiliesFirst
Judith Holmes, PhD, MFCC - Program Director, Y Team
Elree Langford,.MA - Program Director, Lynn Day Treatment Center
Arlette Merritt, MA - Executive Director, Early Childhood Mental Health Program
Elaine Prendergast, BS - Associate Director, Center for Human Development
Irene Rimer, MSW - (Former) Executive Director, We Care Day Treatment Center
Michael Thomas, MA, ASW - Residential Treatment Program Director, La Cheim
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 72
1
Appendix C
HISTORY OF CHILDREN'S MENTAL HEALTH SYSTEM
In the mid 1970's, a State Department of Mental Health Program Audit Team concluded
that Contra Costa County "had-no children's mental health services" and recommended
that such services be established to meet state guidelines.
Mental Health Administration responded to the audit results by:
Designating the Division's Social Work Supervisor as the person
responsible for issues and activities related to children and adolescents;
Developing and distributing a resource directory of mental health providers
who served children in the county;
Establishing a planning group of professionals and interested citizens, called
the Child and Adolescent Task Force (CATF), to define what services were
needed, to advise/support their development, and to advise administration
concerning content of the annual Short-Doyle Plan relative to children and
adolescents;
Recommending that the Mental Health Advisory Board (now the Mental
Health Commission) designate one member to serve as a "child advocate"
with specific criteria for selection and agreed-upon role. [This was done
and, later, a standing Children's Committee to be chaired by the child
advocate was established.]
Over the past two decades, Contra Costa County Boards of Supervisors have supported
the efforts of children's advocates, mental health services administration and staff, and
independent non-profit agencies to create a system of mental health services for children
and adolescents and their families (now called the System of Carel and to establish an
administrative structure to support that service system.
Implementation of new programs (i.e., components of the System of Care) began in the
1970's and continues today as funding and circumstances permit. Many of the programs
established over the years continue. Some have ceased to exist. Today's System of Care
(SOC) is presented in Chapter III, i. and ii. Descriptions of each component of the
current SOC are found in Chapter III, Sections A-K.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 73
Appendix C
Every program implemented has been shaped by the interplay of a number of factors
including the political reality at the time (federal, state, and local), the funding sources
available, and the level of local support (interagency, administrative, community).
Legislation, regulations, and the courts have also had considerable impact on how
services for children and adolescents have developed and continue to change.
A formal identity for Children's Mental Health Services developed more slowly than
services. It took five years for the Division to establish the position of Children and
Adolescent Services Program Chief (1981) and an additional five years to establish
positions titled Mental Health Children Services Supervisor (1986). Designation of a
child psychiatrist as Children's Services Medical Director occurred in 1990.
The history of Children's Services has been characterized by two conflicting trends; a
continuing drive to create and maintain needed services along with the pressure of actual
budget cuts or the threat of same which have occurred nearly every year since 1978, the
year Proposition 13 was passed. -
In Fiscal Year' (FY) 1977-78, 11.4% of the Mental Health Division's budget was
allocated to children and adolescents. However, 9% of that money was administered by
the Division, but was allocated for services to individuals with Developmental
Disabilities. Only 2.4% of the dollars provided services for children and adolescents with
a primary diagnosis of mental illness and/or psychosocial disability. By FY 1982-83, the
percentage expended to serve children and adolescents who are seriously emotionally
disturbed had risen to 16% and to 18.3% by FY 1984-85.
The System of Care (SOC) has changed considerably since the mid-1980's. The last 10
years has been a decade of achieving growth in a period of shrinking resources. (Chapter
III, Section A, "Utilization and Costs" discusses one example of this reality.) Children's
Services Administration has made strenuous efforts to leverage available dollars,
capturing federal dollars where possible, in order to minimize the effect of cuts, to ensure
that programs are truly cost effective and to free up dollars to expand the SOC. The
result has been an expansion of local treatment options despite state and county budget
cuts (in FY 1990-91 Children's Services absorbed 20% of the Division's $3.2 million
funding cut).
Simultaneously, three big changes in how mental health services were funded and
provided were proposed, discussed, and negotiated at all levels of government and finally
were implemented locally.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 74
Appendix C
• Realignment legislation in FY 1992-93 provided a stable funding source for mental
health at the state level as well as the possibility for growth when the economy is
sound (the funding formula includes a portion of the sales tax and a portion of
vehicle license fee increases).
• On July 1, 1993, a change in the 1�= of Medicaid the state collects from
Washington increased local flexibility regarding how and where mental health
services could be provided and still recoup Medi-Cal. This new arrangement is
called the "Short-Doyle/Medi-Cal Rehabilitation Option. . ." New service delivery
requirements were implemented which include assigning one person to ensure that
all the services an individual consumer and family receive are well coordinated.
• On January 1, 1995, Mental Health Managed Care arrived in Contra Costa County
when the Division assumed the responsibility for all fee-for-service Medi-Cal
psychiatric hospitalizations in the county.
There have been profound shifts in the health/mental health care field during the past 10
years. These have created a period of challenge and opportunity that will continue for
the foreseeable future.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 75
Appendix D
MENTAL HEALTH CHILDREN'S SERVICES MISSION STATEMENT
According to the California Mental Health Master Plan of 1991, the mission of Mental
Health Children's Services is to:
1. Enable children with serious emotional disturbances to remain at home, succeed
in school, and avoid involvement with the juvenile justice system.__..
2. Provide a culturally competent, comprehensive spectrum of community-based
services (which are) integrated into coordinated, interagency networks...
3. (Provide these) services in the least restrictive, most appropriate setting with a
child's needs guiding service intensity...
4. (Recognize that) children, unlike adults, face a magnitude of developmental tasks
resulting from their growth in physical, cognitive, social and emotional dimensions
(all of which must be addressed), and...
5. (Respond to the fact that) children are almost always dependent because they are
a part of a family.
Consistent with this mission, Contra Costa County's vision of services for seriously
emotionally disturbed (SED) children and their families is based on the following guiding
principles:
♦ A family-centered approach to service delivery which mandates that the system
conform to the needs of families rather than requiring families to adapt to the
system.
♦ A comprehensive, interagency, integrated, interdisciplinary continuum of service
components (responsive) to the unique needs of (the) children/families served.
♦ Case management... to support service integration and create service mixes
uniquely configured to the needs of the individual families;
♦ Culturally competent services...
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 76
Appendix D
♦ Utilization of the least restrictive setting possible without compromising the safety
and well being of the child...
♦ Outreach and early intervention efforts...to ensure (that) a child's needs are
identified and timely intervention occurs to prevent further deterioration of
functioning; (and)
♦ Family/consumer involvement and participation by community advocates for
children/families...in the development, implementation, oversight, and evaluation
of...policies and programs.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 77
Appendix E 4
CHILDREN/ADOLESCENT MEDICAL NECESSITY CRITERIA
Children or adolescents will be provided Mental Health services where such services are deemed medically
necessary. Medical necessity will be defined as (1) having a 5 axis diagnosis from the current edition of
the Diagnostic and Statistical Manual of Mental Disorders (2) evidence of impaired functioning in the
community and (3) meeting criteria under any one of the six categories (I - VI) below:
I. Any child who is eligible for mental health services pursuant to Chapter 26.5 of the California
Government Code. [AB 3632]
11. A child 5 years old or younger either:
1. Displays severe delays in psychosocial and/or developmental milestones not the result of a
developmental disability.
OR
2. Is at risk for major psychosocial delay and the result of Mental Health Evaluation indicates
significant deficits in at least one of the following areas: emotional, interpersonal, behavioral.
III. Children of any age displaying:
1. At least one of the following:
Persistent danger of hurting self and others.
Serious suicidal act/rumination/plan with clear expectations of death.
_ Behavior considerably influenced by delusions or hallucinations.
_ Stressors: Catastrophic
_ GAF: 0-30
OR
2. At least 3 of the following:
_ Behaviors threatening or dangerous to self or others in past 3 months.
Significant impairment in family, school, self-maintenance or interpersonal relationships.
Threat of or recent removal from home or placement.
Recent release from psychiatric inpatient care.
History of past hospitalization with risk of re-hospitalization.
_ Stressors: Extreme
_ GAF: 31-40
OR
3. At least 4 of the following:
_ History of dangerous behavior to self or others in past year.
History of runaway, extended truancy.
_ Acting out or avoidant, isolative behaviors at school and community.
At risk for higher levels or care.
History of psychiatric hospitalization or out-of-home placement.
Minimally adequate psychological support.
Significant impairment in at least 2 of the following: family, school, self maintenance,
interpersonal relationships.
Clinically significant and persistent anxiety or mood symptoms.
_ Stressors: Severe
_ GAF: 41-60
OR
4. Children or adolescents who have previously met the above criteria and, who are presently in
Individual, group, and/or family therapy, and who no longer meet the above criteria may receive
up to an additional 26 sessions of therapy if necessary for maintenance and continued
stabilization.
PAGE 2
IV. At least one of the following:
1. Referred for treatment in State hospital or presently a patient in State hospital or former patient
in State hospital transitioning to community living.
2. In acute care hospital or former patient in an acute care hospital transitioning to the community.
3. At risk of placement in an RCL Level 13 or 14 facility.
4. Presently in a RCL level 13 or 14 facility or recently discharged from such a capability and
transitioning to a lower level of care.
5. Referred by the Department of Social Services for assessment only regarding out-of-home
placement in the least restrictive setting, return from placement, or family reunification (YIACT
ONLY).
V. At least one of the following:
1. Children whose mental disorder is in full or partial remission may continue to receive
medication support services in order to maintain the remission.
2. If a child meets criteria under I, II, III, or IV above and the parent or primary caretaker requires
medication support services to stabilize the home situation and to prevent out-of-home
placement of the child, such services may be provided.
VI. Any parent, guardian, or primary caregiver of a child 4 years old or younger who has a primary
DSM Axis I diagnosis of mental illness which disrupts or interfere with daily activity and either of
the following (1 or 2) is present:
1. At least one of the following is present:
_ Persistent danger of hurting self and others.
_ Serious suicidal act/rumination/plan with clear expectations of death.
_ Behavior considerably influenced by delusions or hallucinations.
Due to a mental illness, is receiving or in need of medication to stabilize and maintain level
of functioning in the community.
2. At least two of the following are present:
_ Behaviors threatening or dangerous of hurting self or others in the past 3 months.
_ Significant impairment in ability to meet basic physical needs,or to utilize resources for food,
clothing, or shelter for self and children.
Significant impairment in ability to meet basic psychosocial needs for self and child(ren)
displaying severe delays in developmental milestones or a significant impairment in
child(ren)'s self maintenance or family/school functioning.
_ Threat of or recent removal of children rom their care.
_ Inadequate psychological and or'psychosocial support system.
_ Recent release from psychiatric inpatient service.
History of past hospitalization with risk of re-hospitalization.
NOTE: The GAF Scale or Global Assessment of Functioning Scale (referenced on this
Children/Adolescent Medical Necessity Criteria Form) is a 100 point continuum for mental health -mental
illness which identifies ten levels of psychological, social and vocational functioning. Each level contains
ten of the continuum's 100 points. A clinician assigns a numerical rating based on the level at which an
individual is or was functioning at a point in time. The lower the number the more severe the person's
psychiatric disability at that time. Impairment in functioning due to physical or environmental limitation is
not included in assigning ratings.
BGAp
2/9/96
mncriter.8on
V
Appendix F
LEGISLATION APPLICABLE TO MENTAL HEALTH CHILDREN'S SERVICES
Both federal and state legislation provides the framework for the delivery of children's
mental health services in counties in California.
AB 3632 is the original bill number for legislation passed in California in the 80's which
mandates a full continuum of mental health services for special education students who
have emotional and/or behavioral problems which interfere with their ability to profit
from their education. It is often used as an informal adjective, e.g., an "AB 3632 child"
or "AB 3632 services".
"Egeland language„ is used to describe provisions of a bill authored by Assemblywoman
Leona Egeland and passed by the legislature in the 70's. It provided that 50 percent of
certain "new" mental health money allocated to counties be used to expand children's
services in each county until at least 25 percent of the county's gross mental health budget
was devoted to children's services. Some of this language was incorporated in the
"Realignment Act" (see below).
E.P.S.D.T. stands for Early Periodic Screening, Diagnosis, and Treatment, a form of
federal Medicaid that requires states to provide broad health screening and services to
children. The State of California implemented this requirement through the Child Health
and Disability Program (CHDP), which did not provide mental health screening or
treatment. In 1995, the decision in a lawsuit brought by a County Health Department
requires that E.P.S.D.T. funding be used to provide such services. Beginning in 1996,
both County Mental Health Department and fee.-for-service Medi-Cal providers will be
able to expand children's mental health services using E.P.S.D.T. dollars.
Medi-Cal is the name for the California implementation of the federal Medicaid program.
Medicaid is the federal legislation which provides for shared federal/state funding for
health care, including mental health care, for the poor and disabled.
Medicare is the federal health care program for the elderly.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 80
Appendix F
Realignment Act (AB 1288, 1991) is legislation that made significant changes in the
financing and delivery of mental health services in California. It replaced most
provisions of the Short-Doyle Act of the 60's, which provided the original mechanism for
shared state/county funding of mental health services. Under the Realignment Act,
county mental health services are funded by a dedicated portion of sales tax dollars and
counties have more authority and more responsibility for the use of these funds.
Rehab (or Rehabilitation Qption is a form of federal Medicaid funding implemented in
California in 1993. It uses shared federal/state dollars to provide a greater variety of
rehabilitative mental health services to Medi-Cal eligible recipients. It replaced the
earlier "Clinic Option" in use in California.
Short-Doyle Medi-Cal is the name applied in California to shared state and federal
funding for mental health services which is distributed through counties and may be used
to pay private providers of services under contract. It is unlike so-called fee-for-service
Medi-Cal which is used directly by the State to pay private providers.
Special Education refers to educational services provided under Public Law 94-142 (1975)
which is the federal act designed to assure that "all children with disabilties...have ,
available to them a free, appropriate public education". It supplies 40 percent of the
average per-pupil expenditure for children receiving special education and related services
in public elementary and secondary schools in the United States. It establishes standards
for those services which are implemented in State education codes. It has been expanded
by subsequent legislation to include younger children. Many children who are
emotionally disabled require special education services, often provided under contracts
with school districts by private state-certified non-public schools.
S.S.I. is Supplemental Security Income, a kind of social security payment which can be
made to disabled persons, as supplemented in California, it is S.S.P. (State Supplemental
Payment). California makes a supplemental payment in lieu of providing food stamps.
Ventura Model (AB 377) is the name for a pilot program originally implemented in
Ventura County to divert funding which would usually be used to pay for out-of-home
placement for children and adolescents and to fund programs, including mental health
programs, which are demonstratively effective in preventing out-of-home placement.
Subsequent legislation has extended this program to several other California counties.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 81
Appendix F
Victim Witness is the name for a California state program that reimburses victims of
crime. Victim witness funds can be used to pay for mental health services for a child or
adult who has suffered emotional damage as a consequence of a criminal act.
Welfare and Institutions Code 5150(commonly known as "5150") which authorizes short-
term psychiatric "holds" for persons who are a danger to themselves or others or who are
gravely disabled.
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 82
Appendix G
CHILDREN'S MENTAL HEALTH SERVICES
AB 3632 Program
2425 Bisso Lane #280
Concord, CA 94520
(510) 646-5665
Center for Human Development
391 Taylor Boulevard #120
Pleasant Hill, CA 94523
(510) 687-8844
Central County Children's Services
1026 Oak Grove Road
Concord, CA 94518
(510) 646-5468
Contra Costa Association for Retarded Citizens, Inc. (CCARC)
1340 Arnold Drive, #127
Martinez, CA 94553
(510) 370-1818
Lynn Center
950 El Pueblo
Pittsburg, CA 94565
(510) 439-7516
Desarrollo Familiar, Inc.
Familias Unidas
205 39th Street
Richmond, CA 94805
(510) 412-5930
Early Childhood Mental Health Program
4101 MacDonald Avenue
Richmond, CA 94805-2333
(510) 412-9200
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 83
'S
Infant Parent Program
(address above)
Preschool Mental Health Consultation Teams
(address above)
Therapeutic Nursery School (TNS)
(address above)
East Bay Agency for Children
2540 Charleston Street
Oakland, CA 94602
(510) 531-3666
Child and Family Therapy Center
2450 Stanwell Drive #270
Concord, CA 94520
(510) 686-2700
East County Children's Services
2400 Sycamore Drive #33
Antioch, CA 94509
(510) 427-8664
FamiliesFirst, Inc.
2100 Fifth Street
Davis, CA 95616
(916) 753-0220
Intensive Family Preservation Program
825 Alfred Nobel Drive, #F
Hercules, CA 94547
(510) 741-3100
Oak Grove Program
1034 Oak Grove Road
Concord, CA 94518
(510) 827-4104
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 84
First Hospital Vallejo
525 Oregon Street
Vallejo, CA 94590
(707) 648-2200
La Cheim School, Inc.
1 Bolivar Drive
Berkeley, CA 94710
(510) 649-1177
La Cheim Residential Treatment Centers
5626 Sutter Avenue
Richmond, CA 94804
(510) 525-6883
Mental Health Crisis Unit
Merrithew Memorial Hospital
2500 Alhambra Avenue
Martinez, CA 94553
(510) 370-5700
Napa State Hospital
Box A
Napa, CA 94558
(707) 523-5000
Seneca Center
2275 Arlington Drive
San Leandro, CA 94578
(510) 481-1222
Walnut Creek Hospital
175 La Casa Via
Walnut Creek, CA 94598-3069
(510) 933-7990
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 85
We Care Society, Inc.
The Barbara MUM Center
2191 Kirker Pass Road
Concord, CA 94521
(510) 671-0777
West County Children and Adolescent Services
232 Broadway
Richmond, CA 94804
(510) 374-3261
West County Crisis Service
256 24th Street
Richmond, CA 94804
(510) 374-3420
Willow Creek Treatment Center
341 Irwin Lane
Santa Rosa, CA 95401
(707) 576-7218
YMCA of the East Bay, Inc.
4300 Lakeside Drive
Richmond, CA 94806
(510) 222-9622
Y Team
4197 Lakeside Drive #150
Richmond, CA 94806
(510) 262-6551
Youth Interagency Assessment and Consultation Team (YIACT)
2425 Bisso Lane #235
Concord, CA 94520
(510) 646-5240
Contra Costa County Mental Health Commission Children's Committee Status Report, 1996 Page 86