HomeMy WebLinkAboutMINUTES - 12202005 - D3 TO: BOARD OF SUPERVISORS
Contra
FROM: William Walker, M.D., Health Services Director
Costa
DATE: December 20, 2005 •
County
t2 SUBJECT: Adoption of the Three-Year Community Services and Supports Plan under
the Mental Health Services Act(Proposition 63)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Adopt the Community Services and Supports Plan under the Mental Health Services Act (Proposition
63)for fiscal years 2005-2006;2006-200-7-;and 2007-2008.
FISCAL IMPACT:No County funds are required. Contra Costa's allocation of funding from the State
Department of Mental Health for the Community Services and Supports Component of the Mental
Health Services Act is$7,121,500 annually for the first three years.Over the first three years of this new
funding,approximately 60%will be contracted out and 40%will be used for County-operated services.
BACKGROUND:
In November 2004, California voters passed Proposition 63,now known as the Mental Health Services
Act.) intended to transform the public mental health system. The revenues are generated from an
additional one percent tax on individuals whose incomes exceed one million dollars annually. As stated
in the legislation and State Department of Mental Health regulations, there are six components of the
Mental Health Services Act: Community Planning; Community Services and Supports; Capital
Information and Technology; Education and Training; Prevention and Early Intervention; and
Innovation.
The Community Services and Supports component represents the first substantial infusion of funds
under the Mental Health Services Act. In conjunction with State Department of Mental Health
guidelines,Contra Costa Mental Health has conducted an extensive community planning process for the
past year to write the Community Services and Supports Plan.Over 1,100 people have participated in the
planning process that included six community forums; 55 targeted focus groups with consumers,family
members providers and staff; several hundred surveys; and Stakeholder Planning groups. The four
Stakeholder Planning groups Children; Transition Age Youth; Adults; and Older Adults included
required stakeholders: consumers; family members; providers of services; Employment & Human
Services; law enforcement; and education, plus other community members. The four Stakeholder
Planning Groups met over a four-month period from April fluough July 2005. Each group was charged
with coming up with recommendations for priority populations, services and strategies for the new
funding. From these recommendations, Contra Costa Mental Health developed the Draft Community
Services and Supports Plan. An advisory group of Stakeholders reviewed the Draft Plan and gave input
before it was released for public comment.
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ONLkz 16407�k APPROVE AS RECOMMENDED OTHER-
-0-0,
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSEN- AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES- SHOWN.
ABSENT: ABSTAIN: ATTESTED 0 001
CONTACT: JOHN SWEETEN,CLERK OF THE BOARD
OF SUPERVISORS AND COUNTY
ADMINISTRATOR
CC- DonnaWigand(957-5111
Health Services Administration
Health Services(Contracts) BY h Y PUT
T
` Page Two
Prop 63
In order to receive Community Services and Supports funding, County Mental Health systems must
submit athree-year plan that demonstrates broad input and community collaboration. The guidelines
require counties touse a complex logic model that looks at community issues resulting from a lack of
� untreated mental illness and prioritize the most unserved and underserved consumers and family
members. The plan must also be updated annually. (The State Department of Mental Health has not yet
released guidelines or funding allocations for the other components of the Mental Health Services Act).
As required under Welfare & Institutions Code 5835., the Contra Costa Mental Health Commission
conducted a public hearing on the Draft Community Services and Supports Plan on December 7, 2005.
The Mental Health Commission adopted the Final Plan on December 13th., 2005. Following adoption of
the plan by the Board of Supervisors, it will be submitted to the State Department of Mental Health for a
three-month review process. Pending approval by the State Department of Mental health., new programs
will begin start-up in April 2006. Any delays in the approval process will push back this date
accordingly.
ADDENDUM TO D.3.
DECEMBER 209 2005
On this day the Board CONSIDERED adopting the Community Services and Supports
Plan on Proposition 63, the Mental Health Services Act, as recommended by the Mental
Health Commission and the Health Services Department.
After a summation of the background to adopt a three-year Community Services and
Supports Plan under the Mental Health Services Act(Proposition 63)presented by Donna
Wigand,Mental Health Director,the Chair asked the public for comments.
The following individuals presented testimony urging the Board to expand the definition
of homelessness to include those at risk of being homeless:
Herb Putnam,National Alliance for the Mentally III NAMI;
Ann Perridge-Heavey,NAMI;
Barbara Hall NAMI;
Julie Boucher, San Pablo resident;
Vera K. Se,,NAMI;
Anne Perridge-Heavey NAMI;
Liz Callahan,(Contractors;Alliance).
The following individuals did not wish to speak but left their comments urging the Board
to expand the definition of homelessness to include those at risk of being homeless.
Maria Overby, Lafayette resident;
Barbara Hall NAMI;
Art Honegger, Incoming President,NAMI.
Supervisor Glover expressed grave concern on the limited amount of money to serve the
population.
Supervisor DeSaulnier suggested changing the recommendation to add"those in serious
risk of being homeless". He suggested adding at the end of the recommendation"those
without shelter who are unserved".
Supervisor Gioia noted it would be important for the Board to provide input on new
funds coming in to the County for Proposition 63 and thinks the Board may need to do a
workshop to have a greater understanding of how the programs works.
Supervisor Gioia drew the Boards attention to the executive summary under leverage of
additional funding under the new services to be provided over the first three year period,
and noted approximately 60%would be contracted out to the community and 40%would
be County operated, and said the Board did not recommend this.
Supervisor Gioia said the Board should look at expanded services,where the County's
Mental Health Division could submit and compete against community providers. He
suggested removing the provision of the 60/40, and went on to say the County is not
required under State law to decide today who will perform these services.
Supervisor Gioia asked how this could be done with flexibility and reiterated the County
did not want to lock into 60/40 of the funds.
Ms. Wigand responded the County was not locked in,but that they were required to give
the State Department of Mental Health an estimate.
Supervisor Gioia said he would like to see the County meet the needs of the Act and went
on to say to have a competitive process would be good for the County.
Supervisor Gioia asked Ms. Wigand to explain on leveraging other funding sources of the
Act and noted the importance of having great school-based mental health services,
especially in those communities that can access Early and Periodic Screening,
Diagnostic, and Treatment money. Supervisor Gioia noted 95 percent federal and state
dollars; 5 percent local dollars, and remarked"so $1 m of our money yields $19m; I can't
think of a better investment".
Ms. Wigand noted concerns by the Board about the process written into the Act and said
this was not intended to regulate the Board. She went on to say Mental Health Services
would apply for the prevention/early intervention money.
Supervisor Gioia asked Ms. Wigand to talk about the intervention that would be the
opportunity for the school-based Mental Health Services.
Ms. Wigand responded there were opportunities in the innovation part as well.
Supervisor Gioia asked Ms. Wigand to suggest language that would meet the State's
needs with maximum flexibility on who will provide the services, if the Board did not
decide today.
Ms. Wigand responded there would be some core roles held in-house and done by the
County and there would be a competitive RFP process for the balance of the dollars.
Ms. Wigand noted that at least two thirds of the Community Services and Supports
funding would be contracted out and 100% of the capital/IT dollars would be contracted.
Supervisor said the County needs to let Sacramento know the County has a huge Mental
Health population that is not being served. Addressing Ms. Wigand, Supervisor Piepho
said she would like to see some review or discussion on the RFP process to make sure the
County is constantly reviewing and looking into current program providers to see
whether they are the best the County can get.
2
Chair Uilkema said she is aware of the cumbersome nature of the State process and
expressed her wish to adopt the Community Services and Support funding on this day.
She addressed the Board on their concerns on amending the language, concerned if the
Board were to approve this item, the language could in anyway inhibit the Board from
either continuing to explore or becoming more active in the annual review process.
Ms. Wigand responded this would work and the Adult stakeholder group could
reconvene after the first of the year. She went on to say they would send their first
annual update in July 2006.
Supervisor DeSaulnier recognised part of the language under the 60/40 being a-guideline,
and commented it was at least two thirds. He suggested staff have the Adult Stakeholder
group review the language.
The Board of Supervisors took the following action by unanimous decision:
ADOPTED staff's recommendation with an amendment to add the language in the adult
portion that reads: Those without shelter who are unserved.... to add "those at serious
risk of becoming homeless".
3
CONTRA COSTA
HEALTH SERVICES
Mental Health Division
Proposition 63m. Mental Health Services Act
Community Services and Supports Plan - Three-Year Plan
December 2005
Directory of Attachments
Attachment Page Number
Attachment I: Consumer Involvement Steering Committee &Workplan.........A-01
Attachment 2: Letter of Invitation to Stakeholder Orientation &Training.........A-04
Attachment 3: List of attendees at Stakeholder Orientation & Training.......... A-05
Attachment 4: Agenda & Outline of Stakeholder Orientation & Training.........A-14
Attachment 5: Application for Stakeholder Planning Groups.......................... A-36
Attachment 6: Lists of all four Stakeholder Planning Groups ......................... A-37
Attachment 7: Summary, locations of Focus Groups & Surveys.....................A-41
Attachment 8: Flyer, Notes from Community Forums..................................... A-45
Attachment 9: Focus Group Questions (English/Spanish) ............................. A-67
Attachment 10: Summary of CSS Recommendations & Form....................... A-68
Attachment 11: Summary of Web Site Hits (during planning process)........... A-72
Attachment 12: Stakeholder Planning Minutes
Attachment 12a: Children's.....a 060mess a mass&&6&60&ft&a man as&00 AJ4.A-74
Attachment 12b: Transition Age Youth...................................A-111
Attachment 12c: Adults.........................................................A-143
Attachment 12d: Older Adults ................................................A-177
Directory of Attachments = Continued
Attachment 13: Recommendations from Stakeholder PlanningGroups
Attachment 13a: Children's....................................................A-209
Attachment 13b: Transition Age1�outh...................................A-211
Attachment 13c.
• Adults
Attachment 13d: Older Adults.................................................A-216
Attachment 14: Prevalence Rates..................................................................A-219
Attachment 15: Interpreter Services Utilization ..............:...............................A--220
Attachment 16: Modular Home F l er..............................................................A-221
y
Attachment 17: Notice of Public Hearing...son a sos&ose essom moose*&*owes a 0 so 0&Does weeos&o a on memo&A-222
Attachment 18: Contra Costa Times Article .................
.................................A-223
Consumer Involvement Steering Committee
2004-2005
Aaron Kling, Office for Consumer Empowerment
Sharon Kuehn, Once for Consumer Empowerment, Acting
Secretary
Andrea Johnson, Mental Health Consumer Concerns/SPIRIT
Corey Lewis, Young Adult, East County
Jay Mahler, Office for Consumer Empowerment, Acting Chair
Colleen Miller, Mental Health Consumer Concerns
Herb Putnam, Consumer Advocate at large
Connie Steers, Mental Health Consumer Concerns
Marisol Tejada Moore, CSW, East County Clinic
Jonathan San Juan, CSW, Concord Clinic
Veronica Vale, At large Consumer Advocate
Kathryn Wade, CSW for PES/Office for Consumer Empowerment
Janet M. Wilson, Mental Health Consumer Concerns/Patients
Rights Advocates
Chantelle Zavala, Young Adult/Crestwood
Attachment 1
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WILLIAM B.WALKER, M.D.
HEALTH SERVICES DIRECTOR
CONTRA COSTA
DONNA M. WIGAN D, LCSW MENTAL HEALTH
MENTAL HEALTH DIRECTOR
ADMINISTRATION,..
Much 4, 2005 CONTRA COSTA 1340 Arnold Drive, Suite A
HEALTH SERVICES Martinez, California
Dear Community Member: 94553
Ph (925) 957-5150
Fax (925) 957-5156
Thank you for your interest in participating in the planning process for the Mental Health Services Act
(Prop 63). Here are some updates since the training on February 23:
1)
Repeat of MRSA Orientation& Training to be offered on March 22,2005
i
We will offer a repeat of the first orientation and training. The training will consist of a
combination of videotaped and in-person presentations, and is for any potential stakeholders
who were unable to attend the February 23 orientation.
Orientation and Training for Potential Stakeholders#2
Tuesday,March 22,2005
4:00 pm—6:00 pm
651 Pine Street,Room 107 (Board of Supervisors' Chamber)
Martinez.... CA
Please use the enclosed formtoregister. Deadline for registration is March 17, 20050
If vou attended the Febru23'rd Orientation&Training yQu do not need to attend,
2) Revised Stakeholder Meetings Calendar-* Applications for Stakeholder Groups ..�
With the addition of a second Stakeholder Orientation& Training,we have moved the two
stakeholder meetings originally scheduled for March 21 (Children's)and March 23 (Adults)to
the end of the planning schedule(early June). A revised calendar is enclosed.
Applications for Stakeholder Groups* So far we have received over 150 applications for the
four stakeholder groups. With the additional Stakeholder Orientation& Training on March 22,
we will continue to accept at) lications until March 25th.
.M applications
3) Community Forums Announced
Information on the six community forums is posted at mnyw.cchealth.ori
These are"town hall" format meetings hosted by the Contra Costa Mental Health Commission.
4) Focus Group Information
Information for agencies who Wish to participate in the focus group process will be available bymid-March.
Thank you again for your time and commitment to the MRSA Planning Process.
Sincerely,
Donna M. Wigand, LCSW "'�
Mental Health Director
Attachment 2
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• Contra Costa Hazardous Materials Programs •ContraCosta Mental Health e Contra Costa Public Health • Contra Costa Regional Medical Center • contra Costa Health Centers•
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Attachment 3
A-1 3
MENTAL HEALTH SERVICES ACT
Contra Costa County
Stakeholder Orientation &Training#2 ---
Tuesday, March 22, 2005
651 Pine St, Room 107, Martinez
4:00 pm—6:00 pm
AGENDA
1. Welcome & Introductions Donna M. Wigand, LCSW
Mental Health Director
11. Background on the Public MH System
Overview of the MRSA "
Purpose of Stakeholder Work Groups
III. Emphasis on Recovery & Resiliency Sharon Kuehn, Coordinator
Office for Consumer Empowerment
Contra Costa Mental Health
Kathy Davison
Family Involvement Coordinator
Contra Costa Mental Health
IV. Emphasis on Cultural Competency Lisa V. Booker, RN
Technical Assistance Coordinator
Contra Costa Mental Health
V. Contra Costa County Demographics Steve Hahn-Smith, PhD
Research & Evaluation Coordinator
Contra Costa Mental Health
VI. Underserved and Unserved Communities is "
VII. Involving the Community in the MHSA Steve Ekstrom, Consultant
Role of Stakeholders, Community & Facilitator
Forums, Focus Groups
Vill. Next Steps Donna M. Wigand, LCSW
Mental Health Director
IX. Questions &Answers
Attachment 4
A-14
MENTAL HEALTH
SERVICES ACT
March 22, 2005
CONTRA COSTA
HEALTH SERVICES
Welcome & Introductions
bonna M. Wigand, LCSW
Mental Health Director
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 1
A-15
Bac4ground on the Public Mental
Health System
• Loc I systems are stretched beyond
cap city and unable to meet demand
• Con, umers and family members are
without adequate care and are demanding
that mental health be addressed with the
sa e urgency as health care
. Adv cater and Stakeholders have
pre anted the issues to Californians and
hav offered a compelling set of strategies
to c rrect the current system flaws.
kol V VW1 V I vad W Vf ivjLvaiWLa H.Lealthi
0
e S A ct
DMH: "To.., expend funds made available
through this initiative to transform the
current mental health system in California
...T is will not be "business as usual"..
Eve tually access will be easeir, services
mo effective and out-of-home and
ins tutional care will be reduced."
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 2
A-16
v V.;1 V JLe W Of IVJLV.;i al I iK;ai L11
0
q& P jr-jeeg A
•
Revenue is generated through an
ad itional 1% tax on individuals with
tax ble income over $1 million
is Le islative Analyst's Office
esti ates that Proposition 63 (now
MA) w0111 generate in excess of
$60 million in 2005-2006 with annual
tot'
Is expected to increase
0 v eft IqL�W Uf Mej 11111 Iv,,;;alth-
0
7-111"% A
• Fu doing allocations for counties and
melhodology under review by DMH
• En Ileembased program
w/ easurable outcomes (AB2034)
• Tar et Population: Serious Mental
111n ss (SMI); Serious Emotional
DI's urbance (SED); < 200 % of
Po erty; Unserved and Underserved.
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 2212005 3
A-17
]k Ar 4.r-h 1
%4.1 V%;;;I V lvme w Uf IVIVwIlLai x xv.�ax tax
A ^+o
1. Community Program Planning
2. ommunity Services & Supports for
� 0 Children
0 0 Transition Age
LL 0 Adults
0 Older Adults
3. apital Facilities & Information Technology
4. revention & Early Intervention Programs
5. Innovative" Programs
6. Education & Training
T16114k
,Ove w Uf I V% ..al x 1%;;aw
w L.. Act
urrent task: Develop three-year plans
or Community Services & Supports
takeholder participation is required
• Consumers and Family Members
Providers
• Social Services (EHSD)
Education
• Law Enforcement
• Others
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 4
A-18
%J V ul VIC, Uf IVICULdl 11CUIL11
S ry $ A
Ma aging Expectations
• Systems Transformation
• Supplantatimon; Recent Reductions
iphasis on Recovery &
Resiliencyin the MHSA
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 5
A-19
Recovery Language in the Act
813.5 ( Planning for services shall be
consis e nt with the p hilosophy, principles and
practi es of the Recovery Vision for mental
health onsumers.
(1) To pwomote concepts key to the recovery for
individ als who have mental illness: hope, personal
empo rmentrespect, social connections,
self-re onsibility, and self-determination.
(2) To p mote consumer-operated services as a way to
suppo recovery.
(3) To fled the cultural, ethnic, and racial diversity of
mental ealth consumers.
(4) To p an for each consumer's individual needs.
Transformation. . .
--T
"Con umers of mental health
sere ces must stand at the center of
the tem of care. Consumers'
nee s must drive the care and
se ces that are provided."
-Pr sidents New Freedom Commission Report
"If we don't transform the system,
W@ ill have failed.Y� -DMH spokesperson
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 6
A-20
b..ang
S-Y
Consuiner Planning for the Mental Health
Services Act Stakeholder Process:
. Regional Education and Discussion Focus
Gr ups
. Consumer Involvement Steering Committee
Development of Action Plan to reach unserved
a lid underserved groups
. Strong Consumer Representation in all
stakeholder group meetings
I ayatexxx V. beft auppo
The t scan open the door to
c.holi V. ej...powerment and wellness!
•
Perso n=Centered Services
• Provider as Cons u Itant/Coach
• The "As If" Approach
• Exit Strategies
• Co sumers as Providers
•
Self=Help Programs
I F— 1 -1 1
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 2222005 7
A-21
Self-Help Programs
Mental Health Consumer Concerns is the second
olde t Cons u mer=O perated organization in the
USA
Office for Consumer Empowerment employs five
consumer advocates at MH Administration.
Curren Self-Help Programs in Contra Costa County
incl de:
. 3 egional Community Centers
. Contra Costa Network of MH Clients
. WP Support Program
. S IRIT Consumer-Provider Training
F',altifIrIll V V1 V VW111VOOOlit ill fhe
` A
• To romote wellness and resiliency
iinldren and families, our services
an supports
• A c "lid and family driven system
. Srengthmbased approach
. S;riving for stability in the child's living
and educational environment
. E sier access to services
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 8
A-22
MH
• 11 ren, youin ana eir
faes/caregivers are responsible for
malTing plan decisions based on
part ership with their providers
• Info mation is made easily available and is
and rstandable
OS
e ices are flexible and allow children
and families to integrate them into their
dail routines
• Se ices can be provided in the home and
co munity to promote a normal
environment
Fr%-60%00% qW 7 X X AM X 7: 14"
"anlily -III V V1 V VbWIIIqL;IIt III-the
N qft, A
• Outcomes are determined and
me sured for the system, for the
pro ram and for the individual child
an family.
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 9
A-23
Emphasis on- uu ra
do
In LIIV IVIrlOt-V
Community Program Planning for MRSA
counilmes must:
• Enga e in outreach to insure comprehensive
pard ipation from diverse consumers and
famil es
• Reac out to individuals who do not belong to
orga ized advocacy groups
• Reac out to consumers and families who are
unde served or unserved whether by reason of
race/ thnicity, language differences, cultural
com etence, geographic location or other factors
• Insur stakeholder diversity that reflects
dem graphics of county
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 10
A-24
uounty
0 40 0
t n-Diata
p tut., a l,u7Ufihza''' .tu
ContraostaCCounty by Region
Her
Pi
a`
Po
say
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 11
A-25
•
er api
taIncomeCensusTract
•
in Contra Costa County
H
Pi
Ba
.t !
f
1 1
/ft capita Income(projected 2002
❑
50,001 to 150,000 <
❑20,001 to 50,000 w,
❑ 1,000 to 20,000
Source:CWhas Demographic Update
EthnicDiversityCostaCounty
• Wes Countyhas one of the most ethnicalI y
diveisepopulations in the BayArea. An
estimated 65% of residents living in West County
are eop le of color.
• East Countyis also ethnically qudiverse, with
21% atinos 8% Asian/Pacific Islanders, and 6%
Afric n Americans.
• Cent al and South County areas are relatively
mor homogenous in terms of ethnicit with 23%
Y
and 9%, respectively, of their populations being
persons of color.
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 12
A-26
Race/ th
F—
Language ren s in Contra Costa (1 990-2
Percent Change 1990-2000(Contra Costa County)
Population in 2000=9489816
160.0%
140.0%
120.0%
100.0%
68.0%
".0%
40.0%
20.0%
0.0%
Total Foreign Entered US Speak Do not Speak Speak Speak Speak
population born last 10 language speak Spanish Spanish Asian or Asian or
population years other than English and do not Pacific Pacific
English "very w er speak Island Island
English language language
"very w er and do not
speak
English
"very w ell"
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 13
A=27
UNDUPLICATED CLIENTS SERVED BY CCMHP
20000 179353 18,436
17,884
18000
16000
14,081
14000
12000
10000
99501 109004
8000
6000
4000
2000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
AmdOAl AmdOO 1) 4DA COnt� t I
--------------- ------------------------- -------------- --- ----------- --------
---------------- --------------- ------------------ ---------------------
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 14
A-28
Estes of Prevalence of Persons with Serious
EinoHon=1sturDance
in Contra Costa County* CA DMH)
----------------------
3
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48.1
...................... .... ......,.«........-..-......................«.w.w.........-..v-................,..,..,v.,.............................«... .,..,....w...,....,...,.. ,...+.,w..,.......w...«..............w�.,...
2
t
-..w.............x....x............._....w,......w..........____'x.w.....w...............,.�w.......................w...�w.......�..�..w........ �w.w..................-.............. ..........w...........w..............w........
........w.............. ... .......wx......._.�......�.......w..��............�......x..x w....�....w.._�v�.......... .�................�..........�... ww...w...,................V.....�...w
3
.....w�w...... w. w.x..�.............w...x.w...............�... ......................
w.x......... ......w...._�r......... .............w.............V.wn�....
48..$
_ 1
t ----
-Involving e omm
unity
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 221.,2005 15
A=29
Involving the Community
•
The Role of Stakeholder Work
Gr ups
• S rve as delegates
•
C1011ect Proposals and Data
• A alyze
•
Ptiorwitimze
•
Issue Recommendations
•
Advise
IMIf A ink..unu-a %....UbLd %,,..,uunty
plan0
n1inor fnr Comm-unitv Inv 1-1-remehint
March August
Community
Forums
Stakeholder Groups MH Stakeholder MH Commission&
Director Adv.Group Board of Supervisors
Focus
Groups
I F—
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 16
A-30
Contra Costa County Mental Health Services Act
Planning Timeline: February—December 2005
Feb March April May June July Aug Sep Oct Nov Dec
Stakeholder Training p �
Community Forums
Stakeholder Work Groups
Focus Groups 0
Write Plan 0
Advisory Group of Stakeholders Review �
Mental Health Commission O
Publicizes Plan for 30 Days
Public Hearing
D
Submit to Board of Supervisors
Submit to Department of Mental Health(90 day review)
C3 C3:g 1 IWAM333 CX--
LUUP3
nin QXIQ! 1AM 9
%W,W.JLJLd ltzy j- -W1.jLjLjLL.P Ch.....,LL9
• Weico e and manage multiple
points of view
• Sel -interests are minimized; system
nee s are maximized
• Bro d representation
• Def ned period of time
• Faclollotated by a neutral party
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 17
A-31
Next Steps
—T
• Co plete the Sign-up form in your
packets and return today
• Fo r Stakeholder Groups formed by
a c mmitte e including a consumer,
fa ily member, MH Commissioner,
Pro ram Chief, Disparities Work
Gr up
• Sta eholder Groups begin meeting in
Aproll
Additional Information on MHSA
• Cal fornia Department of Mental
HeIth Web S'te:wPw
h //www.dmh.cahwnet.gov
• Cootra Costa Health Services Web
Sit me
. h tpo.//cchealth.org
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 18
A-32
Mental Health Division Contacts
• Off"ice for Consumer Empowerment:
Sharon Kuehn: 925-957-5143;
SkLiehn@hsd.co-contramcosta.ca.us
• Fanil*ly Involvement Coordinator:
Kathy Davison: 925-427-8549
• Adolt/Faml*ly Coordinator:
Glotnia Hill: 925-957-5146
F-
Menta1Health Division Contacts
• MH A Project Management:
Kim erly Mayer, MSSW.o 925-957-5132;
kmaverb,hsd.co.contra-costa.ca.us
Gra4e Boda, MPP: 925-957-5127
grace(&bodaconsultin9 com
• Mental Health Director
Don a M. Wigand, LCSWo. 925-957-5111
dwi and@hsd.co.contramcosta.ca.us
F--
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 19
A-33
Questions & Answers
Attachment 4
MENTAL HEALTH SERVICES ACT-MARCH 22,2005 20
A-34
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CONTRA COSTA
HEALTH SERVICES
MH A i n Contra Costa County
INTERESTED IN WORKING DN A STAKEHOLDER GROUP?
If so, please complete the following and return bv March 23.2005 to:
Jeannie DeTomasi
County Mental Health Administration
1340 Arnold Dr., Ste.200
Martinez CA 94553
Fax: 925-957-5156
1. WHICH STAKEHOLDER GROUP ARE YOU INTERESTED IN:
Children El Transition-age youth❑ Adults❑ Older Adults ❑
2. PLEASE CHECK ALL THAT APPLY TO YOU:
Consumer ❑ Family❑ Provider❑ Education❑
Law Enforcement❑ Social Services❑ Other(specify)
�a
3. Optional:with what ethnic or cultural group(s)do you identify?
4. PLEASE DESCRIBE ANY EXPERIENCE YOU'VE HAD WORKING WITH DIVERSE POPULATIONS:
5. WHAT IS YOUR PRIMARY INTEREST IN BEING INVOLVED IN THIS PLANNING PROCESS?
6. WHAT STRENGTHS WOULD YOU BRING TO THE PLANNING PROCESS?
T. CAN YOU COMMIT TO ATTENDING ALL OF THE STAKEHOLDER MEETINGS FOR THE AGE GROUP YOU'RE
INTERESTED IN?
Yes❑ No❑
8. HOW CAN WE REACH YOU?
NAME:
ORGANIZATION:---
ADDRESS:
PHONE: FAx
Email: THANK YOU VERY MUCH FOR YOUR INTERESTS ' M1
Attachment 5
A-36
Children's Stakeholder Workgroup
Name Affiliation
Joan Alber Retired Special Ed Teacher
Bobbie Arnold Contra Costa Mental Health Commission
Ross Andelman, MD Contra Costa Children's Mental Health
Brenda Blasingame First 5 Contra Costa Children's & Families Commission
Arthur Bolter, MD Alcohol & Other Drugs Advisory Board
Mike Cornwall East County Child &Adolescent Mental Health (Local#1)
Kathy Davison Parent Partner, Children's Mental Health; family member
Melinda Dendinger Parent Partner, Children's Mental Health; family member
Terry Fasheh Central County Child &Adolescent Mental Health (Local
#1)
Paula Hines Contra Costa Public Health
Beatrice Lee Asian Pacific Psychological Services
Devorah Levine Zero Tolerance For Domestic Violence/GAO's Office
Kathi McLaughlin Contra Costa Mental Health Commission/MUSD Board
Arlette Merritt Early Childhood Mental Health
Debi Moss Children & Family Services, EHSD
Lisa Morrell Aspira Foster and Family Services
Nadine Peyrucan Employment& Human Services Department
Daniel Ruxin Contra Costa Mental Health Commission; family member
Gloria Sandoval STAND! Against Domestic Violence
Liz Stallings Mt. Diablo Medical Pavilion
Nickie Swenson Contra Costa Office of Education
Victoria Waxman West Contra Costa Unified School District
Jerry Zimmerman Mt. Diablo Unified School District
Attachment 6
A-37
Transition-Age Stakeholder Workgroup
Name Affiliation
Theo Durden West County Child &Adolescent Mental Health
Myra Emanual Children & Family Services, Employment& Human
Services Department
Laura Fowler Seneca Center
Don Graves Independent Living Skills Program, Employment& Human
Services Department
Diane Soto-Greenwood Contra Costa Mental Health Commission
Paula Hernandez Contra Costa Probation Department
John Hollander Vocational Services, Contra Costa Mental Health
Judy McCahon Contra Costa Mental Health Commission
Stuart McCullough Youth Homes, Inc.
Cally Martin New Connections
Lavonna Martin Homeless Program, Contra Costa Public Health --,
Daniel May, MD Young Adult Program, Contra Costa Mental Health
Valerie Meredeth NAMI; ABN Housing-
Radhika Miles East County Adult Mental Health (Local#1)
Barbara Nelson Jewish Family& Children's Services of the East Bay
Colette O'Keefe, MD Central County Adult Mental Health
William Oye Diablo Valley College
Norma Ramos West Contra Costa Unified School District
Margaret Robbins East County Child &Adolescent Mental Health (Local#1)
Fatima Matal Sol Alcohol & Other Drug Services, Contra Costa Health
Services
Mike Von Savoye Concord Police Department
Kathryn Wade Office for Consumer Empowerment/Community Support
Worker
Susan Waters Family Partner, Contra Costa Children's Mental Health
Attachment 6
A-38
Adults Stakeholder Workgroup
Name Affiliation
Rick Aubrey Rubicon Programs, Inc
Sandy Bustillo Workforce Services Bureau, Employment& Human
Services Department
Aimee Chitayat Community Clinic Consortium of Contra Costa
Sage B. Foster Homeless Program, Contra Costa Public Health
Geet Gobind Contra Costa Mental Health Commission
Lynn Gurko Crestwood Pleasant Hill
Lt. Robin Heineman Concord Police Department
Caroline Jackson NAMI/family member
Miles Kramer Contra Costa Regional Medical/Detention
Candace Kunz Tao Central County Adult Mental Health
Alma Lones Phoenix Programs
Tracy C. Love Crestwood Pleasant Hill/Consumer Provider
Anna Lubarov Office for Consumer Empowerment
Robert McKinnon Central County Adult Mental Health (Local #1)
Delores McNair Los Medanos Community College
Robert Martinez West County Adult Mental Health (Local#1)
Colleen Miller Mental Health Consumer Concerns
Herb Putnam NAMI/family member/Contra Costa Network of Mental
Health Clients
Patricia Rojas-Zambrano Familias Unidas
Lisa Ronan Contra Costa Mental Health Commission
Violet Smith Citizen
Cynthia Staton Mental Health Consumer Concerns; family member
Veronica Vale Consumer Involvement Steering Committee; family
member
Attachment 6
A-39
Older Adults Stakeholder Workgroup
Name Affiliation
Linda Anderson Aging &Adult Services, Employment& Human Services
Department
John Bateson Contra Costa Crisis Center
Lisa Bruce Mental Health Consumer Concerns; consumer
Debbie Card Mental Health/Public Health/EHSD
Tim Chon Pleasant Hill Police Department
Eric Devers West County Adult Mental Health
Nancy Ebbert, MD Contra Costa Mental Health
Albert Flanagan Deputy Public Guardian, Contra Costa County(Local#1)
Dave Kahler NAMI/family member
Sue Meltzer Richmond Health Center
Javier Nunton Familias Unidas ...�
Gisela Hernandez Doctor's Medical Center
Arthur Hollister, MD Contra Costa Advisory Council on Aging
Bettye J. Randle Contra Costa Mental Health Commission
Leah Rolnick-Brunstein Responsible Choices
Scott Singley Contra Costa Mental Health Commission; family member
Ken Salonen Contra Costa Mental Health/Employment& Human
Services Department (Local #1)
Connie Steers NAMI/family member
Carlos Torres Jewish Family& Children's Services of the East Bay
Tom Uhlman NAMI/family member
Larry Vaughn Mental Health Consumer Concerns; consumer
Attachment 6
A-40
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A-43
Locations/Agencies for Focus Groups and Surveys: Note: In out-of-county providers --�
(i.e., Crestwood San Jose), only Contra Costa residents participated in focus groups
and/or surveys.
Agape House Employment& Human Services Department
ARC/Lynn Center Families Unidas
Asian Community Mental Health Services Family Affair Board&Care
Asian Pacific Psychological Services Family-to-Family Support Groups in Danville&
Brookside Community Health Center EI Cerrito
Brookside Shelter Foster Care Parents
Celli House for Homeless Adolescents Guardian Day
Center for Human Development Happy Homes Board&Care
Central County Adult Mental Health Homeless Healthcare Clinic—Concord
Central County Child&Adolescent Mental Independent Living Skills Program (EHSD)
Health John Muir Hospital Support Group
Chris Adams Center Kicker Center
Community Clinic Consortium of Contra Costa La Clinics de la Raza
Community Forum:Antioch Martinez Detention Facility
Community Forum: Brentwood Mental Health Consumer Concerns
Community Forum: Concord Mental Health Division Disparities Workgroup
Community Forum: Danville Mt. Diablo Day Health
Community Forum: EI Cerrito NAMI Support Groups
Community Forum: Martinez Napa State Hospital
Concord Adult Mental Health New Hope Adolescent Support Group
Concord Dual Dx Group Phoenix Programs, Inc.: Nevin House ---
Concord Royale Assisted Living Phoenix Programs, Inc.: Nierika House
Concord Shelter Phoenix Programs, Inc.:Antioch Shelter
Concord WRAP Planned Parenthood
Contra Costa College: Young Adult Psychiatric Emergency Services, CCRMC
Teleconference On Depression Richmond Health Center
Contra Costa Mental Care Management Unit Scenic View board&Care
Contra Costa Mental Health Executive Staff Seneca-Oak Grove
Contra Costa Public Health Spirit Training
Contra Costa Regional Medical Center Springhill Board&Care
Crestwood Angwin Summit Center for Boys
Crestwood Fremont The Bridge Board&Care
Crestwood Patterson Ujima Family Recovery Services
Crestwood Pleasant Hill We Care/Barbara Milliff Center
Crestwood San Jose West County Adult Mental Health
Crestwood Solano West County Child&Adolescent Mental Health
Crestwood Stockton West County Intensive Day Treatment
Early Childhood Mental Health Program Williams Board&Care
East County Child&Adolescent Mental Health
East County Adult Mental Health
East County Healthcare Clinic
EI Cerrito Royale Family Support Group
June 3,2005 Attachment 7
A
-44
CONTRA COSTA
HEALTH SERVICES
PROP 63 NEWS: MENTAL HEALTH SERVICES ACT
The Contra Costa Mental Health Commission is hosting six community forums to hear
input on the implementation of the Mental Health Services Act (Prop 63). The meetings
will be in a town hall format. This is an opportunity for consumers, family members and
other interested parties to give their suggestions as to where they see the biggest needs
for mental health services in their communities.
All facilities are handicapped accessible. The Mental Health Commission will provide
reasonable accommodations for persons with disabilities planning to participate in the
Community Forums who contact the Mental Health Commission at 925-957-5149 at
least 48 hrs. before the meeting date, Interpreters are available.
SCHEDULE OF COMMUNITY FORUMS FOR
THE MENTAL HEALTH SERVICES ACT
s• Wednesday, March 9, 2005 •:
Thursday, March 24,, 2005 7:00 p.m.-9:00 pm. 7.00 p.m.
Brentwood Elementary School El Monte Elementary School
Multi-Use Room 1400 Dina Drive, Concord
200 Griffith Lane, Brentwood District IV
District III (East)
Thursday, March 10,, 2005 Wednesday, April 6. 2005
a
pmw9&00 p.m.
7.&00 p.m.-9:00 p.m. 7:00
Greenbrook Elementary School
Alhambra High School
Performing Arts Center 1475 Harlan Drive, Danville
District III (South)
150 E Street, Martinez
District 11
Wednesday, March 23, 2005 Thursday, Apri121, 2006
7:00 p.m.-9:00 P.M. 7.m00 p.m.-9:00 p.m.
Contra Costa County Castro Elementary School
Fairgrounds, 7125 Donal Avenue, El Cerrito
Hobby Building District 1
1201 West 10"' Street, Antioch
District V
For additional information please contact Karen Shuler, Executive Assistant.,
Contra Costa Mental Health Commission at 925-957-5149.
Additional information on the Mental Health Services Act is available at www.cchealth.ora
March 18,2005
Attachment 8
A-45
Contra Costa County -�
Mental Health Services Act Community Forum
District III — Brentwood
March 9, 2005
Forum Summary
KEY THEMES
� Provision of Supports that assist the consumer in living successfully in the community,
particularly affordable, supportive housing and supported employment opportunities
� Providing places and options for greater Socialization And Engagement, from
clubhouse/membership type models to facilitated support groups
� Collaborations, with K-12 to increase early intervention services;with community colleges
and employers to increase community-based living
� Affordable Housing,with socialization components
PUBLIC COMMENTS
Children
• More effective collaboration with schools. Issue/gap: districts are having difficulty running ----�
effective programs due to funding issues.
• School-based early interventions for children that are at the pre-SED stage. To include:
clinical therapists, staff development.
• Wraparound services that address the whole family needs
Transition-Aged Youth
• The"Clubhouse"Model(see Adult comments)
Adult
• Implement the"Clubhouse"Model, a place where consumer/members can serve
themselves,with services they need to be well in the community and rebuild their lives.
One Clubhouse in each of 3 sections of the County(East, West, and Central). Components
would include:
- Transitional employment for all members via contracts established with outside
employers;
- Education opportunities provided via linkages with community colleges
- Members work side-by-side with staff(approx. 1 to 18, staff-member ratio)to run the
Clubhouse
- Estimated$500,000 per year operating budget
- Based on New York's Fountain House clubhouse model founded 50 years ago
Attachment 8 -1
A-46
• Provide community supports to consumers after parent-caregivers,can no longer care for
them. Supports to include:
- Affordable housing(e.g., supported housing options)
- Medication management and monitoring
- Employment/training options and coaching
- Social connections and engagement
• Support Groups(with facilitators)throughout the community
- Peer-to-Peer: how to cope; share strategies;joint recreation/social opportunities;
support each other in taking ownership towards recovery
- Family member support groups also
• Housing with socialization components,to counteract isolation
• Some transitional housing options where those that need it can get supports and skill-
building services as a transition to independent living
• "Fair Weather Lodge"program that provides housing with the vocational aspect(training
and joint employment opportunities)
Older Adult
• The"Clubhouse"Model (see Adult comments)
Miscellaneous Comments
• Desires and needs of the mental health population are the same as for the general public
(affordable housing, education, employment, social contacts, etc.)
MHSA Forum-Brentwood -2- March 9,2005
Attachment 8
A-47
Contra Costa County ---1
Mental Health Services Act Community Forum
District II — Martinez
March 10, 2005
Forum Summary
KEY THEMES
.\r Support for comprehensive, integrated(mental health and substance abuse) approaches
interwoven into primary and general care.
Nf Sensitivity towards the use of language,terminology, and practices that stigmatizes and
distances disempowered populations.
� In addition,the use of creative,culturally-and age-appropriate outreach and
communication strategies to increase knowledge of, and access to, services.
,\f Increase of prevention, early intervention, and wraparound services and approaches in local
schools and neighborhoods more readily accessible to community members.
� Overall increase in consumer-operated and provided services, including within the existing
system.
Nf Populations with unmet need or underserved: Older Adults,Adults, and uninsured. •-�
Nf Recovery Model and Cultural Competence as key overarching principles.
PUBLIC COMMENTS
Children
• Make"Mental Health"a friendly word at this age; a culturally competent approach
• Family members and general public need education as to where to go (relevant to all age
groups)
• Services for children in out-of-home placements
• Build school-based services:
- Wraparound services for children and families
- Prevention and early intervention
- Work collaboratively with families
- Flexible hours
Transition-Aged Youth,
• Target dollars towards uninsured,particularly persons of color
• Utilize outreach and communication via media and language that young people embrace
• The"Clubhouse"Model(see Adult comments)
Attachment 8 7
A-48
• Expansion of consumer-operated services
• Expand WRAP groups county-wide
• Better assessment and services for teens; gap in dual-diagnosis services (see Miscellaneous
comments)
Adult
• Target dollars towards uninsured.
• Adults are disproportionately underserved;target dollars to them
• Stigma reduction: uninsured may not come forward; undocumented persons' fear of
government; `mental health' term carries stigma.
• "Integrated Model" as part of routine primary care activities (reduces hospitalization and
severity of illnesses)
- With multi-disciplinary teams
- Value of`empowerment'
- Community clinics are ideal sites for implementing this model
• Cultural competency
•
]Implement the"Clubhouse"Model(based on NY's successful Fountain House model)
- Social rehabilitation based
- A working community of"members"participating in tasks
- Focus on strengths and skill-building;building capacities
- Goal development
- Transitional and supported employment options
- Housing support
- Supported education
- Governance: a partnership of members and staff
• Expansion of Consumer Operated services and consumer providers
- Currently under-funded;wages are low
- Add benefits counselors
- Crisis response centers run by trained peers(as alternative to PES and hospital)
• Expand the notion of what"consumer providers"means
- Capitalize on their knowledge and skills within the existing system
- The new PhD's=Presently Here Doing it
• Look at building in"Exit"strategies for system;use the recovery model and values
• Disaster Response(team)-a system of services that communicates to consumers that a
plan is in place to maintain their safety in such situations
MHSA Forum-Martinez -2- March 10,2005
Attachment 8
A-49
Older Adult
• The"Clubhouse"Model(see Adult comments)
• Expansion of Consumer Operated services(see Adult comments)
• Peer-staffed"Warm Line"to provide access to support after hours
• Lack of services for this population in the County(e.g.,psychiatrists not even available for
paying clients)
• Reinstitute geriatric program
• Link up with Area Agency on Aging planning process
Miscellaneous Comments
• Regarding"Cultural Competency"
- Should be embedded throughout the process
- Use language that people can access
- Use processes that break down power relationships
- For example, "Mental Health"-transform the language into a positive reinforcement
vehicle,particularly for disempowered populations
• Use more innovative outreach, communication to reach more people
• Expand Wellness Recovery Action Plan(WRAP)groups
• Make"Recovery,"(and goal-setting)our focus -^
- Change language we use
- Re-train staff in order to change structures and process
• Use an Integrated, Comprehensive Approach: Mental Health and Substance Abuse
• We need programs with:
.Nf Well-trained staff
.Nf Well-paid staff
.Nf Cultural competence
� Culture of trust
� Highly sensitive
� Join together;build upon their expertise
.Nf Don't compete with each other
• Make services more accessible in localities and communities where people feel
comfortable
• Also target communities that are of high need and low capacity to serve(e.g.,Monument
corridor)
• Gap: lots of`walking wounded' in our communities and neighborhoods not being served
• Capitalize on/integrate with `early intervention' providers with services tailored to those at
lower acuity
MHSA Forum-Martinez -3- March 10,2005
Attachment 8
A-50
• Gap: demand exceeds capacity to serve
MHSA Forum-Martinez 0 40 March 10,2005
Attachment 8
A=51
Contra Costa County
Mental Health Services Act Community Forum
District V-Antioch
March 23,2005
FORUM SUMMARY
� Create partnerships with the educational system to improve mental health staffing,
training, and services in schools and colleges
� Provide early intervention and treatment for children, as well as people in other
age groups
� Eliminate the stigma attached to mental health services to encourage more people
to seek treatment
� Provide more in-home support for seniors
� Provide vouchers to be used for alternative health care, and to subsidize advanced
education of people with mental disabilities
=> Provide services for dental care, drug rehabilitation, eating disorders, and
counseling
Children
• Not enough therapy available. Long wait lists for services
• Need adults to make a commitment to children when they turn 18
• Agencies should try to find at least one family member to keep the child connected
with family
• Children K-12 have no place to turn,no one to talk to when they're troubled
o Do not see the church as an acceptable place to go for help
• Kids killing kids at school is increasing. We must stop this from happening
o Need more mental health counselors
o Don't just come in after the incident
• Teachers are not trained to deal with behavioral problems
o Therapists are overwhelmed
• Kids are not being diagnosed early enough. This affects their health,their future, and
them being"lost"
• Too many kids slip through the cracks
• Must get to the parents and help them with services
o Parent support groups
o Teach them how to work with the kids
o Find out what the parents need,not what the book says
Transition-Aged Youth
• There is a serious lack of services and activities for 11-18 year olds
• 200 students at Antioch High School that won't graduate
• Community Colleges are seeing students with mental health issues (same for adult)
Attachment 8 1
A-52
o Need a partnership between the community colleges and mental health for
services
• There are no drug/alcohol treatment facilities. Renting 4 beds outside the area
o Need a specialized drug and alcohol treatment program for youth
• Concerned about academic performance.
o Need to revamp ROP to provide training in the trades
o ROP is inaccessible
o Youth who don't want to go to college have no other choices available
o Youth need to be engaged beyond 14 years of age
• Need to focus on youth employment; if not,it could lead to mental health issues,
homelessness, self esteem, and other problems
• Kids must commit a crime in order to get services
• The state is done with the youth at 18 years old
o Need a transitional place for them
o Need encouragement,transportation,jobs
o Need mentoring
• Agencies want to help but don't have the funding and staff
• Need case managers to follow up with the youth
• Need more support for youth in the schools-training and services. Also need support
when they're out of school
� Counselors in the schools are like"police"
• Need to work with the media to provide better support for kids
• The suicide rate among gay, lesbian and transgender youth is alarming.
o Partner with the schools
• School counselors need funding
• Youth need to be kept engaged so they won't"spin-out"
o Many people in the system gave up and were given up on
• Youth need help getting into the school system
• For youth of color, the culture at home is very different from school
o Need more understanding of the cultural differences
Adult
• Lack of drug treatment facilities/services for all ages
o People need better understanding and help filling out the paperwork
• Community Colleges are seeing students with mental health issues
• People are seen two times a year just to get medication.Need more than that
o Need help adjusting to college to prevent them from getting to the critical
state
o Colleges need more staff
o Need periodic case managers on campus
o Colleges should better publicize services to students
• Want this act to help fund services in the colleges
• People are seeking help through their primary care doctors rather than Mental Health.
This is more so with Hispanics. This also applies to transition aged youth
Attachment 8 2
A-53
• Latinos are a growing population
o Have bilingual and bi-cultural issues
o New immigrants need specialized services
• There is a stigma attached with mental health clinics.
• Need new language(terms) for treatment. If not,people will continue to reject it.
• Will patients be charged for any Proposition 63 services?
Older Adult
• Want seniors to receive services.
o They need support groups and a place to talk-at least monthly
o Go to their home and pick them up
o Develop a relationship with them
o Have facilitated groups in their homes
• Seniors are isolated and have no transportation
• Need housing—innovative programs for housing
• How do you find out about them being isolated and needing transportation and
housing?
o Can create a screening program and teach case workers to use it
o Mental Health has a Senior Peer Counseling Program
o Let the seniors do the outreach and use their natural resources—church,
stores, community centers, etc.
Miscellaneous
• Want money to go toward se_,not buildings and equipment
• Provide alternative therapeutic services for people who cannot benefit from
traditional drug therapy
o Improve relationship between practitioner and patient
o Create a county housed alternative health care cooperative run by
professionals
o Provide tax credits as incentives to treat economically disadvantaged people
• Create a drug rehab facility(subsidize treatment in existing facilities) for mentally
disabled people addicted to or abusing prescription drugs
• Create a dental cooperative to be housed in the same building as the alternative health
care cooperative
o Sliding scale mental health clinics do not have staff trained to treat people
with long term mental disabilities
o There is no facility in the County to treat people with dental phobias
• Provide subsidized rape, sexual or emotional or physical abuse counseling and/or
trauma counseling regardless of date of occurrence or ability to pay
• Pay grant writers to solicit private grants to continue and further support programs
• Make legislative recommendations to the federal and state government to address the
issue of the false"poverty line" ..—.�
Attachment 8 3
A-54
Contra Costa County
Mental Health Services Act Community Forum
District IV-Concord
March 24,2004
FORUM SUMMARY
� Provide early intervention and treatment for people in all categories
� Partner with the educational system; improve mental health staffing,training, and
services in schools and colleges
� Improve housing for seniors,transition-aged youth, and adult mentally ill
� Provide opportunities for socialization; community centers, support groups, in-
home support
� Work to eliminate the stigma and negative perceptions people have about mental
health services. Create a new and affirming language.
Children
• Better support the relationship between mother and child
o Focus on the child
o Children should not be separated from their mothers. They should grow with
the mom,which will help her heal faster
o Will prevent the mom from being forgotten by the child
• Prevention., early intervention and treatment for the mother
o In-home support services for children with children
• Stay away from"therapy language"
• Schools should describe what a healthy family looks like
• Need prevention/intervention early to keep them from getting into the system
• Mental Health and the school system are disconnected.
o Kids' mental health issues are missed
o Schools don't see the warning signs
o Mental Health could provide better training and support
• Need more culturally based outreach programs.Not just at the therapist level
• Early education about warning signs
• Tests should be given throughout the county to assess kids before Columbine happens
again
• Support kids with mentally ill mothers. See Adults
Transition-Aged Youth
• Kids in foster care for many years need something to address the transition of youth
raised outside the family
Attachment 8 1
A-55
o Need services to continue the transition -^
• Adults need to make unconditional commitment to the kids
Adult
• People identified as victims of sexual abuse don't get mental health services. The
services end soon after the crime is committed
• Mentally ill mothers and kids
o The mom usually loses her kids
o Want more support for the pregnant woman-don't want CPS to take the kids
away
o Help women get their kids back
o Housing is an issue
o Provide support to deal with the woman's anger
• Seeking treatment is a deterrent. Women don't want to lose their kids so they don't
seek treatment
• There are a lot of people who have needs the County can't meet.
o Many people don't want drugs-not everyone can be helped by drugs
o They need someone to talk to
• The family system needs rehabilitation
o Homeless issues
• Ninety-eight percent of people in shelters were abused,which later resulted in:
o Needing help and unable to get it
o Dental problems
o Self esteem issues
o People not wanting to be in the mental health system
• Need good licensed board and care homes(also applies to transition aged youth and
seniors)
o These homes are a step down from long term care and locked facilities
o Need unlocked facilities
o Many of these homes have closed and the people are taken out of the county
and away from their families
o Provide incentives for people to want to open these homes
o Need quality room and board with independent living of all types
• Get family and community involved in their lives
• Need more developments like Kirker Court
• Provide availability of resident manager and social/case manager
• Are Socialization Centers still around?
o These can be provided inside community colleges-people will be more
motivated to go
o Have attorneys and doctors go once a month to help seniors,teens, and
homeless people. They might be able to catch problems before they occur
• Provide activities
• Pay the care operators more money
• Can provide information/education. Broad-based community support to identify
people who need help
Attachment 8 2
A-56
• Set aside funds for people who need legal help
Older Adult
• Medicare co-pay is a problem for many seniors
• Remove the crises and let them enjoy their remaining years
• Help in ways Medicare does not
• Open more Centers---opportunities for them to talk, eat, get services
o Seniors have nothing to do during the day.
o Most centers charge a fee,which takes money from their budget
o Need more drop-in Centers
• Consider a model of senior housing on college campuses-or some type of
intergenerational nexus with youth.
• Seniors need help with their medications,housekeeping,meals,transportation, and
other things.
• Lobby areas of senior apartments should have:
o Cable TV
o Sewing machines
o Knitting
o Exercise equipment
o Patio/BBQ area
o Monthly birthday celebrations
o Love
• Consider a model like the Alano Clubs-run by alcoholics. San Diego has one. Very
effective. Safe place to be around people who are clean and sober
o Don't have to have alcohol problem to go there
o People need to feel loved
• Incorporate psychological in-patient treatment just for mentally ill elderly
• Provide training for volunteers especially for those isolated with mental health issues
Miscellaneous,
• Alternative health care methods can be used to neutralize psychotic dysfunction. This
is not currently permitted in the system
• People are over-using anti-depressant drugs
o Easy way out
o Not getting the therapy they need
o Some prescribed drugs are just as harmful as street drugs
• We need a new language,but the only way to get funded is to use Medical language
o Should not ever speak that kind of language to the client
o There is a stigma associated with the language. Latinos won't want to access
the system
• Need a model with psychological component each time they access the service
o Short term counseling
o Culturally sensitive support groups
o Referral to recognized traditional medicine
Attachment 8 3
A-57
• Take Mental Health services to the client �
• People with co-occurring disorders should have a representative on the Advisory
board(preferably two people)
o Include people who know the issues
• Can Medi-Care benefits be supplemented using these funds?
• People are not getting the full diagnosis and treatment they need
• How do we get Medi-Cal to take the need for a complete work-up seriously?
• Mental Health should not just label people. Should work with other systems to help
• Want services to address homelessness and dual diagnosis. Many get in trouble with
police
• Provide in-home support for each category(children, adult,transition aged youth, and
seniors)
• Support"Ticket to Work"program
o People are in dire need of help
o Help people get back into the workforce
o Need real jobs and work training for people with mental illness
• Consider a therapeutic response team-similar to an emergency response team.
o Go to peoples' homes
o Provide support, follow-up
o Address their spirit(emotional needs)
• We have an opportunity to put"health"back in Mental Health
o Make it a"cool thing"
• Need a statewide PR campaign
Attachment 8 4
A-58
Contra Costa County
Mental Health Services Act Community Forum
District III — Danville
April 6, 2005
Forum Summary
KEY THEMES
,\r Various approaches towards addressing stigma as an issue,including: informational efforts
in schools and for the general public;training for teachers, county and service provider
staff; and facilitating knowledge about and access to support groups and associations
.\f Improved outreach about existing programs and organizations, and in particular,the use of
culturally-appropriate outreach and communication strategies for immigrant and non-
English speaking populations
.\f Information strategies to improve knowledge about prevention, dealing with stress, and
"emotional health"
� Look outside the County to increase knowledge about successful program models that can
be replicated in Contra Costa County
� Dual diagnosis and treatment options as an overarching need in the County
� In general, a shortage of quality programs to meet the needs of county residents
PUBLIC COMMENTS
Children
• Teach our kids early how to identify/manage stress.
• Provide school-based MH programs
• Provide help/support for families of children with mental health issues
• Get kids talking about"emotional state of health"in order Whelp de-stigmatize mental
health
Transition-Aged Youth,
• Address stigma by training teachers how to recognize mental health issues; teach youth at
an early age about mental health
• Provide support for students in community colleges, etc. Provide supports to help them
better manage their education
Adult
• Identify ways to put together structured, supported housing
• Address dual diagnosis issues
Attachment 8
A-59
• Need to do a better job of sharing information regarding mental health issues with law -�
enforcement to prevent inappropriate police interventions
• Need more case workers
• Gap: Dual Diagnosis services
• Stigma is a big issue. Support groups are an important way of addressing this.
• Provide anti-stigma training for County and service provider staff(some of them also
stigmatize MH consumers)
• Provide personal motivation/self esteem presentations for the public(helps them before
onset of crisis situations)
• Programs that help consumers gain employment but also maintain their health insurance
coverage
• Create opportunities for talking about addressing stress
• The"Clubhouse"Model (see Miscellaneous comments)
Older Adult
• The"Clubhouse"Model (see Miscellaneous comments)
Miscellaneous Comments
• "Clubhouse"model-need more than one to cover the county
• Lack of mobile case managers and housing
• Poor communication between County Mei and community regarding available programs
• Need County MH to be more proactive in getting clients into local programs
• This is a big county-need services throughout to cover all areas
• Need prevention and informational programs that help our community identify what is
"mental health"
• Need outreach to get clients/families involved in existing support
organizations/associations and the system itself
• Look at the"Farmhouse"model(Yolo County)with transition to supported
living/employment
• Look at entering into reciprocal agreements with other counties to improve access to
quality programs
• Look at/replicate success of other county's programs, e.g.,Yolo county
• Provide One-Stop Shops,where people can find out about services and be directed to them
• Do a better job of publicizing information regarding programs and events
• Provide education regarding mental health prevention for the general public
MHSA Forum-Danville -2- April 6,2005
Attachment 8
A-60
1
• Need advertising/outreach and information suited for different languages and immigrant
populations
• Utilize more mainstream media outlets(public service announcements)
• Support client participation in all processes
MRSA Forum-Danville -3- April 6,2005
Attachment 8
A-61
Contra Costa County
Mental Health Services Act Community Forum ---.
District I — EI Cerrito
April 21, 2005
Forum Summary
KEY THEMES
.Nf School-based services and supports for youth and their families,provided via partnerships with
community-based organizations. Particularly the provision of prevention, early detection, and
early intervention approaches that identify and serve students early,before the onset of more
serious issues. Also, school based services such as case management and therapy to address
post-traumatic stress issues that act as barriers to learning for many students.
.Nf Expansion and replication of successful models and increase in availability of caring
professionals that students feel safe to talk to.
� Services for the uninsured and underinsured,particularly for those of different cultures who may
have stigmas around"mental health"or distrust/fear of governmental programs, and services for
monolingual families.
� The provision of culturally competent services in community-based settings such as clinics
where individuals and families feel safe and welcome. Integrated approaches between primary
care and mental health. .�
� Addressing the needs of the homeless population,particularly: strong outreach; stable, affordable
housing with supports that assist them in maintaining housing; counseling and coaching to
support their entering pathways to employment; and dual diagnosis services to address the
prevalence of co-occurring disorders.
� Capacity to provide 24 hour/7 day a week mobile crisis response, assessment, and
comprehensive wraparound services to those in need.
PUBLIC COMMENTS
Children
• We are only treating 50%of the children who need services
• Use the funds to address the surging need here(for children and youth services)in light of huge
decline in dollars
• Need for children/youth is huge: untreated issues (e.g., trauma) are barriers to their ability to
focus on education. Support school-based responses like: the Y-Team that goes where the kids
are; youth drop-in services; community services at Richmond High. Need more staff to expand
and replicate these models.
• Need more school-based prevention/early detection(e.g.,of bi-polar))/early intervention services
• More services for seriously emotionally disturbed youth. Leveraging of Prop 63 with EPSDT
funding could expand impact greatly
Attachment 8 -1 -
A-62
• Behaviors can be detected early on school campuses
• Address needs of monolingual parents;need funding to provide access and services for them and
their children. Strengthen and standardize school-based services.
• School-based mental health and primary care are an important necessity.
- Schools are key access point for youth; a sanctuary for our kids
- Works well using non-profit partner providers
- Make awide-range of supports available: aone-stop"circle-of-care"
- MHSA funds can provide sustainability
• School-based case management,therapy, and other services are enormously important. Issue to
be addressed: complex post-traumatic stress disorder is a barrier to learning and affects
attendance. Also impacts/adds stress on teachers; contributes to burnout.
• Provide services for non-Medical students and their families
• Need for counseling(non-academic) at schools. Create safe places for kids to go; someone safe
to talk to. Get kids early.
• Provide prevention and early intervention programs in schools.
• Focus on under-represented or those not currently receiving services.
• Need for services at schools.
• Need to address mental health and other issues of youth in high school (sexual abuse; substance
abuse; domestic abuse; self-cutting;post-traumatic stress; etc.) lots of dysfunction impacting our
youth. Richmond High services losing non-Medical CBO services.
• Support successful pilot programs in high schools and replicate these in other high schools and
middle schools.
• Provide mental health services at school campuses to improve school climate.
• Culturally competent services needed.
• Youth who are at the edge of serious mental health issues need services
• Provide day treatment/wraparound services for youth in high school or transitioning out of
schools,particularly for non-Medical. Also for 18 year olds in foster care or group homes.
• Support community clinics that serve uninsured patients of different cultures; 35,000 patients
need services.
• Provide more culturally competent services in community settings (e.g., clinics,primary care
settings);reaches those with stigma issues or fear of government programs and the uninsured.
Transition-Aeed Youth
MRSA Forum-EI Cerrito -2- April 21,2005
Attachment 8
A-63
• Need to address mental health and other issues of youth in high school(sexual abuse; substance
abuse; domestic abuse; self-cutting;post-traumatic stress; etc.)lots of dysfunction impacting our
youth. Richmond High services losing non-Medical CBO services.
• Growing gap: transition to adult services.
• Support successful pilot programs in high schools and replicate these in other high schools and
middle schools.
• Provide mental health services at school campuses to improve school climate.
• Culturally competent services needed.
• Youth who are at the edge of serious mental health issues need services
• Provide day treatment/wraparound services for youth in high school or transitioning out of
schools,particularly for non-Medical. Also for 18 year olds in foster care or group homes.
• Use the funds to address the surging need here(for children and youth services)in light of huge
decline in dollars
• Need for children/youth is huge: untreated issues (e.g.,trauma) are barriers to their ability to
focus on education. Support school-based responses like: the Y-Team that goes where the kids
are; youth drop-in services; community services at Richmond High. Need more staff to expand
and replicate these models.
• Need more school-based prevention/early detection(e.g., of bi-polar))/early intervention services
• More services for seriously emotionally disturbed youth. Leveraging of Prop 63 with EPSDT
funding could expand impact greatly
• Behaviors can be detected early on school campuses
• School-based mental health and primary care are an important necessity.
- Schools are key access point for youth; a sanctuary for our kids
- Works well using non-profit partner providers
- Make awide-range of supports available: aone-stop `circle-of-care'
- MHSA funds can provide sustainability
• School-based case management,therapy, and other services are enormously important. Issue to
be addressed: complex post-traumatic stress disorder is a barrier to learning and affects
attendance. Also impacts/adds stress on teachers; contributes to burnout.
• Need for counseling(non-academic) at schools. Create safe places for kids to go; someone safe
to talk to. Get kids early.
• Provide prevention and early intervention programs in schools.
• Support community clinics that serve uninsured patients of different cultures; 35,000 patients
need services.
• Provide more culturally competent services in community settings(e.g., clinics,primary care
settings);reaches those with stigma issues or fear of government programs and the uninsured. ,..�
Adult
MHSA Forum-EI Cerrito -3- April 21,2005
Attachment 8
A-64
• Support existing mental health facilities/day treatment services. Need more mental health
professionals/clinicians to meet the need.
• Support the ability of consumers to contribute to society,maintain employment,become self-
employed, etc.by providing supports such as counseling, coaching,business/entrepreneurial
expertise.
• Support consumers in finding conducive/appropriate jobs.
• Homelessness is big issue(7,000 tallied at recent count); this population is unserved and
underserved and a large proportion of whom have co-occurring disorders. Need for housing,
24/7 wraparound, and available assessment services for them.
• Affordable housing is the keystone to recovery
- Supported housing
- Case management
- Effective providers
• Use the AB2034—Integrated Services model: services supporting recovery
• Provide multi-service consumer run centers that are well-funded to provide the level of quality
needed
- Literacy training
- Computer skills
- Job training
• Address homeless population needs: housing and supportive services. Desperate need for
outreach services and services to help them maintain housing once they get it.
• Address multiple needs of large Latino population;build in sustainability for these approaches:
- Stigma issues
- Service needs of uninsured
- Trauma issues
- Home-based visiting services
- Supports for entering educational ladder; develop pathways
- Services for the whole family/life spectrum
• Need for ongoing services for homeless adults
• Provide programs for homeless with mental health disabilities at an appropriate amount of
funding
• Services for those with co-occurring disorders
• Need mobile crisis services that can respond 24/7 (people currently not assessed and are taken to
jail)
• Provide services for uninsured and those that can't pay
• Consumers who utilize shelters need close-by day treatment services and supports
MHSA Forum-EI Cerrito -4- April 21,2005
Attachment 8
A-65
• Issue: Patient rights advocates gaining release of some clients too early
• Great need for homeless services;most vulnerable population �
• Important to provide services for whole family as well as kids
• More outreach, dual diagnosis and homeless services needed
• Culturally competent services needed.
• Support community clinics that serve uninsured patients of different cultures; 35,000 patients
need services.
• Provide more culturally competent services in community settings(e.g.,clinics,primary care
settings);reaches those with stigma issues or fear of government programs and the uninsured.
Older Adult
• Support existing mental health facilities/day treatment services. Need more mental health
professionals/clinicians to meet the need.
• Support community clinics that serve uninsured patients of different cultures; 35,000 patients
need services.
• Provide more culturally competent services in community settings(e.g., clinics,primary care
settings);reaches those with stigma issues or fear of government programs and the uninsured.
• Provide better integration between primary care and mental health.
• Culturally competent services needed.
Miscellaneous Comments
• Funding needed for effective assessment and evaluation services at Doctors Hospital. Issue:
5150s transported to hospital then released at end of 72 hours to access needed services
voluntarily. Police often become next level of response.
Additional Written Comments submitted
• Needed by caregivers: services for family members evenings and weekends
• Needed for severe clients: daytime facilities and program's with professional staff to provide
support and monitor taking of medications
• Crisis intervention teams available to respond instead of police
• Teenagers are needing/waiting too long for treatment in locked facilities
• Places to live for clients with special needs and fixed incomes. Waiting list is years long.
• Need for a special group for persons with schizophrenia and hallucinations that lead to anger
• School-based mental health services such as those delivered by Gateway, Y-Team, and ECHS
Community Project
MHSA Forum-EI Cerrito -5- April 21,2005
Attachment 8
A-66
Community Services & Supports Focus Group Questions
1) What community mental health services and supports are needed for
mental health and wellness in your community?What would help you
and/or others the most?
Qui servicios de salud mental y apoyo se nesesitan en nuestra
communidad. Qui sena benefecioso para nosotros como comunidad?
2) Have you or others experienced any barriers or difficulties to accessing
mental health services in your community? If yes, please describe. What
would have helped you or others in this situation?
Aiguno de ustedes o alguien a quien conocen, ha experimentado
dificultades para obtener acceso a los servicios de salud mental en su
comunidad? Si es asi, por favor describe la situacibn. Qui podnVa haber
ayudado en este situaci8n?
3) What changes would make mental health services and supports more
welcoming to you or others in your community? What are the most
important things a mental health organization can do to honor your culture
and establish trust in your community?
Que cambios harian mas acsequible los servicios de apoyo y salud mental
en su comunidad? Cuales son las cocas mas importantes que una
organizacion de salud mental puede hacer para honrar su culture y ganar
la confianza de su comunidad?
4) What needs to be done to make community mental health services and
supports more culturally and linguistically competent? What
organizations, individuals, or practices are most helpful to you or others in
reaching out to those who usually will not seek existing mental health
services?
Que se deberia hacer parer que los servicios de salud mental en nuestra
comundiad seen mss competentes linguistics y culturalmente? Cuales
organizaciones, inviduos or practices son de mss beneficio para usted y
otros en su comunidad que no buscan servicios de salud mental?
5) What specific new or additional community mental health services and
supports would you like to see in Contra Costa?
Que servicios de salud mental adicionales especificos le gustaria ver en el
condado de contra costa?
March 22, 2005 Attachment 9
A-67
Summary of CSS Recommendations --�
Agency/Organization Recommendation
ABN Housing (2 recommendations) Working farm for adult
mental health consumers
in Contra Costa
Anonymous Housing, especially more
Section 8 vouchers
Asian Community Mental Health Services Increase community
resources for Southeast
Asian population:
counseling, parenting,
housing, substance
abuse treatment,
prevention
Bay Area Community Resources/Gateway Project Increase school-based
mental health services in
WCCUSD
Clinic Consortium of Contra Costa Integrated mental
health/physical
healthcare &wellness
Consumer Involvement Steering Committee (5) -Supportive housing --�
-Integrated services for
consumers
-Program for parenting
women with psychiatric
disorders
-Increase consumer-run
services
-Clubhouse Social
Rehabilitation
Contra Costa Alcohol & Other Drugs Advisory Board Enhance overall capacity
(2) in CCMH/AODS for co-
occumn disorders
Contra Costa Crisis Center (2) -Operate a 211 toll-free
line for local health &
social services
-Mobile crisis unit
Sue Meltzer Implement satellite
clinics for MH
assessment& meds in
the community
Attachment 10
A-68
Contra Costa Mental Health: Vocational Services (2) -Supported
volunteering/employment
for consumers
-Supported short-term
employment for
consumers
Contra Costa Mental Health: West County Adult Expand young adult
program/transitional
youth program
Filipinos for Affirmative Action Prevention/support
program for immigrant
families
Mt. Diablo Center of Adult Day Health Care and Expand capacity for
Bedford Center adult day healthcare for
older adults
NAMI Contra Costa Clubhouse Rehabilitation
Model
Opportunities for Technology Information Careers Add mental health
services to participants
in em 1ent t
YMCA of the East Bay Increase school-based
mental health services in
WCCUSD
Attachment 10
A-69
Date: �,
CONTRA COSTA_
HEALTH SERVICES
Recommendation Form for MRSA CommunityServices and Support
Contact Person:
Phone: fax: email:
Street: city: ZIP:
Agency Affiliation:
Stakeholder group covered in recommendation: (check all that apply)
❑Children Transition Age ❑Adult ❑Older Adult
Recommendation Description:
Who is the primary target population of recommended services?
Approximately how many consumers/children/youth/family members would benefit by your
recommended services?
Are they currently being served by Contra Costa County Mental Health Division or some other
agency? [:]Yes ❑No
If so,, how?
What barriers prevent this population from being served or from being served adequately?
Attachment 10 1
A-TO
FHow would your recommended services break down these barriers?
How would the recommended services integrate with other services provided by the County or
by some other agency in the County?
How does your recommendation fit into the client and family driven model of wellness and
recovery?
How will you incorporate cultural competency into your recommended services?
How will you measure your program's success? What outcomes do you envision collecting to
show measurable results?
Other information you want to include:
Please return this recommendation (original plus two copies) by May 10, 2005 to:
MHSA: CSS 1340 Arnold Dr. #200 Martinez CA 94553. All recommendations are considered public
information.
Attachment 10
A-71
cchealth.org Prop 63 pages 2005 Jan 1 thought Oct 27
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3 Mar 6.93% 9m0MB 7.57% 599 428 1,023 2
4 Apr 11.8% 15.4M6 12•9% 642 498 1,697 2
5 May 133% 16.1M6 13.5% 517 419 1,890 10
6 Jun 15.6% 17m8MB 15.0% 518 412 2,254 7
7 Jul lZs% 14v3MB 11•9% 472 368 1,846 0
Attachment 11
A-72
8 Aug 13.2% l5s3MB 12.8% 484 390 1,863 15
9 Sep 11.6% l3w3MB 11.2% 481 378 1,666 0
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Attachment 11
A=73
Stakeholder Planning Group - Children - Contra Costa Health Services Page 1 of 5
CONTRA COSTA
HEALTH SERVICES
Contra Costa County MRSA Planning
Stakeholder Planning Group - Children
Minutes
April 11,, 2005
Next Meeting: Tuesday,, April 25 at 4 - 6 p.m.
Assignments:
Whom. All members
What: Read DMH Program Requirements document; review needs assessment; study
hand out materials
When: Before 4/25/05
Welcome/Introductions/Orientation
Steve Ekstrom, stakeholder group facilitator, introduced himself and County MH staff
(Kimberly Mayer, Grace Boda, Steve Hahn-Smith). Resource staff to the Stakeholder
Group was also introduced (Vern Wallace) as was Susan Waters, Family Involvement
Co-Coordinator.
Steve E described the process by which members were selected. Regarding
attendance, members are expected to attend every meeting. If they are unable to
attend a meeting due to unforeseen circumstances, they should not send a substitute.
Regarding communication, a group email list will be created. All meetings will be
recorded and minutes will be sent electronically. It's likely that there will be other
documents that will need to be distributed to members - they'll be sent electronically
or by mail. If members choose to communicate to another member, they are
encouraged to cc the communication to all members in order to keep everyone up-to-
date.
Members then introduced themselves.
Ground rules were also discussed and agreed upon. They are:
Attachment 12a
http://www,cchealth.org/services/mental he I h/stakeholder minutes children.... 10/27/2005
4
Stakeholder Planning Group - Children - Contra Costa Health Services Page 2 of 5
1. Start on time
2. End on time,, unless there's agreement to continue
3. One speaker at a time
o Allow people to finish; don't interrupt
o Be concise
o Facilitator "directs traffic"
4. No sidebar conversations
5. Listen for understanding
o Suspend judgment - try on other ideas
o Appreciate other points of view
o Seek common ground
6. Decision-making:
o Use a consensus model (This means that while you might not fully agree
with a decision,, you will support it outside of our meetings.)
o If consensus can't be reached, and time is of the essence, prioritize using
"sticky-dot" or other type of voting
7. Declare any vested interests you may have when making a point.
8. Turn off cell phones and pagers before each meeting.
Training
Steve E, Kimberly, Grace,, Steve HS and Sharon presented a slide show aimed at
creating a context for the SH group's work. The slide show captured the essence of
the State DMH's program requirements that all counties will need to incorporate into
their proposals. Knowing this in advance will help stakeholder group members as they
formulate their recommendations to the County's MH Director.
The State's Logic Model (community issues >>> unmet needs >>>focal
population>>> service strategies) was reviewed at length, as was the distinction
between enrollee-based vs. system capacity program development. The point was
made the this Group must address two primary matters: 1) identifying a focal or
enrollee population; and 2) identifying three to five service strategies (system
capacity) to fill in the service gap for children.
A needs assessment was reviewed. This was developed from a tool provided by DMH
that is to be used by all counties.
Examples of recommendations to the MH Director were presented so members could
get an idea of what the product of their work will look like.
Questions and Comments
Members asked several questions or made comments following the slide presentation.
Paraphrased, they included:
• Could the list of community issues change?
Attachment 12a
http://www,cchealth.org/services/mentalminutes children.... 10/27/2005
Stakeholder Planning Group - Children - Contra Costa Health Services Page 3 of 5
Responses. That question hasn't come up in DMH's stakeholder meetings. It's
unlikely that DMH will change this list. .r..._
• Since the age ranges are different from what we use, will you help us distinguish
between children and transition-aged issues?
Responses. Yes. DMH developed the age ranges. You may want to communicate
with the Transition-aged Youth Stakeholder Planners. You may want to focus
less on teens.
• In your presentation, it sounded like clinics will no longer be a service strategy
for our County. Is this true?
Response: No, it is. not true. Clinics are an important component in our service
array. We meant to convey that MHSA gives us the option to provide services to
children in non-traditional settings, at non-traditional times of the day. Also, it is
true that DMH doesn't want to see more of what counties have always done.
• Will the recall ballot be in November 2006?
Responses, That is what we're hearing.
• Do we have a representative from juvenile justice in our group?
Responses. No; unfortunately we didn't have any such applicants.
• Will we have the opportunity to learn about the programs we already have in
place?
Response: Yes, we'll get you that. We will try to email a fact sheet on each
program to you before the next meeting. If we can't do that, Vern will bring hard
copies to the next meeting.
• Is expansion of an existing program OK?
Response: Yes.
• It's ironic that we may have some program cuts as we're planning expansion
through the MHSA, Stakeholder planners should go to budget workshops and
hearings to have their voices heard.
• Could we get a list of services the Federal Government provides?
Responses. Vern will get what information we have; but understand that the
Feds provide dollars, e.g., Medical, not direct services. Medical money is in a lot
of our current programs.
• Can we serve kids who are not legal residents of the County?
Responses. We're not sure, but we'll check with DMH.
• Regarding the Community Issues slide, I see them as resources, not issues.
What is DMH's intent? --�
Attachment 12a
http://vvww,cchealth.org/services/mental h I 'stakeholder minutes children.... 10/27/2005
A-
Stakeholder Planning Group - Children - Contra Costa Health Services Page 4 of 5
Responses. Their vision is to keep families intact by maximizing services in the
home or in the community.
• I'm concerned with the language of the MRSA. It seems to leave out the 0 to 5
year age range.
Responses. DMH is open to this group, but it's true they don't have the
appropriate language yet. If this group wanted to recommend a focal population
of children under six, the community issue of inability to be in a typical school
setting could be interpreted to include preschools. Out of home placements
would apply as well since we know our biggest out of home placement
population is children under one year of age.
• We need to avoid the child vs. adult struggle. We need to support the families.
• I see some really positive things in all of this.
• This is an opportunity to look at some perennially difficult issues.
• What about prevention?
Responses. There will be separate funding from MHSA for prevention services. If
in your work you identify some important prevention ideas,, "park them" so they
can be considered when prevention funding becomes available.
• We should meet with adult and transition-aged youth stakeholder planners to
discuss how to address the whole family. Maybe we could have a "family forum"
that all planning groups could send representatives to.
Responses, Excellent idea. We'll look into planning such meeting(s).
• The language DMH uses in describing cultural competence is confusing.
Response: We'll get a copy of the complete DMH document to all stakeholder
planning groups.
Homework
For the next meeting, members should read DMH's Program & Expenditure
Requirements document,, study the needs assessment that Steve Hahn-Smith
reviewed, and study the materials that were distributed at the end of the meeting.
Next Meeting/Agenda
The next meeting will be on April 25,, 4 - 6 p.m.; same location.
Agenda:
• Answer any questions about DMH requirements or anything else that was
presented on April 11,
Attachment 12a
http://vvww,cchealth.org/services/mental,,.heAWWakeholder minutes children.... 10/27/2005
Stakeholder-Planning Group - Children - Contra Costa Health Services Page 5 of 5
• Discuss and agree on specific community issues this group will address
• Discuss and agree on unmet needs this group will address ----
Content provided by Contra Costa County Mental Health Division.
Contra Costa County, California, USA
Copyright O 2000-2005 Contra Costa Health Services
Home Privacy, Terms of Use, Accessibility I siteM ( validate ( toy of Daae
Attachment 12a
http://www.cchealth.org/services/mental.helltV,fakeholder minutes children.... 10/27/2005
contra Costa County MRSA Planning
Stakeholder Planning Group
Children
Minutes
April 25,2005
Present: Debi Moss,Jerry Zimmerman,Joan Alber,Nicki Swenson, Gloria Sandoval, Brenda
Blasingame,Paula Hines,Ross Andelman,Teri Fasheh,Vicki Waxman,Devorah Levine,Lisa
Morrell,Melinda Dendinger,Arlette Merritt,Daniel Ruxin,Bobbie Arnold,Nadine Peyrucain,
Mike Cornwall,,Beatrice Lee,Liz Stallings,Kathi McLaughlin,Kathy Davison,Vern Wallace,
Steve Ekstrom
Next Meeting: Monday,May 9 @ 4—6pm
Assignments:
All members Study the"County Readiness Self-assessment"document Before 5/9/05
(developed by Steve Hahn-Smith); read Community Forum
reports and any Focus Group reports you may have received
Vern tCheck in with MHSA Planning Team to see if they know Before 5/9/05
when prevention money will become available.
All who Rework the draft"issues statement"(see below)using email Before 5/9/05
choose
Announcements
In the interest of maintaining an open planning process,we will be allowing observers to attend
stakeholder planning meetings. They will be inforned that they can only observe the discussi ons,
not participate in them.
Occasionally we may be able to use the larger conference room downstairs. We'll post a sign on
the upstairs door when those opportunities arise.
Q &A regarding the planning process
• From last meeting: can enrollees in MHSA programs include residents of the County who
are Medi-Cal beneficiaries of another county? Specifically,can children who have been
adopted into Contra Costa.or are in long-term placements here be enrolled in our MHSA
program?
1
Attachment 12a
A-79
Response from DMH: DMH would have no concerns about the "receiving"county
including an out-of-county client in MHSA services. However,the "sending"county
continues to have a legal responsibility to coordinate the care for that individual.
Services would have to be provided with the consent of the case manager in the home
county and there would need to be periodic discussion about the best interests of the
client involved. (NOTE:the group interpreted this response from DMH as being"no.")
• Can we serve children who are residing in our County,who are indigent and uninsured?
Response:.Yes.
• Regarding the self-assessment, should we identify unidentified risk factors,e.g.,exposure
to trauma?There's no such data.,but can we impart our knowledge?
Response:.There are holes in the data; if you have some, sent it to Steve Hahn-Smith.
Also,our job and the job of the resource staff is to use our knowledge to help reach
decisions.
• The State silos the different populations; can we use the model of the family to reach
conclusions?
Response: Yes. DMH wants us to look at inter-generational issues. We might hold a
"family forum," inviting representatives of each stakeholder group to give progress
reports,and look for ways to address inter-generational issues.
• How liberal can our interpretation of DMH's Community Issues be?For example,can
they be adjusted to cover 0—5 years of age?
Response: Yes. But you should also email your concerns to DMH
(www.dmh.cahwnet.gov)so they are considered in the revision of their planning
guidelines.
• We should use the Community Issues DMH has provided as a window into the ----.
dysfunction of the family and community.
• Can we meet in subgroups?
Response: We don't want to specify what you can and can't do. However,we advise that
if the purpose of a subgroup is to discuss the larger group's dynamics or process,that
should be discussed in the full group.But if it's to discuss an idea or proposal,there
shouldn't be a problem with meeting as a subgroup.
• What about ideas that don't get funded?
Response: They could get funded under the"innovative and prevention"category at a
later point.
• The fact sheets are good,but hard to sift through; can we have a matrix of what the
programs are,funding levels,who is served,and performance outcomes?
Response: Vern will put something together,email it to Steve who will forward it to the
group before the next meeting.
• Is a focus group(s)planned to address gay, lesbian and transgender perspectives?
Response: Yes.
• Is a focus group(s)planned for parents of kids 0 to 5 years of age?
Response: Yes.
• Is a focus group(s)planned for relative caregivers and foster parents?
Response: Yes.
• Suggest we do a focus group with kids,on the school grounds.
Developing an Issues statement
The first step in the logic model/planning process is to agree on a community issue or issues. The
"menu"of options provided by DMH were reviewed. They are:
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➢ Inability to be in a typical school environment
➢ Hospitalization
➢ Out-of-home placement
➢ Juvenile justice system involvement
A discussion followed and several comments were made. They include:
• Difficulty in schools seems to be the central issue
• Out-of-home placement is the central issue. If there aren't primary parent/caregivers,
problems flow from that.
• If there's no daycare for kids, it increases stress on the family, financially and otherwise.
• We shouldn't use an IP(identified patient)viewpoint.
• When you"back up the microscope"from the Community Issues listed,the focus is on
the family, schools and community.
• What we don't do (as a system) is put the attention on the kid before they have trouble.
• It's good that DMH wants new and creative ideas and approaches,but we have existing
programs with waiting lists"a mile long."
• The Community Issues from DMH are not broad enough.
• When will prevention money come under the MHSA?(NOTE: Vern will check on this).
• The issue that impacts the most kids and families is"inability to be in a school
environment."The others flow from this.
• Yes,but there's also a problem with effective diagnoses.
• "Inability to be in a school environment"is the key issue, but only if we move the age
down to cover pre-school and childcare. We should use Healthy Starts' approach,by
looking at what we need in the community to make a difference.
• Out-of-home placement and the school environment are the key issues for me.
• Schools are one of the first chances we get to reach kids. Most kids who get hospitalized
rarely have had previous contact with the mental health system
• Day car providers don't know where to turn for help.
• What about the kids who aren't in school?
• Foster care is a shrinking resource.
• WRAP not offered soon enough—it doesn't help when it's timed with a crisis.
• Out-of-home placement and schools are the key issues. But schools don't have the
resources to"fix"things.
• We should create a common tool for teachers,parents,counselors,etc.,that could help
with early identification of problems. We also need a good referral system.
• The State has set a floor,not a ceiling. Their list is very limiting. Still, looking at what
we've been given, hospitalization and juvenile justice system involvement seem to be
outcomes of out-of-home placement and difficulty in schools issues. School is not a
significant part of all communities. Some minority communities don't view them as
meaningful. We need to keep a cultural lens on our work. Could we remove"school"
from the issue and replace it with"education"or"learning?"
• "In home, in school,out of trouble."
• It's really important to include early intervention years;the trouble often starts before
kindergarten.
• The problem is desperate families.
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The• "learning environment" is an important place to start. Some of our language is
medical model language,e.g.,"we need to diagnose better."We should look at it from J�
the perspective of that is required to be a health child. When there are severe problems in
the family then we expect all the social services to fill in the family's gaps. We need to be
realistic about what we can do with limited funds.
• DMH's list is not an issues list but a systems list. We need more effective interventions.
We need to focus on problems not diagnoses. Getting to kids with problems in schools
may be a good way to reach them. Hospitalization is a small piece of the puzzle.
• What's the context here? With all the cuts we've had over the years,we're planning in a
crisis situation. We need to frame all of this in that context.
• It's frustrating that we have to pick from this short list.
The group agreed that the central issues are"inability to be in a typical school environment-,-, and
"out-of-home placement."Members also agreed that we need to word this in a way that captures
the 0 to 5 age group. We decided to start with a draft that Steve will write(below)and use email
before the next meeting to refine it.
Steve's draft :
Reductions in funding to children's mental health services over the last several years have
created a critical situation. Existing services are limited and many have long waiting lists. It
is in this context that we plan for the MHSA.
There are two key issues that send a signal that kids are having problems. The first is their �,,
inability to function in a learning environment. This can be in day care,pre-school or a
regular school environment. The second issue is out-of-home placement. When kids are"in
school and at home"they're more likely to be"out of trouble."If we focus our attention on
maintaining(in some cases creating)a health home environment, and are able to help kids
perform well in their learning environments,the chances are greater that they will grow into
healthy young adults.
Homework
Rework the above issues statement using email.
At the next meeting the group will discuss where it believes the greatest unmet needs are. The
point is to start zeroing in on the focal population that this group will identify as its
recommended enrollee population under the MRSA. In preparation,members should study the
"County Readiness Self-assessment!'that Steve Hahn-Smith reviewed at the first meeting. They
should also look at Community Forum reports and any Focus Group reports that are distributed.
Where we are in the process
Once the group agrees on a focal population, it will start discussing specific community supports,
services and programs that(1)are needed to serve the focal population, and(2)are needed to fill
out the service array for children who aren't necessarily in the focal population(identified by
DMH as the"systems capacityll services).
Next meeting/Agenda
The next meeting will be on May 9,4-bpm; same location,
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Agenda:
• Agree on an issues statement
� Information on when prevention funding might be available(Vern)
• Discuss unmet needs;time peri itting, identify a focal population
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Contra Costa County MRSA Planning
Stakeholder Planning Group
Children
Minutes
May 9,2005
Present: Teri Fasheh,Mike Cornwall,Nicki Swenson, Daniel Ruxin, Liz Stallings,Beatrice Lee,
Devorah Levine,Arlette Merritt, Lisa Morrell,Kathy Davison,Melinda Dendinger,Victoria
Waxman,Arthur Bolter, Gloria Sandoval,Bobbie Arnold,Ross Andelman,Jerry Zimmerman,
Nadine Peyrucain,Debi Moss,Brenda Blasingame, Sandy Marsh, Steve Hahn-Smith, Steve
Ekstrom
Next Meeting: Monday,May 23 @ 4—6pm
Assignments:
All members Study Community Forum reports and any Focus Group Before 5/23/05
reports_you may have received
Announcements
• We'll start a"parking lot"of ideas that should be considered when prevention and early
intervention funds become available. We still haven't learned from DMH when that
might be.
• Focus Group data will not be available for a couple of more weeks. Because this slows
down the stakeholder group process,*it's necessary to add an additional meeting day. The
group agreed to hold a 6thmeeting on June 20,4pm.
• Sandy Marsh briefly described who is eligible for services under the MHSA,but
emphasized that specifically identifying which diagnoses are eligible is not a matter that
needs to concern this group. She passed out the"Mental Health Services Act Target
Population Definitions from Welfare and Institution Code"from MHSA and"Medical
Necessity for Specialty Mental Health Services that are the Responsibility of Mental
Health Plans"from the State Department of Mental Health. These two documents define
serious emotional disturbance for children and adolescents,and serious mental illness for
adults and older adults including diagnostic categories,functional impairment,and
intervention criteria which are used by CC County Mental Health to determine eligibility
for all county mental health services.
• On page 36 of the needs assessment document,the last column should read(%Change
from 2000 to 2004.
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Issues Statement
The group reviewed the various amendments to the draft Steve had written(see minutes from
4/25/05).After discussion it was agreed to adopt the piece written by Jerry Zimmerman,with a
few minor amendments. It reads:
Reductions in funding to children's mental health services over the last several years have
created a critical situation.Existing services are limited and many have long waiting lists. It
is in this context that we plan for the MHSA.
When it becomes obvious to health and other professionals, and possibly to
parents/caregivers,that a child or adolescent is having problems functioning safely and
productively in his/her home, learning environment and/or community, it can be assumed
that the child has serious social,emotional or physical needs that are inadequately met.
Healthy functioning and reasonable growth in the home and in the learning environment are
the best indicators that a child will develop into a healthy and productive young adult.
When health professionals and educators assist families in meeting the social,emotional and
physical needs of their children,the community in general is a happier and healthier place for
all of us.
In addition to this statement,the group wanted the"statement of purpose"(with minor
amendments)written by Ross Andelman to be appended to the final report from this group.
Some of the language may be useful to the person who will be writing the proposal from Contra
Costa County to the State DMH. This document is included at the end of these minutes.
Focal Populations
We agreed that we would make no decisions about selecting a focal population until members
have had a chance to study Focus Group data. That said,we agreed to start the conversation.
Based on their experience,knowledge and the review of Community Forum data,members were
asked to speak to what they thought the greatest needs were. Comments included:
• Children under one year of age whose mother is seriously depressed. The ability to serve
this family under Medical is better in west county, but it gets worse in central and east
county. (NOTE: the group agreed that this was largely a prevention/early intervention
matter,unless it's picked up by the adult stakeholder group.the point was made that we
need to know what the other groups are developing.)
• Adolescents and teenagers up to the age of 18 need therapeutic support and medication
management.
� In the far east part of the county(past Antioch),there's a sizeable group of Hispanic and
Asian children who don't speak English,nor do they have some of the same concepts in
their language.For example,there's no word in their language for"foster care."There is
a gross lack of resources for these children.
• There's a large%of students in juvenile hall who need MH services, but they get left
behind. There's a particularly large segment in west county, but the problem is county-
wide.
• Children exposed to domestic violence,or to parents using drugs/alcohol.
• Children need access to medication and therapy.
• The kids from low socio-economic families get the least service,especially in west
county.
2
Attainment 12a
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• There are so many who need services that it's difficult to make a choice. ...�,,
• Kids from kindergarten and up,whose families make too much to qualify for Medical,
but can't pay for the services their kids need.
• If the child or the family don't speak English,they likely won't even know about services
that do exist.
• Similarly,parents who have drug/alcohol problems may not be aware that services exist.
• Those children who are currently receiving services,but are not getting enough of what
they need and/or are about to get cut off from services.
• There's a large growth of Asian and Latino populations in the county,but the MH
penetration rates are very low. Asians fleeing war-torn countries have additional
problems.Refugees from Laos in west and east county are good examples.There's a lot
of violence and drug use.
• Uninsured children,particularly undocumented immigrants,kids in juvenile hall,out-of-
county foster kids
• There are very low MH penetration rates for non-English speaking populations,e.g.,
Southeast Asians and Central American refugees.
• What is the percentage of kids in juvenile hall who don't speak English?(NOTE:Nicki
will get data from the last fiscal year and circulate it to the group.)
• Kids that remain truant(middle school and up)and who often break the law.
• Trauma is often an invisible issues (we may not know what they've been through,or
what's happening in the home). We should look at the youngest age possible in
immigrant and refugee populations,perhaps zeroing in on Kindergarten through 2nd
grade.Maybe we should provide"Cadillac"services to a group that none of us knows
about.
• We need to look at how we'll do the most good with the limited funds available.At least
the underserved are getting something. We should focus on those with language barriers
who are getting no services at all.
• Regarding teen suicides,do we have figures on the number who have committed suicide?
There's an underlying depression these kids have.The issue is starting to be addressed,
e.g.,Mt. Diablo school district got a grant.
• Middle and high school kids who are dually diagnosed. The problem is county-wide.
• Regarding dually diagnosed kids,this problem cuts across race and socio-economic lines.
It's often secondary to PTSD-
Are
there currently other sources of funds that are aimed at immigrant/refugee
populations who don't speak English?Is anything being done now?If so,perhaps we
could partner with those services. (NOTE:there were responses to this—(1)there is
funding for Native Americans; (2)this type of grant money is often time-limited.
Parking Lot ideas
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
Homework
Study Community Forum and,when available,Focus Group data,to see what our communities
are saying.
Next meeting/Agenda
The next meeting will be on May 23,4-bpm.
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Agenda:
• Continue discussion of focal populations. If possible,reach a decision.
4
Attachment 12a
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Statement of purpose CHILDREN'S STAKEHOLDER PLANNING GROUP
Effectively identifying and promoting the well-being of children suffering with serious
emotional,behavioral,and developmental problems has always been an enterprise fraught with
challenges-a lack of consensus on what constitutes a serious problem, let alone the nature or
cause of a problem; a paucity of evidence for the efficacy of available interventions;poor
communication and coordination between various systems and agencies-mental health,
education,juvenile justice,children and family services,drug abuse services,and primary care;
ignorance of and insensitivity to cultural, linguistic, and familial differences; a mental health
model that has promoted out-of-home placement and hospitalization as panacea while
distrusting, if not blaming parents,and a failure to effectively counter the stigma associated with
mental illness and mental health treatment.
Advances in our understanding of mental disorders in children and more rigorous evaluation of
available treatments have provided considerable hope for children. Here in Contra Costa County,
the implementation of the System of Care philosophy has helped bring the major social services
agencies to the table to better coordinate care,has helped promote a shift in mental health
providers to be more respectful of cultural differences and to see the benefits of keeping families
together, focusing on family strengths,and fostering a therapeutic partnership with families in
the treatment plan.
However,just as we are making great strides in our understanding of children's emotional and
behavioral problems and in our conceptualization of mental health needs and appropriate mental ---.
health services, recent reductions in funding for public-sector children's mental health services
have brought about a crisis in our ability to identify and treat children in need. Epidemiological
studies demonstrate that the majority of children with emotional and behavioral problems are
never identified, and for those who have been identified,families confront a system that is
confusing, difficult to navigate,and often plagued by long delays before securing an evaluation
or meeting with a therapist.
Although signs and symptoms of serious emotional or behavioral problems may be recognized in
a variety of circumstance by a number of adults involved in a child's life,there are two critical
signals that deserve special attention. The first signal is a child's inability to successfully adapt to
the social,behavioral,or learning expectations of an educational program.The work of
childhood,from child care and pre-school through high school graduation and beyond involves
the acquisition of intellectual,physical,emotional,and social skills and experiences.A child's
failure,when compared to a peer group,to meet these challenges may be the most sensitive
indicator of a significant problem demanding evaluation and attention. The second signal is the
threatened or actual loss to a child of a home with her primary family.A child's internal sense of
security and esteem is predicated on a relationship with one or more dependable,engaging,
attentive, loving,and protecting parents.When this relationship is threatened or fractured,for
example by environmental, economic,or health-related challenges to the parent,child's
emotional well-being is at risk.The threat or experience of out-of-home placement, in addition to
suggesting trauma in the family system, should in itself demand a heightened level of concern for
the child's emotional welfare. Just as functional difficulties in a learning environment are
sensitive signals for an individual child,out-of-home placement is a sensitive signal at the r...`,
systems level.By focusing on these two signals,we can have the greatest impact in assuring or
restoring a child's sense of security, self-esteem, and happiness.
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Contra Costa County MRSA Planning
Stakeholder Planning Group
Children
Minutes
May 23,2005
Present: Paula Hines,Arthur Bolter,Jerry Zimmerman, Vicki Waxman,Melinda Dendinger,
Kathy Davison,Michael Cornwall, Teri Fasheh,Beatrice Lee, Debi Moss,Daniel Ruxin, Gloria
Sandoval,Nicki Swenson,Liz Stallings,Ross Andelman,Nadine Peyrucain,Bobbie Arnold,
Arlette Merritt,Devorah Levine, Brenda Blasingame,Kathi McLaughlin,Vern Wallace,
Kimberly Mayer,Donna Wigand, Steve Ekstrom
Next Meeting: June 6 @ 4—6pm
Assignments:
All members Study"Recommendations"that were distributed Before 6/6/05
Announcements
• An intergenerational/Family Forum will be held on May 31, 4-bpm in the downstairs
conference room. This is an optional meeting,but we're hoping that several
representatives from all stakeholder groups will participate. The purpose is to discuss the
progress of each group, as well as to identify possible focal populations that cross the age
"silos"we're dealing with in each stakeholder group.
• "Recommendations"from the community-at-large were distributed.
• Donna Wigand thanked the group for their work to date, and also announced that we'll
need to schedule more meetings in order to get the work done. She explained the reasons
for the additional meetings:
finalo We only just received the requirements from DMH. It will take some time to
determine the impact of any changes on our planning process.
o We have much more focus group and survey data than we had anticipated,which is
good. But it's taking a lot of time to finish the groups and prepare their reports.
o And we don't want to do a rush job in this important phase of planning;the process
needs to be comprehensive.
So we need to add two extra meetings, bringing the total to 9. Meetings 7, 8, and 9 have
yet to be scheduled,but we plan to do that this week.
Donna apologized if these additional meetings conflict with members' vacation plans.
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• All focus group and survey data will be available to members by about May 30,about ---.
three weeks before the June 20 meeting at which we'll make a decision on an enrollee
group. This will give members ample time to study all data.before making an enrollee
decision.
Focal Populations
We continued our discussion from the last meeting. Steve described the tool or worksheet he's
developing that each member will use to help them identify an enrollee group. This should
facilitate the decision the group will need to make.The tool is a matrix.Across the top will be
focal populations, broadly described. Down the left column will be conditions or status
indicators.Members will"score"each condition/status indicator for each focal population,
indicating the degree of concern/need as well whether the group is unserved,underserved or
inappropriately served.
Members liked the idea and offered suggestions for the"across the top"focal populations. It was
understood that all of these suggestions pertain to SED kids. The long list included:
• Non-Medical eligible kids; uninsured; low income
• Kids with limited access to MH services
• Children with multiple foster care placements
• Children living with relatives
• High risk kids who are dangerous to self or others
• Homeless kids
• Kids in the juvenile justice system
• Kids involved in prostitution
• Kids involved with gangs
• Kids with"out-of-the-norm"traumatic experiences
• Kids lacking adequate support from parents
• Kids with parents who are seriously mentally ill
• Children seen in PES
• Kids repeatedly expelled from learning environments
• Teen parents
• Children with developmentally disabled parents
After more discussion,the group narrowed the list down to the following focal populations that
will be considered:
• Children of parents in high risk populations, e.g.,AOD usage, SMI,developmental
disabled,minors
• Non-Medical eligible, low income,uninsured,and limited access to MH services
• Experience with juvenile justice system
• PES visits
• Multiple foster care,or relative caregiver,placements
• Out-of-the-norm trauma
• Repeated failure in learning environments
These seven focal populations will appear across the top of the worksheet.
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Down the left side of the worksheet the group agreed to add the following age groups: 0-2; 3-5;
6-11; 12-18.
The worksheet will accompany the remaining data that gets distributed at the end of the month.
Each member will use the worksheet as a tool to help them identify their first and second choice
enrollee groups. Sources that members will use to complete the worksheet are:
• Needs assessment
• Survey data
• Focus group data
• Knowledge
• Experience
• Other handouts
Later in June the full group will consider the enrollee suggestions from each member and will
reach a decision about which enrollee group it will recommend to the Mental Health Director.
Parking lot
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
Homework
Study "recommendations"from the community-at-large that were distributed at the beginning of
the meeting.
Next meeting/Agenda
The next meeting will be on June 6,4-bpm.
Agenda:
• Presentation on the new DMH requirements; Q&A
• Begin discussing the possible services and supports that could be helpful to kids. This
will help us get a head start on the systems development discussions that will come later.
Parking Lot ideas
� Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
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contra Costa County MRSA Planning
Stakeholder Planning Meeting
Forum on Family and Intergenerational Issues
Minutes
May 31,2005
Present:
Children's Group: Kathy Davison, Melinda Dendinger,Jerry Zimmerman,Arlette Merritt,
Brenda Blasingame,Lisa Morrell,Bobbie Arnold
Transition Awe Youth Group: Susan Waters, Stuart McCullough, Don Graves,Kathryn
Wade, Colette O'Keeffe,Theo Durden,Katie Roberts
Adult Group: Herb Putnam,Violet Smith,Aimee Chitayat,Anna Lubarov,Veronica Vale,
Connie Steers, Caroline Jackson, Geet Gobind,Bob McKinnon
Older Adult Group: Leah Rolnick-Bronstein,Tim Chon, Connie Steers,Bettye Randle
Observer: Janet Wilson
Staff/consultants: Jay Mahler,John Allen,Lisa Booker,Nancy Frank, Steve Ekstrom
Introduction;purpose of meeting
The idea for this Forum came from at least two stakeholder planning groups, largely in response
to the need to have a dialogue across groups to look at family and intergenerational issues. The
planning for MHSA implementation is organized around age"silos,"yet DMH has stressed the
importance of considering family and intergenerational issues. This Forum was organized to help
each age-related stakeholder group look at this broader context of the MHSA.
The point was made that all of the groups have yet to make decisions regarding enrollee
populations(Full Service Partnership)or services and supports strategies, so the timing of this
Forum is advantageous.
Participants received a handout that showed the focal populations each stakeholder group is
considering for an enrollee population recommendation. Members then introduced themselves.
Why are you here today?
Participants were asked what they hoped to get from the meeting. Responses included:
• The County should work together in a more systematic way; maybe this session will help
make that happen
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• The populations we're studying in our stakeholder groups aren't stagnant;they are all
transitioning, so we need to be talking with each other
• So we can look at the full picture
Issues
The remainder of the meeting was devoted to an open-ended discussion of the key issues and
concerns participants had. Comments during this discussion included:
• If kids with SED are symptoms of broken down families,then we need to see that their
parents get help
• Every client comes with a family;we need to focus on the full family
• But we also need to look at the distinct needs of each age group, so that they really
benefit from the MRSA
• Older adults could serve as mentors,for example to transition age youths
• Parents with SMI who have their children removed from them. This is a real problem.
o In most cases it's the mom not the dad
o In-home support services(IHSS)would be of great help
o When a parent is placed in longer-term care, e.g.,over 30 days,the children are
removed and the mother loses custody
o In the reunification process,housing is not adequately considered. For example,an
apartment may be found for a mother, but there's no room for her kid(s)
o If the mother is labeled mentally ill,the custody of the children goes to the husband
� Transition age kids leaving foster care need a committed adult in their life;there should
be a core of mentor volunteers
• We need to start with the newborns of families with problems.An IHSS service that
would focus on helping families raise their newborns in a healthy way would be good
• What about adults who don't want help? Sometimes we(children's services)go into a
house and see a parent who could use help;we'd like to be able to call someone who can
respond. Has the Adult Stakeholder Group looked at this?
• Wrap-around services help the whole family
o It's documented that it works
o But we need more members on the teams
o And we don't have MOUs with agencies that serve adults
o What if a parent needs help, but they are not seriously MI.Maybe this should be a
"prevention and early intervention"service we might want to consider with future
MHSA funding.
• We must remember this about consumers: many are very capable, are stable, and can be
of real help to others
• The silos that DMH has created present a problem. How can we meet DMH's
requirements and find a service that's holistic and"threads"its way across age groups?
We need to be creative. Wrap-around is real answer to this. It represents a holistic,
strength-based approach to working with families. It's a support blanket.
• Populations may be in silos,but the services needn't be
o Families are the place for integrated services to occur
o Maybe we could develop a"one-stop"approach
• Our county is fragmented; one has to go through many hoops to get help. A thread,e.g.,
wrap-around services,to pull everyone together would be great
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• But can we add more wrap-around services with MHSA funding? It's not a new service, ---.
and isn't DMH saying we shouldn't replicate existing services?
• All of the stakeholder groups need to look at innovative approaches
• Some transition age youths are sent to other counties or states to receive services. They
need to come home.
• Also,there are adults and older adults in long-term facilities that may be inappropriately
housed.
• The older adult group is concerned that DMH also wants us to focus on"transition age
older adults"aged 50 through 59.We're concerned this could drain services from much
older adults in their 70s, 80s and 90s. Is the adult stakeholder group looking specifically
at services to 50—59 year olds?
o Maybe we need to look less at the age of a group,e.g.,older adults or adults,and look
more at the needs of people. For example, a person could be in their mid-50s,but due
to many circumstances,could have the needs of someone in their 80s.
• We do need to bring people out of isolation,and find meaningful activities for them to
do.
• Insurance, insurance, insurance!
• We need to start programs that can apply to all ages. One example is the Clubhouse,an
approach that has been implemented across the U.S. and internationally. It emphasizes
meaningful activities.Members are encouraged to work, in whatever way they can. It can
be tailored to serve all age groups. We should have one in every region of the County.
• We need to look at the services for each age group,and look at where they can overlap;
or we need to create those overlaps.
• Regarding outreach and enrollment,where will we find populations that are hard to �
reach?Primary care clinics are places we can find them.
• There are some models the County has considered, and in some cases attempted to
implement.They are:
o The Parent Project developed at the University of Massachusetts. It's for parents with
SMI,and emphasizes peer support,crisis planning,mental health education for kids,
etc.
o Ashbury House in San Francisco,operated by Progress Foundation. It's for mothers
with SMI—their children live with them in the house helping keep the family intact.
o Pollack Model in Colorado.Among other things it deals with"empty nest" issues,
and focuses on natural support systems
o Hope City model,that focuses on hard-to-place foster care kids
• We need easier community-based access to MH services; for example,when we see
mothers with MI in primary care clinics, maybe we could offer IHSS to them. We need to
be able to co-locate services.
• Rather than start elaborate,complex programs,we should look for simpler solutions and
build on what we already have in place.
Next steps
Participants were encouraged to discuss this Forum at their next stakeholder meetings. They
should make the point that there was considerable interest in thinking creatively to find ways
where there can be overlaps of services. Each group has to think about distinct services for the
ages it represents,but they should also look for ways that those services could impact or involve
other age groups. Even if we start small, if it's innovative,maybe family-oriented,and/or age- �
inclusive, it could represent something we could build upon over time.
3
Attachment 12a
A-94
Contra Costa County MRSA Planning
Stakeholder Planning Group
Children
Minutes
June 6,2005
Present: Melinda Dendinger,Jerry Zimmerman,Nicki Swenson,Kathy Davison,Arthur Bolter,
Arlette Merritt,Joan Alber,Brenda Blasingame,Teri Fasheh,Ross Andelman, Paula Hines,
Daniel Ruxin,Bobbie Arnold,Liz Stallings,Beatrice Lee,Lisa Morrell,Debi Moss,Vern
Wallace, Grace Boda,Kimberly Mayer, Steve Ekstrom
Next Meeting: June 20 @ 4—6pm
Assignments:
Each Study all data that will be distributed at the end of May.Use By 6/18/05
member the worksheet(to be distributed with data)to decide on your
top 2 priorities for Full Service Partnership funding; email or
fax your 2 priorities to Steve Ekstrom
DMH Program and Expenditure Requirements
Kimberly Mayer and Grace Boda reviewed the highlights of the new DMH requirements. DMH
made a number of changes to the original document. They included:
• Increased emphasis on client and family direction,peer support efforts and client and
family-run programs
• Greater emphasis on cultural competence
• More appropriate language for children and youth
• Expanded language on statewide outcomes
• Three types of funding
o Full service partnerships(formerly"enrollees")
o System development(formerly"system capacity")
o Outreach and engagement(new category)
• The logic model hasn't changed
• Conservatees are eligible for services under the MHSA,but as far as we know, MHSA
funds can't be used to create more involuntary beds.
Kimberly also reminded everyone of the group's assignment:
1
Attachment 12a
A-95
I- Identify community issues(done)
2. Analyze mental health needs(in process)
3. Identify a group for full service partnership(to be done by mid-June)
4. Identify service and support strategies for developing the system(to be done in July)
5. Submit recommendations to the Mental Health Director(to be done in July)
Forum on Family and Intergenerational Issues
Several members had attended this Forum on May 31,and they discussed their understanding of
the key points,which included an emphasis on wrap-around services for children/youth and
AB2034-like services for adults and older adults.
System development
We began discussing ideas for services and supports. This was an opportunity for members to
inform their peers about different strategies they are aware of.Again,we won't be making
decisions about services and supports we'll recommend until July.
Several ideas were presented and discussed:
• A consistent therapist who can follow a child who has multiple foster care placements
• Emergency respite or in-home services for foster care parents and kids
• More frequent home visits by therapists
• Services to help families succeed,e.g.,the Parent Project,characterized by:
0 10-16 hours of training '^
o Tough love approach
o Strategies for dealing with AOD,truancy,difficult behaviors,etc.
o An action plan
o Connection with schools and other community resources
o Families are referred by therapists,CFS,other parents,courts,etc.
o There's also a Parent Project Juniors with a shorter training period,that is for parents
of kids aged 6— 12
• Outreach to families whose kids have been to PES;this would be a way of treating them
without requiring them to go to a MH clinic for their first visit(which some have an
aversion to)
• A service for mothers with newborns where nurses(who have concerns about a mother
with MH issues)can make an immediate referral. A therapist would come to the hospital,
and then arrange for afollow-up home visit
� MH specialists who go to child care centers or schools in response to a provider's call for
help
• MH experts located at primary care clinics;they would receive referrals from primary
care MDs and nurses
o Services would be provided"in the moment"
o This is effective for the Asian/Pacific Islander population
o This service exists to some extent in east county but not in the other regions
• Wrap-around services with mono-lingual populations
o Flex funds
o It's an approach these populations can relate to because of the emphasis on the family
o It builds trust
o Include family partners who aren't a part of the traditional MH system
2
Attachment 12a
A-97
• Wrap-around is effective with most populations
o Currently the county uses Federal criteria(through October,2005)that include:
• 5-18 years of age
• DSM diagnosis
• Covered by Medi-Cal
• Problem has existed for more than 6 months
• Problems in more than one area
o But we're just scratching the surface as far as addressing the need; our capacity is
very limited
o The ideal: wrap-around services for any kid presenting a problem,not just for SED
kids
• Wrap-around services to ou sof families (who are amendable);this would stretch
dollars
o If we trained non-MH specialists to do this, it would save even more dollars and
would get more peer/family support
• More family partners
• Multi-disciplinary diagnoses and treatment plans in a one-stop setting. This would
include psychiatry, medicine,nutrition,education, etc. Children's Hospital has a good
model for this.
• Quarterly community forums that would provide a presence in to community,provide
information on resources available, as well as answers to questions residents might have.
This would build trust. (NOTE:this idea came from minutes of one of the Community
Forums)
Parking lot
• Teen suicide prevention using peers,.
• Services to kids whose parent(s)have a serious mental illness.
• Wrap-around services for kids presenting problems,but who haven't been diagnosed as
SED.
Homework
Study all the data that will be distributed shortly. Each member should use the sorting
tool/worksheet(to be distributed with data)to help decide on a full service partnership group
they wish to recommend.
Next meeting/Agenda
The next meeting will be on June 20,4-bpm.
Agenda:
• The children's stakeholder planners will decide on the full service partner group it wants
to recommend.
3
Attachment 128
a-9s
Contra Costa County MRSA Planning
Stakeholder Planning Group
Children
Minutes
June 20,2005
Present: Bobbie Arnold,Arthur Bolder,Jerry Zimmerman, Daniel Ruxin,Kathy Davison,
Arlette Merritt,Joan Alber, Beatrice Lee,Melinda Dendinger,Paula Hines, Teri Fasheh,
Devorah Levine, Ross Andelman,Liz Stallings,Lisa Morrell,Mike Cornwall,Nadine Peyrecain,
Brenda Blasingame, Steve Ekstrom
Next Meeting: June 27*4—6pm
Assignments:
Each Continue to study data for continuing discussion of service Before 6/27/05 --�.
member and support strategles
Full Service Partnership
After much conversation,the group agreed to recommend that the County establish a full service
partnership with the following focal population:
Children, 0-18 years of age, who have a history of reheated failure in learning environments.
These environments include home, childcare,preschool and school. In addition, these
children arefrom families whoe�t,�ble.
(NOTE:the highlighted language will be replaced with CCS language).
There are many associated risk factors that may be taken into account in an assessment.
These risk factors are:
• Multiple foster care or family caregiver placements
• Limited English proficiency
0 High-risk parents or community
0 Cultural differences
0 Out-of-norm trauma
0 Substance abuse
0 Experience with the juvenile justice system
0 PES visits
1
Attachment 12a
A=98
Parking lot
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
• Wrap-around services for kids presenting problems,but who haven't been diagnosed as
SED.
Substitute
Brenda asked if her Deputy Director could fill in for her since she'll miss the remaining
meetings. The group readily consented.
Homework
Continue studying the data that's been distributed. Search through this data.for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on June 27,4-bpm.
Agenda:
• Continue discussion of service and support strategies.
2
At#achment 12a
A=99
Contra Costa County MHSA Planning
Stakeholder Planning Group
Children
Minutes
June 27,2005
Present: Daniel Ruxin, Paula Hines, Debi Moss,Teri Fasheh,Lisa Morrell,Ross Andelman,
Melinda Dendinger,Arlette Merritt, Bobbie Arnold, Joan Alber,Nadine Peyrucain, Beatrice Lee,
Vern Wallace, Steve Ekstrom
Next Meeting: June 30 @ 4—6pm
Assignments:
Each Continue to study data in preparation for final decisions Before 6/30/05
member regarding recommendations for service& support strategie
Full Service Partnership
The group revisited the Full Service Partner(FSP)definition from the last meeting. Following
discussion the group agreed to the following definition:
Unserved children, 0-18 years of age, who have a history of repeated failure in learning
environments. These environments include home, childcare,preschool and school. In
addition, these children are from families who are at or below 300%of poverty and are not
eligible for other funding sources.
Finally, those with one of more of the following risk factors will be given priority:
e Multiple foster care or family caregiver placements
9 Limited English proficiency
e High-risk parents or community
9 Populations whose cultural differences have historically precluded them from MH
services
9 Out-of-norm trauma
e Substance abuse
0 Experience with the juvenile justice system
0 PES visits
1
Attachment 12a
A=100
Systems development—service and support strategies
Members looked at a list of ideas generated at a previous meeting. They also looked at the menu
of options from DMH. It was understood that it would be wise if any strategies we recommend
can be supported by DMH's menu of options.
We began by thinking about what service and support strategies might be needed for the full
service partnership we are endorsing. The following strategies were generated:
• Wrap around service that has the following characteristics:
o Involve the family
o Maximize the use of existing community resources and individuals, e.g.,help with
translation; help with identifying kids/families and with access
o Where feasible, services are delivered to groups;train family and community
members to facilitate family support groups
o Nurses in hospitals identify families their concerned about
o Home visits for infant/parent therapy
o Parent Partners: parents assisting parents with troubled kids (peer support)
o Provide services where the kids and families are(don't require clinics as the only
place where services are delivered)
o Mobile crisis response teams
o Outreach and community education using non-traditional approaches to reach
unserved populations
o Ensure coordination with existing resources outside of MH system,e.g.,
■ Child welfare
■ First Five Home Visiting Program
■ Faith communities
■ Zero Tolerance
■ Asian Pacific Psychological Services
• Interpretation services using the latest technologies,e.g.,211 system
• Parent-Child Enrichment Program
• Educational program for parents with problem kids; support groups ala Parent Project
Junior
• Meaningful activities for kids, e.g.,volunteer work, healthy places to"hang out"
Parking lot
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
• Wrap-around services for kids presenting problems,but who haven't been diagnosed as
SED.
Homework
Continue studying the data that's been distributed. Search through this data for service and
support strategies that our community constituents are interested in.
2
Attachment 12a
Awl 01
Next meeting/Agenda
The next meeting will be on June 30,4-bpm.
Agenda:
• Continue discussion of service and support strategies
• Develop recommendations for service and support strategies
3
Attachment 12a
A-102
Contra Costa County MHSA Planning
Stakeholder Planning Group
Children
Minutes
June 30,2005
Present: Bobbie Arnold,Arthur Bolter,Nicki Swenson,Teri Fasheh,Kathy Davison,Melinda
Dendinger, Paula Hines,Arlette Merritt,Joan Alber, Debi Moss,Beatrice Lee,Lisa Morrell,Nadine
Peyrucain Vern Wallace, Steve Ekstrom
Next Meeting: July 18 @ 4—6pm
Assi ments:
Each Be prepared to discuss our recommendations with the Mental 7/18/05
member Health Director
Systems development—service and support strategies �
Members looked at the wrap around definition it had developed at the last meeting, and made some
refinements. They also agreed on 4 other strategies. These strategies are
The following strategies,which include cultural competence,will be recommended to the MH
Director. The wrap around strategy was developed with the Full Service Partners in mind,but it is
not limited to this group. These strategies are not listed in any priority order:
1. Wrap around service that has,but is not limited to,the following characteristics:
o Involve families,and create age and development-appropriate treatment plans
o Maximize the use of existing community resources and individuals,e.g.,help with
translation; help with identifying kids/families and with access
o Where feasible, services are delivered to groups;train family and community members to
facilitate family support groups
o Nurses in hospitals identify families they're concerned about
o Home visits for infant/parent therapy
o Provide services where the kids and families are(don't require clinics as the only place
where services are delivered,e.g., schools,family resources centers,child care centers,
CBOs)
o Employ evidence-based clinical best practices; also employ practices tailored to each
family's specific needs
1
Attachment 12a
A-103
o Fiscally sound services that are leveraged to the greatest extent possible
o Assure coordination with existing resources outside of MH system, e.g.,
■ Child welfare
■ First Five Home Visiting Program
■ Faith communities
■ Zero Tolerance
■ Asian Pacific Psychological Services
■ AOD services
2. Mobile crisis response
3. School and community-based services
4. Parent and Youth Partners(peer support strategies)
5. Outreach and early identification with the following features:
o Use of non-traditional approaches
o Community engagement and education targeted at unserved populations(e.g.,use
community leaders,case managers, interpreters)
Advisory Committee
The MH Director has requested that each stakeholder group name 4 members to a Stakeholder
Advisory Committee.This Committee will most likely conduct its work after Labor Day.It's
purpose is to review and comment on the first draft of the County's proposal to State DMH. Criteria
for selecting members are: 1 Parent Partner, 1 family member, 1 MH service provider(County or
CBO)and 1 from the community-at-large. In addition,the Advisory Committee needs to be diverse --
and representative of all regions. Advisory Committee members will represent their Stakeholder
Group and the recommendations they've made. Their role is not to represent individual interests.
The following members indicated interest:
Parent Partner:
• Kathy Davison
Family member:
• Melinda Dendinger
MH service provider:
• Arlette Merritt(CBO,west county)
• Teri Fasheh(County MH,central county)
• Beatrice Lee(CBO,west county,Asian/Pacific Islander)
Community partner:
• Paula Hines(public health,county-wide)
• Debi Moss(EHSD/CFS,county-wide)
• Joan Alber(community-at-large,county-wide)
• Nicki Swenson(County Office of Education,county-wide)
• Lisa Morrell (foster care CBO,east county)
The group decided that we would try to make a decision at the next meeting(July 18)after other
members not present at this meeting have an opportunity to indicate interest. However,the point was
made that those selected should have participated in most of the meetings.
2
Attachment 12a
A-1.44
Parking lot
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
• Wrap-around services for kids presenting problems,but who haven't been diagnosed as SED.
Next meeting/Agenda
The next meeting will be on July 18,4-bpm.
Agenda:
• Discuss recommendations with the MH Director
3
Attachm,9M 12a
A-1 05
Contra Costa County MHSA Planning
Stakeholder Planning Group
Children
Minutes
July 18,2005—Last Meeting
Present: Arthur Bolter, Jerry Zimmerman,Joan Alber,Arlette Merritt, Paula Hines,Daniel Ruxin,
Bobbie Arnold,Kathy Davison, Beatrice Lee, Melinda Dendinger, Liz Stallings, Kathi McLaughlin,
Donna Wigand, Kimberly Mayer, Sandy Marsh,Nancy Frank, Steve Ekstrom
Advisory Committee
The group discussed who would represent the Children's Stakeholder Group on the Advisory
Committee. This Committee will review the draft plan before it is submitted to the Mental Health
Commission. Members voted and the following representatives were selected:
0 Kathy Davison(parent partner)
* Melinda Dendinger(family member) '�'`
* Beatrice Lee(MH service provider)
* Paula Hines (community partner)
The point was made that these members should represent the work/recommendations of the
Children's Stakeholder Group, and not individual interests.
Recommendations to the MH Director
Before reviewing the recommendations from the Children's Stakeholder Group(see Appendix to
these minutes)Donna discussed the latest MHSA information from the State.
1. Apparently DMH has acknowledged that some"streamlining" is needed in the Three Year
Plan that counties will submit for Community Services& Supports. The way it's currently
set up,there could be 12 different MHSA programs a county would develop(4 age groups X
3 programs each—Full Service Partnerships, Systems Development and
Outreach/Engagement, along with required workplans and budgets). This could be quite
cumbersome to implement, manage and evaluate so DMH is considering ways to make it less
burdensome, %Wf of
2. The Oversight and Accountability Commission has begun to meet and it appears they may
take a more active role in determining how MHSA funds are allocated, e.g.,they've indicated
an interest in setting aside some funding for a housing bond. It is unclear if this potential "re-
allocation"of funds is within their role as set in the legislation. It is likely that the time
frames for completing our proposal will be set back while we await additional instructions
1
Ament 12a
A-106
from the State.At this point, Donna is anticipating that Contra Costa.County will submit its
proposal in November rather than October.
Next,there was a discussion between members and Donna about the Group's recommendations.
Topics discussed included:
• The emphasis on failure in learning environments
• The emphasis on wrap-around-like services
• The idea that some recommended strategies(e.g.,mobile crisis response, school and
community-based services,outreach/early identification)could be woven into the wra-around
strategy
• Regional preferences
• The Full Service Partnership enrollment stipulation of less than 300%of poverty
• Reaching out to mono-lingual communities
Parking lot
Ideas for future consideration have been logged during the course of this Group's work. The point
was made that these items should be considered during the planning for Prevention and Early
Intervention funds:
• Teen suicide prevention using peers.
• Services to kids whose parent(s)have a serious mental illness.
• Wrap-around services for kids presenting problems, but who haven't been diagnosed as SED.
And Finally...
There will be a"Thank You Celebration"to acknowledge the hard work of all stakeholder group
members. This party will be held on July 27thfrom 4:00 to 6:00 p.m. at Marie Callender's,2090
Diamond Boulevard in Concord. Donna thanked the Children's Stakeholder Group members for all
their hard work, and encouraged them to join her and the other stakeholder groups in this informal
celebration.
2
Attachment 12a
A-1 0-7r--..
APPENDIX
Children's Stakeholder Group Recommendations
3
Athwhment 128
14108
Contra Costa County MRSA Planning
Children's Stakeholder Planning Group
Recommendations
Community Issues
Reductions in funding to children's mental health services over the last several years
have created a critical situation. Existing services are limited and many have long
waiting lists. It is in this context that we plan for the MHSA.
When it becomes obvious to health and other professionals, and possibly to
parents/caregivers, that a child or adolescent is having problems functioning safely and
productively in his/her home, learning environment and/or community, it can be
assumed that the child has serious social, emotional or physical needs that are
inadequately met. Healthy functioning and reasonable growth in the home and in the
learning environment are the best indicators that a child will develop into a healthy and
productive young adult.
When health professionals and educators assist families in meeting the social,
emotional and physical needs of their children, the community in general is a happier
and healthier place for all of us.
Full Service Partnership
The Children's Stakeholder Group recommends for Full Service Partnership, unserved
children, 0-18 years of age, who have a history of repeated failure in learning
environments. These environments include home, childcare, preschool and school. In
addition, these children are from families who are at or below 300% of poverty and are
not eligible for other funding sources.
Finally, those with one or more of the following risk factors should be given priority:
• Multiple foster care or family caregiver placements
• Limited English proficiency
• High-risk parents or community
• Populations whose cultural differences have historically precluded them from MH
services
• Out-of-norm trauma
• Substance abuse
• Experience with the juvenile justice system
• PIES visits
4
A�rn+ent 1'2a
Service and Support Strategies
Inherent in the following strategies is cultural competence. The wrap around strategy
(#1)was developed with the Full Service Partnership in mind, but it is not limited to this
group. These strategies are not listed in any priority order:
3. Wrap around service that has, but is not limited to, the following characteristics:
o Involve families, and create age and development-appropriate treatment plans
o Maximize the use of existing community resources and individuals, e.g., help with
translation; help with identifying kids/families and with access
o Where feasible, services are delivered to groups; train family and community
members to facilitate family support groups
o Nurses in hospitals identify families they're concerned about
o Home visits for infant/parent therapy
o Provide services where the kids and families are (don't require clinics as the only
place where services are delivered, e.g., schools, family resources centers, child
care centers, CBOs)
o Employ evidence-based clinical best practices; also employ practices tailored to
each family's specific needs
o Fiscally sound services that are leveraged to the greatest extent possible
o Assure coordination with existing resources outside of MH system, e.g.,
■ Child welfare
■ First Five Home Visiting Program
■ Faith communities
■ Zero Tolerance for Domestic Violence
■ Asian Pacific Psychological Services
■ AOD services
4. Mobile crisis response
5. School and community-based services
6. Parent and Youth Partners (peer support strategies)
7. Outreach and early identification with the following features:
o Use of non-traditional approaches
o Community engagement and education targeted at unserved populations (e.g.,
use community leaders, case managers, interpreters)
5
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Stakeholder Planning Group - Transition-aged Youth - Contra Costa Health Servi... Page 1 of 4
CONTR-A C
HEALTH SERVICES
Contra Costa County MRSA Planning
Stakeholder Planning Group - Transition-aged Youth
Minutes
April 5,, 2005
Next Meeting: Tuesday,, April 19 at 4 - 6 p.m.
Assignments:
Whom. All members
What: Read DMH Program Requirements document; review needs assessment; study
hand out materials
When: Before 4/19/05
Welcome/Introductions/Orientation
Steve Ekstrom, stakeholder group facilitator, introduced himself and County MH staff
(Kimberly Mayer., Grace Boda,, Steve Hahn-Smith). Resource staff to the Stakeholder
Group were also introduced (Sandy Marsh,, ]ay Mahler). Scott Singley,, Chair of the
Mental Health Commission welcomed members and spoke of the importance of their
work.
Steve E described the process by which members were selected. Regarding
attendance, members are expected to attend every meeting. If they are unable to
attend a meeting due to unforeseen circumstances, they should not send a substitute.
Regarding communication, a group email list will be created. All meetings will be
recorded and minutes will be sent electronically. It's likely that there will be other
documents that will need to be distributed to members - they'll be sent electronically
or by mail. If members chose to communicate to another member, they are
encouraged to cc the communication to all members in order to keep everyone up-to-
date.
Members then introduced themselves.
Ground rules were also discussed and agreed upon. They are:
Attachment 12b
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11
Stakeholder Planning Group -Transition-aged Youth - Contra Costa Health Servi Page 2 of 4
1. Start on time
2. End on time,, unless there's agreement to continue
3. One speaker at a time
o Allow people to finish; don't interrupt
o Be concise
o Facilitator "directs traffic"
4. No sidebar conversations
5. Listen for understanding
o Suspend judgment - try on other ideas
o Appreciate other points of view
o Seek common ground
6. Decision-making:
o Use a consensus model (This means that while you might not fully agree
with a decision., you will support it outside of our meetings.)
o If consensus can't be reached, and time is of the essence, prioritize using
"sticky-dot" or other type of voting
7. Declare any vested interests you may have when making a point.
Training
Steve E,, Kimberly,, Grace,, Steve HS and Jay presented a slide show aimed at creating
a context for the SH group's work. The slide show captured the essence of the State
DMH's program requirements that all counties will need to incorporate into their
proposals. Knowing this in advance will help stakeholder group members as they ._....
formulate their recommendations to the County's MH Director.
The State's Logic Model (community issues >>> unmet needs >>> service
strategies) was reviewed at length, as was the distinction between enrollee-based vs.
system capacity program development. The point was made the this Group must
address two primary matters: 1) identifying a focal or enrollee population; and 2)
identifying three to five service strategies (system capacity) to fill in the service gap
for transition-aged youth.
A needs assessment was reviewed. This was developed from a tool provided by DMH
that is to be used by all counties.
Examples of recommendations to the MH Director were presented so members could
get an idea of what the product of their work will look like.
Questions and Comments
Members asked several questions following the slide presentation. Paraphrased, they
included:
• What about scale? The County is large and the demand is great. How do we take
all this into account?
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A=N12
Stakeholder Planning Group - Transition-aged Youth - Contra Costa Health Servi... Page 3 of 4
Response: we don't know the allocation from the DMH yet. Knowing this will
help answer the scale question. But financing the system is County MH's
concern. The stakeholder groups' primary responsibility is to identify enrollee
target population(s) and priorities for service strategies.
• I like the idea of a "parking lot" for good ideas that may not fit into the MHSA
but may have merit in some other context.
• I hope and believe we can show results in the first three years.
• A lot of kids are tired of being "told what to do." Services need to be attractive.
• I don't see any suicide statistics, or references to suicide issues in any of the
materials from DMH.
• I'm glad we're also doing focus groups because young adults are unlikely to
attend and speak out at community forums.
• TA-youth want to associate with peers. Too often we send them to children or
adult programs where they don't feel they fit in.
Homework
For the next meeting, members should read DMH's Program & Expenditure
Requirements document,, study the needs assessment that Steve Hahn-Smith
reviewed, and study the materials that were distributed at the end of the meeting.
Next Meeting/Agenda
The next meeting will be on April 19,, 4 - 6 p.m.; same location.
Agenda:
• Answer any questions about DMH requirements or anything else that was
presented on April 5.
• Discuss and agree on specific community issues this group will address
• Discuss and agree on unmet needs this group will address
Content provided by Contra Costa County Mental Health Division.
� a Contra Costa County, California, USA
0 Copyright O 2000-2005 Contra Costa Health Services
Home Privacy, Terms of Use. Accessibility Site Mvalitop of page
Attachment 12b
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3
contra Costa County MHSA Planning10
--
Stakeholder Planning Group
Transition-aged Youth
Minutes
April 19,2005
Present on 4/19/05: Stuart McCullough,Don Graves,John Hollender, Susan Waters,Fatima
M I Sol,Valerie Meredith,Judy McCahon,Cally Martin,Theo Durden,Mike von Savoye,
Kathryn Wade,William Oye,Norma Ramos,Margaret Robbins, Lavonna.Martin,Daniel May,
Radhika Miles, Barbara Nelson,Myra Emanuel,Paula Hernandez,Jay Mahler, Sandy Marsh,
Steve Ekstrom
Next Meeting: Tuesday,May 10 @ 4—6pm
Assignments:
All members Study the"County Readiness Self-assessment"document Before 5/10/OS ---,
(developed by Steve Hahn-Smith);read Community Forum
reports and any Focus Group reports you may have received
Announcements
In the interest of maintaining an open planning process,we will be allowing observers to attend
stakeholder planning meetings.They will be informed that they can only observe the discussions,
not participate in them.
Occasionally we may be able to use the larger conference room downstairs. We'll post a sign on
the upstairs door when those opportunities arise.
Q &A regarding the planning process
• SED is a term used in MH and education systems,and has different meanings in each.
Response: We're using the MH definition.
• Is PTSD included as a major MH diagnosis?
Response: We'll look into this;we'll also get copies of a related CC Times article.
Developing an Issues statement
The first step in the logic model/planning process is to agree on a community issue or issues. The
"menu"of options provided by DMH were reviewed.They are:
1
Attachment 12b
A-1 14
➢ Inability to be in a regular school environment
➢ Hospitalization
➢ Out-of-home placement
➢ Juvenile justice system involvement
➢ Homelessness
➢ Inability to work
➢ Involuntary care
➢ Institutionalization
A discussion followed and several comments were made. They include:
• The issues from DMH seem like a continuum;how can you separate them?
• It's difficult to pick only one,or even a few
• The issues are more complicated when co-occurring issues are considered
• Juvenile justice stops at 18 years of age
• Some of the issues are nested
0 The issues are pathology-oriented
• We need to help transitional-aged youth gain independence
• When they turn 18 we can't get them into the MH system;we're told that the student has
to initiate the contact themselves
• A homeless count on January 26,2005 showed 162 homeless youths; about 75%were in
the MH system; about 12%were gay/lesbian
• For law enforcement personnel it's more difficult to find resources after they turn 18
• We need to prevent chronic institutionalization
• MH-enhanced classrooms seem to really help
• 18 is a cliff
• We need to be cognizant of young adults who have experienced a first psychiatric
episode
After a number of attempts to cluster the key community issues,the group agreed to a
representation of a cycle of three core issues: homelessness, incarceration and
hospitalization/involuntary care. These really can't be separated: involvement in any one can
lead to involvement in another. Then a ripple effect occurs. Youths who are homeless,,
incarcerated and/or hospitalized stand a very good chance of having difficulty in regular school
settings or holding a job.Additionally,the likelihood of being placed in foster care or a group
home is increased.
Homework
At the next meeting the group will discuss where it believes the greatest unmet needs are. The
point is to start zeroing in on the focal population that this group will identify as its
recommended enrollee population under the MHSA. In preparation,members should study the
"County Readiness Self-assessment"that Steve Hahn-Smith reviewed at the first meeting. They
should also look at Community Forum reports and any Focus Group reports that are distributed.
Where we are in the process
Once the group agrees on a focal population, it will start discussing specific community supports,
services and programs that(1)are needed to serve the focal population, and(2)are needed to fill
2
Attachment 12b
A-1 15
out the service array for transitional-aged youth who aren't necessarily in the focal population
(identified by DMH as the"systems capacity"services).
Next meeting/Agenda
The next meeting will be on May 10,4-bpm; same location.
Agenda:
• Review the work done on April 19
• Discuss unmet needs;time permitting, identify a focal population
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Attachment 12b
A-116
Contra Costa County MRSA Planning
Stakeholder Planning Group
Transition-aged Youth
Minutes
May 10,2005
Present: Cally Martin, Bill Oye,Paula Hernandez,John Hollender, Dan May,Fatima Matal Sol,
Radhika Miles, Laura Fowler, Stuart McCullough,Barbara Nelson, Colette O'Keeffe,Diane
Soto,Judy McCahon,Norma Ramos,Mike von Sovoye,Myra Emanuel,Kathryn Wade,
Lavonna Martin,Theo Durden,Margaret Robbins,Jay Mahler, Sandy Marsh, Steve Ekstrom
Next Meeting: Tuesday,May 17 @ 4—6pm
Assignments:
All members Study Community Forum reports and any Focus Group Before 5/17/05
reports you may have received
Steve Hahn- Provide a description of services and supports currently Before 5/17/05
Smith available
Sandy Marsh Use CSI data to identify where youths are housed Before 5/17/05
Steve Prepare a set of criteria that can be used to help narrow down Before 5/17/05
Ekstrom our field of possible enrollee populations
Announcements
•
We'll start a"parking lot"of ideas that should be considered when prevention and early
intervention funds become available. We still haven't learned from DMH when that
might be.
• Focus Group data will not be available for a couple of more weeks. Because this slows
down the stakeholder group process, it's necessary to add an additional meeting day. The
group agreed to hold a 6hmeeting on June 14,4pm.
• Sandy Marsh briefly described who is eligible for services under the MHSA,but
emphasized that specifically identifying which diagnoses are eligible is not a matter that
needs to concern this group. She passed out the"Mental Health Services Act Target
Population Definitions from Welfare and Institution Code"from MRSA and"Medical
Necessity for Specialty Mental Health Services that are the Responsibility of Mental
Health Plans"from the State Department of Mental Health. These two documents define
serious emotional disturbance for children and adolescents,and serious mental illness for
adults and older adults including diagnostic categories,functional impairment,and
1
Attachment 12b
A-1 17
intervention criteria which are used by CC County Mental Health to determine eligibility
for all county mental health services.
Focal Populations
We agreed that we would make no decisions about selecting a focal population/enrollee group
until members have had a chance to study Focus Group data. That said,we agreed to start the
conversation. Based on their experience,knowledge and the review of Community Forum data,
members were asked to speak to what they thought the greatest needs were. Comments included:
• Everyone is underserved; but the most vulnerable is the child with no advocate.This is
especially true for kids 18-19 years old who are aging out of the children's MH system
and child welfare.
• Children of emotionally disturbed parents. And it's even worse for kids whose families
don't speak English.
• Kids in foster care are more stable than kids with parents who are mentally ill.
• Kids with serious emotional disturbances don't transition easily into the adult system.
There are about 200 direct service staff to serve children; but there are only 7 direct
service staff to work with young adults who have turned 18.
• The real issue is kids between 17 and 18. There's no clear path for them.
• Kids with co-occurring issues;there are limited assessment services and they don't really
get dually diagnosed services. A lot come from foster care. We often see them after
they've been arrested.
• Only the most disturbed foster care kids are served by the MH system. We need to catch -�"-
them before they become seriously mentally ill. Preparation should start @ 16 years.
• How many kids enter as SED,but go back to their families?And how many stay in the
system?How many kids does the children/adolescent system have that they'd like to see
served by the transitional age system?
• We need to focus on unserved populations. There are homeless youths getting no service.
They're labeled as criminals and victims. It cuts across all groups including those with
parents who don't speak English,those aging out of foster care. 35%of kids leaving
foster care end up homeless.And they often don't want help from"the system."About
55%of homeless youth have been in foster care at some point in their lives.
• What about youths with a first episode of mental illness. We can't forget them.
• A lot of kids in foster care drop out along the way. Many end up homeless.
• In schools,there's going to be some kind of help available, e.g., special education.The
gap is in the senior year-those who don't graduate with a diploma. Public schools are
required to continue their education until 22 years old,but often they don't want to
continue with school. Maybe 5%of them are SED.
• The common denominator at the high end of foster care is that they have no adult who
will make a commitment to them. Most of these youths hate the system,and most are 3 to
4 grade levels behind.
• The education system isn't equipped to deal with a lot of kids with SED problems.These
kids need to build an academic and social skill base.
• One study shoed that nationally,28 is the average age that youth leave their families.
Who why do we expect foster care youth with SED to become successful at 18?
• We need to find a way to make the help that's available attractive.
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Attachment 12b
A-1 18
• How many come to community colleges and leave for lack of a mentor? We don't know,
but we do know that the attrition rate is high for all students.
• We need to be mindful of the need to achieve independence. We need to catch people at
the cliff,and five them a lift to success.
• There's a large growth of Southeast Asians and Latinos who enter the system via
incarceration. Their families are an untapped resource.
• I have a 22-year-old youth. The job of the committed adult we spoken about is to foster
independence,but often that person can't be a parent. Youths are trying to become
independent of their parents.
• A lot of work helping SED kids involves working with their parents.
• We need to help kids build hope at an early age,e.g.,at 12 years old.
• What are the stressors or indicators that might lead to a first psychiatric episode?It can be
heredity,drug involvement/self-medication,ADHD,problems with cognitive
functioning.
• In my homeless program we had 3 youths with first psychiatric episodes last year. 2 got
connected via PES and are in appropriate housing. One"disappeared."But many are
depressed or may have cutting behavior,but haven't hada"first break."
• What is the suicide risk for transition aged youth?
• LGBTQ are at a high risk of suicide. Peers,parents,and community often reject them.
• It seems like a whole generation of parents is lost. Often grandparents get involved.
• Not all MH needs could be met in the schools,even if we had school-based MH services.
• In a focus group of homeless kids 18-22,they felt homelessness was a key issue. So was
housing. They talked a lot about coaching/mentoring models; and tutoring.
• Dually diagnosed kids who are cognitively delayed—we play ping gong between the MH
and DD systems.
• The cliff is at 18 years. To have an impact we should identify pre-18 indicators and
address them between 16 and 18. It's going to take a collaborative effort involving many
partners(law enforcement, social services, MH, etc.).
• We need to narrow down to an enrollee group we'll select. What criteria will we use to
do that?
• What's the relation of the enrollee population we select and the community issues we
identified(homelessness, incarceration and hospitalization/involuntary care)?
• What services and supports do we currently have?(Steve Hahn-Smith will get this
information).
• Where is everyone housed now?(Sandy will get CSI data).
• Of the kids in jail,how many are opened to the MH system?
Homework
Study Community Forum and,when available, Focus Group data,to see what our communities
are saying.
Next meeting/Agenda
The next meeting will be on May 17,4-6p m* 1
Agenda:
3
Attachment 12b
A.119
• Continue discussing focal populations. Discuss the relationship between focal/enrollee ----
populations and community issues.Narrow the field without making a final"enrollee"
decision.
• Time permitting, start the discussion of the possible services and supports that could be
helpful to TA youth. This would help us get a head start on the systems capacity
discussions that will come later.
h
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Attachment 12b
A-120
Cancra Costa Jaunty MRSA Planning
Stakeholder Planning Group
Transition-aged Youth
Minutes
May 17,2005
Present: John Hollender, Colette O'Keeffe, Susan Waters,Barbara Nelson,Cally Martin,Val
Meredith,Theo Durden,,Kathryn Wade,Fatima Matal Sol,Don.Graves,Radhika Miles,Norma
Ramos,Dan May,Laura Fowler,Myra Emanuel,Michael Von Savoye,Bill Oye,Margaret
Robbins,Jay Mahler, Sandy Marsh,Donna Wigand, Steve Ekstrom
Next Meeting: Tuesday,May 24 @ 4—6pm
Assignments:
All members Study"Recommendations"that were distributed Before 5/24/05
Announcements
• Please note:the following members were present at the last meeting but weren't in the
original minutes: Cally Martin,Susan Waters,Val Meredith.
• An intergenerational/Family Forum will be held on May 31,4-bpm in the downstairs
conference room. This is an optional meeting,but we're hoping that several
representatives from all stakeholder groups will participate. The purpose is to discuss the
progress of each group, as well as to identify possible focal populations that cross the age
"silos"we're dealing with in each stakeholder group.
• "Recommendations"from the community-at-large were distributed.
• On May 26 PBS will air a documentary on adolescents"aging out"of children's services.
• Donna Wigand thanked the group for their work to date,and also announced that we'll
need to schedule more meetings in order to get the work done. She explained the reasons
for the additional meetings:
o We still don't have the final requirements from DMH. It's not possible to plan
effectively without those requirements.
o We have much more focus group and survey data than we had anticipated,which is
good.But it's taking a lot of time to finish the groups and prepare their reports.
o And we don't want to do a rush job in this important phase of planning;the process
needs to be comprehensive.
So we need to add two extra meetings,bringing the total to 9. Meetings 7, 8,and 9 have
yet to be scheduled,but we plan to do that next week.
1
Attachment 12b
A-1 21
Donna apologized if these additional meetings conflict with members' vacation plans.
• All focus group and survey data will be available to members by May 30, about two
weeks before the June 14 meeting at which we'll make a decision on an enrollee group.
This will give members ample time to study all data before making an enrollee decision.
• Upon the request of a member, staff will prepare a brief document describing the product
that stakeholder groups are expected to deliver at the end of their work.
Focal Populations
We continued our discussion from the last meeting. Steve described the tool he's developing that
each member will use to help them identify an enrollee group. This should facilitate the decision
the group will need to make. The tool is a matrix. Across the top will be focal populations,
broadly described. Down the left column will be conditions or status indicators. Members will
64score'l each condition/status indicator for each focal population, indicating the degree of
concern/need as well whether the group is unserved, underserved or inappropriately served.
Members liked the idea and offered suggestions for the left hand side of the tool. For the"across
the top"populations,we had a lengthy discussion which concluded with the agreement that those
focal populations(all SED youths)that we'll consider will be:
Immigrant youths not attached to a system
Youths who are or have been in the criminal justice system
• Youths who have been 5150-d -.,
• Youths who are homeless and under-educated
• Youths aging out of foster care
• Youths aging out of the children's MH system
• Youths experiencing their"first break"(e.g.,psychosis, severe depression, bipolar
disorder)
Steve will finalize the matrix tool. It will be distributed to members along with focus group and
survey data at the end of the month.
Homework
Study "recommendations"from the community-at-large that were distributed at the beginning of
the meeting.
Next meeting/Agenda
The next meeting will be on May 24,4-bpm.
Agenda:
• Begin discussing the possible services and supports that could be helpful to TA youth.
This would help us get a head start on the systems development discussions that will
come later.
2
Attachment 12b
A=122
Contra costa County MHSA Planning
Stakeholder Planning Group
Transition-aged Youth
Minutes
May 24,2005
Present: Norma Ramos,Judy McCahon, Susan Waters,Barbara Nelson, Val Meredith,,Theo
Durden,John Hollender,Bill Oye, Stuart McCullough,Cally Martin, Paula Hernandez, Radhika
Miles,Dan May,Colette O'Keeffe,Fatima Matal Sol,Diane Soto,Mike von Savoye,Myra
Emanuel, Kathryn Wade, Lavonna Martin, Steve Hahn-Smith, Grace Boda,Kimberly Mayer,
Jay Mahler, Sandy Marsh, Steve Ekstrom
Next Meeting: Tuesday,June 14 @ 4—6pm
Assignments:
Each Study all data that will be distributed at the end of May. Use Before 6/14/05
member the worksheet(to be distributed with data)to decide on your
,top 2 priorities for Full Service Partnership funding
DMH Program and Expenditure Requirements
Kimberly Mayer, Grace Boda and Steve Hahn-Smith reviewed the highlights of the new DMH
requirements. DMH made a number of changes to the original document. They included:
• Increased emphasis on client and family direction,peer support efforts and client and
family-run programs
• Greater emphasis on cultural competence
• More appropriate language for children and youth
• Expanded language on statewide outcomes
• Three types of funding
o Full service partnerships(formerly"enrollees")
o System development(formerly"system capacity")
o Outreach and engagement(new category)
• The logic model hasn't changed
Regarding the full service partnerships,the point was made that we need to work with the
"whole person."To accomplish this,agreements with other systems(education, law
enforcement, social services, etc.)will need to be made so that full service partners get the
benefits of a coordinated system of care.
1
Attachment 12b
A-123
Kimberly also reminded everyone of the group's assignment:
1. Identify community issues(done)
2. Analyze mental health needs(in process)
3. Identify a group for full service partnership(to be done by mid-June)
4. Identify service and support strategies for developing the system(to be done in July)
5. Submit recommendations to the Mental Health Director(to be done in July)
System development
We began discussing ideas for services and supports. This was an opportunity for members to
inform their peers about different strategies they are aware of.Again,we won't be making
decisions about services and supports we'll recommend until July. Several ideas were presented
and discussed:
• Intensive case management
o One person leading a team that's working in the community where the consumers are
0 24/7 availability
o Attentive to privacy issues
• Another intensive case management idea was to have team approach
o Consumer is the"captain"of the team,with aback-up staff member as"co-captain"
o Treat the whole person
o Services are in the community
o Law enforcement officers should be on a team,where appropriate
o Develop individual"life plans"for each person
o Develop exit strategies so consumers aren't in the system any longer than necessary
• Housing
o More options are needed
o Also,consumers need support to retain their existing housing
• Supported education on a community college campus
o Linkage to various services available on campus,e.g.,financial aid
o Remedial education for those who need it
o Provide other services,e.g.,AOD training and support
o Peer group support; and individual support
0 2 people per campus
• Another supported education idea was to have one county-wide director with a staff of
consumer mentors.A mentor is assigned to each community college in the county.
• Learning Center
o Maybe 15-20%of TA youths can engage in a community college curriculum; and
maybe 30%could take a class here and there. But what about the remaining group
that need to take some preliminary steps before they can attend a college campus?
o Intensive case management
o Help with trauma
o A transition to community college
o Classes that offer training in: social skills, life skills(e.g.,cooking,basic survival
information),basic education
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Attachment 12b
A-124
Homework
Study all the data that will be distributed at the end of May. Each member should use the sorting
tool/worksheet(to be distributed)to help decide on a full service partnership group they wish to
recommend.
Next meeting/Agenda
The next meeting will be on June 14,4-bpm.
Agenda:
� The transition-age youth stakeholder planners will decide on the full service partner
group it wants to recommend.
3
Attachment 12b
A-125
Contra Costa County MRSA Planning --�
Stakeholder Planning Meeting
Forum on Family and Intergenerational Issues
Minutes
May 31,2005
Present:
Children's Group: Kathy Davison, Melinda Dendinger,Jerry Zimmerman,Arlette Merritt,
Brenda Blasingame,Lisa Morrell, Bobbie Arnold
Transition Aye Youth Gro Susan Waters, Stuart McCullough,Don Graves,Kathryn
Wade, Colette O'Keeffe,Theo Durden,Katie Roberts
Adult Group: Herb Putnam,Violet Smith,Aimee Chitayat,Anna Lubarov, Veronica Vale,
Connie Steers, Caroline Jackson, Geet Gobind,Bob McKinnon
Older Adult Group: Leah Rolnick-Bronstein,Tim Chon, Connie Steers,Bettye Randle
Observer: Janet Wilson
Staff/consultants: Jay Mahler,John Allen,Lisa Booker,Nancy Frank, Steve Ekstrom
Introduction;purpose of meeting
The idea for this Forum came from at least two stakeholder planning groups, largely in response
to the need to have a dialogue across groups to look at family and intergenerational issues.The
planning for MHSA implementation is organized around age"silos,"yet DMH has stressed the
importance of considering family and intergenerational issues.This Forum was organized to help
each age-related stakeholder group look at this broader context of the MHSA.
The point was made that all of the groups have yet to make decisions regarding enrollee
populations(Full Service Partnership)or services and supports strategies, so the timing of this
Forum is advantageous.
Participants received a handout that showed the focal populations each stakeholder group is
considering for an enrollee population recommendation.Members then introduced themselves.
Why are you here today?
Participants were asked what they hoped to het from the meeting. Responses included:
• The County should work together in a more systematic way;maybe this session will help -�
make that happen
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Attachment 12b
A=126
• The populations we're studying in our stakeholder groups aren't stagnant;they are all
transitioning, so we need to be talking with each other
• So we can look at the full picture
Issues
The remainder of the meeting was devoted to an open-ended discussion of the key issues and
concerns participants had. Comments during this discussion included:
• If kids with SED are symptoms of broken down families,then we need to see that their
parents get help
• Every client comes with a family;we need to focus on the full family
• But we also need to look at the distinct needs of each age group, so that they really
benefit from the MHSA
• Older adults could serve as mentors, for example to transition age youths
• Parents with SMI who have their children removed from them. This is a real problem.
o In most cases it's the mom not the dad
o In-home support services(IHSS)would be of great help
o When a parent is placed in longer-term care,e.g.,over 30 days,the children are
removed and the mother loses custody
o In the reunification process,housing is not adequately considered. For example,an
apartment may be found for a mother,but there's no room for her kid(s)
o If the mother is labeled mentally ill,the custody of the children goes to the husband
• Transition age kids leaving foster care need a committed adult in their life;there should
be a core of mentor volunteers
• We need to start with the newborns of families with problems. An IHSS service that
would focus on helping families raise their newborns in a healthy way would be good
• What about adults who don't want help? Sometimes we(children's services)go into a
house and see a parent who could use help;we'd like to be able to call someone who can
respond.Has the Adult Stakeholder Group looked at this?
• Wrap-around services help the whole family
o It's documented that it works
o But we need more members on the teams
o And we don't have MOUS with agencies that serve adults
o What if a parent needs help,but they are not seriously MI. Maybe this should be a
"prevention and early intervention"service we might want to consider with future
MHSA funding.
• We must remember this about consumers: many are very capable,are stable,and can be
of real help to others
• The silos that DMH has created present a problem. How can we meet DMH's
requirements and find a service that's holistic and"threads"its way across age groups?
We need to be creative. Wrap-around is real answer to this. It represents a holistic,
strength-based approach to working with families. It's a support blanket.
• Populations may be in silos, but the services needn't be
o Families are the place for integrated services to occur
o Maybe we could develop a"one-stop"approach
• Our county is fragmented; one has to go through many hoops to get help. A thread,e.g.,
wrap-around services,to pull everyone together would be great
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Attachment 12b
A-127
• But can we add more wrap-around services with MHSA funding?It's not a new service, ,r..,,.
and isn't DMH saying we shouldn't replicate existing services?
• All of the stakeholder groups need to look at innovative approaches
• Some transition age youths are sent to other counties or states to receive services. They
need to come home.
• Also,there are adults and older adults in long-tern facilities that may be inappropriately
housed.
• The older adult group is concerned that DMH also wants us to focus on"transition age
older adults"aged 50 through 59. We're concerned this could drain services from much
older adults in their 70s, 80s and 90s. Is the adult stakeholder group looking specifically
at services to 50—59 year olds?
o Maybe we need to look less at the age of a group, e.g., older adults or adults, and look
more at the needs of people. For example, a person could be in their mid-50s, but due
to many circumstances,could have the needs of someone in their 80s.
• We do need to bring people out of isolation, and find meaningful activities for them to
do,
• Insurance, insurance, insurance!
• We need to start programs that can apply to all ages. One example is the Clubhouse, an
approach that has been implemented across the U.S. and internationally. It emphasizes
meaningful activities. Members are encouraged to work, in whatever way they can. It can
be tailored to serve all age groups. We should have one in every region of the County.
• We need to look at the services for each age group, and look at where they can overlap;
or we need to create those overlaps.
• Regarding outreach and enrollment,where will we find populations that are hard to '"'
reach?Primary care clinics are places we can find them.
• There are some models the County has considered,and in some cases attempted to
implement. They are:
o The Parent Project developed at the University of Massachusetts. It's for parents with
SMI, and emphasizes peer support, crisis planning,mental health education for kids,
etc,
o Ashbury House in San Francisco,operated by Progress Foundation. It's for mothers
with SMI—their children live with them in the house helping keep the family intact,
o Pollack Model in Colorado.Among other things it deals with"empty nest" issues,
and focuses on natural support systems
o Hope City model,that focuses on hard-to-place foster care kids
• We need easier community-based access to MH services; for example,when we see
mothers with MI in primary care clinics,maybe we could offer IHSS to them. We need to
be able to co-locate services.
Rather than start elaborate, complex programs,we should look for simpler solutions and
build on what we already have in place.
Next steps
Participants were encouraged to discuss this Forum at their next stakeholder meetings. They
should make the point that there was considerable interest in thinking creatively to find ways
where there can be overlaps of services. Each group has to think about distinct services for the
ages it represents, but they should also look for ways that those services could impact or involve
other age groups. Even if we start small, if it's innovative, maybe family-oriented, and/or age-
inclusive, it could represent something we could build upon over time.
3
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A=128
Contra Costa County MRSA Planning
Stakeholder Planning Group
Transition-aged Youth
Minutes - June 14,2005
Present: Theo Durden,, Laura Fowler, Stuart McCullough, Val Meredith, Myra Emanuel, Susan
Waters,Paula Hernandez,Diane Soto,Judy McCahon,Norma Ramos,Bill Oye, Cally Martin,
Don Graves,Fatima Matal Sol,John Hollender, Mike von Savoye,Kathryn Wade,Larry
Hanover,Jay Mahler, Steve Ekstrom
Next Meeting: Tuesday,June 21 @ 4—6pm
Assignments:
M M
Each Continue to study data for continuing discussion' of service Before 6/216/05
member and support strate ies
Full Service Partnership
After much conversation,the group agreed to recommend that the County establish a full service
partnership with the following focal population:
Transition age youth, 16-25 years of age, with serious emotional disturbances, who are
homeless or at imminent risk of homelessness.
There are many associated risk factors. Thesefactors do not determine whether or not a
youth meeting the criteria definition above should receive services; rather, they will be taken
into account when deciding on service and support strategies. These risk factors are:
• Dual diagnoses(SED with A OD, developmental disability, or head injury)
• Psychoses
• Exposure to violence (community, domestic)
• Under educated
• Immigrant status
• Non-English speaking
• LGBT
• In the juvenile justice system
• Living with parents who are seriously mentally ill
• Jobless
• History of 5150s
• In, or has been in,foster care system
• Unable to get appropriate medications
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Attachment 12b
A-129
Homework -----
Continue studying the data that's been distributed. Search through this data for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on June 21,4-bpm.
Agenda:
• Continue discussion of service and support strategies.
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Attachment 12b
A-130
Contra Costa County MRSA Planning
Stakeholder Planning Group
Transition-aged Youth
Minutes - June 21,2005
Present: John Hollender,Val Meredith,Barbara Nelson,,Dan May, Radhika Miles,Bill Oye,
Theo Durden,Laura Fowler,Cally Martin,Lavonna Martin, Diane Soto,Fatima Matal Sol,
Sandy Marsh,Jay Mahler, Steve Ekstrom
Next Meeting: Tuesday,July 5 @ 4—6pm
Assignments:
Each Continue to study data.in preparation for final decisions Before 7/5/05
member regarding recommendations for service& support strategies
Full Service Partnership
The group briefly revisited the description of the full service partnership developed at the last
meeting. It was agreed that we should amend it to include the words"serious and persistent
mentally illness."The description now reads:
Transition age youth, 16-25 years of age, with serious emotional disturbance or serious and
persistent mental illness, who are homeless or at imminent risk of homelessness.
There are many associated risk factors. Thesefactors do not determine whether or not a
youth meeting the criteria definition above should receive services;rather, they will be taken
into account when deciding on service and support strategies. These risk factors are:
• Dual diagnoses(SED with A OD, developmental disability, or head injury)
• Psychoses
• Exposure to violence (community, domestic)
• Under educated
� Immigrant status
• Non-English speaking
• LGBT
• In the juvenile justice system
• Living with parents who are seriously mentally ill
• Jobless
• History of 5150s
• In, or has been in,foster care system
• Unable to get appropriate medications
1
Aftachment 12b
A-1 31
Systems development-service and support strategies
Members looked at a list of ideas generated at a previous meeting.They also looked at the menu
of options from DMH. It was understood that it would be wise if any strategies we recommend
can be supported by DMH's menu of options.
We began by thinking about what service and support strategies might be needed for the full
service partnership we are endorsing.Attention was paid to the factors that needed to be
considered, including:
• Limited funding and the need to spend wisely
• Sustainability, i.e.,whatever is developed needs to be sustainable over time,with MRSA
funds, leveraged funds or funds from other partners
• Mainstreaming
• A full continuum of services
• Exit strategies for consumers
There was much discussion that led to the following strategy:
We need a full continuum of housing services in all regions of the County that includes
emergency shelters,transitional housing,and permanent housing.To achieve this will require
developing service and funding partnerships,e.g.,with local providers,the Federal Department
of Health and Human Services/Administration of Children and Family Services,etc.MHSA
funds should be used to provide services for TA Youths in these various levels of housing,but
should not be used to develop housing.
The goal will be to have, in each rem, a sufficient number of emergency beds(using Federal
DHHS funding for 16& 17 year olds),2 transitional homes(maximum 6 beds)and more
vouchers for peri anent housing. In transitional homes,mixing populations(e.g., SED/SPMI
with other youths)should be considered as well as the special needs and legal requirements for
16 and 17 year olds.
A key to this housing strategy will be to maximize flexibility,meaning there is"no wrong door"
to getting services. There should be multiple points of entry that would involve:
• Multi-disciplinary mobile outreach/engagement team(s)with the following attributes:
o Peer counseling
o Cultural competence(including language,values,youth-friendliness)
o Access to all geographic regions
0 5150 capacity
o Knowledgeable of MH/AOD issues
o Direct access to emergency shelters
• First responders including 5150-certified personnel
• PES
• Foster care providers
• Schools and other venues where youths are turning 18
Throughout the housing continuum youths should have an array of services available to them. �
The location for providing these services should be based upon what's best for each individual
and may include: shelter,house, school,youth centers,etc.These services should include:
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• Case management per MHSA's definition for full service partnerships (consider using
alternative language such as wellness coach or navigator instead of case manager)
• Life skills training
• Substance abuse training and counseling
• Information about and referral to existing community services and systems
• Peer support,with an eye towards developing peer as staff
• Consumer mentoring program
• Crisis intervention
• Pro-active check-in
• Counseling services-for families and significant others
• Benefits counseling
• Legal services
• Assistance with preparing advanced directives
• Access to educational venues,e.g.,community colleges
• Vocational training and placement
• Transportation
At the next meeting,we'll briefly revisit the above strategy and decide whether to recommend it
to the MH Director.
A major focus of the next meeting will be on service and support strategies for TA Youth not
necessarily in the full service partnership we've identified, i.e.,what are the high priority
strategies we would like to see funded that any TA Youth with SED or SPMI could benefit
from?
Homework
Continue studying the data that's been distributed. Search through this data.for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on July 5,4-bpm.
Agenda:
• Continue discussion of service and support strategies
• Develop recommendations for service and support strategies
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Contra Costa County MRSA Planning �-
Stakeholder Planning Group
Transition-aged Youth
Minutes—July 5,2005
Present: John Hollender,Barbara Nelson,Laura Fowler,Theo Durden,LaVonna Martin,Val
Meredith,Diane.Soto,Myra Emanuel,Judy McCahon,Don Graves,Fatima Matal Sol,Dan May,
Sandy Marsh,Jay Mahler, Steve Ekstrom
Next Meeting: Tuesday,July 19 @ 4—6pm
Assignments:
Each Be prepared to discuss our recommendations with the Mental 7/19/05
member lHealth Director
Systems development—service and support strategies Members revisited the strategy discussed at the last meeting. They made a few changes and then
agreed to the following housing strategy for full service partnership and other youths:
Contra Costa County should have a full continuum of housing services in all regions of the
County that includes emergency shelters,transitional housing,and permanent housing.To
achieve this will require developing service and funding partnerships,e.g.,with local
providers,the Federal Department of Health and Human Services/Administration of
Children and Family Services,etc.MHSA funds should be used to provide services for TA
Youths in these various levels of housing,but should not be used to develop housing.
The goal will be to have, in each region, a sufficient number of emergency beds/interim
housing with a MH crisis component(using Federal DHHS funding for 16& 17 year olds),
2 transitional homes(maximum 6 beds)and more vouchers for peril anent housing. In
emergency shelters and transitional homes,mixing populations(e.g., SED/SPMI with other
youths) should be considered as well as the special needs and legal requirements for 16 and
17 year olds.
A key to this housing strategy will be to maximize flexibility, meaning there is"no wrong
door"to getting easy access to needed services. There should be multiple points of entry
that would involve:
• Multi-disciplinary mobile outreach/engagement team(s)with the following
attributes:
o Peer counseling
o Cultural competence(including language,values,youth-friendliness)
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o Access to all geographic regions
0 5150 capacity
o Knowledgeable of MH/AOD issues
o Direct access to emergency shelters
• First responders including 5150-certified personnel
• PES
• Foster care providers
• Schools and other venues where youths are turning 18
Throughout the housing continuum youths should have an array of services available to
them. The location for providing these services should be based upon what's best for
each individual and may include shelter,house, school,youth centers,etc. These services
should include:
• Case management per MHSA's definition for full service partnerships(consider
using alternative language such as wellness coach or navigator instead of case
manager)
• Life skills training
• Substance abuse training and counseling
• Information about and referral to existing community services and systems
• Peer support,with an eye towards developing peer as staff
• Consumer mentoring program
• Crisis intervention
• Pro-active check-in
• Counseling services for families and significant others
• Benefits counseling
• Legal services
• Assistance with preparing advanced directives
• Access to educational venues, e.g.,community colleges
• Vocational training and placement
• Transportation
In addition,two other strategies were agreed to:
• Outreach strategies to identify youths in serious need of MH services. These should
include:
o Supporting youths before they reach 18 years of age and leave the children's MY
system
o Public relations efforts aimed at suicide prevention
• Engagement strategy:
o Wellness and recovery centers in existing community locations that rely on peer
counselors and peer support to promote recovery. These centers would provide,
among other things,day activities, learning experiences, recreation,etc.
Advisory Committee
The MH Director has requested that each stakeholder group name 4 members to a Stakeholder
Advisory Committee. This Committee will most likely conduct its work after Labor Day. It's
purpose is to review and comment on the first draft of the County's proposal to State DMH.
Criteria for selecting members are: 1 Consumer, 1 family member, 1 MH service provider
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(County or CBO)and I from the community-at-large. In addition,the Advisory Committee
needs to be diverse and representative of all regions.Advisory Committee members will �'
represent their Stakeholder Group and the recommendations they've made. Their role is not to
represent individual interests.
The following members were nominated or indicated interest:
Parent Partner:
• Kathryn Wade
Family member:
• Val Meredith
MH service provider:
• Laura Fowler(county-wide)
• Cally Martin(county-wide)
• Radhika Miles(east county)
• Theo Durden(west county)
Community partner:
• LaVonna Martin(county-wide)
Members decided that they would make a final decision at the next meeting(July 19)after other
members not present at this meeting have had an opportunity to indicate interest.
Next meeting/Agenda
The next and last meeting will be on July 19,4-bpm. .---.._,
Agenda:
• Decide on Advisory Committee members
• Discuss recommendations with the MH Director
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Contra Costa County MHSA Planning
Stakeholder Planning Group
Transition Age Youth
Minutes
July 19,2005—Last Meeting
Present: Val Meredith, Cally Martin,Theo Durden,Barbara Nelson,Radhika Miles,Diane Soto,
Lavonna Martin,John Hollender, Don Graves, Stuart McCullough,Mike von Savoye,Dan May,
Susan Waters,Donna Wigand,Kimberly Mayer, Sandy Marsh,Nancy Frank, Steve Ekstrom
Advisory Committee
The group discussed who would represent the TA Youth Stakeholder Group on the Advisory
Committee. This Committee will review the draft plan before it is submitted to the Mental Health
Commission. Members voted and the following representatives were selected:
• Kathyrn Wade(consumer)
• Val Meredith(family member)
• Cally Martin(MH service provider)
• Lavonna Martin(community partner)
The point was made that these members should represent the work/recommendations of the TA
Youth Stakeholder Group,and not individual interests.
Recommendations to the MH Director
Before Donna Wigand joined the group, some amendments were made to the recommendations. In
the Full Service Partnership description,the language"and/or severe mental illness"was added after
"...with serious emotional disturbances..."In Strategy 1, under Multi-disciplinary mobile
outreach/engagement team(s),the phrase"Knowledgeable of MH/AOD issues"was replaced with
"Trained in MH/AOD issues." One other minor editing change was also made.
Donna then joined the group. Before reviewing the recommendations from the TA Youth
Stakeholder Group(see Appendix to these minutes)she discussed the latest MHSA information
from the State.
1. Apparently DMH has acknowledged that some"streamlining" is needed in the Three Year
Plan that counties will submit for Community Services& Supports. The way it's currently
set up,there could be 12 different MHSA programs a county would develop(4 age groups
X 3 programs each—Full Service Partnerships, Systems Development and
Outreach/Engagement,along with required workplans and budgets). This could be quite
cumbersome to implement,manage and evaluate so DMH is considering ways to make it
1
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less burdensome,perhaps by allowing counties to develop an all-encompassing, single
program rather than up to 12 separate programs.
2. The Oversight and Accountability Commission has begun to meet and it appears they may
take a more active role in determining how MRSA funds are allocated,e.g.,they've
indicated an interest in setting aside some funding for a housing bond. It is unclear if this
potential "re-allocation"of funds is within their role as set in the legislation.It is likely that
the time frames for completing our proposal will be set back while we await additional
instructions from the State.At this point,Donna is anticipating that Contra Costa.County
will submit its proposal in November rather than October.
Next,there was a discussion between members and Donna about the Group's recommendations.
Topics discussed included:
• How the three community issues were arrived at
• What is meant by"imminent risk of homelessness"
• Given that the recommendations would cost more money to implement than we'll get,
what did the group think could be"bought"with the limited MHSA funding that will be
available;what are some roll-out strategies?
• The point that the TAY group is recommending that the first round of Services and
Supports funds be used to develop housing services and not housing development
• Suicide prevention
• Wellness and recovery centers
• Unserved ethnic communities
• LGBT needs
• Dealing with co-occurring issues
• Recovery,resilience and leaving the MH system rather than staying in it indefinitely
• Involving youth-in-recovery in planning processes
And Finally...
There will be a"Thank You Celebration"to acknowledge the hard work of all stakeholder group
members.This party will be held on July 27thfrom 4:00 to 6:00 p.m. at Marie Callender's,2090
Diamond Boulevard in Concord.Donna thanked the TA Youth Stakeholder Group members for all
their hard work,and encouraged them to join her and the other stakeholder groups in this informal
celebration.
2
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APPENDIX
Transition Age Youth Stakeholder Group Recommendations
3
AtUkchment 12b
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Contra Costa County MRSA Planning
Transition Age Youth Stakeholder Planning Group
Recommendations
Community Issues
There are three core issues: homelessness, incarceration and hospitalization/involuntary care.
These are difficult to separate as involvement in any one can lead to involvement in another.
Then a ripple effect occurs. Youths who are homeless, incarcerated and/or hospitalized stand a
very good chance of having difficulty in regular school settings or holding a job.Additionally,
the likelihood of being placed in foster care or a group home is increased.
Full Service Partnership
The Transition Age Youth Stakeholder Group recommends for Full Service Partnership,
transition age youth, 16-25 years of age,with serious emotional disturbances and/or severe
mental illnesses,who are homeless or at imminent risk of homelessness.
There are many associated risk factors. Depending on the availability of funding,these factors
may need to be taken into account to determine which youths would be considered for full
service partnership benefits. These risk factors are:
• Dual diagnoses(SED with AOD,developmental disability,or head injury)
• Psychoses
• Exposure to violence(community,domestic)
• Under educated
• Immigrant status
• Non-English speaking
• LGBT
• In the juvenile justice system
• Living with parents who are seriously mentally ill
• Jobless
• History of 5150s
• In,or has been in, foster care system
• Unable to get appropriate medications
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Service and Support Strategies
When considering the recommended strategies below,the following principles should be kept in
mind:
• With limited funding we need to spend wisely
• Sustainability- i.e.,whatever is developed needs to be sustainable over time,with MHSA
funds, leveraged funds or funds from other partners
• Mainstreaming, i.e.,use/partner with existing systems of care
• A full continuum of services is necessary to help homeless youths
• Exit strategies(from the system)need to be a component of all individual plans
The Transition Age Youth group recommends the following strategies for full service partners
and other youths in the MH system:
1. Contra Costa County should have a full continuum of housing services in all regions of
the County that includes emergency shelters,transitional housing, and permanent
housing. To achieve this will require developing service and funding partnerships,e.g.,
with local providers,the Federal Department of Health and Human
Services/Administration of Children and Family Services,etc. MRSA funds should be
used to provide services for TA Youths in these various levels of housing,but should not
be used to develop housing.
The goal will be to have, in each region,a sufficient number of emergency beds/interim
housing with a MH crisis component(using Federal DHHS funding for 16& 17 year
olds), 2 transitional homes(maximum 6 beds)and more vouchers for permanent housing.
In emergency shelters and transitional homes,mixing populations(e.g., SED/SPMI with
other youths)should be considered as well as the special needs and legal requirements for
16 and 17 year olds.
A key to this housing strategy will be to maximize flexibility, meaning there is"no wrong
door"to getting easy access to needed services. There should be multiple points of entry
that would involve:
• Multi-disciplinary mobile outreach/engagement team(s)with the following
attributes:
o Peer counseling
o Cultural competence(including language,values,youth-friendliness)
o Access to all geographic regions
0 5150 capacity
o Trained in MH/AOD issues
o Direct access to emergency shelters
• First responders including 5150-certified personnel
• PES
• Foster care providers
• Schools and other venues where youths are turning 18
5
Attachment 12b
A-9 41
Throughout the housing continuum youths should have an array of services available to
them.The location for providing these services should be based upon what's best for
each individual and may include shelter,house, school,youth centers,etc. These services
should include:
• Case management per MHSA's definition for full service partnerships(consider
using alternative language such as wellness coach or navigator instead of case
manager)
• Life skills training
• Substance abuse training and counseling
• Information about and referral to existing community services and systems
• Peer support,with an eye towards developing peer as staff
• Consumer mentoring program
• Crisis intervention
• Pro-active check-in
• Counseling services for families and significant others
• Benefits counseling
• Legal services
• Assistance with preparing advanced directives
• Access to educational venues, e.g., community colleges
• Vocational training and placement ----
• Transportation
2. Outreach strategies to identify youths in serious need of MH services. These should include:
• Supporting youths before they reach 18 years of age and leave the children's MH
system
• Public relations efforts aimed at suicide prevention
3. Engagement strategy:
• Wellness and recovery centers in existing community locations that rely on peer
counselors and peer support to promote recovery. These centers would provide,
among other things,day activities, learning experiences, recreation, etc.
6
Attachment 12b
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Stakeholder Planning Group - Adults - Contra Costa Health Services Page 1 of 4
"'i.
.... .......
CONTFLA COSTA
HEALTH SERVICES
Contra Costa County MRSA Planning
Stakeholder Planning Group - Adults
Minutes
April 13,, 2005
Next Meeting: Tuesday,, April 27 at 4 - 6 p.m.
Assignments:
Whom. All members
What: Read DMH Program Requirements document; review needs assessment; study
hand out materials
When: Before 4/27/05
Welcome/Introductions/Orientation
Steve Ekstrom, stakeholder group facilitator, introduced himself and County MH staff
(Kimberly Mayer, Steve Hahn-Smith). Resource staff to the Stakeholder Group were
also introduced (John Allen, Sharon Kuehn).
Steve E described the process by which members were selected. Regarding
attendance, members are expected to attend every meeting. If they are unable to
attend a meeting due to unforeseen circumstances, they should not send a substitute.
Regarding communication, a group email list will be created. All meetings will be
recorded and minutes will be sent electronically. It's likely that there will be other
documents that will need to be distributed to members - they'll be sent electronically
or by mail. If members choose to communicate to another member, they are
encouraged to cc the communication to all members in order to keep everyone up-to-
date.
Members then introduced themselves.
Ground rules were also discussed and agreed upon. They are:
1. Start on time
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Stakeholder Planning Group - Adults - Contra Costa Health Services Page 2 of 4
2. End on time, unless there's agreement to continue
3,. One speaker at a time
• Allow people to finish; don't interrupt
• Be concise
• Facilitator "directs traffic"
4. No sidebar conversations
5. Listen for understanding
• Suspend judgment - try on other ideas
• Appreciate other points of view
• Seek common ground
6,. Decision-making:
• Use a consensus model (This means that while you might not fully agree
with a decision, you will support it outside of our meetings.)
• If consensus can't be reached, and time is of the essence,, prioritize using
"sticky-dot" or other type of voting
7. Declare any vested interests you may have when making a point,
8. Turn off cell phones and pagers before each meeting.
Training
Steve E, Kimberly,, Steve HS and Sharon presented a slide show aimed at creating a
context for the SH group's work. The slide show captured the essence of the State
DMH's program requirements that all counties will need to incorporate into their
proposals,, Knowing this in advance will help stakeholder group members as they
formulate their recommendations to the County's MH Director,
The State's Logic Model (community issues >>> unmet needs >>>focal
population»> service strategies) was reviewed at length,, as was the distinction
between enrollee-based vs. system capacity program development, The point was
made the this Group must address two primary matters: 1) identifying a focal or
enrollee population; and 2) identifying three to five service strategies (system
capacity) to fill in the service gap for adults.
A needs assessment was reviewed. This was developed from a tool provided by DMH
that is to be used by all counties.
Examples of recommendations to the MH Director were presented so members could
get an idea of what the product of their work will look like.
Questions and Comments
Members asked several questions or made comments following the slide presentation,
Paraphrased, they included:
• Are these open meeting? Can others sit in to observe?
Responses, Staff will check with DMH and legal counsel about this,
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Stakeholder Planning Group - Adults - Contra Costa Health Services Page 3 of 4
• Who can benefit from MHSA., i.e., do they have to already be in the MH system?
Responses. People with private insurance, or those who don't have Medical, can
participate,, although we don't want to offer services that a private carrier should
be providing. But they must have an MI or SED diagnosis. Also, for people at
risk of becoming MI or SED,, there will be MHSA prevention money coming to the
counties at some point.
• Why are the other funds (e.g., prevention) coming later.?
Responses. Probably because it just takes a lot of time to roll everything out.
Also, the money generated by the MRSA needs to accumulate.
• (There were several questions about the needs assessment. It was
acknowledged that there are gaps in the data; members were encouraged to
send any good data they have to Steve Hahn-Smith.)
• What's the agenda for the next meeting?
Responses. To agree on community issue(s), and start discussing unmet needs
for adults.
• When will the 6th meeting be?
Response: It's not set; this group will schedule it.
• What kind of money are we talking about? Do we need to know what's available
in order to recommend systems capacity strategies?
Responses. We still don't know how much Contra Costa County will receive. But
regardless of the amount, Stakeholder Planners should focus on service priorities
only. County planning staff will do the budgeting.
• If we have to focus on 200% of poverty, don't we need to know what that
consumer "looks like."
Responses. Actually, no. The 200% of poverty is a proposed fund allocation tool
that DMH might use to distribute dollars to the counties. It doesn't have
anything to do with eligibility for receiving services_ under the MHSA,
• Can the data points on the needs assessment be cross-referenced?
Response: We'll see what we can do about that.
• What adult services do we have now? Can we get some of that information?
Responses. Yes,, we'll get that for you.
Homework
For the next meeting, members should read DMH's Program & Expenditure
Requirements document,, study the needs assessment that Steve Hahn-Smith
reviewed, and study the materials that were distributed at the end of the meeting.
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Stakeholder Planning Group - Adults - Contra Costa Health Services Page 4 of 4
Next meeting/Agenda
The next meeting will be on April 27,, 4 - 6 p.m.; same location. -----
Agenda:
• Answer any questions about DMH requirements or anything else that was
presented on April 13.
• Discuss and agree on specific community issues this group will address
• Discuss and agree on unmet needs this group will address
Content provided by Contra Costa County Mental Health Division.
Contra Costa County, California, USA
Copyright O 2000-2005 Contra Costa Health Services
Home Privacy[, Terms of Usk Accessibility Site Ma VaIICIat@ I top Of pe9E
Attachment 12c
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A-
Contra Costa County MRSA Planning
Stakeholder Planning Group
Adults
Minutes
April 27,2005
Present: Sage Foster,Anna Lubarov, Rick Aubry,Robert Martinez,Robin Heineman, Robert
McKinnon,Lisa Ronan, Delores McNair,,Veronica Vale, Herb Putnam, Caroline Jackson, Sandy
Bustillo, Candace Kunz Tao, Geet Gobind, Colleen Miller,Alma Lones, Tracy Love, Cynthia
Staton, Lynn Gurko,Miles Kramer,Aimee Chitayat,Violet Smith
Observer: Joan Sorisia
Next Meeting: Tuesday,May 11 @ 4—6pm
Assignments:
I E
All members Study the"County Readiness Self-assessment"document Before 5/11/OS
(developed by Steve Hahn-Smith);read Community Forum
reports and any Focus Group reports you mayhave received
All who Rework the draft"issues statement"(see below)using email Before 5/11/OS
choose I I I
Announcements
In the interest of maintaining an open planning process,we will be allowing observers to attend
stakeholder planning meetings. They will be informed that they can only observe the discussions,
not participate in them.
Occasionally we may be able to use the larger conference room downstairs. We'll post a sign on
the upstairs door when those opportunities arise.
Q &A regarding the planning process
• Can we fund programs that have been cut,e.g.,warm line?
Response: DMH hasn't provided supplanting rules yet so we can't answer the questin yet.
However, normally it means that an existing services can't have it's money replaced by
new money.A service that existed,but was then eliminated,would typically be
considered a new service.
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• Can we get an unduplicated count of consumers served in the last fiscal year? --..
Response: It's in the needs assessment document.
• Is the 8.88%of SMI in the adult population an annual figure or a point in time?
Response: Point in time.
• Who decided what the community issues were?
Response: DMH did,probably based on their statewide data.
• What is the 200%of poverty used for?
Response: It's DMH's factor for determining allocation of MHSA funds to counties. It
has no bearing on who should be served.
Developing an Issues statement
The first step in the logic model/planning process is to agree on a community issue or issues.The
"menu"of options provided by DMH were reviewed. They are:
➢ Homelessness
➢ Inability to work
➢ Isolation
➢ Involuntary care
➢ Institutionalization
➢ Jail
A discussion followed and several comments were made. They include:
• Isolation jumps out. It applies to people,whether they're homeless or not. -"`--
• Isolation comes from stigma and hopelessness.
• The issue is social rehabilitation.
• When a person tries to get a job and earns over$800/month,they risk losing their
benefits. This income restraint leads to limited lives and inability to work.
• The issue is isolation. Related to that is inability to work and homelessness.
• Homelessness is the issue. People who are homeless have multiple stigmas.
• The first three(homelessness, inability to work, isolation)are the nexus of what we
should talk about.The goal is"full membership in society."
• Rehabilitation is really about restoring dignity.Homelessness is the main issue. Without a
home,nothing else happens.
• There is another kind of homelessness: living in the back room of your parents' home.
• With AB2034,jail recidivism dropped 81%when people got housing and community
supports.
• Too many go into the justice system,which makes things worse for them.Homelessness
is the central issue;just look at the complaints the police get regarding the homeless.
• In my clinic,the issue I've been dealing with the most is housing.All the other
community issues are symptoms of a mental health disorder.
• Housing is needed here.But it has to be designed to meet them where they're at,e.g.,
specialized for individual needs such as alcohol and other drugs.
• In social service programs, it's usually unemployment or under-employment that puts
them on the edge of homelessness.The two issues are closely linked.
• Housing should be affordable,and has to have supports. .---�
• People living with elder parents are in serious danger of homelessness.
• A lot of people have Section 8 vouchers,but they are still isolated.
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Attachment 12c
A-148
• We need to focus on institutionalization. It can lead to homelessness.
• We should have patients rights advocates on all stakeholder groups.
• Jail;when you group the other issues together it all adds up to jail. In jail they lose
Medical, SSI;they can be excluded from housing and jobs because of their criminal
record;there's limited access to services once they're released.
• The greatest impact would be to address homelessness; but the real issue is the
community's failure to understand which leads to stigma.
• It's offensive that people with mental illness get locked up. The jail is the homeless
shelter for many people.
• Jail is the largest MH treatment facility in the county.
• Isolation is the greatest issue; but the idea of becoming homeless is my worst fear.
• It's hard to choose from the list; I've experienced every one of them;they're all
interactive. But homelessness is the foundational issue—you can be homeless in jail or in
an institution.
• How does it all unravel for people? We should reach them when problems first strike. It's
really about having a decent system of care.
• Housing,housing,housing.
• A lot of people need"habilitation."
• They're all so intertwined.
• It's about the lack of housing and the lack of services.
The group agreed that the core issues are isolation, homelessness and inability to work. There's a
logical link between these. Problems in one can lead to problems with the others. We decided to
start with a draft that Steve will write(below)and use email before the next meeting to refine it.
Because of a lack of appropriate services at the time people need them,the result on adults
with serious psychiatric disabilities is often an inability to financially support themselves,
isolation due to the effects of mental illness and stigma,and homelessness. Any one of these
can initiate a cycle that leads to the others. Common outcomes are incarceration and
institutionalized care. Stated in positive terms,the goal for adults with serious mental
illnesses should be"greater membership in society."
Homework
Rework the above issues statement using email.
At the next meeting the group will discuss where it believes the greatest unmet needs are. The
point is to start zeroing in on the focal population that this group will identify as its
recommended enrollee population under the MHSA. In preparation,members should study the
"County Readiness Self-assessment"that Steve Hahn-Smith reviewed at the first meeting. They
should also look at Community Forum reports and any Focus Group reports that are distributed.
Where we are in the process
Once the group agrees on a focal population, it will start discussing specific community supports,
services and programs(identified by DMH as the"systems capacity"services).
Next meeting/Agenda
The next meeting will be on May 11,4-bpm; same location.
3
Attachment 12c .
A-149
Agenda:
• Agree on an issues statement
• Discuss unmet needs; identify a focal population
4
Attachment 12c
A-150
I
Contra Costa County MRSA Planning
Stakeholder Planning Group
Adults
Minutes
May 11,2005
Present: Cynthia Staton,Violet Smith, Caroline Jackson, Robert Martinez,Veronica Vale,
Patricia Rojas, Sandy Bustillo, Geet Gobind,Lisa Ronan, Connie Steers,Robert McKinnon,Rick
Aubry,Robin Heinemann,Anna Lubarov, Sage Foster, Candace Kunz Tao,Alma Lones,Miles
Kramer,Lynn Gurko,Delores McNair,John Allen, Steve Hahn-Smith, Steve Ekstrom
Observer: Captain Greg Gilbert
Next Meeting: Tuesday,May 18 @ 4—6pm
Assignments:
All-members Study Community Forum reports and any Focus Group and Before 5/18/05
survey reports 0
I _you may have received
Announcements
• We'll start a"parking lot"of ideas that should be considered when prevention and early
intervention funds become available. We still haven't learned from DMH when that
might be.
• Focus Group data.will not be available for a couple of more weeks. Because this slows
down the stakeholder group process, it's necessary to add an additional meeting day. The
group agreed to hold a 6�"meeting on June 15,4pm.
Issues statement
The group considered the draft statement included in the minutes of the last meeting as well as
Veronica's revision.After discussion,the following was adopted:
"The goal for adults with serious mental illnesses should be"greater membership in society."
But due to a lack of appropriate integrated services at the time people need them,the major
impacts on adults with serious psychiatric disabilities are:
• An inability to financially support themselves or access benefits,
• Isolation due to the effects of mental illness and discrimination,and
• Homelessness or inappropriate housing.
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Any one of these can initiate a cycle that leads to the others. Common outcomes are ....�
incarceration and/or institutionalized care without integrated services and a continuum of
supports."
Focal Populations
We agreed that we would make no decisions about selecting a focal population/enrollee group
until members have had a chance to study Focus Group and Survey data.. That said,we agreed to
start the conversation. Based on their experience, knowledge and the review of the needs
assessment and Community Forum data,members were asked to speak to what they thought the
greatest needs were. Comments included,
• The uninsured
• Latinos are the least served,whether insured or uninsured. Many don't speak English,
and there's a lack of Spanish-speaking care givers.And for some there's a stigma
associated with going to mental health programs or clinics. as a result many go to primary
care clinics or traditional healers.
• '1i12
Non-Engisn speaking adults, e.g.,Asians. It's hard to get help for them.
• Of those served by the homeless ambulatory clinic in central county, 60-70%are Latino.
• It's the institutionally homeless;there aren't integrated services to help them in the
community.
• County residents sent out-of-county to be in locked facilities or board and care homes,
• People with co-occurring issues, not in the system. This is a problem across the county.
• We should focus on documented people who are in the system,or could be in the system.
• We need to fill in the gaps in the continuum of care for people who are discharged from "-''
institutional care.
• People living with parents or who are inappropriately housed.
• Individuals who don't go along with treatment that is offered, or reject that treatment;
people who are difficult to engage. This is primarily adults who are dually diagnosed
(MH and drug/alcohol),
• People who are not in the system,e.g., homeless men and women.
• The ones who have fallen through the cracks;people who are seen by first responders
(e.g.,police, fire fighters,emergency responders). In Concord this is primarily the
chronic homeless with untreated mental illness and substance abuse. It's a problem for all
ethnic groups.
• The uninsured who can't access services.
• We need to focus on people who have serious MH needs and don't have access to
services.
• We need to focus on institutional or transformational change. We should focus on people
with co-occurring illnesses and treat them differently than we are now.
• 70%of people with serious MH issues are doing drugs and alcohol, and no one's telling
them they've got these problems. They often end up homeless. They've gone from one
system to the other(MH and AODS). Homeless adults with serious MI and drug/alcohol
issues-this is the most important group to serve.
• Mothers with serious MI who have had their kids taken away. 48-50%of those who
apply for GA are women. Most of the women who apply tend to have a MI problem.
With the men it's mostly substance abuse problems.
• Who ever we pick as our enrollee group will touch many systems. These systems (law
enforcement', social services,AODS, CBOs, etc.) should commit some of their funding
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I
(in kind,cash)to match the funds from the MHSA. This way we'd be embedding them
into the process of seeking solutions; and that starts to build institutional change.
9 A local study showed there aren't any significant services available to the uninsured.
(NOTE: some members stated that this was not the case.)
0 Mothers in long tern care who lose their children to CPS.
0 With respect to mothers with serious MI who have children,we need to meet with the
children's stakeholder group to see what they're coming up with.
e The populations are overlapping,e.g.,homeless,co-occurring issues,hard to serve/reach
populations. We'll need a good set of integrated services to meet their needs. risk of
0 Focus on severely mentally ill adults,who are the"working poor,"uninsured, or at
losing insurance.And of this group, focus on those with the greatest opportunity for
recovery.
Homework
Study Community Forum and,when available,Focus Group and Survey data,to see what our
communities are saying.
Next meeting/Agenda
The next meeting will be on May 18,4-bpm.
0
Agenda. field without making a final
• Continue discussing focal populations.Narrow the
"enrollee"decision.
• Time permitting, start the discussion of the possible services and supports that could be
helpful to adults. This would help us get a head start on the systems capacity discussions
that will come later.
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A-153
Contra Costa County MRSA Planning
Stakeholder Planning Group
Adults
Minutes
May 18,2005
Present: Lisa Ronan, Geet Gobind,Tracy Love,Anna Lubarov,Connie Steers,Veronica Vale,
Bob McKinnon,Aimee Chitayat,Violet Smith, Sandy Bustillo, Cynthia Staton, Sage Foster,
Robert Martinez, Herb Putnam,Caroline Jackson,Candace Kunz Tao,Alma Lones,Patricia
Rojas,John Allen,Jay Mahler, Sharon Kuehn,Donna Wigand, Steve Ekstrom
Observer: Captain Greg Gilbert
Next Meeting: June 1 @ 4—6pm
Assignments:
All members Study"Recommendations"that were distributed Before 6/1/05
Announcements
• An intergenerational/Family Forum will be held on May 31,4-bpm in the downstairs
conference room.This is an optional meeting,but we're hoping that several
representatives from all stakeholder groups will participate.The purpose is to discuss the
progress of each group,as well as to identify possible focal populations that cross the age
"silos"we're dealing with in each stakeholder group.
• "Recommendations"from the community-at-large were distributed.
• Alma distributed information from San Diego about an intervention program designed to
divert homeless chronic inebriates off the street and into effective treatment.
• Greg distributed jail statistics pertaining to%of homeless inmates,%of arrestees under
the influence of alcohol or drugs at time of arrest,etc.
• Donna Wigand thanked the group for their work to date,and also announced that we'll
need to schedule more meetings in order to get the work done. She explained the reasons
for the additional meetings:
o We still don't have the final requirements from DMH. It's not possible to plan
effectively without those requirements.
o We have much more focus group and survey data than we had anticipated,which is
good.But it's taking a lot of time to finish the groups and prepare their reports.
o And we don't want to do a rush job in this important phase of planning;the process
needs to be comprehensive.
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So we need to add two extra meetings,bringing the total to 9. Meetings 7, 8,and 9 have
yet to be scheduled,but we plan to do that next week.
Donna apologized if these additional meetings conflict with members' vacation plans.
• All focus group and survey data.will be available to members by May 30,about two
weeks before the June 14 meeting at which we'll make a decision on an enrollee group.
This will give members ample time to study all data before making an enrollee decision.
Focal Populations
We continued our discussion from the last meeting. Steve described the tool or worksheet he's
developing that each member will use to help them identify an enrollee group.This should
facilitate the decision the group will need to make. The tool is a matrix.Across the top will be
focal populations, broadly described.Down the left column will be conditions or status
indicators.Members will"score"each condition/status indicator for each focal population,
indicating the degree of concern/need as well whether the group is unserved,underserved or
inappropriately served.
Members liked the idea and offered suggestions for the"across the top"focal populations., The
long list included:
• Adults who want treatment
• Dually diagnosed adults(MI and AOD)
• Adults with no meaningful activities
• Adults resistant to treatment
• Adults inappropriately housed
• Adult recidivists frequently picked up by"first responders"
• Uninsured or underinsured
• Impaired parents
• Monolingual adults,or with limited English proficiency
• Families who only get service from primary care physicians
� Those with the greatest chance for recovery
• Homeless adults
• Incarcerated adults
After more discussion,the group narrowed the list down to the following focal populations that
will be considered:
• Incarcerated
• Homeless(no shelter)
• Inappropriately housed
• Parents with minor children
• Dually diagnosed(MI and AOD)
• Uninsured or underinsured
These six focal populations will appear across the top of the worksheet. The worksheet will
accompany the remaining data that gets distributed at the end of the month. Each member will
. 2
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use the worksheet as a tool to help them identify their first and second choice enrollee groups.
Sources that members will use to complete the worksheet are:
• Needs assessment
• Survey data
• Focus group data
• Knowledge
• Experience
• Other handouts
Later in June the full group will consider the enrollee suggestions from each member and will
reach a decision about which enrollee group it will recommend to the Mental Health Director.
Homework
Study "recommendations"from the community-at-large that were distributed at the beginning of
the meeting.
Next meeting/Agenda
The next meeting will be on June 1,4-bpm.
Agenda:
• Begin discussing the possible services and supports that could be helpful to adults. This
will help us get a head start on the systems development discussions that will come later.
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A-156
Contra Costa County MRSA Planning
Stakeholder Planning Meeting
Forum on Family and Intergenerational Issues
Minutes
May 31,2005
Present:
Children's GrogR: Kathy Davison, Melinda Dendinger,Jerry Zimmerman,Arlette Merritt,
Brenda Blasingame, Lisa Morrell, Bobbie Arnold
Transition Age Youth Group: Susan Waters, Stuart McCullough, Don Graves, Kathryn
Wade, Colette O'Keeffe, Theo Durden,Katie Roberts
Adult Gro Herb Putnam,Violet Smith,Aimee Chitayat,Anna Lubarov, Veronica Vale,
Connie Steers,Caroline Jackson, Geet Gobind,Bob McKinnon
Older Adult Gr Leah Rolnick-Bronstein,Tim Chon,Connie Steers, Bettye Randle
Observer: Janet Wilson
Staff/consultants: Jay Mahler,John Allen,Lisa Booker,Nancy Frank, Steve Ekstrom
Introduction;purpose of meeting
The idea for this Forum came from at least two stakeholder planning groups, largely in response
to the need to have a dialogue across groups to look at family and intergenerational issues. The
planning for MHSA implementation is organized around age"silos,"yet DMH has stressed the
importance of considering family and intergenerational issues. This Forum was organized to help
each age-related stakeholder group look at this broader context of the MHSA.
The point was made that all of the groups have yet to make decisions regarding enrollee
populations(Full Service Partnership)or services and supports strategies, so the timing of this
Forum is advantageous.
Participants received a handout that showed the focal populations each stakeholder group is
considering for an enrollee population recommendation. Members then introduced themselves.
Why are you here today?
Participants were asked what they hoped to get from the meeting. Responses included:
• The County should work together in a more systematic way; maybe this session will help
make that happen
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• The populations we're studying in our stakeholder groups aren't stagnant;they are all ...-..
transitioning, so we need to be talking with each other
So we can look at the full picture
Issues
The remainder of the meeting was devoted to an open-ended discussion of the key issues and
concerns participants had. Comments during this discussion included:
0 If kids with SED are symptoms of broken down families,then we need to see that their
parents get help
0 Every client comes with a family;we need to focus on the full family
0 But we also need to look at the distinct needs of each age group, so that they really
benefit from the MHSA
9 Older adults could serve as mentors, for example to transition age youths
e Parents with SMI who have their children removed from them' . This is a real problem.
o In most cases it's the mom not the dad
o In-home support services(IHSS)would be of great help
o When a parent isplaced in longer-tern care, e.g., over 30 days,the children are
removed and the mother loses custody
o In the reunification process, housing is not adequately considered. For example,an
apartment may be found for a mother, but there's no room for her kid(s)
o If the mother is labeled mentally ill,the custody of the children goes to the husband
9 Transition age kids leaving foster care need a committed adult in their life;there should
be a core of mentor volunteers ---�.
0 We need to start with the newborns of families with problems.An IHSS service that
would focus on helping families raise their newborns in a healthy way would be good
0 What about adults who don't want help? Sometimes we(children's services)go into a
house and see a parent who could use help; we'd like to be able to call someone who can
respond. Has the Adult Stakeholder Group looked at this?
0 Wrap-around services help the whole family
o It's documented that it works
o But we need more members on the teams
o And we don't have MOUS with agencies that serve adults
o What if a parent needs help, but they are not seriously MI. Maybe this should be a
"prevention and early intervention"service we might want to consider with future
MHSA funding.
• We must remember this about consumers: many are very capable, are stable, and can be
of real help to others
• The silos that DMH has created present a problem. How can we meet DMH's
requirements and find a service that's holistic and"threads"its way across age groups?
We need to be creative. Wrap-around is real answer to this. It represents a holistic,
strength-based approach to working with families. It's a support blanket.
• Populations may be in silos, but the services needn't be
o Families are the place for integrated services to occur
o Maybe we could develop a"one-stop"approach
• Our county is fragmented; one has to go through many hoops to get help. A thread,e.g.,
wrap-around services,to pull everyone together would be great
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• But can we add more wrap-around services with MRSA funding? It's not a new service,
and isn't DMH saying we shouldn't replicate existing services?
• All of the stakeholder groups need to look at innovative approaches
• Some transition age youths are sent to other counties or states to receive services. They
need to come home.
• Also,there are adults and older adults in long-term facilities that may be inappropriately
housed.
• The older adult group is concerned that DMH also wants us to focus on"transition age
older adults"aged 50 through 59. We're concerned this could drain services from much
older adults in their 70s, 80s and 90s. Is the adult stakeholder group looking specifically
at services to 50—59 year olds?
o Maybe we need to look less at the age of a group,e.g.,older adults or adults, and look
more at the needs of people. For example,a person could be in their mid-50s,but due
to many circumstances,could have the needs of someone in their 80s.
• We do need to bring people out of isolation,and find meaningful activities for them to
do.
•
Insurance,, insurance, insurance!
• We need to start programs that can apply to all ages. One example is the Clubhouse,an
approach that has been implemented across the U.S. and internationally. It emphasizes
meaningful activities. Members are encouraged to work, in whatever way they can. It can
be tailored to serve all age groups. We should have one in every region of the County.
• We need to look at the services for each age group, and look at where they can overlap;
or we need to create those overlaps.
• Regarding outreach and enrollment,where will we find populations that are hard to
reach?Primary care clinics are places we can find them.
• There are some models the County has considered,and in some cases attempted to
implement. They are:
o The Parent Project developed at the University of Massachusetts. It's for parents with
SMI, and emphasizes peer support,crisis planning, mental health education for kids,
etc.
o Ashbury House in San Francisco, operated by Progress Foundation. It's for mothers
with SMI—their children live with them in the house helping keep the family intact.
o Pollack Model in Colorado.Among other things it deals with"empty nest" issues,
and focuses on natural support systems
o Hope City model,that focuses on hard-to-place foster care kids
• We need easier community-based access to MH services; for example,when we see
mothers with MI in primary care clinics,maybe we could offer IHSS to them. We need to
be able to co-locate services.
• Rather than start elaborate, complex programs,we should look for simpler solutions and
build on what we already have in place.
Next steps
Participants were encouraged to discuss this Forum at their next stakeholder meetings. They
should make the point that there was considerable interest in thinking creatively to find ways
where there can be overlaps of services. Each group has to think about distinct services for the
ages it represents,but they should also look for ways that those services could impact or involve
other age groups. Even if we start small, if it's innovative,maybe family-oriented, and/or age-
inclusive, it could represent something we could build upon over time.
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Contra Costa County MRSA Planning -
Stakeholder Planning Group
Adults
Minutes
Junel,2005
Present: Geet Gobind,Herb Putnam,Robert Martinez,Miles Kramer,Lisa Ronan,Rick Aubrey,
Caroline Jackson, Candace Kunz Tao,Tracy Love,Violet Smith,Anna Lubarov,Patricia Rojas,
Sage Foster,,Alma Lones,Connie Steers,Veronica Vale, Cynthia Staton,Bob,McKinnon, Sandy
Bustillo, Lynn Gurko,Vic Montoya,John Allen, Steve Hahn-Smith,Kimberly Mayer, Steve
Ekstrom
Observer: Captain Greg Gilbert
Next Meeting: June 15 @ 4—6pm
Assignments:
Each Study all data.that will be distributed at the end of May.Use By 6/13/05
member the worksheet(to be distributed with data.)to decide on your
top 2 priorities for Full Service Partnership funding; email or
fax your 2 priorities to Steve Ekstrom
DMH Program and Expenditure Requirements
Kimberly Mayer and Steve Hahn-Smith reviewed the highlights of the new DMH requirements.
DMH made a number of changes to the original document. They included:
• Increased emphasis on client and family direction,peer support efforts and client and
family-run programs
• Greater emphasis on cultural competence
• More appropriate language for children and youth
• Expanded language on statewide outcomes
• Three types of funding
o Full service partnerships(formerly"enrollees")
o System development(formerly"system capacity")
o Outreach and engagement(new category)
• The logic model hasn't changed
• Conservatees are eligible for services under the MHSA,but as far as we know,MHSA
funds can't be used to create more involuntary beds.
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Kimberly also reminded everyone of the group's assignment:
1. Identify community issues(done)
2. Analyze mental health needs (in process)
3. Identify a group for full service partnership(to be done by mid-June)
4. Identify service and support strategies for developing the system (to be done in July)
5. Submit recommendations to the Mental Health Director(to be done in July)
Who can be served?
Vic the question of insurance, it was clarified that if someone is uninsured,but they meet other
requirements(diagnosis, impairment)they are served. Vic also noted that as of the latest adult
system data.review,20%of clients in west county are uninsured,20%in east county are
uninsured, and 30%in central county are uninsured.
Forum on Family and Intergenerational Issues
Several members had attended this Forum on May 3 1,and they discussed their understanding of
the key points,which included:
• There were some common threads that emerged:
o A need for meaningful activities across all age groups
o The importance of wrap-around services
o Housing
o The Clubhouse model
� We can't forget that consumers and families are the focal point of the MRSA,and they
help determine the services they receive
• While we should look at ways of serving the whole family,we also need to honor the
specific needs of each age group
• Don't get too elaborate—build on what we already have
• We need to emphasize consumers as staff
• We need to stop fragmenting our services
• We might want to have afollow-up Forum; maybe we could start a"chat room"
System development
We began discussing ideas for services and supports. This was an opportunity for members to
inform their peers about different strategies they are aware of.Again,we won't be making
decisions about services and supports we'll recommend until July. The point was made that
whatever we recommend should be evidence-based.Another key point was that we all need to
take a global,planner's look at things, and not just focus on our self interests.
Several ideas were presented and discussed:
• An array of supported housing services,with step-down and wrap-around services. This
could link to ...
• ... Multi-service centers that are consumer-run. Components could include:
o Mobile crisis unit
o Multi-disciplinary outreach teams
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Attachment 12c
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o Warm line between Spm and l Ipm. --.
• Clubhouse programs in each region of the county(additional information was provided in
a handout).
• Supported, pert anent housing
• AB2034 approach
o Connected to consumer-run,multi-service centers
o Connected to educational systems.
• Three things: 1)decent and affordable housing,2)productive activities and 3)
meaningful social lives.All of these help a person feel a part of their community
o We need housing options with supportive services,but MH should stay out of the
housing development business
o We need to develop meaningful work opportunities for consumers
o We should build on existing consumer-run programs.
• One-stop,easy access to holistic services; services should be co-located and consumer-
driven.
• Supportive MH staff to help those going through detox
• Housing—clustered and unclustered. But don't create MH ghettos.
• Build on existing outreach services to homeless consumers.
Homework
Study all the data that will be distributed at shortly. Each member should use the sorting
tool/worksheet(to be distributed with data)to help decide on a full service partnership group
they wish to recommend.
Next meeting/Agenda
The next meeting will be on June 15,4-bpm.
Agenda:
• The adult stakeholder planners will decide on the full service partner group it wants to
recommend.
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A-162
Contra Costa County MHSA Planning
Stakeholder Planning Group
Adults
Minutes
June 15,2005
Present: Candace Kunz Tao, Caroline Jackson,Alma Lones, Robert Martinez,Patricia Rojas,
Sage Foster, Connie Steers,Herb Putnam,Violet Smith,Bob McKinnon,Veronica Vale,Anna
Lubarov, Geet Gobind,Aimee Chitayat,Lisa Ronan,Rick Aubry, Sandy Bustillo, Sharon
Kuehn,John Allen, Steve Ekstrom
Observers: Captain Greg Gilbert,Virginia Luchetti
Next Meeting: June 22 *4—6pm
Assignments:
Each Continue to study data.for continuing discussion of service Before 6/22/05
member and support strategies__
Full Service Partnership
Some points were made during the conversation. They included:
0 If we deal effectively with high users of the system maybe we'll free up money for other
services
0 We should think about how we can leverage dollars
0 Cost avoidance is an important consideration
0 We should start small and be exemplary;then help it spread to other populations
After more conversation,the group tentatively agreed to recommend that the County establish a
full service partnership with the following focal population:
Adults with serious and persistent mental illnesses who are uninsured and homeless.
Emphasis will be placed on those that are unserved and uninsured, however exceptions
should be made for underserved individuals at great risk. Full service partnerships should be
countywide and culturally competent. Every effort should be made to treat homeless families
as a unit without breaking them up.
There are many associated riskjactors. These factors do not determine whether or not an
adult meeting the criteria definition above should receive services; rather, they will be taken
into account when deciding on service and support strategies. If the full service partnership
I
Attachmen# 12c
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population is larger than the County is able to service, individuals with some of the following
risk factors maybe given priority. These risk factors are:
• Alcohol and other drug abuse and dependency
• Serious medical issues
• Limited English proficiency
• History of incarceration
This definition will be further discussed at the next meeting,when it, or a revised version,will be
adopted.
Homework
Continue studying the data that's been distributed. Search through this data for service and
support strategies that our community constituents are interested in,.
Next meeting/Agenda
The next meeting will be on June 22,4-bpm.
Agenda:
• Finalize the definition of full service partnership
• Continue discussion of service and support strategies.
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A-164
Contra Costa County MHSA Planning
Stakeholder Planning Group
Adults
Minutes
June 22,2005
Present: Caroline Jackson, Robert Martinez, Cynthia Staton,Aimee Chitayat, Sage Foster,Anna
Lubarov, Connie Steers, Geet Gobind, Lisa Ronan,Alma Lones, Candace Kunz Tao,Herb
Putnam, Rick Aubry, Sharon Kuehn, Steve Ekstrom
Next Meeting: July 6 @ 4—6pm
Assignments:
Each Continue to study data for continuing discussion of service Before 6/22/05
member and support strate ies
Full Service Partnership
Herb Putnam distributed and spoke to a memo he'd written to Stakeholder Committees in which
he raised concerns about the State DMH requirement to spend more than V2of the MHSA
Community Services and Supports allocation on Full Service Partnerships. There was some
discussion.
The group then revisited the tentative Full Service Partner(FSP)definition from the last meeting.
Following discussion the group agreed to the following definition:
Adults with serious and persistent mental illnesses who homeless (no shelter). Riskjactors
which may be taken into account to help determine who will receive FSP services are:
• Alcohol and other drug abuse and dependency
• Serious medical issues
• Limited English proficiency
• History of incarceration or institutionalization
Systems development—service and support strategies
Members looked at the menu of options from DMH. It was understood that it would be wise if
any strategies we recommend can be supported items on this menu.
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We began by thinking about the goals we are trying to achieve. It was suggested that those goals,
discussed at an earlier meeting,are:
• Highest level of independent housing possible
• Meaningful activity, including employment
• Participation in, and a sense of belonging to,the community
We also discussed the philosophical underpinnings of anything we recommend. Beyond those
that are inherent in the MHSA,the group listed:
• Choice
• Harm reduction
• Keeping families intact
• Sustained services until a person is ready to exit
Next the group discussed service and support strategies.A number of items were listed, but no
decisions were made—that activity is reserved for the next meeting. Ideas generated fell into
three primary categories: outreach and enga eg menta hous and meaningful activities. Knitting
these services together is a"wrap around"type of service in which each FS Partner receives a
service plan. It is important that each service plan have identified exit strategies for each person.
Teams of diverse,multi-disciplinary staff would provide this"wrap around"service,which
should focus on"step down"strategies. These teams need to be culturally competent
(representative of the cultures of the people being served),and must have quick access to mobile
crisis team(s). It was understood that mobile crisis teams should be developed that can serve all ^-
age groups,which would be more cost effective than developing a service for each age group.
Elaboration of the outreach and enga e� ment category included:
• Meeting people"where they're at"
• SPMI evaluation
• Transportation
Elaboration of the housing category included:
• Use the"Housing First"model
• Housing must be safe and affordable
• Built in wrap around services
• Crisis respite capability
Elaboration of the meaningful activities category included:
• Consumer-run multi-service centers(consumer staff should be in dual recovery,and have
personal experience with homelessness
• Clubhouses,or other social rehabilitation services,that help people with social,
educational and vocational/job interests
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Finally,throughout each FS Partner's involvement in outreach,housing and meaningful
activities,the following should be available:
• Medically-supervised detox
• Patients' Rights Advocate
• Benefits planning
• Access to professional services,e.g.,therapy,dental,medical
At the next meeting,we'll briefly revisit the above strategy and decide whether to recommend it
to the MH Director.
A major focus of the next meeting will be on service and support strategies for Adults not
necessarily in the full service partnership we've identified, i.e.,what are the high priority
strategies we would like to see funded that any Adult SPMI could benefit from?
Homework
Continue studying the data.that's been distributed. Search through this data for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on July 6,4-bpm.
Agenda:
• Continue discussion of service and support strategies
• Develop recommendations for service and support strategies
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Contra Costa County MHSA Planning
Stakeholder Planning Group
Adults
Minutes
July 6,2005
Present: Anna Lubarov,Veronica Vale, Cynthia Staton, Caroline Jackson,Robert Martinez,,
Aimee Chitayat, Sage Foster, Candace Kunz Tao,Herb Putnam,Rick Aubry,Bob McKinnon,
Lynn Gurko,Robin Heinemann,Tracy Love,Geet Gobind,Lisa Ronan,Alma Lones, Sandy
Bustillo,Violet Smith,John Allen, Sharon Kuehn, Steve Ekstrom
Next Meeting: July 20 @ 4—6pm
Assignments:
Each Be prepared to discuss our recommendations with the Mental 7/20/05
member Health Director
Full Service Partnership
Steve was reminded to add the language regarding countywide, cultural competence and intact
families to the full service partnership definition.
Systems development—service and support strategies
Members began discussing strategies they felt needed to be included in our recommendations to
the MH Director. Suggestions included:
• Mobile crisis,with:
o Peer support
o Proactive personal service coordination
o Follow-up
o Clinical component
• Integrated Mental Health and Primary Care,especially for people not reached by the MH
system and who may feel more comfortable talking with a primary care physician;
provide cognitive behavioral therapy
• Involving first responders in developing a resource guide they can use in the field; a
training component would accompany this
• A Health, Housing,Integrated Services Network
• Clubhouses that incorporate employment,housing and education into amember-driven
center in which people can rebuild there lives
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• Outreach and Engagement Teams(HOPE Team model); formerly homeless consumer-
providers with clinical staff support
• Expand Consumer-Operated Community Centers
• Consumer involvement in the running of whatever new services we provide
• 2034 Programs; consumer-based services
During the discussion a member raised a concern that we were generating lists of strategies that
aren't really new,and that if implemented might not really address the systems transformation
philosophy and expectations inherent in the MHSA. This member felt that we were listing
members' favorite services and not really looking at how we could reconstruct things to have
significant impact on outcomes for consumers. So rather than list specific strategies or program
ideas,this member offered a different approach. Many members were interested in this approach
and ultimately decided to adopt it as their preferred strategy.
This strategy begins with being clear about the goals we're trying to achieve which,as
previously agreed to,are:
• Highest level of independent housing possible
• Meaningful activity, including employment
• Participation in, and a sense of belonging to,the community
The underpinning philosophies are:
• Recovery
• Consumer-driven services
• Choice
• Harm reduction
• Keeping families intact
• Sustained services until a person is ready to exit
At its core,this strategy would ask collections of agencies and individuals to collaboratively
propose how to make the best use of MHSA funds(e.g., leveraging funds,developing
collaborative relationships with MH and other systems agencies, etc.)to accomplish
improvements in people's lives in the areas of housing, involvement in meaningful activities,and
fuller participation in their communities.
Proposals should address two specific components:
1. Attitudinal,e.g.,
o Cultural competence
o Recovery
o Consumer involvement in all aspects
o Consumer-driven services
o Integration, i.e.,the extent to which existing resources and systems are included. This
might include law enforcement, social services,education to name a few
o Education and training of staff
o The extent to which real systems transformation is likely to occur
2. Services,e.g.,
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o Stable,affordable housing .---r.
o Meaningful day activities
o Mobile crisis
o Multi-disciplinary outreach teams that provide follow-up, include consumer-providers
and that are culturally appropriate to the individuals being served
o Service coordination
o Anti-stigma/Community Education campaign
Proposals from these collaborative groups would be evaluated based on factors such as cost
efficiency, innovation,use of best practices, and adherence to the philosophies cited above.
Ideally an independent group that is neutral and objective-possibly a group from outside the
county-would evaluate proposals. However, if reviewed by County Administration,the review
panel should have members who are neutral and objective,with no vested interest in the
outcome.
Advisory Committee
The MH Director has requested that each stakeholder group name 4 members to a Stakeholder
Advisory Committee. This Committee will most likely conduct its work after Labor Day. It's
purpose is to review and comment on the first draft of the County's proposal to State DMH-
Criteria
for selecting members are: 1 Consumer, 1 family member, 1 MH service provider
(County or CBO)and 1 from the community-at-large.In addition,the Advisory Committee
needs to be diverse and representative of all regions.Advisory Committee members will
represent their Stakeholder Group and the recommendations they've made. Their role is not to
represent individual interests. �---
The following members were nominated or indicated interest:
Consumer:
• Tracy Love(central county)
• Geet Gobind(county-wide)
• Anna Lubarov(county-wide)
Family member:
• Herb Putnam(county-wide)
• Lisa Ronan((county-wide)
• Veronica Vale(central county)
MH service provider:
• Lynn Gurko(county-wide)
• Candace Kunz Tao(central county)
• Aimee Chitayat(county-wide)
Community partner:
• Aimee Chitayat(county-wide)
• Robin Heinemann(central county)
• Sage Foster(county-wide
It was strongly suggested that members within each of the above categories contact each other
before the last meeting and make a decision amongst themselves as to who will be the
representative.Members not at this meeting who are interested in being on the Advisory �
Committee should contact those in the appropriate category so they can be considered.
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We will discuss membership on the Advisory Committee at the last meeting,July 20.
Parking lot
• A"field resource guide"that provides people in the field with a list of agencies,names
and numbers they can call when they need to reach certain resources on the spot. This
could be particularly helpful for first responders(e.g.,police,fire,EMT). It should be
complete,but also very transportable.A desktop version could be available at a unique
website.
Next meeting/Agenda
The next and last meeting will be on July 20,4-bpm.
Agenda:
• Agree on Advisory Committee members
• Discuss recommendations with the MH Director
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Contra Costa County MRSA Planning
Stakeholder Planning Group
Adults
Minutes
July 20,2005—Last Meeting
Present: Candace Kunz Tao, Herb Putnam,Aimee Chitayat,Robert Martinez,Veronica Vale,
Sandy bustillo,Connie Steers, Bob McKinnon,Patricia Rojas,Anna Lubarov,Violet Smith,
Robin Heinemann, Geet Gobind,Tracy Love,Lisa Ronan,Rick Aubry, Sage Foster,John Allen,
Donna Wigand,Kimberly Mayer,Nancy Frank, Steve Ekstrom
Advisory Committee
The group discussed who would represent the Adult Youth Stakeholder Group on the Advisory
Committee. This Committee will review the draft plan before it is submitted to the Mental Health
Commission.Members voted and the following representatives were selected:
• Tracy Love(consumer)
• Veronica Vale(family member)
• Aimee Chitayat(MH service provider)
• Sage Foster(community partner)
The point was made that these members should represent the work/recommendations of the
Adult Stakeholder Group,and not individual interests.
(Later,when Donna Wigand joined the group, she made the point that the Advisory Committee
could assist with plan preparation,revisions,the public hearing,etc. She anticipates asix-month
commitment from Committee members. And in 2006 she may want to form another Committee
to advise on implementation of MHSA-funded services.)
Recommendations to the MH Director
Donna Wigand acknowledged some of the difficulties this group had experienced,particularly
with respect to the definition of the Full Service Partnership, i.e.,the decision on this was not
unanimous;there was a split vote on June 22 with seven members in favor,6 opposed and one
abstention. Donna also acknowledged she had read a Minority Report(which upon request was
circulated at this meeting) in which several members had issued their own recommendations for
Full Service Partnership and service/support strategies.
Donna then asked for any questions or comments on the stakeholder group process. These
included:
• A request that the Minority Report recommendations be considered along with the
Adult Stakeholder Group's final recommendations
1
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• A request that a member of the Minority Report group be on the Advisory Committee
• A statement from a member regarding the passion of all the members
• A comment that the group did produce a product
At this point Donna led a discussion about the group's recommendations. Topics discussed
included:
• Homelessness and housing as a common denominator in the Group's deliberations
• The difficulty the group had deciding on a Full Service Partnership(FSP). (Three
FSPs had been discussed: 1) isolated in the community,2)isolated in IMDs, 3)
homeless without any shelter. The decision the group made was for#3,but this was
not unanimous)
• People in out-of-county IMDs needing assistance to"come home"
• Educating/training first responders
• Not giving"mixed messages"to those in dual recovery
• The need for"step down"programs,with a combination of clinical and consumer
staff
• Weaving cultural competency,recovery and co-occurring issues into the strategies
o Need staff who have experienced homelessness and dual recovery
o Clinical staff should work closely with consumer colleagues
o Need to find new ways of working together
• The recommended process for making decisions on which strategies to employ
o Ask for coalitions of providers to unite and propose transformational strategies
o Need neutral proposal evaluators
o Need to leverage existing resources with MHSA funds
o This approach got the group very close to consensus
• Insufficient time to closely study all the various strategies
• 2034 approach
•
Starting in one region vs.the whole county at once
Housing
Donna also pointed out that the newly formed MHSA Oversight and Accountability Commission
is considering the feasibility of using a portion of capital investment funds to leverage a federal
housing bond. They're also looking at using some of each county's allocation for this purpose.
And Finally,.,
There will be a"Thank You Celebration"to acknowledge the hard work of all stakeholder group
members..This party will be held on July 27thfrom 4:00 to 6:00 p.m. at Marie Callender's,2090
Diamond Boulevard in Concord. Donna thanked the Adult Stakeholder Group members for all
their hard work,and encouraged them to join her and the other stakeholder groups in this
informal celebration.
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APPENDIX
Adult Stakeholder Group Recommendations
3
Attachment 12c
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Contra Costa County MHSA Planning
Adult Stakeholder Planning Group
Recommendations
community issues
The goal for adults with serious mental illnesses should be to achieve their highest possible
level of personal independence. Specifically,this means:
• Achieving the highest level of independent housing possible
• Engagement in meaningful activity, including employment
• Participation in,, and a sense of belonging to,the community, i.e.,becoming an equal
member of society
But due to a lack of appropriate integrated services at the time people need them,the major
impacts on adults with serious psychiatric disabilities are:
• An inability to financiallYsupport themselves or access benefits,
• Isolation due to the effects of mental illness and discrimination, and
• Homelessness or inappropriate housing.
Any one of these can initiate a cycle that leads to the others. Common outcomes are
incarceration and/or institutionalized care without integrated services and a continuum of
supports.
Full Service Partnership
The Adult Stakeholder Group recommends for Full Service Partnership, adults with serious
and persistent mental illnesses who are homeless(i.e.,having no shelter). Full service
partnerships should be countywide and culturally diverse.Every effort should be made to
treat homeless families as a unit without breaking them up.
Risk factors,which may be taken into account to help determine who will receive FSP
services,are:
• Alcohol and other drug abuse and dependency
• Serious medical issues
• Limited English proficiency
• History of incarceration or institutionalization
Service and Support Strategy
This strategy represents a systems transformation approach that calls upon the creative
realignment and redesign of existing services as well as the introduction of new programs
based on emerging best practices. The strategy also promotes the leveraged use of new funds
wherever possible.
4
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The guiding principles of this strategic approach are:
• Recovery values and principles
• Consumer-driven services
• Choice
•
Hart reduction
• Keeping families intact
• Sustained services until a person is ready to exit
At its core,this strategy calls upon agencies and individuals to propose how to make the best
use of MHSA funds(e.g.,developing collaborative relationships with MH and other systems,
leveraging funds, etc.)to accomplish improvements in people's lives in the areas of housin&
involvement in meaningful activities,and fuller participation in their communities, i.e.,
individuals achieving their highest level of personal independence.Proposals should address
two specific components:
1. Attitudinal,e.g.,
— Cultural competence
— Recovery
— Consumer involvement in all aspects
— Consumer-driven services
— Integration, i.e.,the extent to which existing resources and systems are included.
This might include law enforcement, social services, education to name a few
— Education and training of staff
— The extent to which real systems transformation is likely to occur. (Systems
transformation is a process of the system's recovery, i.e.,unlearning the old
ineffective methods and embracing the inclusion of emerging recovery-based
practices.)
2. Services, e.g.,
— Stable,affordable housing
— Meaningful day activities
— Mobile crisis
— Integrated services with: 1)Personal Services Coordinators,2)multi-disciplinary
outreach teams that provide follow-up, include consumer providers and are
culturally appropriate to the individuals being served,and 3)strong ties in the
community and reliance on CBOs.
— Anti-stigma/Community Education campaign
Proposals would be evaluated based on factors such as cost efficiency, innovation,use of best
practices, likelihood of achieving systems transformation,and adherence to the principles
cited above. Collaborations of agencies and individuals are strongly encouraged.
Ideally an independent group-possibly a group from outside the county-would evaluate
proposals.This group would need to be neutral,objective,not invested in the outcome, �
culturally diverse and well grounded in recovery values and principles. However, if proposals
are reviewed internally,the review panel should have members with these characteristics.
5
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Stakeholder Planning Group - Older Adults - Contra Costa Health Services Page 1 of 3
,Now
CONTRA COSTA_
HEALTH SERVICES
Contra Costa County MRSA PlannON
ing
Stakeholder Planning Group - Older Adults
Minutes
April 7,, 2005
Next Meeting: Tuesday,, April 21 at 4 - 6 p.m.
Assignments:
Whom. All members
What: Read DMH Program Requirements document; review needs assessment; study
hand out materials
When: Before 4/21/05
Welcome/Introductions/Orientation
Steve Ekstrom, stakeholder group facilitator., introduced himself and County MH staff
(Kimberly Mayer,, Grace Boda,, Steve Hahn-Smith). Resource staff to the Stakeholder
Group were also introduced (Karen Pratt) as was Sharon Kuehn with the Consumer
Involvement Steering Committee. Scott Singley., member of the Older Adult Group
and Chair of the Mental Health Commission welcomed members and spoke of the
importance of their work.
Steve E described the process by which members were selected. Regarding
attendance, members are expected to attend every meeting. If they are unable to
attend a meeting due to unforeseen circumstances, they should not send a substitute.
Regarding communication, a group email list will be created. All meetings will be
recorded and minutes will be sent electronically. It's likely that there will be other
documents that will need to be distributed to members - they'll be sent electronically
or by mail. If members chose to communicate to another member, they are
encouraged to cc the communication to all members in order to keep everyone up-to-
date.
Members then introduced themselves.
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Stakeholder Planning Group - Older Adults - Contra Costa Health Services Page 2 of 3
Ground rules were also discussed and agreed upon. They are:
1. Start on time
2. End on time,, unless there's agreement to continue
3. One speaker at a time
• Allow people to finish; don't interrupt
• Be concise
• Facilitator "directs traffic"
4. No sidebar conversations
5. Listen for understanding
• Suspend judgment - try on other ideas
• Appreciate other points of view
• Seek common ground
6. Decision-making:
• Use a consensus model (This means that while you might not fully agree
with a decision, you will support it outside of our meetings.)
• If consensus can't be reached, and time is of the essence,, prioritize using
"sticky-dot" or other type of voting
7. Declare any vested interests you may have when making a point,
8. Turn off cell phones and pagers before each meeting,
Training
Steve E,, Kimberly, Grace,, Steve HS and Sharon presented a slide show aimed at ....,
creating a context for the SH group's work. The slide show captured the essence of
the State DMH's program requirements that all counties will need to incorporate into
their proposals, Knowing this in advance will help stakeholder group members as they
formulate their recommendations to the County's MH Director.
The State's Logic Model (community issues >>> unmet needs >>> service
strategies) was reviewed at length,, as was the distinction between enrollee-based vs.
system capacity program development, The point was made the this Group must
address two primary matters: 1) identifying a focal or enrollee population; and 2)
identifying three to five service strategies (system capacity) to fill in the service gap
for older adults.
A needs assessment was reviewed. This was developed from a tool provided by DMH
that is to be used by all counties.
Examples of recommendations to the MH Director were presented so members could
get an idea of what the product of their work will look like,
Questions and Comments
Members asked several questions or made comments following the slide presentation,
Paraphrased, they included:
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Stakeholder Planning Group - Older Adults - Contra Costa Health Services Page 3 of 3
• Who decided on the model? Responses. State DMH
• Can the MRSA address the needs of older adults with dementia or Alzheimer's
Disease? Response: no, the legislation is very clear about this.
• As we move through the process we need to keep in mind the potential impact
the MRSA could have on the larger health care system.
• On the last homeless count in Contra Costa County,, how many were 60+ years
old? Responses. unsure at this moment, but this information will be made
available.
• Can we get exclusionary/inclusionary diagnoses from the state? Response: yes.
• We may be able to use the Area Agency on Aging (AAA) as a resource.
Homework
For the next meeting, members_should read DMH's Program & Expenditure
Requirements document, study the needs assessment that Steve Hahn-Smith
reviewed, and study the materials that were distributed at the end of the meeting.
Next Meeting/Agenda
The next meeting will be on April 21,, 4 - 6 p.m.; same location.
Agenda:
• Answer any questions about DMH requirements or anything else that was
presented on April 7.
• Discuss and agree on specific community issues this group will address
• Discuss and agree on unmet needs this group will address
Content provided by Contra Costa County Mental Health Division.
Contra Costa County, California, USA
Copyright O 2000-2005 Contra Costa Health Services
Home Privacy, Terms of Use, Accessibility Site Mvalid too of Page
Attachment 12d
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stakeholderminutes older ad... 10/27/2005
Contra Costa County MRSA Planning --�
Is
Stakeholder Planning Group
Older Adults
Minutes
April 21,2005
Present on 4/21/05: Leah Rolnick-Bronstein, Carlos Torres,John Bateson,A.C. Hollister,
Debbie Card, Sue Meltzer,Al Flanagan,Javier Nunton, Ken Salonen, Linda A son,, ancy
9Ebbert,Eric Devers, Larry Vaughan, Lisa Bruce, Tim Chon, Linda Anderson,Karen Pratt, Steve
Ekstrom
Next Meeting.* Thursday,May 12 *4—6pm
Assignments:
All members Study the"County Readiness Self-assessment"document Before 5/-12/05---
(developed by Steve Hahn-Smith); read Community Forum
reports and an Focus Group reports you may have received
Nancy, Prepare a presentation on what isolation for a seriously Before 5/12/05
Karen mentall ill older adult might look like
Announcements
In the interest of maintaining an open planning process, we will be allowing observers to attend
49 40
stakeholder planning meetings. They will be informed that they can only observe the discussions.,
not participate in them.
Occasionally we may be able to use the larger conference room downstairs. We'll post a sign on
the upstairs door when those opportunities arise.
Q &A regarding the planning process
• Are there any older adult consumers(over 60 years)on our group?
Response:None applied, however one member is a few months away from 60 years old.
• Is there a reason there are only two consumers on this group?
Response: Again, not many applied to be on this group.
• Regarding the snapshot of the homeless population count in January,how many were
over 60?
1
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I
Response: We don't have exact numbers because it was a visual count. But we do have
statistics from another survey that showed about 3-4%were over 60 years.John Bateson
volunteered to get some percentages of seniors calling the homeless hotline.
• We need to interface with long-tern planning group to make sure there aren't duplicative
efforts;there's a collaborative effort between Health and Social Services Departments',
MH is a part of that system
Response: Linda is on that planning group and will watch for any duplication with our
planning process..
• How did the State arrive at the Community Issues menu?
Response: DMH put these menus together,probably based on a lot of their data..
Developing an Issues statement
The first step in the logic model/planning process is to agree on a community issue or issues. The
fl(lmenu59 of options provided by DMH were reviewed. They are:
> Homelessness
> Inability to work/function
> Isolation
> Involuntary care
> Institutionalization
> Jail
A discussion followed and several comments were made. They include:
• Physical and mental issues are interrelated
• We need levels of housing
• We need to pay attention to issues of death and dying
• There are more issues than DMH has given us
• The community issues are symptoms of not having a system of care.
• Substance abuse is a large issue
• MHSA won't work if it's not integrated with Prop 36
The group agreed that it was not possible or reasonable to select one Community Issue; instead,
members chose to look at a clustering. They described it as a dynamic between"unnecessary loss
of ability to function" (lack of resources available that results in a downward spiral)and
"isolation."Either of these two issues can stimulate the other, and they are exacerbated by lack
of transportation, lack of case management services, language barriers,and discrimination based
on age/race/alternative life styles. From isolation/unnecessary loss of ability to function follows a
cascade of secondary problems such as: inability to attend to health care needs; inability to care
for one's self; inability to work* substance abuse; and hopelessness. Common outcomes of this
pattern are institutionalization and homelessness.
Homework
At the next meeting the group will discuss where it believes the greatest unmet needs are. The
point is to start zeroing in on the focal population that this group will identify as its
recommended enrollee population under the MRSA. In preparation,members should study the
"County Readiness Self-assessment"that Steve Hahn-Smith reviewed at the first meeting. They
should also look at Community Forum reports and any Focus Group reports that are distributed.
2
Attachment 12d
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Where we are in the process ----
Once the group agrees on a focal population, it will start discussing specific community supports,
services and programs that(1)are needed to serve the focal population,and(2)are needed to fill
out the service array for transitional-aged youth who aren't necessarily in the focal population
(identified by DMH as the"systems capacity"services).
Next meeting/Agenda
The next meeting will be on May 12,4-bpm; same location.
Agenda:
• Review the work done on April 21
• Description of what isolation for an older adult with serious mental illness can look like
(Nancy Ebbert and Karen Pratt will present this)
• Discuss unmet needs;time permitting, identify a focal population
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Contra Costa County MRSA Planning
Stakeholder Planning Group
Older Adults
Minutes
May 12,2005
Present: Leah Rolnick-Bronstein, Carlos Torres,John Bateson, Bettye Randle,Ace Hollister,
Gisela Hernandez,Al Flanagan, Connie Steers, Scott Singley,Nancy Ebbert,Larry Vaughan,
Ken Salonen,Linda Anderson,Javier Nunton,Tim Chon, Steve Hahn-Smith,Karen Pratt, Steve
Ekstrom
Next Meeting: Thursday,May 19 @ 4—6pm
Assignments:
All members Study Community Forum reports and any Focus Group and Before 5/19/05
survey reports you may have received
Announcements
•
We'll start a"parking lot"of ideas that should be considered when prevention and early
intervention funds become available. We still haven't learned from DMH when that
might be.
• Focus Group data will not be available for a couple of more weeks. Because this slows
down the stakeholder group process, it's necessary to add an additional meeting day. The
group agreed to hold a 6thmeeting on June 9,4pm.
Community issues
Per the request from the last meeting,Nancy and Karen described a profile of an older adult that
generically fit our community issues, isolation and unnecessary loss of ability to function.
Focal Populations
We agreed that we would make no decisions about selecting a focal population/enrollee group
until members have had a chance to study Focus Group and Survey data. That said,we agreed to
start the conversation. Based on their experience,knowledge and the review of the needs
assessment and Community Forum data.,members were asked to speak to what they thought the
greatest needs were. Comments included:
• The most underserved are not those who have had long-term mental illness.
� African-American men who come to a community center but don't accept services.
1
Attachment 12d
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• Many who are invisible(e.g., immigrant community members)don't believe they have a
MH problem. The MH system is often seen as"government"and is not perceived as
being helpful. This is particularly true on Chinese,Latino and SE Asian communities.
• Referencing page 48 of the Needs Assessment,the widest disparity between ethnic Medi-
Cal recipients and culturally competent staff is in the Latino community. 29.9%of the
Medi-Cal population is Latino,yet only 11.9%of staff is Latino.
• Should we include the needs of adults who are transitioning into older adults? (A
response was that we shouldn't because those 60+are already so underserved.
• At Doctors' Hospital in west county,we have great difficulty finding psychiatrists who
can conduct psych evaluations on older adults brought in on 5150s. Patients can be
inappropriately detained for weeks. (Some responses included that it may be a funding
problem; and that these patients should have access to a patient's rights advocate.)
• Senior citizens,usually living alone in central county are a concern. They are often
resistant to care,may not be 5150-able. But if they are 5150-able,they often end up back
in the community again and not getting any help.
• We should hire the best and brightest consumers to provide self-help to older adults.
• We need to really focus on those with serious MI who are in their 70s, 80s or 90s. Some
have never had any psychiatric help; often they are 5150-d,then end up back in their
home or nursing home.These older adults live in all parts of the county and are in all
ethnic groups. We need a psychiatrist who can partner with APS.
• Years ago we had a good system of geriatric services,but over the last 10 years most of
that system has been lost to cuts. It looked like this:
0 1980: developed outreach teams for older adults with psychiatric issues.
0 1983 to about 2003: had older adult clinics that offered medical and psychiatric
services.
0 1984-, added a geriatric inpatient psych unit.
o Late 1980s and into the 1990s: had older adult clinics in each region of the county
o There was good coordination between outreach,clinics and inpatient care.
The remaining remnant of this system is the one MH specialist assigned to APS
• We had a good system,and then we lost it. We need to recreate what we had.
• People in institutions lack integrated services that include good medical care. They often
can't get medical help in a hospital or clinic because the hospital won't take Medi-Cal.
We need integrated case management. We need a geropsych ward.Funding streams are
in conflict.
• People who receive Medi-Care shouldn't be excluded,as they are now. This is a problem
across the county.
• We need mobile outreach services that are run by consumers.They need to have multi-
lingual and multi-cultural capacity. They should be deployed in areas where poverty is
the greatest.
• We need to serve people who are resistant to care.There's often cultural stigma
associated with this resistance. Mobile outreach team would help.
• We need to serve people who are self-neglecting.Their conditions often include: low
functioning levels,depression,anxiety,poor nutrition,and inadequate medical attention.
We need long-term case management with outreach that is culturally sensitive. It's a
county-wide problem.
• We need to address the needs of patients who are out-of-county and in long-term
institutions. We need more APS resources with MH specialists. We also need outreach �
teams.
2
Attachment 12d
A-184
• We need integrated services;we need a uniform flow of information with a basic
information technology system. We need to keep recovery and prevention in mind.
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Homework
Study Community Forum and,when available,Focus Group and Survey data.,to see what our
communities are saying.
Next-meeting/Agenda
The next meeting will be on May 19,,4-6pm.
Agenda:
• Continue discussing focal populations.Narrow the field without making a final
"enrollee"decision.
• Time permitting, start the discussion of the possible services and supports that could be
helpful to older adults. This would help us get a head start on the systems capacity
discussions that will come later.
3
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Contra Costa County MRSA Planning -�
Stakeholder Planning Group
Older Adults
Minutes
May 19,2005
Present: Lisa Bruce,Debbie Card, Sue Meltzer,Leah Rolnick-Brunstein, Carlos Torres,John
Bateson,Bettye Randle,Ace Hollister,Gisela Hernandez,Al Flanagan, Connie Steers,Nancy
Ebbert,Larry Vaughan,Tim Chon,Karen Pratt,Donna Wigand, Steve Ekstrom
Next Meeting: May 26 @ 4—6pm
Assignments:
All members Study"Recommendations"that were distributed Before 5/26/05
Announcements
• An intergenerational/Family Forum will be held on May 31,4-bpm in the downstairs
conference room.This is an optional meeting,but we're hoping that several
representatives from all stakeholder groups will participate.The purpose is to discuss the
progress of each group,as well as to identify possible focal populations that cross the age
"silos"we're dealing with in each stakeholder group.
• "Recommendations"from the community-at-large were distributed.
• Donna Wigand thanked the group for their work to date,and also announced that we'll
need to schedule more meetings in order to get the work done. She explained the reasons
for the additional meetings:
o We only just received the final requirements from DMH. It will take some time to
determine the impact of any changes on our planning process.
o We have much more focus group and survey data than we had anticipated,which is
good.But it's taking a lot of time to finish the groups and prepare their reports.
o And we don't want to do a rush job in this important phase of planning;the process
needs to be comprehensive.
So we need to add two extra meetings,bringing the total to 9.Meetings 7, 8,and 9 have
yet to be scheduled,but we plan to do that next week.
Donna apologized if these additional meetings conflict with members' vacation plans.
1
Attachment 12d
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• All focus group and survey data will be available to members by May 30, about ten days
before the June 9 meeting at which we'll make a decision on an enrollee group. This will
give members ample time to study all data before making an enrollee decision.
Focal Populations
We continued our discussion from the last meeting. Steve described the tool or worksheet he's
developing that each member will use to help them identify an enrollee group. This should
facilitate the decision the group will need to make. The tool is a matrix.Across the top will be
focal populations, broadly described.Down the left column will be conditions or status
indicators. Members will"score"each condition/status indicator for each focal population,
indicating the degree of concern/need as well whether the group is unserved, underserved or
inappropriately served.
Members liked the idea and offered suggestions for the"across the top"focal populations. The
long list included:
• Transition to older adult status
• Incarcerated
• In community centers, but not engaged in treatment
• Multiple needs; complex presentation(MI,medical, AOD)
• Unable to care for themselves
• Immigrants/refugees
• Homeless
• Resistant to treatment
• Uninsured/underinsured
• Facing, or in, inappropriate placement because of financial hardship
• Stuck in the recovery process
• Behaviors that jeopardize remaining in the community
• Poverty
• At low functioning levels
• Self-neglecting
• Lack of personal supports
• In crisis in their home
• unemployed
After more discussion,the group narrowed the list down to the following focal populations that
will be considered:
� In crisis,with complex presentation(MI,medical,AOD)
• In the community without supports/resources and therefore at risk
• In institutions,without supports/resources and therefore at risk
• Homeless
• Resistant to treatment and recovery
• Uninsured/underinsured(in poverty)
• Lack of employment or meaningful activity
These seven focal populations will appear across the top of the worksheet. Down the left side of
the worksheet the group agreed to add"immigrant"and"refugee."
2
Attachment 12d
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The worksheet will accompany the remaining data.that gets distributed at the end of the month.
Each member will use the worksheet as a tool to help them identify their first and second choice
enrollee groups. Sources that members will use to complete the worksheet are:
9 Needs assessment
0 Survey data
9 Focus group data
rV
9 Knowledge
0 Experience
0 Other handouts
Later in June the full group will consider the enrollee suggestions from each member and will
reach a decision about which enrollee group it will recommend to the Mental Health Director.
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Homework
Study "recommendations"from the community-at-large that were distributed at the beginning of
the meeting.
Next meeting/Agenda
The next meeting will be on May 26, 4-bpm.
Agenda:
• Begin discussing the possible services and supports that could be helpful to adults. This
will help us get a head start on the systems development discussions that will come later,
3
Attachment 12d
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contra Costa County MRSA Planning
Stakeholder Planning Group
Older Adults
Minutes
May 26,2005
Present: Connie Steers, Lisa Bruce,Larry Vaughan, Bettye Randle,John Bateson,Eric Devers,
Ace Hollister,Linda Anderson,Leah Rolnick-Bronstein, Gisela Hernandez,Albert Flanagan,
Javier Nunton, Ken Salonen,Deborah Card, Carlos Torres,Nancy Ebbert, Tim Chon,Karen
Pratt, Steve Hahn-Smith, Kimberly Mayer Steve Ekstrom
Next Meeting: June 9 @ 4—6pm
Assignments:
Each Study all data that will be distributed at the end of May. Use By 6/7/05
member the worksheet(to be distributed with data)to decide on your
top 2 priorities for Full Service Partnership funding; email or
Ifaxyour 2 priorities to Steve Ekstrom
DMH Program and Expenditure Requirements
Kimberly Mayer and Steve Hahn-Smith reviewed the highlights of the new DMH requirements.
DMH made a number of changes to the original document. They included:
• Increased emphasis on client and family direction,peer support efforts and client and
family-run programs
• Greater emphasis on cultural competence
• More appropriate language for children and youth
• Expanded language on statewide outcomes
• Three types of funding
o Full service partnerships(formerly"enrollees")
o System development(formerly"system capacity")
o Outreach and engagement(new category)
• The logic model hasn't changed
• Conservatees are eligible for services under the MHSA,but MHSA funds can't be used
to create more involuntary beds.
Several members expressed concerns that by DMH including"transition-aged older adults,"a
much needed emphasis on older adults(70 years+)might get lost.
1
Attachment 12d
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Kimberly also reminded everyone of the group's assignment:
1. Identify community issues(done)
2. Analyze mental health needs (in process)
3. Identify a group for full service partnership(to be done by mid-June)
4. Identify service and support strategies for developing the system(to be done in July)
5. Submit recommendations to the Mental Health Director(to be done in July)
System development
We began discussing ideas for services and supports.This was an opportunity for members to
inform their peers about different strategies they are aware of.Again,we won't be making
decisions about services and supports we'll recommend until July. Several ideas were presented
and discussed:
• Grief counseling,e.g., loss of family member,or a pet,or ability to function.
• Outreach to find older adults; use multiple resources;use a combination of case
management and direct service; go wherever the person is in the community;outreach
services must be culturally competent.
• Place a full time gero-psychiatrist in a clinic in all three regions. Each gero-psychiatrist's
salary would be covered by MHSA and the Health Services Department which would
help assure that a consumer doesn't have to"identify themselves"at the front door as to
whether they have a health or mental health issue. The gero-psychiatrist would be a
member of amulti-disciplinary team that should have outreach capability and should -�
include as members: nurses,case managers,peers, social workers. There would be
linkages to community-based organizations and in-home supportive services. finally,
there should be follow-up inpatient assessment.
• Senior peer counselors
• Appropriate housing
• Senior support groups that includes caregivers. There should be multi-lingual capability.
• The infrastructure for what we need is already in APS. Use MHSA funding to build on
this foundation.
• We need to look at other efforts so we can collaborate and not duplicate. Other planning
already underway includes: "Every Generation,"and along-term care study group that
includes CA Department of Health Services, Contra Costa County Health Services
Department and Contra Costa County Employment and Human Services Department
(this group has a January 2007 target date for service implementation).
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Homework
Study all the data that will be distributed at the end of May.-Each member should use the sorting
tooUworksheet(to be distributed)to help decide on a full service partnership group they wish to
recommend.
2
attachment 12d
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Next meeting/Agenda
The next meeting will be on June 9,4-bpm.
Agenda:
• The older adult stakeholder planners will decide on the full service partner group it wants
to recommend.
3
Attachment 12d
A-1 91
Contra Costa County MRSA Planning
Stakeholder Planning M eeting
Forum on Family and Intergenerational Issues
Minutes
May 31,2005
Present:
Children's Groo: Kathy Davison, Melinda Dendinger,Jerry Zimmerman,Arlette Merritt,
Brenda Blasingame,Lisa Morrell,Bobbie Arnold
Transition Age Youth Group: Susan Waters, Stuart McCullough,Don Graves,Kathryn
Wade, Colette O'Keeffe,Theo Durden,Katie Roberts
Adult Group: Herb Putnam,Violet Smith,Aimee Chitayat,Anna Lubarov, Veronica Vale,
Connie Steers,Caroline Jackson, Geet Gobind,Bob McKinnon
Older Adult Group: Leah Rolnick-Bronstein,Tim Chon, Connie Steers, Bettye Randle
Observer: Janet Wilson
Staff/consultants: Jay Mahler,John Allen,Lisa Booker,Nancy Frank, Steve Ekstrom
Introduction;purpose of meeting
The idea for this Forum came from at least two stakeholder planning groups, largely in response
to the need to have a dialogue across groups to look at family and intergenerational issues.The
planning for MHSA implementation is organized around age"silos,"yet DMH has stressed the
importance of considering family and intergenerational issues. This Forum was organized to help
each age-related stakeholder group look at this broader context of the MHSA.
The point was made that all of the groups have yet to make decisions regarding enrollee
populations(Full Service Partnership)or services and supports strategies, so the timing of this
Forum is advantageous.
Participants received a handout that showed the focal populations each stakeholder group is
considering for an enrollee population recommendation.Members then introduced themselves.
Why are you here today?
Participants were asked what they hoped to get from the meeting. Responses included:
• The County should work together in a more systematic way; maybe this session will help '�-
make that happen
1
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• The populations we're studying in our stakeholder groups aren't stagnant;they are all
transitioning, so we need to be talking with each other
• So we can look at the full picture
Issues
The remainder of the meeting was devoted to an open-ended discussion of the key issues and
concerns participants had. Comments during this discussion included:
• If kids with SED are symptoms of broken down families,then we need to see that their
parents get help
• Every client comes with a family;we need to focus on the full family
• But we also need to look at the distinct needs of each age group, so that they really
benefit from the MHSA
• Older adults could serve as mentors, for example to transition age youths
• Parents with SMI who have their children removed from them. This is a real problem.
o In most cases it's the mom not the dad
o In-home support services(IHSS)would be of great help
o When a parent is placed in longer-term care,e.g.,over 30 days,the children are
removed and the mother loses custody
o In the reunification process,housing is not adequately considered. For example, an
apartment may be found for a mother,but there's no room for her kid(s)
o If the mother is labeled mentally ill,the custody of the children goes to the husband
• Transition age kids leaving foster care need a committed adult in their life;there should
be a core of mentor volunteers
• We need to start with the newborns of families with problems. An IHSS service that
would focus on helping families raise their newborns in a healthy way would be good
• What about adults who don't want help? Sometimes we(children's services)go into a
house and see a parent who could use help; we'd like to be able to call someone who can
respond. Has the Adult Stakeholder Group looked at this?
• Wrap-around services help the whole family
o It's documented that it works
o But we need more members on the teams
o And we don't have MOUs with agencies that serve adults
o What if a parent needs help,but they are not seriously MI. Maybe this should be a
"prevention and early intervention"service we might want to consider with future
MRSA funding.
• We must remember this about consumers: many are very capable, are stable, and can be
of real help to others
� The silos that DMH has created present a problem.How can we meet DMH"s
requirements and find a service that's holistic and"threads"its way across age groups?
We need to be creative. Wrap-around is real answer to this. It represents a holistic,
strength-based approach to working with families. It's a support blanket.
• Populations may be in silos, but the services needn't be
o Families are the place for integrated services to occur
o Maybe we could develop a"one-stop"approach
• Our county is fragmented; one has to go through many hoops to get help.A thread,e.g.,
wrap-around services,to pull everyone together would be great
2
Attachment 12d
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• But can we add more wrap-around services with MHSA funding?It's not a new service, .._.�
and isn't DMH saying we shouldn't replicate existing services?
• All of the stakeholder groups need to look at innovative approaches
• Some transition age youths are sent to other counties or states to receive services. They
need to come home.
• Also,there are adults and older adults in long-term facilities that may be inappropriately
housed.
• The older adult group is concerned that DMH also wants us to focus on"transition age
older adults"aged 50 through 59. We're concerned this could drain services from much
older adults in their 70s, 80s and 90s. Is the adult stakeholder group looking specifically
at services to 50—59 year olds?
o Maybe we need to look less at the age of a group, e.g., older adults or adults,and look
more at the needs of people. For example,a person could be in their mid-50s,but due
to many circumstances,could have the needs of someone in their 80s.
• We do need to bring people out of isolation,and find meaningful activities for them to
do.
• Insurance, insurance, insurance!
• We need to start programs that can apply to all ages. One example is the Clubhouse, an
approach that has been implemented across the U.S. and internationally. It emphasizes
meaningful activities. Members are encouraged to work, in whatever way they can. It can
be tailored to serve all age groups. We should have one in every region of the County,
• We need to look at the services for each age group, and look at where they can overlap;
or we need to create those overlaps.
• Regarding outreach and enrollment,where will we find populations that are hard to
reach?Primary care clinics are places we can find them.
• There are some models the County has considered, and in some cases attempted to
implement. They are:
o The Parent Project developed at the University of Massachusetts. It's for parents with
SMI, and emphasizes peer support, crisis planning,mental health education for kids,
etc.
o Ashbury House in San Francisco, operated by Progress Foundation. It's for mothers
with SMI—their children live with them in the house helping keep the family intact.
o Pollack Model in Colorado.Among other things it deals with"empty nest" issues,
and focuses on natural support systems
o Hope City model,that focuses on hard-to-place foster care kids
• We need easier community-based access to MH services; for example,when we see
mothers with MI in primary care clinics,maybe we could offer IHSS to them. We need to
be able to co-locate services.
• Rather than start elaborate,complex programs,we should look for simpler solutions and
build on what we already have in place.
Next steps
Participants were encouraged to discuss this Forum at their next stakeholder meetings. They
should make the point that there was considerable interest in thinking creatively to find ways
where there can be overlaps of services. Each group has to think about distinct services for the
ages it represents,but they should also look for ways that those services could impact or involve
other age groups. Even if we start small, if it's innovative, maybe family-oriented, and/or age-
inclusive, it could represent something we could build upon over time.
3
Attachment 12d
A=194
Contra Costa County MHSA Planning
Stakeholder Planning Group
Older Adults
Minutes
June 9,20Q5
S
Present: Tim Chon, Gisela Hernandez, Carlos Torres,, John Bateson,Larry Vaughan,Linda
Anderson, Scott Singley,Ken Salonen,Ace Hollister,Debbie Card,Al Flanagan, Sue Meltzer,
Nancy Ebbert,Karen Pratt, Steve Ekstrom
Next Meeting: June 16 @ 4—6pm
Assignments:
Each Continue to study data for continuing discussion of service Before 6/16/05
member and support strategies
Full Service Partnership
After much conversation,the group agreed to recommend that the County establish a full service
partnership with the following focal population:
Older adults, 60 years of age and up, who are living in the community without adequate
supports and resources(including inadequate insurance). These are the most seriously
disabled consumers, characterized as having complex presentations,, e.g., a serious mental
illness with other factors such as serious medical problems.Also, these older adults,
including older adults from ethnic populations, have not been served by the MH system.
There was interest in the full service partnership recommendations from the other stakeholder
groups. We agreed we should forward each group's recommendations to the other groups.
System development
In a parallel conversation,the group discussed a service strategy that generated a lot of interest. It
was described as a medical clinic-based service in each region of the County.A gero-psychiatrist
would screen each older adult needing services. If they met specific criteria(living in the
community, inadequate supports and resources,complex psychiatric/medical presentation,
unserved by the MH system)then they would be identified as a"full service partner"who would
then be eligible for more intensive services from amulti-disciplinary team. Each clinic would
also have an outreach component similar to the"aging network"that once existed.
1
Attachment 12d
A-195
The group will continue discussing this and other strategies at the next meeting.
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Homework
Continue studying the data that's been distributed. Search through this data.for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on June 16,4-bpm.
Agenda:
• Continue discussion of service and support strategies.
2
Attachment 12d
A-196
Contra costa County MHSA Planning
Stakeholder Planning Group
Older Adults
Minutes
June 16,2005
Present: Bettye Randle,Nancy Ebbert, Scott Singley,Linda Anderson, Ken Salonen,Al
Flanagan, Tim Chon, Debbie Card, Connie Steers, Larry Vaughan,Karen Pratt, Steve Ekstrom
Next Meeting: July 7 @ 4—6pm
Assignments:
Each Continue to study data in preparation for final decisions Before 7/7/05
member regarding recommendations for service&su --- ort strate ies
Service and support strategy: outreach/primary care clinic model
The group continued the discussion from the last meeting regarding a combined outreach and
primary clinic-based model. Members looked at the menu of options from DMH to make sure
that they weren't on the wrong track. It turns out there are several items on DMH's menu older
adults that supports the strategy the group has been discussing.
Continued discussion led to this next iteration of a model the group is interested in. This is an
outreach-driven strategy that would rely on community-based organizations(CBOs)to help
identify older adults who are isolated in their community. Upon identification,a multi-
disciplinary team with multi-cultural capacity would initiate an assessment. Those older adults
who satisfy the criteria for full service partnerships would receive all the benefits of that
partnership. Written treatment plans for full service partners must include afollow-up
component. But the outreach service is not limited to full service partners, as others could also
receive assistance, although not at the intensity of full service partners.
The outreach team would be based out of regional primary care clinics and would work closely
with those clinics. However, it is understood that not all consumers will want to receive services
at a clinic;therefore the outreach team will provide assistance at the consumer's residence or
some other community location. Thus a person can be treated in the manner and location that's
most appropriate.
The outreach team would be composed of at least the following members, all trained in
geriatrics:
• MH social worker;team leader
1
Attachment 12d
A-197
• Public health nurse
• MD
Consumer and family peers who are well-versed in the recovery model
• CBO representative,to provide cultural and/or language competency
The team will have a range of resources available to it, including:
0 Pharmacist(from the clinic)
9 Gero-neuropsychologist
9 CBOs
0 Interpreter pool from Contra Costa.Health Services
0 First responders (police, churches,neighbors,recovery groups, etc.)
9 Inpatient treatment
The group identified the aspects of this strategy that were of the highest priority. Without these
high priority items the strategy would not be effective. These items are:
• One individual, at a program chief level,to oversee the countywide service
• Outreach teams
• Primary clinic partners
Other aspects of the strategy that were discussed included:
• Centralized, customer-friendly access
• A cash-on-hand,"make it work"fund that could be used to assist a consumer with
immediate needs, e.g.,transportation
• To the greatest extent,the outreach team should use existing resources, e.g.,housing,
transportation. MOUs with other agencies may have to be developed.
The question was asked whether this strategy embraces recovery principles. The response was
that it does because 1)the consumer has a voice in their plan, 2) it has AB 2034 and wrap-around
qualities, 3) it's client-centered, and 4) it relies on culture, attitude and language competencies to
enhance recovery.
Other strategies
There was insufficient time to discuss other strategies other than to mention some the group
wants to discuss. These included:
• Multi-service,consumer-run centers
• Affordable housing
• Supported housing
• Transportation
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services --�
0
Older adults with Medi-Care aren't getting services
0 Clarify the fuzzy lines between included and excluded diagnoses
2
Attachment 12d
A=198
Homework
Continue studying the data that's been distributed. Search through this data.for service and
support strategies that our community constituents are interested in.
Next meeting/Agenda
The next meeting will be on July 7,4-bpm.
Agenda:
• Continue discussion of service and support strategies
• Develop recommendations for service and support strategies
3
Attachment 12d
A-1 99
Contra Costa County MHSA Planning ---�
Stakeholder Planning Group
Older Adults
Minutes
July 7,2005
Present: Al Flanagan, Ace Hollister, Bettye Randle, Carlos Torres, Gisela Hernandez, Ken
Salonen, Larry Vaughan,Leah Rolnick-Brunstein, Linda Anderson,Nancy Ebbert, Scott
Bingley, Tim Chon Karen Pratt, Steve Ekstrom
Next Meeting: July 21 *4—6pm
Assignments:
Each Be prepared to discuss our recommendation-s with the Mental 7/21/05
member -Health Director
Systems development—service and support strategies
The group reexamined the strategy it had worked on at the last meeting and made some
revisions. That strategy,which was approved by the group, now reads:
This is an outreach/engagement/community education strategy that would rely on community-
based organizations(CBOs)to help identify older adults who are isolated in their communities.
Upon identification,a multi-disciplinary team with multi-cultural capacity would initiate an
assessment. Those older adults who satisfy the criteria for full service partnerships would receive
all the benefits of that partnership. Written treatment plans for full service partners must include
a follow-up component. But the outreach/engagement service is not limited to full service
partners, as others could also receive assistance, although not at the intensity offu 11 service
partners.,
The outreach team would be based out of regional primary care clinics and would work closely
with those clinics. This partnership with primary care clinics is for a specific reason: older adults
present complicated medical and psychiatric interactions that are difficult to evaluate and treat.
The partnership with clinics allows for more thorough assessment and treatment.Also,primary
care clinics are settings that older adults are likely to access and accept care, given that they
don't often readily define their problem as psychiatric.
However, it is understood that not all consumers will want to receive services at a clinic;
therefore the outreach team will provide assistance at the consumer's residence or some other
community location. Thus a person can be treated in the manner and location that's most
appropriate.
1
Attachment 12d
A=200
The outreach team would be composed of at least the following members,all trained in recovery
principles/practices and in geriatrics:
• MH social worker;team leader
• Registered Nurse
MD
• Consumer and family peers who are well-versed in the recovery model
• CBO representative,to provide cultural and/or language competency
The team will have access to a range of resources including:
• CBOs
• Interpreter pool from Contra Costa Health Services
• First responders(police,churches,neighbors,recovery groups,etc.)
• Gero-neuropsychologist
• Pharmacist(from the clinic)
• Inpatient treatment
The group identified the aspects of this strategy that were of the highest priority. Without these
high priority items the strategy would not be effective. These items are:
• One individual, at a program chief level,who is dedicated to geriatric services and who
would oversee the countywide service, and provide linkage with other agencies providing
services to older adults
• Outreach teams
• Primary clinic partners
Other aspects of the strategy include:
• Funding for the provision of MH education and advocacy to increase community
awareness of services available and to help de-stigmatize mental illness; CBOs, faith-
based organizations are examples of organizations that could provide this
• Centralized,customer-friendly access
• A cash-on-hand,"make it work"fund that could be used to assist a consumer with
immediate needs,e.g.,transportation
• To the greatest extent,the outreach team should use existing resources,e.g.,housing,
transportation. MOUs with other agencies may have to be developed.
• Clinical staff on outreach teams and in primary care clinics should be partially funded by
the County's Health Services Department as a way of embedding the services in the
system
Other strategies embraced by the group are:
� Affordable, supportive housing
• Adult day activity centers,possibly using existing programs which would need to be
made more accessible to older adults with SMI.Features of these centers include:
o Recovery-based services
2
Attachment 12d
A-201
o Peer counseling -----_
o Transportation services
o Support groups
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Advisory Committee
The MH Director has requested that each stakeholder group name 4 members to a Stakeholder
Advisory Committee.This Committee will most likely conduct its work after Labor Day.It's
purpose is to review and comment on the first draft of the County's proposal to State DMH.
Criteria for selecting members are: 1 Consumer, 1 family member, 1 MH service provider
(County or CBO)and 1 from the community-at-large.In addition,the Advisory Committee
needs to be diverse and representative of all regions.Advisory Committee members will
represent their Stakeholder Group and the recommendations they've made.Their role is not to
represent individual interests.
The following members were nominated or indicated interest:
Consumer:
• Larry Vaughan(west county)
Family member:
• Bettye Randle(west county)
MH service provider:
• Nancy Ebbers
Community partner:
• Debbie Card(county-wide)
• Ken Salonen(alternate, if Debbie declines)
Members not at this meeting who are interested in being on the Advisory Committee should
contact Steve by email before July 18. We will finalize membership on the Advisory Committee
at the last meeting,July 2 1.
Parking lot
• Lack of treatment/care for people with dementia
• Lack of integrated services
• Older adults with Medi-Care aren't getting services
• Clarify the fuzzy lines between included and excluded diagnoses
Next meeting/Agenda
The next and last meeting will be on July 21,4-bpm.
Agenda:
• Agree on Advisory Committee members
• Discuss recommendations with the MH Director
3
Attachment 12d
A-202
contra Costa bounty MHSA Planning
Stakeholder Planning Group
Older Adults
Minutes
July 21,2005—Last Meeting
Present: Larry Vaughan, Connie Steers,Nancy Ebbert, Debbie Card, Sue Meltzer, Leah Rolnick
Brunstein, Linda Anderson,Al Flanagan,John Bateson,Ken Salonen, Carlos Torres,Tim Chon'.
Gisela Hernandez, Scott Singley, Karen Pratt,Donna Wigand, ,Vic Montoya,Kimberly Mayer
Nancy Frank, Steve Ekstrom
Advisory Committee
The group discussed who would represent the Older Adult Stakeholder Group on the Advisory
Committee. This Committee will review the draft plan before it is submitted to the Mental Health
Commission,and may be involved in other activities such as plan preparation,post-DMH revisions,
etc. Members voted and the following representatives were selected:
• Larry Vaughan(consumer)
• Bettye Randle(family member)
• Nancy Ebbert(MH service provider)
• Debbie Card(community partner)
These members should represent the work/recommendations of the Older Adult Stakeholder Group,
and not individual interests. They should be prepared for asix-month commitment.
(Later when Donna Wigand joined the group she indicated that she might want to form another
Committee in 2006 to advise on implementation of MHSA-funded services.)
Recommendations to the MH Director
Next,there was a discussion between members and Donna about the Group's recommendations.
Topics discussed included:
• How the Community Issues were arrived at
• How to reach unserved populations
• How to implement the recommended strategies
• Which primary care clinics to start with
• How an outreach team would function
• How to avoid duplication of existing services; how to link with them
• Leveraged funding
1
Aftachment 12d
A-203
• Using existing senior peer counselors
• Transportation
• Cash-on-hand,"make it work"funds
• Housing and the use of existing resources/partners
• Meaningful activities and the use of existing senior centers
• Co-occurring(MH/AOD) issues
Housing
Donna also pointed out that the newly formed MHSA Oversight and Accountability Commission is
considering the feasibility of using a portion of capital investment funds to leverage a federal
housing bond.They're also looking at using some of each county's allocation for this purpose.
And Finally...
There will be a"Thank You Celebration"to acknowledge the hard work of all stakeholder group
members. This party will be held on July 27thfrom 4:00 to 6:00 p.m.at Marie Callender's,2090
Diamond Boulevard in Concord. Donna thanked the Older Adult Stakeholder Group members for all
their hard work,and encouraged them to join her and the other stakeholder groups in this informal
celebration.
2
Attachment 12d
A-204
APPENDIX
Older Adult Stakeholder Group Recommendations
3
Attachment 12d
A-205
Contra Costa County MHSA Planning
Older Adult Stakeholder Planning Group
Recommendations
Community Issues
For older adults with serious mental illnesses,there is a dynamic between"unnecessary loss of
ability to function,"(lack of resources available that results in a downward spiral)and"isolation."
Either of these two issues can stimulate the other, and they are exacerbated by lack of
transportation, lack of case management services, language barriers,and discrimination based on
age/race/alternative life styles. From isolation/unnecessary loss of ability to function follows a
cascade of secondary problems such as: inability to attend to health care needs; inability to care
for one's self; inability to work; substance abuse; and hopelessness. Common outcomes of this
pattern are institutionalization and homelessness.
Full Service Partnership
The Older Adult Stakeholder Group recommends for Full Service Partnership,older adults, 60 ...-..,._
years of age and up,who are living in the community without adequate supports and resources
(including inadequate insurance). These are the most seriously disabled consumers,characterized
as having complex presentations,e.g.,a serious mental illness with other factors such as serious
medical problems.Also,these older adults, including older adults from ethnic populations,have
not been served by the MH system.
Service and Support Strategy
The first strategy is viewed as a priority strategy and offers a methodology for identifying full
service partners.
1. This is an outreach/engagement/community education strategy that would rely on
community-based organizations(CBOs)and other services/resources(e.g.,APS,primary
care clinics,PES, inpatient psychiatry)to help identify older adults who are isolated in their
communities.Upon identification,amulti-disciplinary team with multi-cultural capacity
would initiate an assessment. Those older adults who satisfy the criteria for full service
partnerships would receive all the benefits of that partnership. Written treatment plans for
full service partners must include afollow-up component. But the outreach/engagement
service is not limited to full service partners,as others could also receive assistance,
although not at the intensity of full service partners.
4
Attachment 12d
A-206
The outreach team would be based out of regional primary care clinics and would work
closely with those clinics. This partnership with primary care clinics is for a specific
reason: older adults present complicated medical and psychiatric interactions that are
difficult to evaluate and treat..The partnership with clinics allows for more thorough
assessment and treatment.Also,primary care clinics are settings that older adults are likely
to access and accept care, given that they often don't readily define their problem as
psychiatric in nature.
However, it is understood that not all consumers will want to receive services at a clinic;
therefore the outreach team will provide assistance at the consumer's residence or some
other community location. Thus a person can be treated in the manner and location that's
most appropriate.
The outreach team would be composed of at least the following members,all trained in
recovery principles/practices and in geriatrics:
• MH social worker(team leader)
• Registered Nurse
• Psychiatrist
• Consumer and family peers who are well-versed in the recovery model
• CBO representative,to provide cultural and/or language competency
The team will have access to a range of resources including:
• CBOs
• Interpreter pool from Contra Costa.Health Services
• First responders(police,faith communities,neighbors,recovery groups,etc.)
• Gero-neuropsychologist
• Pharmacist(from the clinic)
• Inpatient treatment
This strategy will not succeed without certain critical elements. These elements are:
• A dedicated Program Chief solely for geriatric services who would oversee the
countywide service,and provide linkage with other agencies providing services to
older adults
• Outreach teams
• Primary care clinic partners
Other aspects of the strategy include:
• Funding for the provision of MH education and advocacy to increase community
awareness of services available and to help de-stigmatize mental illness; CBOs,
faith-based organizations are examples of organizations that could provide this
• Centralized,customer-friendly access
5
Attachment 12d
A4=207
• A cash-on-hand,"make it work"fund that could be used to assist a consumer with
immediate needs,e.g.,transportation
• To the greatest extent,the outreach team should use existing resources,e.g.,
housing,transportation. MOUs with other agencies may have to be developed.
• Clinical staff on outreach teams and in primary care clinics should be partially
funded by the County's Health Services Department/Hospital and Clinics as a way
of embedding the services in the broader health care system
2. Affordable, supportive housing
3. Adult day activity centers,possibly using existing programs which would need to be made
more accessible to older adults with SMI. Features of these centers include:
• Recovery-based services
• Peer counseling
• Transportation services
• Support groups
6
Attachment 12d
A-208
Contra Costa County MRSA Planning
Children's Stakeholder Planning Group
Recommendations
Community Issues
Reductions in funding to children's mental health services over the last
several years have created a critical situation. Existing services are limited
and many have long waiting lists. It is in this context that we plan for the
MRSA.
When it becomes obvious to health and other professionals, and possibly to
parents/caregivers, that a child or adolescent is having problems functioning
safely and productively in his/her home, learning environment and/or
community, it can be assumed that the child has serious social, emotional or
physical needs that are inadequately met. Healthy functioning and reasonable
growth in the home and in the learning environment are the best indicators
that a child will develop into a healthy and productive young adult.
When health professionals and educators assist families in meeting the
social, emotional and physical needs of their children, the community in
general is a happier and healthier place for all of us.
Full Service Partnership
The Children's Stakeholder Group recommends for Full Service Partnership,
unserved children, 0-18 years of age, who have a history of repeated failure
in learning environments. These environments include home, childcare,
preschool and school. In addition, these children are from families who are at
or below 300% of poverty and are not eligible for other funding sources.
Finally, those with one of more of the following risk factors should be given
priority:
• Multiple foster care or family caregiver placements
• Limited English proficiency
• High-risk parents or community
• Populations whose cultural differences have historically precluded
them from MH services
• Out-of-norm trauma
• Substance abuse
• Experience with the juvenile justice system
• PES visits
Aftachment 13a
A-209
Service and Support Strategies
Inherent in the following strategies is cultural competence. The wrap around
strategy (#1)was developed with the Full Service Partnership in mind, but it is
not limited to this group. These strategies are not listed in any priority order:
1. Wrap around service that has, but is not limited to, the following
characteristics:
o Involve families, and create age and development-appropriate
treatment plans
o Maximize the use of existing community resources and individuals,
e.g., help with translation; help with identifying kids/families and with
access
o Where feasible, services are delivered to groups; train family and
community members to facilitate family support groups
o Nurses in hospitals identify families they're concerned about
o Home visits for infant/parent therapy
o Provide services where the kids and families are (don't require clinics
as the only place where services are delivered, e.g., schools, family
resources centers, child care centers, CBOs)
o Employ evidence-based clinical best practices; also employ practices
tailored to each family's specific needs �
o Fiscally sound services that are leveraged to the greatest extent
possible
o Assure coordination with existing resources outside of MH system,
e.g.,
■ Child welfare
■ First Five Home Visiting Program
■ Faith communities
■ Zero Tolerance for Domestic Violence
■ Asian Pacific Psychological Services
■ AOD services
2. Mobile crisis response
3. School and community-based services
4. Parent and Youth Partners (peer support strategies)
5. Outreach and early identification with the following features:
o Use of non-traditional approaches
o Community engagement and education targeted at unserved
populations (e.g., use community leaders, case managers,
interpreters)
Attachment 13a
2
A-210
Cancra Costa County MRSA Planning
TA Youth Stakeholder Planning Group
Recommendations
Community Issues
There are three core issues: homelessness, incarceration and
hospitalization/involuntary care. These are difficult to separate as involvement
in any one can lead to involvement in another. Then a ripple effect occurs.
Youths who are homeless, incarcerated and/or hospitalized stand a very good
chance of having difficulty in regular school settings or holding a job.
Additionally, the likelihood of being placed in foster care or a group home is
increased.
Full Service Partnership
The Transition Age Youth Stakeholder Group recommends for Full Service
Partnership, transition age youth, 16-25 years of age, with serious emotional
disturbances and/or severe mental illnesses, who are homeless or at
imminent risk of homelessness.
There are many associated risk factors. Depending on the availability of
funding, these factors may need to be taken into account to determine which
youths would be considered for full service partnership benefits. These risk
factors are:
• Dual diagnoses (SED with AOD, developmental disability, or head
injury)
• Psychoses
• Exposure to violence (community, domestic)
• Under educated
• Immigrant status
• Non-English speaking
• LGBT
• In the juvenile justice system
• Living with parents who are seriously mentally ill
• Jobless
• History of 5150s
• In, or has been in, foster care system
• Unable to get appropriate medications
Attachment 13b
1
A-21 1
Service and Supp rt Strategies
When considering the recommended strategies below, the following principles
should be kept in mind:
o With limited funding we need to spend wisely
o Sustainability- i.e., whatever is developed needs to be sustainable
over time, with MRSA funds, leveraged funds or funds from other
partners
o Mainstreaming, i.e., use/partner with existing systems of care
o A full continuum of services is necessary to help homeless youths
o Exit strategies (from the system) need to be a component of all
individual plans
The Transition Age Youth group recommends the following strategies for full
service partners and other youths in the MH system:
1. Contra Costa County should have a full continuum of housing services in
all regions of the County that includes emergency shelters, transitional
housing, and permanent housing. To achieve this will require developing
service and funding partnerships, e.g., with local providers, the Federal
Department of Health and Human Services/Administration of Children and
Family Services, etc. MRSA funds should be used to provide services for
TA Youths in these various levels of housing, but should not be used to
develop housing.
The goal will be to have, in each region, a sufficient number of emergency
beds/interim housing with a MH crisis component (using Federal DHHS
funding for 16 & 17 year olds), 2 transitional homes (maximum 6 beds)
and more vouchers for permanent housing. In emergency shelters and
transitional homes, mixing populations (e.g., SED/SPMl with other youths)
should be considered as well as the special needs and legal requirements
for 16 and 17 year olds.
A key to this housing strategy will be to maximize flexibility, meaning there
is "no wrong door" to getting easy access to needed services. There
should be multiple points of entry that would involve:
• Multi-disciplinary mobile outreach/engagement team(s)with the
following attributes:
o Peer counseling
o Cultural competence (including language, values, youth-
friendliness)
o Access to all geographic regions
Attachment 13b
2
A-212
0 5150 capacity
o Trained in MH/AOD issues
o Direct access to emergency shelters
• First responders including 5150-certified personnel
• PES
• Foster care providers
• Schools and other venues where youths are turning 18
Throughout the housing continuum youths should have an array of
services available to them. The location for providing these services
should be based upon what's best for each individual and may include
shelter, house, school, youth centers, etc. These services should include:
• Case management per MHSA's definition for full service
partnerships (consider using alternative language such as wellness
coach or navigator instead of case manager)
• Life skills training
• Substance abuse training and counseling
• Information about and referral to existing community services and
systems
• Peer support, with an eye towards developing peer as staff
• Consumer mentoring program
• Crisis intervention
• Pro-active check-in
• Counseling services for families and significant others
• Benefits counseling
• Legal services
• Assistance with preparing advanced directives
• Access to educational venues, e.g., community colleges
• Vocational training and placement
• Transportation
2. Outreach strategies to identify youths in serious need of MH services.
These should include:
• Supporting youths before they reach 18 years of age and leave the
children's MH system
• Public relations efforts aimed at suicide prevention
3. Engagement strategy:
• Wellness and recovery centers in existing community locations that
rely on peer counselors and peer support to promote recovery.
These centers would provide, among other things, day activities,
learning experiences, recreation, etc.
Attachment 13b
3
A-213
Contra Costa County MRSA Planning �
Adult Stakeholder Planning Group
Recommendations
Community Issues
The goal for adults with serious mental illnesses should be to achieve their highest
possible level of personal independence. Specifically, this means:
• Achieving the highest level of independent housing possible
• Engagement in meaningful activity, including employment
• Participation in, and a sense of belonging to, the community, i.e., becoming
an equal member of society
But due to a lack of appropriate integrated services at the time people need them,
the major impacts on adults with serious psychiatric disabilities are:
• An inabili!y to financially support themselves or access benefits,
• Isolation due to the effects of mental illness and discrimination, and
• Homelessness or inappropriate housing.
Any one of these can initiate a cycle that leads to the others. Common outcomes are
incarceration and/or institutionalized care without integrated services and a
continuum of supports.
Full Service Partnership
The Adult Stakeholder Group recommends for Full Service Partnership, adults with
serious and persistent mental illnesses who are homeless (i.e., having no shelter).
Full service partnerships should be countywide and culturally diverse. Every effort
should be made to treat homeless families as a unit without breaking them up.
Risk factors, which may be taken into account to help determine who will receive
FSP services, are:
• Alcohol and other drug abuse and dependency
• Serious medical issues
• Limited English proficiency
• History of incarceration or institutionalization
Service and Support Strategv
This strategy represents a systems transformation approach that calls upon the
creative realignment and redesign of existing services as well as the introduction of
new programs based on emerging best practices. The strategy also promotes the
leveraged use of new funds wherever possible.
The guiding principles of this strategic approach are:
Attachment 13c
1
A-214
• Recovery values and principles
• Consumer-driven services
• Choice
• Harm reduction
• Keeping families intact
• Sustained services until a person is ready to exit
At its core, this strategy calls upon agencies and individuals to propose how to make
the best use of MHSA funds (e.g., developing collaborative relationships with MH
and other systems, leveraging funds, etc.)to accomplish improvements in people's
lives in the areas of housing, involvement in meaningful activities, and fuller
participation in their communities, i.e., individuals achieving their highest level of
personal independence. Proposals should address two specific components:
1. Attitudinal, e.g.,
o Cultural competence
o Recovery
o Consumer involvement in all aspects
o Consumer-driven services
o Integration, i.e., the extent to which existing resources and systems are
included. This might include law enforcement, social services, education
to name a few
o Education and training of staff
o The extent to which real systems transformation is likely to occur.
(Systems transformation is a process of the system's recovery, i.e.,
unlearning the old ineffective methods and embracing the inclusion of
emerging recovery-based practices.)
2. Services, e.g.,
o Stable, affordable housing
o Meaningful day activities
o Mobile crisis
o Integrated services with: 1) Personal Services Coordinators, 2) multi-
disciplinary outreach teams that provide follow-up, include consumer
providers and are culturally appropriate to the individuals being served,
and 3) strong ties in the community and reliance on CBOs.
o Anti-stigma/Community Education campaign
Proposals would be evaluated based on factors such as cost efficiency, innovation,
use of best practices, likelihood of achieving systems transformation, and adherence
to the principles cited above. Collaborations of agencies and individuals are strongly
encouraged.
Ideally an independent group - possibly a group from outside the county-would
evaluate proposals. This group would need to be neutral, objective, not invested in
the outcome, culturally diverse and well grounded in recovery values and principles.
However, if proposals are reviewed internally, the_review panel should have
members with these characteristics.
Attachment 13c
2
A-215
Contra Costa County MH A Planning ----
Older Adult Stakeholder Planning Group
Recommendations
Community Issues
For older adults with serious mental illnesses, there is a dynamic between
"unnecessarYloss of ability to function" (lack of resources available that results in a
downward spiral) and "isolation." Either of these two issues can stimulate the other,
and they are exacerbated by lack of transportation, lack of case management
services, language barriers, and discrimination based on age/race/alternative life
styles. From isolation/unnecessary loss of ability to function follows a cascade of
secondary problems such as: inability to attend to health care needs; inability to care
for one's self; inability to work; substance abuse; and hopelessness. Common
outcomes of this pattern are institutionalization and homelessness.
Full Service Partnership
The Older Adult Stakeholder Group recommends for Full Service Partnership, older
adults, 60 years of age and up, who are living in the community without adequate
supports and resources (including inadequate insurance). These are the most
seriously disabled consumers, characterized as having complex presentations, e.g.,
a serious mental illness with other factors such as serious medical problems. Also,
these older adults, including older adults from ethnic populations, have not been
served by the MH system.
Service and Support Strateav
The first strategy is viewed as a priority strategy and offers a methodology for
identifying full service partners.
1. This is an outreach/engagement/community education strategy that would
rely on community-based organizations (CROs) and other services/resources
(e.g., APS, primary care clinics, PES, inpatient psychiatry)to help identify
older adults who are isolated in their communities. Upon identification, a
multi-disciplinary team with multi-cultural capacity would initiate an
assessment. Those older adults who satisfy the criteria for full service
partnerships would receive all the benefits of that partnership. Written
treatment plans for full service partners must include afollow-up component.
But the outreach/engagement service is not limited to full service partners, as
others could also receive assistance, although not at the intensity of full
service partners. .�--...
The outreach team would be based out of regional primary care clinics and
would work closely with those clinics. This partnership with primary care
Attachment 13d
1
A-216
clinics is for a specific reason: older adults present complicated medical and
psychiatric interactions that are difficult to evaluate and treat. The partnership
with clinics allows for more thorough assessment and treatment. Also,
primary care clinics are settings that older adults are likely to access and
accept care, given that they often don't readily define their problem as
psychiatric in nature.
However, it is understood that not all consumers will want to receive services
at a clinic; therefore the outreach team will provide assistance at the
consumer's residence or some other community location. Thus a person can
be treated in the manner and location that's most appropriate.
The outreach team would be composed of at least the following members, all
trained in recovery principles/practices and in geriatrics:
• MH social worker(team leader)
• Registered Nurse
• Psychiatrist
• Consumer and family peers who are well-versed in the recovery model
• CBO representative, to provide cultural and/or language competency
The team will have access to a range of resources including:
• CBOs
• Interpreter pool from Contra Costa Health Services
• First responders (police, faith communities, neighbors, recovery
groups, etc.)
• Gero-neuropsychologist
• Pharmacist (from the clinic)
• Inpatient treatment
This strategy will not succeed without certain critical elements. These
elements are:
• A dedicated Program Chief solely for geriatric services who would
oversee the countywide service, and provide linkage with other
agencies providing services to older adults
• Outreach teams
• Primary care clinic partners
Other aspects of the strategy include:
• Funding for the provision of MH education and advocacy to increase
community awareness of services available and to help de-stigmatize
mental illness; CBOs, faith-based organizations are examples of
organizations that could provide this
• Centralized, customer-friendly access
Attachment 13d
2
A-217
• A cash-on-hand, "make it work"fund that could be used to assist a .r-...
consumer with immediate needs, e.g., transportation
• To the greatest extent, the outreach team should use existing
resources, e.g., housing, transportation. MOUs with other agencies
may have to be developed.
• Clinical staff on outreach teams and in primary care clinics should be
partially funded by the County's Health Services Department/Hospital
and Clinics as a way of embedding the services in the broader health
care system
2. Affordable, supportive housing
3. Adult day activity centers, possibly using existing programs which would need
to be made more accessible to older adults with SMI. Features of these
centers include:
• Recovery-based services
• Peer counseling
• Transportation services
• Support groups
Attachment 13d
3
A-218
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CONTRA COSTA 1340 Arnold Drive,Suite 200
Martinez, California
MENTAL H F.ALTH
94553
-5149
P
COMMISSION h(925)957
Fax(925)957-5156
CONTRA COSTA '~`
HEALTH SERVICES
MENTAL HEALTH SERVICES ACT DRAFT PLAN PUBLIC HEARING
Hosted by the Contra Costar County Mental Health Commission
Wednesday,December 7,2405 . 2:00-5:00 p.m*
Board of Supervisors Chambers # 651 Pine Street, l'`Floor,Martinez
Yhe Mental Health Commission will provide reasonable accommo&Wonsfor persons with disacbilities
planning to parWc4we in this Public Hewing who contact F...xecufive Amistmt Karen Shuler at leasl 48
hrs,obefore the meeting at 925-957-5149. Anyonein need of special languarg+e or sign language
interpretation, are requested to contact a staff member prior to the begiMning of the meeting.
AGENDA
1. Call to Order/Introductions: Scott Singley, C Mental Health Commission
2. Authority for the Public Hearing.
Welfare &Institutions Code 5848. b) The mental health board established pursuant to Section
5604 shall conduct a public hearing on the draft plan and amual updates at the close of the 30-
day comment period required by subsection(a),
3. Ground Rules for the Public Hearing
a) COURTESY AND RESPECT for the time and opinions of others are required. -'�
b) PERSONS WISHING TO SPEAK must complete the Public Comment Form and be called '
order,
c) C0MIlVIEEN'f S ARE LIMITED to expression of support, opposition, suggested changes,
additions, or deletions pertaining to specific sections, heading and page number items.
d) FOCUSED, CONSTRUCTIVE CRITICISM will be accepted;unfocused, negative personal or
is *us
professional comments or opinions will u not be allowed.
e) OFF.-TOPIC STATEMENTS will not be given time;the Chairperson will stop the speaker in
the event of inappropriate comments.
f) ANY SPEAKER providing a written record of his/her verbal comments made during the
hearing should provide two copies to assure that the information is recorded accurately.
g) DISCUSSION about the planning process will not be considered. Proposed legislative
iang or adivocacy forrosed legislation win not be accepted, nor will general concerns
pI"
about California's mental health system. Those comments be addressed to the
. +A%0+0+4&
appropriate legislative bodies or departments.
LCSW,,Mental Health Director
4. Overview of the MHSA Draft Plan: Donna Wigand,
5. Public Comment Period. In the interest of time and equal opportunity, speakers are requested to
observe a 3-minute change at the discretion of the Chairperson). Thosetime limit(subject to ch""..."
wishing to speak will please complete the Public Comment Request Form and place it irm the box
next to the podium.
6. Next Steps. �'``_
7. Adjournment.
The Mental Health Commission has a dual misssion:
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 with dignity and respect;and,
Second,to be the advocate with the Board of SuIwrvisors,the Mental Health Division,and the community on behalf of all Contra Costa
residents who are in need of mental health serywes. Attachment 17
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Mental health fund blueprint is announced Page 1 of 2
CONTRA COSTA TIMES
Posted on Mon. Nov. 21, 2005
Mend health fund blueprint Is announced
By Sara Steffens
CONTRA COSTA TIMES
After nearly a year of work, Contra Costa and Alameda counties have released puns for spending millions of new tax dollars earmarked for
mental health services.
The hefty reports recommend a range of programs and services, including major efforts to target the needs of mentally ill homeless people
and young people leaving foster care or juvenile hall.
"This is a step to start creating services for people who have been unserved in the past,"said Kimberly Mayer, project manager for
Proposition 63 planning in Contra Costa. "It's acknowledged how underfunded this public mental health system has been for a long time."
Passed by California voters last November, Prop 63 collects a 1 percent tax on personal income over$1 million and dedicates to money to
improving mental health services.
Statewide,the act is expected to generate $683 million annually, but some of the money is reserved for capital expenses.
This year, Contra Costa will get$7.1 million from the act to fund new programs and services,adding to a mental health budget of$100
million.
imeda County will add$11 million,compared with a $230 million annual mental health budget.
That's nowhere near enough to radically transform everything, so the money must be carefully directed, planning participants agree.
"The amount is very small given the mental health needs of the community,"said Sohn Bateson of the Crisis Center of Contra Costa. "It's
not the be-all and end-all. But... it's the first new funding that's come down the pike in mental health in years,and for that reason it's
very important."
Counties across the state have spent much of the year following a state-mandated process to decide how to spend their share of the
money.
State officials encouraged local planning teams to find ways to reduce the fallout of untreated mental illness, including homelessness,
incarceration,frequent emergency room visits and institutionalization.
Contra Costa's recommendations aim to reach hundreds of people with unserved mental health needs.
Three new full-service programs will provide treatment and wide-ranging support, also known as wrap-around care,to:
* Children from lower-income families in far East County.
*West County youths age 16 to 25 with psychiatric disabilities who are homeless or about to become homeless.
* Homeless adults in West County with serious, persistent mental illness.
Eventually,the county hopes to expand the programs to other areas, Mayer said, but limited funding forced a focus on locations where
services are most needed.
East County cities such as Brentwood and Oakley, for instance, remain separated from family mental health programs by an hour's
Mayer said.
And West County is home to an estimated 47 percent Contra Costa's homeless people.An outreach team will visit outdoor encampments
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Mental health fund blueprint is announced Page 2 of 2
to connect people and try to link them with supportive housing and treatment.
A fourth program will focus on the mental health needs of older adults throughout Contra Costa,,with the help of assessment teams
assigned to county hospitals and clinics.
The report also recommends using Prop 63 dollars to house people with mental illness., both in new supportive housing and transitional
living centers and in existing emergency shelters and treatment programs.
'The No. 1 issue that came from all of our community input was the need for a full range of housing,,"said Mayer. "And we know that.a
housing-first model can support people long-term with recovery."
Finally, new employees will be added to existing programs that help Contra Costa consumers and their families navigate the mental health
system.
Alameda County's plan hits similar themes,, including outreach to homeless people with persistent mental illness.,wrap-around services far
at-risk youths leaving foster care,jail or treatment, and a screening program to Identify mental health needs of older adults seeking care
in emergency rooms and clinics.
Another set of recommendations strives to end repeat incarceration of adults with severe mental illness by staffing Alameda County
courthouses with mental health specialists and coordinating conditional release programs with treatment and other services*
Smaller initiatives would add bilingual staff members to public clinics,, expand crisis response services in the Tri-City and Tri-Valley areas,
and create support centers for mental health clients and their families.
Sara Steffens covers social services. Reach her at 925-943-8048 or ssteffens@cctimes.com.
How to respond
Contra Costa County's plan for new mental health services can be found online at cchealth.org and in print at public libraries.
To request a copy, e-mail mhsahsd.co.contra-costa.ca.us or call 925-957-5151.
A public hearing on the plan has been set for 2-5 p.m. Dec. 7 at the Board of Supervisor's Chamber,, 651 Pine St. in Martinez.
Written comments may be sent before Dec. 7. Mail to the Contra Costa Mental Health Commission,, 1340 Arnold Drive 200 Martinez 94553,
fax to 925-957-5156, or e-mail to mhsa@hsd.co.contra-costa.ca.us.
Alameda County's plan can be found online at acbhcs.org.A series of public hearings have been set to gather public comment:
* 2-4 p.m. Dec. 12 at the Livermore Public Library, 1880 S. Livermore Ave.
*7-9 p.m. Dec. 12 at the San Leandro Public Library,, 300 Estudillo Ave,
* 2-4 p.m, Dec. 13 at the Oakland Masonic Center,, 3903 Broadway.
*7-9 p.m. Dec. 13 at the Fremont Public Library
Written comments may be sent until Dec. 12. Mail to MHSA,, 2000 Embarcadero Cove,, Oakland CA 94606,, or
mhsa@bhca.mail.co.alameda.ca.us.
C)2(W;ContraCostaTimes.com and wire sen,-ice sources.All Rights Reserved.
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