Imperial County Behavioral Health Services

This painting was created by a group of ten consumers in approximately eight hours. Each of the hidden figures (heart, star, cylinder, hand, square, circle) in the painting has a meaning to the participant who painted it.

Mental Health Services Act Annual Update Fiscal Year 2013-2014

Table of Contents

MHSA County Fiscal Accountability Certification . . . . . . . . . . . . . . . . . . . . . . .

1

Stakeholder Planning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

MHSA Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

Annual Update Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

Implementation Progress Report by Component . . . . . . . . . . . . . . . . . . . . . . .

7

Community Services and Supports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Full Service Partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Ward Access to Services and Supports Program . . . . . . . . . . . . . . . . . .

7

Transition-Age Youth-Supportive Transitional Services Program . . . . . .

13

Jail Supportive Transitional Services Program . . . . . . . . . . . . . . . . . . . .

18

Senior Access to Support and Services Program . . . . . . . . . . . . . . . . . .

21

Dual Disorders – Integrated Supportive Treatment Services Program . .

23

General Systems Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

Recovery Center Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

Outreach and Engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32

Outreach and Engagement Program . . . . . . . . . . . . . . . . . . . . . . . . . . .

32

Transitional Engagement Supportive Services Program . . . . . . . . . . . .

35

Prevention and Early Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38

Workforce Education and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Capital Facilities and Technological Needs . . . . . . . . . . . . . . . . . . . . . . . . . .

49

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

53

MHSA Funding Summary FY 2013/14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

MHSA COUNTY FISCAL ACCOUNTABILITY CERTIFICATION1 County/City:

Imperial

 Three-Year Program and Expenditure Plan  Annual Update  Annual Revenue and Expenditure Report

Local Mental Health Director

County Auditor-Controller / City Financial Officer

Name: Michael W. Horn

Name: Douglas Newland

Telephone Number: (760) 482-4068

Telephone Number: (760) 482-4535

E-mail: [email protected]

E-mail: [email protected]

Local Mental Health Mailing Address: Imperial County Behavioral Health Services 202 N. Eighth Street El Centro, CA 92243 I hereby certify that the Three-Year Program and Expenditure Plan, Annual Update, or Annual Revenue and Expenditure Report is true and correct and that the County has complied with all fiscal accountability requirements as required by law or as directed by the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, and that all expenditures are consistent with the requirements of the Mental Health Services Act (MHSA), including Welfare and Institutions Code (WIC) sections 5813.5, 5830, 5840, 5847, 5891, and 5892; and Title 9 of the California Code of Regulations sections 3400 and 3410. I further certify that all expenditures are consistent with an approved plan or update and that MHSA funds will only be used for programs specified in the Mental Health Services Act. Other than funds placed in a reserve in accordance with an approved plan, any funds allocated to a county which are not spent for their authorized purpose within the time period specified in WIC section 5892(h), shall revert to the state to be deposited into the fund and available for other counties in future years. I declare under penalty of perjury under the laws of this state that the foregoing and the attached update/report is true and correct to the best of my knowledge.

Local Mental Health Director (PRINT)

Signature

Date

I hereby certify that for the fiscal year ended June 30, ________, the County/City has maintained an interestbearing local Mental Health Services (MHS) Fund (WIC 5892(f)); and that the County’s/City’s financial statements are audited annually by an independent auditor and that the most recent audit report is dated ____________ for the fiscal year ended June 30, ________. I further certify that for the fiscal year ended June 30, ________, the State MHSA distributions were recorded as revenues in the local MHS Fund; that County/City MHSA expenditures and transfers out were appropriated by the Board of Supervisors and recorded in compliance with such appropriations; and that the County/City has complied with WIC section 5891(a), in that local MHS funds may not be loaned to a county general fund or any other county fund. I declare under penalty of perjury under the laws of this state that the foregoing and the attached report is true and correct to the best of my knowledge.

County Auditor-Controller / City Financial Officer (PRINT)

Signature

1

Welfare and Institutions Code Section 5847(b)(9) and 5899(a) Three-Year Program and Expenditure Plan, Annual Update, and RER Certification (02/14/2013) 1

Date

Stakeholder Planning Process The Imperial County Behavioral Health Services (ICBHS) Director, in collaboration with the Mental Health Board, headed the administration of the planning process as well as the development of the FY 2013-2014 MHSA Plan Annual Update. A Steering Committee that includes stakeholders was involved at all levels of the MHSA planning process. Stakeholders participating in the Steering Committee represented consumers, family members, and peer supporters; the local probation department, sheriff’s department, superior court, SELPA, social services department, County CEO’s office, Child Abuse Prevention (CAP) council, and public administrator’s office; education; community health agencies; and provider and system partners. The MHSA Steering Committee met on a quarterly basis. The committee provides input and recommendations to the department regarding the population to be targeted for services under MHSA funding and evidence-based practices that would address issues and needs identified in the community. The committee is informed and directly involved by providing ongoing planning, monitoring, and oversight of the MHSA Program planning, development, and implementation. The following stakeholders were members of the Steering Committee:                  



Gloria Blanquel, Peer Supporter – ICBHS TAY-STS Program Mickey Castro, Deputy Director - DSS Scott Dudley, Behavioral Health Manager – ICBHS Youth & Young Adult Unit Adolfo Estrada, Behavioral Health Manager – ICBHS Accounting Unit John Grass, Behavioral Health Manager – ICBHS Children Unit Michael Horn, Director – ICBHS Gabriela Jimenez, Behavioral Health Manager – ICBHS Children Unit Kristi Kussman, CEO – Courts Kurt Leptich, Director – SELPA Anne Mallory, Superintendent – ICOE Joe Picazo Jr., Deputy CEO – CEO Maria Rhinehart, Operation Manager Courts Norma Saikhon, Public Administrator – Public Administration Juan Ulloa, Judge – Superior Court Deborah Witt, Senior Behavioral Health Manager – ICBHS Crisis Unit Margaret Price, Director – DSS Maria Wyatt, Behavioral Health Manager – ICBHS Youth & Young Adult Unit Family Members

             

2

Gloria Brunswick, Division Manager – Probation Department Claudia Gonzalez, Accountant – ICBHS Accounting Unit Mary Esquer, Behavioral Health Manager – ICBHS Adult Unit Francisco Ortiz, Senior Behavioral Health Manager – ICBHS Adult Unit Yvette Garcia, Director – CAP Council Cindy Guz, Senior Behavioral Health Manager – ICBHS Youth & Young Adult Unit Leticia Ibarra, Program Director – Clinicas de Salud del Pueblo Andrea Kuhlen, Deputy Director – ICBHS Amanda LaWall, ISC Coordinator – ISC Scott Sheppeard, Lieutenant – Sheriff’s Department Leticia Plancarte, Senior Behavioral Health Manager – ICBHS Children Unit Lori Robinson, Regional Manager – San Diego Regional Center Jessica Vega, Peer Supporter – ICBHS WASS Program Adult Consumers Transition-Age Youth Consumers

During FY 2011-2012, ICBHS continued a community planning process to identify needed supports and services for unserved and underserved populations. Outreach and engagement to underserved populations continued to expand through the scope of “Let’s Talk About It” and “Exprésate”, the weekly-aired, and locally produced and hosted, behavioral health radio programs in English and Spanish, the two local threshold languages. MHSA Program information shows continued to provide the community with program overviews, referral and access information, who each programs serves, and contact information. KXO Radio provided internet podcast hosting of all the radio shows that aired. With this podcast storing, any community member, friend, neighbor, family member, as well as agency personnel from ICBHS or any community agency can access the information and refer an individual to a particular topic that may apply to their recovery at any time. Moreover, anyone can search the archives and listen in support of their own interests and/or needs. The ongoing outreach and engagement to underserved populations identified in the MHSA processes received a variety of media and advertising support. The local English and Spanish newspapers, their internet sites, the Imperial Valley Women’s Magazine, and the local radio stations are targeted with program advertising. The shows, going on their ninth year of broadcasting, have attracted a regular listenership and have established their voice as the local voice of radio wellness in the community.

30-Day Public Comment The Annual Update will be posted for a 30-day public review and comment period from April 17, 2013, through May 16, 2013.

Circulation The FY 2013-2014 MHSA Annual Update will be posted on the Department’s website. In addition, it will be distributed through the Steering Committee and the Mental Health Board. Advertisement for the Public Hearing will be posted in the Imperial Valley Press, which is distributed throughout all regions of the County.

Public Hearing After the 30-day public review and comment period, a Public Hearing will be held by the Mental Health Board on May 21, 2013. All community input and comments will be reviewed to determine if changes to the Annual Update are necessary. All input, comments, and Board recommendations will be documented and are included as Attachment 1 to this plan.

3

MHSA Background In November 2004, California voters passed Proposition 63, which became a state law entitled the Mental Health Services Act (MHSA). The MHSA is funded through a 1% tax on personal incomes of over $1 million. The MHSA was designed to expand and transform California’s mental health service systems. It was enacted into law on January 1, 2005. The MHSA provides funding for services and resources that promote wellness, recovery, and resiliency for adults and older adults with severe mental illness and for children and youth with serious emotional disturbances and their family members. The MHSA aims to reduce the long-term adverse impact of untreated serious mental illness and serious emotional disturbance by expanding and transforming services that promote well-being, recovery, and self-help, and introduce prevention and early intervention strategies to prevent long-term negative impact of serious mental illness and reduce stigma. Services are culturally competent, easier to access, and more effective in preventing and treating serious mental illness. A core set of values apply to all MHSA activities:     

Promote wellness, recovery, and resilience. Increase consumer and family member involvement in policy and service development and employment in service delivery. Develop a diverse, culturally sensitive, and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. Deliver individualized, consumer, and family-driven services that are outcome oriented and based upon successful or promising practices. Outreach to underserved and unserved populations.

MHSA funding was distributed to county mental health systems upon approval of their plans for each component of the MHSA. The MHSA is comprised of five major components. Each component addresses critical needs and priorities to improve access to effective, comprehensive, and culturally and linguistically competent county mental health services and supports. These components are:     

Community Services and Supports (CSS) – The programs and services being identified by each county to serve unserved and underserved populations. Prevention and Early Intervention (PEI) – Programs designed to prevent mental illnesses from becoming severe and disabling. Workforce Education and Training (WET) – Targets workforce development programs to remedy the shortage of qualified individuals to provide services. Capital Facilities and Technological Needs (CF/TN) – Addresses the infrastructure needed to support the CSS programs. Innovation – Promotes recovery and resilence, reduces disparities in mental health services and outcomes, and leads to learning that advances mental health in California in the directions articulated by the MHSA.

In March 2011, the signing of AB 100 into law by Governor Brown created immediate changes to the MHSA. The key changes eliminated the Department of Mental Health and the Mental

4

Health Services Oversight and Accountability Commission (MHSOAC) from their respective review and approval of county MHSA plans and expenditures. AB 1467, which was chaptered into law on June 17, 2012, requires that the annual update be adopted by the county board of supervisors and submitted to the Mental Health Services Oversight and Accountability Commission. It also requires that the plans be certified by the county mental health director and the county auditor-controller.

5

Annual Update Requirements In accordance with MHSA regulations, every county mental health program is required to submit a three-year program and expenditure plan and update it on an annual basis. This Annual Update for Imperial County’s Mental Health Services Act (MHSA) programs is an overview of the work plans and projects being implemented as part of the series of service components launched with the passage of Proposition 63 in 2004. The passage of the MHSA provided Imperial County increased funding, personnel, and other resources to support mental health programs for children, transition-age youth, adults, older adults, and families. The MHSA addresses a broad continuum of prevention, early intervention, and service needs, as well as the necessary infrastructure, technology, and training elements that support the County’s public mental health system. The intent of the Annual Update is to provide the community with a progress report on the various projects being conducted as part of the MHSA. This report includes descriptions of programs and services, as well as results for the work plans of the following MHSA components:     

Community Services and Supports (CSS) Prevention and Early Intervention (PEI) Workforce Education and Training (WET) Capital Facilities andTechnological Needs (CF/TN) Housing

The information compiled in this update is twofold: it is an update of work plans and projects implemented during FY 2011-2012 and a forecast for FY 2013-2014.

6

Implementation Progress Report by Component Community Services and Supports Community Services and Support (CSS) is the first and largest component funded under the Mental Health Services Act (MHSA). This component focuses on those individuals with serious emotional disturbances or mental illnesses for the following populations:    

Children and Families Transition-Age Youth Adults Older Adults

To serve these four groups, counties are required to implement three components within their CSS programs:   

Full Service Partnerships Systems Development Outreach and Engagement

Under the Community Services and Supports component of the MHSA, counties can request three different kinds of funding to make changes and expand their mental health services and supports. Funding includes:   

Full Service Partnership Funds – to provide all of the mental health services and supports a person wants and needs to reach his or her goals General Systems Development Funds – to improve mental health services and supports for people who receive mental health services Outreach and Engagement Funds – to reach out to people who may need services but are not receiving them

Imperial County has requested Full Service Partnership funds for the Ward Access to Services and Supports (WASS) Program, Transition-Age Youth-Supportive Transitional Services (TAYSTS) Program, Jail Supportive Transitional Services (JSTS) Program, Senior Access to Support and Services (SASS) Program, Dual Disorders – Integrated Supportive Treatment Services (DDx-ISTS) Program. General Systems Development funds were requested for the Recovery Center Program and Outreach and Engagement funds were requested for the Outreach and Engagement Program and the Transitional Engagement Supportive Services (TESS) Program.

Full Service Partnerships Ward Access to Services and Supports (WASS) Program The WASS Program is intended to provide a wide array of services and supports to seriously emotionally disturbed (SED) youth between the ages of 12-15 and SED transition-age youth (TAY) between the ages of 16-18 who are involved in or at risk of entering the juvenile justice 7

system; are diagnosed with a co-occurring substance abuse disorder; and have a mental health disorder whose service needs are not currently being met through the existing system or other funding sources. Recovery for youth with a mental health disorder that has contributed to their criminal activity and to their involvement in the juvenile justice system is frequently derailed by inadequate care and the stigma of a criminal record. Collaboration between ICBHS and the Juvenile Probation Department was established to promote interagency collaboration, shared responsibility, and accountability for effective outcomes for youth involved in the WASS Program and their families. The WASS Program outcome goals are to reduce the number of youth in juvenile halls, reduce re-incarceration, and increase permanence at home, school, and in the community. This Full Service Partnership offers a full range of integrated community services and supports which may include housing, education, and vocational opportunities. WASS Program Youth/TAY and their families are provided a continuum of services and supports, including direct delivery and use of community resources. Services and supports include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. The services and supports are provided in the youth/TAY’s primary language and program staff is bilingual and bicultural. Notable Performance Measures: The WASS Program served a total of 107 clients during FY 2011-2012. The demographic breakdown includes: 

Age:

17 age 11-15 90 age 16-18



Gender:

78 male 29 female



Primary Language:

83 English 24 Spanish



Race/Ethnicity:

90 10 2 4 1

Hispanic White Blacks Alaskan/Native American Chinese Gender

Age 16% 27%

73%

84%

11-15

Male

16-18 8

Female

Primary Language

Race/Ethnicity 100%

84%

80%

22%

60% 40% 20% 78%

English

9%

2%

4%

1%

0%

Spanish

One client obtained a high school diploma, 19 made significant academic progress, seven obtained employment, and one successfully terminated probation status. Examples of Notable Community Impact: Multidisciplinary Services Team: In 2011, ICBHS spearheaded the implementation of the Multidisciplinary Services Team (MST), formally known as the interagency Placement Review Committee. The members of these groups consist of representatives from the WASS Program, Imperial County Probation Department, Department of Social Services (DSS), and Imperial County Office of Education (ICOE). The MST meets weekly to review cases for at-risk youth following the filing of a petition in child abuse and neglect, and delinquency cases. The MST works to ensure that all the circumstances impacting the child and family, especially those related to the child’s potential strengths and needs, are fully identified and considered in formulating recommendations for the court. In order to make effective court recommendations, the team includes the youth, his or her family members, and professionals who have particular knowledge of the child and family. The MST identifies the youth’s and family’s needs and identifies the services and supports likely to address those needs. The MST makes every effort to recommend measurable goal(s) designed to track progress in addressing the family’s concerns. The MST makes every effort to recommend the least restrictive means of attaining the goals and monitors the progress in subsequent meetings to ensure success by the youth and family. The MST has promoted collaboration between agencies and identifies service gaps and breakdowns in coordination between agencies or individuals. The MST also has enhanced the professional skills and knowledge of individual team members by providing a forum for increased learning regarding the strategies, resources, and approaches used by various disciplines. Intensive Assessments for At-Risk Juvenile Offenders: Imperial County Juvenile Probation Department contracted with ICBHS to ensure that mental health services are provided to highrisk juvenile offenders in the Juvenile Hall Facility. ICBHS implemented a significant change in assessing youth who are at risk of being placed out of county or state by ensuring youth are properly assessed. The Mental Health Clinician assigned to the Juvenile Hall team completes a comprehensive mental health assessment by interviewing the at-risk youth, as well as the parents, assigned probation officer, and any other significant person in the youth’s life. Moreover, the clinician also reviews any relevant documentation from previous placements, probation, mental health treatment, etc., and, if needed, makes referrals to the WASS Program. Upon completion, the mental health assessment is forwarded to the Multidisciplinary Services Team (MST). The MST reviews the mental health assessment and provides an integrated 9

approach to identifying, coordinating, and linking appropriate resources/services to meet the needs of youth and determine if in-county, out-of-county, or out-of-state placement is appropriate. Nurturing Parenting Program: In September 2011, ICBHS implemented the Nurturing Parenting Program (NPP) for youth and TAY enrolled in the WASS Program. The NPP is a validated, family-centered program designed to build nurturing skills as alternatives to abusive parenting and child rearing attitudes and practices. The NPP targets youth between the ages of 13-18 from a variety of ethnic and cultural groups presenting very serious problems such as delinquency, conduct disorder, oppositional defiant disorder, disruptive behavior disorder, violent acting-out, and substance abuse. The NPP structural model is based on a re-parenting philosophy: parents and children attend separate groups that meet concurrently, participating in activities that build self-awareness, positive self-concept/self-esteem, and empathy; provide alternatives to yelling and hitting; enhance family communication and awareness of needs; replace abusive behavior with nurturing; promote healthy physical and emotional development; and teach appropriate role and developmental expectation. NPP utilizes the Adult-Adolescent Parenting Inventory (AAPI-2) to perform a Pre-Treatment Assessment, Process Assessment, and a Post-Treatment Assessment to the adolescent and his or her family to measure outcomes. The AAPI-2 is an inventory designed to measure the pre and post effectiveness of the NPP, determine parenting strengths and areas that need improvement. The Pre-Treatment Assessment is used to collect data prior to the formal start of the program to determine entry level capabilities; the Process Assessment is used to collect data during the course of the program to monitor ongoing growth and changes; and the PostTreatment Assessment collects data at the completion of the program to determine the level of growth and future intervention needs of the family. Based on the known parenting and child rearing behaviors of abusive parents, responses to the inventory provide an index of risk for practicing behaviors known to be attributable to child abuse and neglect. The outcomes of the NPP are to stop the generational cycle of child abuse by building nurturing parenting skills; reduce the rate of recidivism, juvenile delinquency, and alcohol abuse; and lower the rate of teenage pregnancies. During NPP sessions, families will learn nurturing communication strategies, how to recognize each other’s needs, how to understand the period of adolescence, and ways to build their own personal power, selfconcept, and self-esteem. Families will also discuss issues related to pregnancy delay, sex, AIDS, suicide, and peer pressure. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: In FY 2011-2012, ICBHS experienced workforce shortages in most clinical and support positions to include Mental Health Rehabilitation Technicians and Peer Supporters. Due to the staffing shortage, Imperial County was unable to implement two new evidence-based programs, Trauma-Focused Cognitive Behavioral Therapy and Aggression Replacement Therapy, and one wellness program, Horsemanship Services. These programs are planned to be implemented during FY 2012-2013. In FY 2011-2012, the WASS Program also encountered challenges in providing Mental Health Specialty Services due to not having an assigned full-time psychiatrist or nurse. Steps were taken to hire an additional part-time child psychiatrist and nurse in order to adequately provide mental health services to the WASS Program population. Imperial County’s limited community

10

supportive services such as employment, job training, housing opportunities, educational, and vocational services has also been exacerbated with the current economic crisis. The other area of challenge was the building of effective interagency relationships and protocols that supported the full engagement of services and supports at the earliest opportunity while also expanding the provision of program supports to youth who may have appeared beyond local intervention supports in the older paradigm and been ‘automatic’ candidates for placement. To this end, the establishment of the Multidisciplinary Services Team, as noted above, provided a structure to support goals of achieving earlier and broader service access to this population. It was expected that by relying on a systematic evaluation of history, evidence, and outcomes through the structure of this meeting, an emphasis on the importance of treatment prior to placement would gradually arise from the systematic, mutually engaged and supportive intervention plan that included WASS Program services. An additional intervention was to build relationships and referral protocols with schools, community schools, and continuation schools to provide for referral of WASS Program eligible individuals at the beginning of the eligibility criteria, when their pattern of behaviors had established them to be on a trajectory for being at risk of placement. Finally, the unique characteristics of a small county status were used to build and maintain referral relationships with any and all agencies, groups, or citizens that might provide supportive structure to the intervention strategies of the WASS Program. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: There were no new, significantly changed, or discontinued programs for FY 2011-2012. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts on a specific age group and tailor services by considering the unique needs and challenges of the particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services. In order to improve access to services in FY 2013-2014, there will be an establishment of satellite clinics in outlying areas of the county including two satellite Youth and Young Adult Services clinics. One will be located in Calexico and the other in Brawley. Historically, when access availability increases from the establishment of satellite clinics in unserved or underserved areas, a significant increase in caseload quickly follows. To further enhance services at each of the satellite clinics and ensure easy accessibility of an array of services for MHSA eligible individuals, various Full Service Partnership Programs (WASS, TAY-STS, and Adolescent DDx-ISTS programs) will be merged into one Full Service Partnership Team, which will be renamed the Youth and Young Adult Full Service Partnership. It is anticipated that by providing one Full Service Partnership team at each of the three Youth and Young Adult Services clinics, individuals will find it easier to obtain “wrap-like” services in their local area of residence. Services offered will continue to consist of a full range of integrated community services and supports including direct delivery and use of community resources. These services and 11

supports will continue to include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. By having staff trained in the overall needs of the age 12-25 MHSA population, as opposed to one very specific target group, staff availability will increase. It has also been found that many of the individuals within the age group of 12-15 and those 16-25 share commonalities that, when treated in a supportive and interactive environment, can enhance the recovery process. Many share the need for similar mental health services and supports to reach his or her goals and therefore can be better served by merging the current distinct Full Service Partnerships. Along with the anticipated positive results from this merge, concerns have been identified as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Youth and Young Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments, while individuals with psychotic disorders may come in on another day, and those in the juvenile justice system on another. Supportive services will also be set up accordingly depending on the “clinic day” so as to ensure group services such as Anger Replacement Training or Drumming Circles also follow this model. It is believed that by distinguishing the populations in this manner, each will experience a higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible. The target population for each of the Full Service Partnerships located at the three Youth and Young Adult Services clinics will be as follows: 

SED adolescents, age 12-15, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or the ability to function in the community and who are either at risk of or have already been removed from the home; or whose mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment; or who display at least one of the following: psychotic features, risk of suicide, or risk of violence due to a mental disorder. These individuals may also be diagnosed with a co-occurring substance abuse disorder.



SED or SMI transition-age youth, age 16-25, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or the ability to function in the community and are unserved or underserved and are experiencing either homelessness or are at risk of being homeless; aging out of the child and youth mental health system; aging out of the child welfare system; aging out of the juvenile justice system; have involvement in the criminal justice system; are at risk of involuntary hospitalization or institutionalization; or are experiencing a first episode of serious mental illness. These individuals may also be diagnosed with a co-occurring substance abuse disorder.

Lastly, all clinicians assigned to the Youth and Young Adult Full Service Partnership, have been trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This evidence-based model has proven to be highly effective in the treatment of individuals age 3-18 who are 12

suffering from symptoms related to Post-Traumatic Stress Disorder (PTSD). In FY 2013-2014, clinicians will begin using this model for adolescents, age 12-18, who are diagnosed with PTSD, and will attend weekly TF-CBT consultation calls with a certified consultant from the California Institute of Mental Health (CiMH). A program supervisor will also attend the consultation calls and track performance outcome measurements and fidelity to the model and submit these results to CiMH on a regular basis.

Transition-Age Youth-Supportive Transitional Services (TAY-STS) Program The Mental Health Services Act is intended to provide a wide array of services and supports to transition-age youth (TAY), age 16-25, who are homeless or at risk of becoming homeless; are aging out of the mental health or child welfare system; have a co-occurring substance abuse disorder; are involved in the criminal justice system; and have a mental health disorder whose service needs are not currently being met through the existing system or other funding sources. The transition period from adolescence to stable adulthood represents a specific challenge as youth may not access services even when needed. These youth have extraordinary mental health needs as they separate from parents and family. They are vulnerable because they are moving through a period in their lives wrought with changes and challenges: physical, emotional, financial, academic, vocational, psychological, and social. Collaboration between ICBHS and the Imperial County Probation Department was established to promote interagency collaboration, shared responsibility, and accountability for effective outcomes for TAY and their families. zThis Full Service Partnership offers a full range of integrated community services and supports which may include housing, education, and vocational opportunities. TAY and their families are provided a continuum of services and supports including direct delivery and use of community resources. Services and supports will include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall/jail; home and community re-entry from juvenile hall/placement/jail; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. The services and supports are provided in the TAY’s primary language and program staff is bilingual and bicultural. Notable Performance Measures: The TAY-STS Program served a total of 174 clients during FY 2011-2012. The demographic breakdown includes: 

Gender:

105 male 69 female



Primary Language:

130 English 44 Spanish

13



156 7 6 1 4

Race/Ethnicity:

Hispanic White Black Alaskan/Native American Other Primary Language

Gender

25% 60%

66%

75%

Male

English

Female

Spanish

Race/Ethnicity 100%

90%

80% 60% 40% 20%

4%

3%

1%

2%

0%

There were a total of six clients who obtained a high school diploma and three who obtained their General Education Diploma (GED). A total of 68 clients continued their education through high school. 14 clients enrolled at Imperial Valley College, ten obtained employment, and one enrolled in Job Corps. Examples of Notable Community Impact: Multidisciplinary Services Team: In 2011, ICBHS spearheaded the implementation of the Multidisciplinary Service Team (MST), formally known as the interagency Placement Review Committee. The members of these groups consist of representatives from the TAY-STS Program, Imperial County Probation Department, Department of Social Services (DSS), and Imperial County Office of Education (ICOE). The MST meets weekly to review cases for at-risk youth following the filing of a petition in child abuse and neglect, and delinquency cases. The MST works to ensure that all the circumstances impacting the child and family, especially those related to the child’s potential strengths and needs, are fully identified and considered in formulating recommendations for the court. In order to make effective court recommendations, the team includes the youth, his or her family members, and professionals who have particular knowledge of the child and family. The MST identifies the youth’s and family’s needs and

14

identifies the services and supports likely to address those needs. The MST makes every effort to recommend measurable goal(s) designed to track progress in addressing the family’s concerns. The MST makes every effort to recommend the least restrictive means of attaining the goals and monitors the progress in subsequent meetings to ensure success by the youth 0and family. The MST has promoted collaboration between agencies and identifies service gaps and breakdowns in coordination between agencies or individuals. The MST also has enhanced the professional skills and knowledge of individual team members by providing a forum for increased learning regarding the strategies, resources, and approaches used by various disciplines. Intensive Assessments for At-Risk Juvenile Offenders: Imperial County Juvenile Probation Department contracted with ICBHS to ensure that mental health services are provided to highrisk juvenile offenders in the Juvenile Hall Facility. ICBHS implemented a significant change in assessing youth who are at risk of being placed out of county or state by ensuring youth are properly assessed. The Mental Health Clinician assigned to the Juvenile Hall team completes a comprehensive mental health assessment by interviewing the at-risk youth, as well as the parents, assigned probation officer, and any other significant person in the youth’s life. Moreover, the clinician also reviews any relevant documentation from previous placements, probation, mental health treatment, etc., and, if needed, makes referrals to the TAY-STS Program. Upon completion, the mental health assessment is forwarded to the Multidisciplinary Services Team (MST). The MST reviews the mental health assessment and provides an integrated approach to identifying, coordinating, and linking appropriate resources/services to meet the needs of youth and determine if in-county, out-of-county, or out-of-state placement is appropriate. Nurturing Parenting Program: In September 2011, ICBHS implemented the Nurturing Parenting Program (NPP) for youth and TAY enrolled in the TAY-STS Program. The NPP is a validated, family-centered program designed to build nurturing skills as alternatives to abusive parenting and child rearing attitudes and practices. The NPP targets youth between the ages of 13-18 from a variety of ethnic and cultural groups presenting very serious problems such as delinquency, conduct disorder, oppositional defiant disorder, disruptive behavior disorder, violent acting-out, and substance abuse. The NPP structural model is based on a re-parenting philosophy: parents and children attend separate groups that meet concurrently, participating in activities that build self-awareness, positive self-concept/self-esteem, and empathy; provide alternatives to yelling and hitting; enhance family communication and awareness of needs; replace abusive behavior with nurturing; promote healthy physical and emotional development; and teach appropriate role and developmental expectation. NPP utilizes the Adult-Adolescent Parenting Inventory (AAPI-2) to perform a Pre-Treatment Assessment, Process Assessment, and a Post-Treatment Assessment to the adolescent and his or her family to measure outcomes. The AAPI-2 is an inventory designed to measure the pre and post effectiveness of the NPP, determine parenting strengths and areas that need improvement. The Pre-Treatment Assessment is used to collect data prior to the formal start of the program to determine entry level capabilities; the Process Assessment is used to collect data during the course of the program to monitor ongoing growth and changes; and the PostTreatment Assessment collects data at the completion of the program to determine the level of growth and future intervention needs of the family. Based on the known parenting and child rearing behaviors of abusive parents, responses to the inventory provide an index of risk for practicing behaviors known to be attributable to child abuse and neglect. The outcomes of the NPP are to stop the generational cycle of child abuse 15

by building nurturing parenting skills; reduce the rate of recidivism, juvenile delinquency, and alcohol abuse; and lower the rate of teenage pregnancies. During NPP sessions, families will learn nurturing communication strategies, how to recognize each other’s needs, how to understand the period of adolescence, and ways to build their own personal power, selfconcept, and self-esteem. Families will also discuss issues related to pregnancy delay, sex, AIDS, suicide, and peer pressure. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: In FY 2011-2012, ICBHS experienced workforce shortages in most clinical and support positions to include Clinicians, Mental Health Rehabilitation Technicians, and Peer Supporters. Due to the staffing shortage, Imperial County was unable to implement two new evidence-based programs, Trauma-Focused Cognitive Behavioral Therapy and Aggression Replacement Therapy, and one wellness program, Horsemanship Services. These programs are planned to be implemented during FY 2012-2013. In FY 2011-2012, the TAY-STS Program also encountered challenges in providing Mental Health Specialty Services due to not having an assigned full-time psychiatrist or nurse. Two part-time psychiatrists and one part-time nurse were assigned to the TAY population. Imperial County’s limited community supportive services such as employment, job training, housing opportunities, educational, and vocational services has been exacerbated with the current economic crisis. As a result, opportunities for recovery growth in areas of young adult importance, such as access to jobs, access to housing, continuing education, healthcare, and other supportive services, are limited. We rely on close relationships with agencies and consistent sharing of opportunities and information to mitigate the reality of living in one of the poorest areas of the United States, with an unemployment rate commonly above 25%. Additionally, services for TAY have to market themselves to those youth. This means establishing referral sources where youth congregate and offering services in a way that is engaging to this population. To establish referral sources, the program reached out to CalWORKs, where young families attended services, Imperial Valley College, where most of the local young people begin post high school education, and Imperial Valley Regional Occupation Program, the local job development agency for youth and young adults. The best success was with Imperial Valley College, where a Licensed Professional Counselor Intern ran a counseling service center with a co-worker. The counselor referred approximately a dozen young adults who had significant mental health concerns, including emerging psychotic disorders. Engagement and motivation were crucial factors in the referral process that resulted in selfadvocating individuals strongly committed to their individual recovery. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: There were no new, significantly changed, or discontinued programs for FY 2011-2012. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts on a specific age group and tailor services by considering the unique needs and challenges of the particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services.

16

In order to improve access to services in FY 2013-2014, there will be an establishment of satellite clinics in outlying areas of the county including two satellite Youth and Young Adult Services clinics. One will be located in Calexico and the other in Brawley. Historically, when access availability increases from the establishment of satellite clinics in unserved or underserved areas, a significant increase in caseload quickly follows. To further enhance services at each of the satellite clinics and ensure easy accessibility of an array of services for MHSA eligible individuals, various Full Service Partnership Programs (WASS, TAY-STS, and Adolescent DDx-ISTS programs) will be merged into one Full Service Partnership Team, which will be renamed the Youth and Young Adult Full Service Partnership. It is anticipated that by providing one Full Service Partnership team at each of the three Youth and Young Adult Services clinics, individuals will find it easier to obtain “wrap-like” services in their local area of residence. Services offered will continue to consist of a full range of integrated community services and supports including direct delivery and use of community resources. These services and supports will continue to include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. By having staff trained in the overall needs of the age 12-25 MHSA population, as opposed to one very specific target group, staff availability will increase. It has also been found that many of the individuals within the age group of 12-15 and those age 16-25 share commonalities that, when treated in a supportive and interactive environment, can enhance the recovery process. Many share the need for similar mental health services and supports to reach his or her goals and therefore can be better served by merging the current distinct Full Service Partnerships. Along with the anticipated positive results from this merge, concerns have been identified as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Youth and Young Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments, while individuals with psychotic disorders may come in on another day, and those in the juvenile justice system on another. Supportive services will also be set up accordingly depending on the “clinic day” so as to ensure group services such as Anger Replacement Training or Drumming Circles also follow this model. It is believed that by distinguishing the populations in this manner, each will experience a higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible. The target population for each of the Full Service Partnerships located at the three Youth and Young Adult Services clinics will be as follows: 

Seriously emotionally disturbed (SED) adolescents, age 12-15, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: selfcare, school functioning, family relationships, or the ability to function in the community and who are either at risk of or have already been removed from the home; or whose mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment; or who display at least one 17

of the following: psychotic features, risk of suicide, or risk of violence due to a mental disorder. These individuals may also be diagnosed with a co-occurring substance abuse disorder. 

SED or SMI transition-age youth, age 16-25, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or the ability to function in the community and are unserved or underserved and are experiencing either homelessness or are at risk of being homeless; aging out of the child and youth mental health system; aging out of the child welfare system; aging out of the juvenile justice system; have involvement in the criminal justice system; are at risk of involuntary hospitalization or institutionalization; or are experiencing a first episode of serious mental illness. These individuals may also be diagnosed with a co-occurring substance abuse disorder.

Lastly, all clinicians assigned to the Youth and Young Adult Full Service Partnership, have been trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This evidence-based model has proven to be highly effective in the treatment of individuals age 3-18 who are suffering from symptoms related to Post-Traumatic Stress Disorder (PTSD). In FY 2013-2014, clinicians will begin using this model for adolescents, age 12-18, who are diagnosed with PTSD, and will attend weekly TF-CBT consultation calls with a certified consultant from the California Institute of Mental Health (CiMH). A Program Supervisor will also attend the consultation calls and track performance outcome measurements and fidelity to the model and submit these results to CiMH on a regular basis.

Jail Supportive Transitional Services (JSTS) Program The Jail Supportive Transitional Services (JSTS) Program is a Full Service Partnership Program that is client-driven, community-focused, and promotes recovery and resiliency. The program is designed to serve seriously emotional disturbed transition-age youth, ages 18-25, and seriously mentally ill adults, ages 26-59, who are incarcerated in the adult criminal justice system and transitioning back into the community. The JSTS Program assists individuals in obtaining services in a timely manner, including mental health services and referrals to a variety of different community resources. Intensive support services are provided immediately following the individual’s release. A Mental Health Rehabilitation Technician works collaboratively with the California Forensic Medical Group staff located within the county jail and attends quarterly psychiatric teleconferences. The services offered by the JSTS Program include case management; rehabilitative services; integrated community mental health and substance abuse treatment; illness management; crisis response; peer support; housing support; employment support; educational assistance; transportation; housing assistance; benefit acquisition; co-occurring disorder treatment; and independent living skills. All services are personalized, integrated, and developed to emphasize cultural competency, recovery, and resiliency through collaborative efforts within the community. The staff assigned to the JSTS Program provide a “whatever it takes” approach to ensure that all individuals receive needed services/assistance. The JSTS Program Supervisor ensures that all services are offered in a culturally competent manner. Language assistance and interpreter services are available to all clients who request such assistance. Additionally, American Sign

18

Language interpretative services are available, upon request, for clients with speech and/or hearing impairments. Notable Performance Measures: The JSTS Program served a total of 17 clients during FY 2011-2012. The demographic breakdown includes: 

Age:

2 age 18-25 15 age 26+



Gender:

15 male 2 female



Primary Language:

15 English 2 Spanish



Race/Ethnicity:

12 Hispanic 5 White

Age

Gender

12%

12%

88% 88%

18-25

26+

Male

Primary Language

Female

Race/Ethnicity 100%

12% 80%

71%

60% 40%

88%

29%

20% English

0%

Spanish

Hispanic

White

Examples of Notable Community Impact: During FY 2011-2012, the JSTS Program assisted clients that were identified as being at high risk of decompensating without medication and/or linkage to programs. The JSTS Program staff established rapport with clients while they were incarcerated, and, upon release, assisted them in obtaining needed services throughout the community. Additionally, JSTS Program staff

19

worked collaboratively with other community agencies such as the Probation Department, Adult Protective Services, Social Security, Social Services, Public Administrator, and a variety of other agencies, in order to better assist this population. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: Despite efforts made to obtain referrals from the county jail, a high number of inmates are discharged from the county jail without being referred to the JSTS Program. JSTS Program staff have continuously met with California Forensic Medical Group staff (and other staff) quarterly to explain the availability of mental health services offered by this program in order to increase the number of referrals received. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: The designated JSTS Program Mental Health Rehabilitation Technician increased the number of hours spent working at the county jail to assist in identifying possible clients for this program, as well as to build a positive rapport with county jail personnel. Additionally, the designated JSTS Program Mental Health Rehabilitation Technician attended a weekly teleconference in order to identify possible candidates for the JSTS Program and started working on engaging the clients while they were still incarcerated. The JSTS Program utilized family involvement and provided education to the families regarding available services through the JSTS Program. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: It is anticipated that once the new AB-109 Program is implemented, the JSTS Program will receive additional referrals due to the high number of inmates in need of mental health services expected to be released from the criminal justice system. The designated JSTS Program Mental Health Rehabilitation Technician continues to work on building rapport with county jail personnel to improve communication between agencies, which will ultimately increase the number of referrals being made by county jail personnel. In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts by specific age groups and to tailor services by considering the unique needs and challenges of each particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services. Due to the reorganization, only clients age 26 and older will be served at the Adult and Older Adult Services Division. In addition, the Full Service Partnership Programs (JSTS, SASS, and Adult DDx-ISTS) will be merged into one Full Partnership Program, which will be renamed the Adult and Older Adult Full Service Partnership. Along with the anticipated positive results from this merge, concerns have been identified by clients as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Adult and Older Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments while individuals with psychotic disorders on another day. Supportive services will also be set up accordingly depending on the “clinic day”. It is believed that by distinguishing the populations in this manner, each will experience a higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible.

20

Senior Access to Support and Services (SASS) Program The SASS Program provides services to the unserved and underserved older adult population age 60 and older. These services are geared toward the seriously mentally ill (SMI) clients who are isolated and homebound, homeless, or at risk of homelessness. The SASS Program’s mobile team (which consists of a Mental Health Rehabilitation Technician, clinician, nurse, and psychiatrist) provides services in the community to this target population. The individuals served are part of the unserved and underserved population that otherwise could not access services at the outpatient clinic. The SASS Program continues to provide a “whatever it takes” approach to ensure that all individuals receive needed services and assistance. This high coordination of service approach provides services while promoting recovery and resiliency. In addition, the provision of these services in the client’s home increases the utilization of services for this target population. Client outcomes include: the attainment of stable housing, addressed physical health care needs, reduced emergency medical services, increased penetration and utilization of mental health services, reduced need of skilled nursing facilities, and reduced isolation by linkage to older adult day out programs. Language assistance and interpreter services are available to all clients who request such assistance. Additionally, American Sign Language interpretative services are available, upon request, for clients with speech and/or hearing impairments. Notable Performance Measures: The SASS Program served a total of 11 clients during FY 2011-2012. The demographic breakdown includes: 

Gender:

3 male 8 female



Race/Ethnicity:

7 Hispanic 4 White



City of Residence:

4 2 2 2 1

El Centro Brawley Niland Imperial Calipatria City of Residence

Gender

100% 80%

27%

60% 40%

73%

20%

36% 18%

18%

18% 9%

0% Male

El Centro Brawley

Female 21

Niland

Imperial Calipatria

Race/Ethnicity 100% 80% 64% 60% 36%

40% 20% 0% Hispanic

White

During FY 2011-12 a total of 84 referrals were received. Out of those 84 referrals, 73 were screened out due to the lack of medical necessity, the inDability by staff to locate the client, the client not having a secure and stable placement, or refusal of services. Examples of Notable Community Impact: The need for outreach continued to be identified in FY 2011-2012 in order to reach the unserved and underserved SMI older adult population. The SASS Program provided outreach to various agencies in Imperial County in order to continue educating the community regarding the services offered by this program. The SASS Program’s mobile team continued to provide services to the older adult population at their residence. These individuals would otherwise not have been able to access mental health services due to transportation and mobility issues. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: Although outreach and engagement efforts made by the SASS Program generated referrals, the program continued to be challenged by quite a number of referrals not meeting the SASS criteria for services. The number of clients served, therefore, was not as high as expected. In order to mitigate this challenge, outreach efforts continue to focus on providing education on mental illness and the service criteria for the SASS Program. Even though the mental health needs are similar to other populations, the older adult population continues to experience disparities and low utilization of mental health services resulting in a barrier for the SASS Program. The racial/ethnic composition of this population is primarily Hispanic, with both English and Spanish languages spoken. Services are provided in both languages to effectively address the needs of this population, and to help eliminate and mitigate linguistic and cultural barriers. Additionally, American Sign Language interpretative services are available for any client with speech and/or hearing impairments to assist in decreasing the disparities and low utilization of mental health services for our target population. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: Even though there continues to be insufficient and inappropriate referrals being received from various community agencies, it is felt that there continues to be a need to reach this unserved and underserved population. The SASS Program will continue to consistently provide outreach services to the community with an emphasis on the program criteria and medical necessity in the hopes of increasing our penetration rate.

22

Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts by specific age groups and to tailor services by considering the unique needs and challenges of each particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services. Due to the reorganization, only clients age 26 and older will be served at the Adult and Older Adult Services Division. In addition, the Full Service Partnership Programs (JSTS, SASS, and Adult DDx-ISTS) will be merged into one Full Partnership Program, which will be renamed the Adult and Older Adult Full Service Partnership. Along with the anticipated positive results from this merge, concerns have been identified by clients as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Adult and Older Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments while individuals with psychotic disorders on another day. Supportive services will also be set up accordingly depending on the “clinic day”. It is believed that by distinguishing the populations in this manner, each will experience a higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible.

Dual Disorders – Integrated Supportive Treatment Services (DDx-ISTS) Program The Mental Health Services Act Dual Disorders – Integrated Supportive Treatment Services (DDx-ISTS) Program is intended to provide a wide array of services and supports to transitionage youth (TAY), ages 12-18, and adults, ages 18-65, who are diagnosed with a co-occurring substance abuse disorder; are aging out of the youth mental health or child welfare system; are involved in the criminal justice system and who have a mental health and substance abuse disorder whose service needs are not currently being met through the existing system or other funding sources. This Full Service Partnership offers a full range of integrated community services and supports which may include housing, education, and vocational opportunities. The person receiving services and his or her family are provided a continuum of services and supports, including direct delivery and use of community resources. Services and supports include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. The services and supports are provided in the person’s primary language and program staff is bilingual and bicultural.

23

Notable Performance Measures: The Adolescent DDx-ISTS Program served a total of 115 clients, age 12-18, during FY 20112012. The demographic breakdown includes: 

Age:



Gender:

69 male 46 female



Primary Language:

81 English 34 Spanish



Race/Ethnicity:

15 age 12-15 100 age 16-18

110 Hispanic 3 White 2 Black

Age

Gender 13% 40% 60%

87%

12-15

16-18

Male

Female

Race/Ethnicity

Primary Language 100% 30%

96%

80% 60% 70%

40% 20%

English

3%

2%

White

Black

0%

Spanish

Hispanic

Services provided to adolescents enrolled included targeted case management; medication support; individualized therapy; crisis intervention; Functional Family Therapy; Nurturing Parenting; referral and linkage to community resources; substance abuse treatment; and peer support. The outcomes the youth accomplished were a result of goal-oriented and problemfocused cognitive behavioral therapy techniques that change thinking, mood, and behaviors. Subsequently, these outcomes resulted in reduced anger outbursts, increased effective communication and improved relationships with significant family members and friends,

24

successful completion of therapy and substance abuse treatment, reduced anxiety and depressed mood, employment, and increased school participation and performance. The Adult DDx-ISTS Program served a total of 153 clients during FY 2011-2012. The demographic breakdown includes: 

Age:

4 49 34 39 23 4



Gender:

74 male 79 female



Primary Language:

124 English 29 Spanish



Race/Ethnicity:

112 27 9 2 3

age 18-21 age 22-30 age 31-40 age 41-50 age 51-60 age 60+

Hispanic White Black Alaskan/Native American Other Gender

Age 3%

3%

15% 32%

48% 52%

25% 22%

18-21

22-30

31-40

41-50

51-60

Male

60+

Female

Race/Ethnicity

Primary Language 100% 19%

80%

73%

60% 40% 20% 81%

English

0%

Spanish

25

18% 6%

1%

2%

One client obtained his or her General Education Diploma (GED) and a total of 63 clients did not drop out of school and continued their education through high school. Four obtained employment and one enrolled in Job Corps. In addition, three adults completed their GED, seven enrolled in community college, five reported employment, and 17 were referred to the Recovery Center. Examples of Notable Community Impact: Multidisciplinary Services Team: In 2011, ICBHS spearheaded the implementation of the Multidisciplinary Service Team (MST), formally known as the interagency Placement Review Committee. The members of these groups consist of representatives from the Adolescent DDxISTS Program, Imperial County Probation, Department of Social Services (DSS), and Imperial County Office of Education (ICOE). The MST meets weekly to review cases for at-risk youth following the filing of a petition in child abuse and neglect, and delinquency cases. The MST works to ensure that all the circumstances impacting the child and family, especially those related to the child’s potential strengths and needs, are fully identified and considered in formulating recommendations for the court. In order to make effective court recommendations, the team includes the youth, his or her family members, and professionals who have particular knowledge of the child and family. The MST identifies the youth’s and family’s needs and identifies the services and supports likely to address those needs. The MST makes every effort to recommend measurable goal(s) designed to track progress in addressing the family’s concerns. The MST makes every effort to recommend the least restrictive means of attaining the goals and monitors the progress in subsequent meetings to ensure success by the youth and family. The MST has promoted collaboration between agencies and identifies service gaps and breakdowns in coordination between agencies or individuals. The MST also has enhanced the professional skills and knowledge of individual team members by providing a forum for increased learning regarding the strategies, resources, and approaches used by various disciplines. Intensive Assessments for At-Risk Juvenile Offenders: Imperial County Juvenile Probation Department contracted with ICBHS to ensure that mental health services are provided to highrisk juvenile offenders in the Juvenile Hall Facility. ICBHS implemented a significant change in assessing youth who are at risk of being placed out of county or state by ensuring youth are properly assessed. The Mental Health Clinician assigned to the Juvenile Hall team completes a comprehensive mental health assessment by interviewing the at-risk youth, as well as the parents, assigned probation officer, and any other significant person in the youth’s life. Moreover, the clinician also reviews any relevant documentation from previous placements, probation, mental health treatment, etc., and, if needed, makes referrals to the DDx-ISTS Program. Upon completion, the mental health assessment is forwarded to the Multidisciplinary Services Team (MST). The MST reviews the mental health assessment and provide an integrated approach to identifying, coordinating, and linking appropriate resources/services to meet the needs of youth and determine if in-county, out-of-county, or out-of-state placement is appropriate. Nurturing Parenting Program: In September 2011, ICBHS implemented the Nurturing Parenting Program (NPP) for youth and TAY enrolled in the Adolescent DDx-ISTS Program. The NPP is a validated, family-centered program designed to build nurturing skills as alternatives to abusive parenting and child rearing attitudes and practices. The NPP targets youth between the ages of 13-18 from a variety of ethnic and cultural groups presenting very serious problems such as delinquency, conduct disorder, oppositional defiant disorder, disruptive behavior disorder, violent acting-out, and substance abuse. The NPP structural model is based on a re-parenting

26

philosophy: parents and children attend separate groups that meet concurrently, participating in activities that build self-awareness, positive self-concept/self-esteem, and empathy; provide alternatives to yelling and hitting; enhance family communication and awareness of needs; replace abusive behavior with nurturing; promote healthy physical and emotional development; and teach appropriate role and developmental expectation. NPP utilizes the Adult-Adolescent Parenting Inventory (AAPI-2) to perform a Pre-Treatment Assessment, Process Assessment, and a Post-Treatment Assessment to the adolescent and his or her family to measure outcomes. The AAPI-2 is an inventory designed to measure the pre and post effectiveness of the NPP, determine parenting strengths and areas that need improvement. The Pre-Treatment Assessment is used to collect data prior to the formal start of the program to determine entry level capabilities; the Process Assessment is used to collect data during the course of the program to monitor ongoing growth and changes; and the PostTreatment Assessment collects data at the completion of the program to determine the level of growth and future intervention needs of the family. Based on the known parenting and child rearing behaviors of abusive parents, responses to the inventory provide an index of risk for practicing behaviors known to be attributable to child abuse and neglect. The outcomes of the NPP are to stop the generational cycle of child abuse by building nurturing parenting skills; reduce the rate of recidivism, juvenile delinquency, and alcohol abuse; and lower the rate of teenage pregnancies. During NPP sessions, families will learn nurturing communication strategies, how to recognize each other’s needs, how to understand the period of adolescence, and ways to build their own personal power, selfconcept, and self-esteem. Families will also discuss issues related to pregnancy delay, sex, AIDS, suicide, and peer pressure. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: In FY 2011-2012, ICBHS experienced workforce shortages in most clinical and support positions to include Clinicians, Mental Health Rehabilitation Technicians, and Peer Supporters. Due to the staffing shortage, Imperial County was unable to implement two new evidence-based programs, Trauma-Focused Cognitive Behavioral Therapy and Aggression Replacement Therapy, and one wellness program, Horsemanship Services. These programs are planned to be implemented during FY 2012-2013. As demographic data indicates, the Adolescent Program was underrepresented ethnically in the white and African-American populations by notable amounts. Exploration into whether this is a function of the referral base, or whether community outreach to the underserved populations is necessary to obtain a more representative ethnic sample of the community will take place. In FY 2011-212, the adult population struggled with community reintegration. In a community with 25%-30% unemployment, persons with lost education, gaps in employment history, criminal records and other aberrations are tasked with an extraordinarily difficult challenge when trying to locate employment. Additionally, the risks for some of impacting their Social Security benefits or drawing them into review status limits this milestone movement of recovery as adult expectations for more normalized lives include work and lifelong learning. By utilizing the Recovery Center, stabilized recovering individuals can begin to obtain job search skills, attend community college, or develop résumés and connect with the co-located One Stop job resource to continue their recovery.

27

Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: There were no new, significantly changed, or discontinued programs for FY 2011-2012. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts on a specific age group and tailor services by considering the unique needs and challenges of the particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services. Subsequently, the Adult DDx-ISTS Program will be transferred to the Adult and Older Adult Services Unit where clients ages 26 and older will be served. In order to improve access to services in FY 2013-2014, there will be an establishment of satellite clinics in outlying areas of the county including two satellite Youth and Young Adult Services clinics. One will be located in Calexico and the other in Brawley. Historically, when access availability increases from the establishment of satellite clinics in unserved or underserved areas, a significant increase in caseload quickly follows. To further enhance services at each of the satellite clinics and ensure easy accessibility of an array of services for MHSA eligible individuals, various Full Service Partnership Programs (WASS, TAY-STS, and Adolescent DDx-ISTS programs) will be merged into one Full Service Partnership Team, which will be renamed the Youth and Young Adult Full Service Partnership. It is anticipated that by providing one Full Service Partnership team at each of the three Youth and Young Adult Services clinics, individuals will find it easier to obtain “wrap-like” services in their local area of residence. Services offered will continue to consist of a full range of integrated community services and supports including direct delivery and use of community resources. These services and supports will continue to include case management; rehabilitative services; “wrap-like” services; integrated community mental health and substance abuse treatment; crisis response; alternatives to juvenile hall; home and community re-entry from juvenile hall; youth and parent mentoring; supported employment or education; transportation; housing assistance; benefit acquisition; and respite care. By having staff trained in the overall needs of the age 12-25 MHSA population, as opposed to one very specific target group, staff availability will increase. It has also been found that many of the individuals within the age group of 12-15 and those age 16-25 share commonalities that, when treated in a supportive and interactive environment, can enhance the recovery process. Many share the need for similar mental health services and supports to reach his or her goals and therefore can be better served by merging the current distinct Full Service Partnerships. Along with the anticipated positive results from this merge, concerns have been identified as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Youth and Young Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments, while individuals with psychotic disorders may come in on another day, and those in the juvenile justice system on another. Supportive services will also be set up accordingly depending on the “clinic day” so as to ensure group services such as Anger Replacement Training or Drumming Circles also follow this model. It is believed that by distinguishing the populations in this manner, each will experience a 28

higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible. The target population for each of the Full Service Partnerships located at the three Youth and Young Adult Services clinics will be as follows: 

Seriously emotionally disturbed (SED) adolescents, age 12-15, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: selfcare, school functioning, family relationships, or the ability to function in the community and who are either at risk of or have already been removed from the home; or whose mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment; or who display at least one of the following: psychotic features, risk of suicide, or risk of violence due to a mental disorder. These individuals may also be diagnosed with a co-occurring substance abuse disorder.



SED or SMI transition-age youth, age 16-25, who, as a result of a mental disorder, have substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or the ability to function in the community and are unserved or underserved and are experiencing either homelessness or are at risk of being homeless; aging out of the child and youth mental health system; aging out of the child welfare system; aging out of the juvenile justice system; have involvement in the criminal justice system; are at risk of involuntary hospitalization or institutionalization; or are experiencing a first episode of serious mental illness. These individuals may also be diagnosed with a co-occurring substance abuse disorder.

Lastly, all clinicians assigned to the Youth and Young Adult Full Service Partnership, have been trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This evidence-based model has proven to be highly effective in the treatment of individuals age 3-18 who are suffering from symptoms related to Post-Traumatic Stress Disorder (PTSD). In FY 2013-2014, clinicians will begin using this model for adolescents, age 12-18, who are diagnosed with PTSD, and will attend weekly TF-CBT consultation calls with a certified consultant from the California Institute of Mental Health (CiMH). A Program Supervisor will also attend the consultation calls and track performance outcome measurements and fidelity to the model and submit these results to CiMH on a regular basis.

General Systems Development Recovery Center Program The Recovery Center Program (MHSA-RCP) serves the unserved and underserved TransitionAge Youth, Adult, and Older Adult Populations. The MHSA-RCP serves individuals over the age of 18 who are severely mentally ill with diagnoses that include Bipolar Type I and Type II Disorders, Psychotic Disorders, Delusional Disorders, and Schizophrenic disorders.

29

The MHSA-RCP offers daily organized and structured activities that are consumer directed and geared to assist consumers in their recovery from their severe mental illness and assist them in obtaining a restoration of a healthy and more independent lifestyle. MHSA-RCP has partnered with the Department of Rehabilitation, Imperial Valley College, and Imperial Valley Regional Occupational Program to offer consumers educational classes, pre-employment readiness, and employment training. Consumers are offered access to computers and internet (to do research, complete school assignments, and etc.), transit and transportation assistance, English language classes, and arts and crafts. Additionally, they are afforded the opportunity to participate in support groups such as medication, psycho-education, smoke cessation groups, wellness groups, health and fitness classes, and individualized Wellness and Recovery Action Plans (WRAP). The MHSA-RCP also offers medication management, nursing support, individual and family therapy, and case management services. The services provided are culturally competent and offered in the consumer’s primary language (in Imperial County consumers are primarily Spanish speaking). Language assistance, interpreter services, and American Sign Language services are available to those consumers that request such assistance. Notable Performance Measures: The Recovery Center Program served a total of 628 clients during FY 2011-2012. The demographic breakdown includes: 

Age Group:

71 transition-age youth 466 adults 91 older adults



Gender:

334 male 293 female 1 unknown



Race/Ethnicity:

469 113 33 5 1 1 1 1 4

Hispanic White Black Alaskan/Native American Asian Native Chinese Other Asian Vietnamese Other Gender

Age Group

0.2% 11%

14%

47% 53% 74%

TAY

Adults

Male

Older Adults

30

Female

Unknown

Race/Ethnicity 100% 80%

75%

60% 40% 20%

18% 5%

1%

0.2%

0.2%

0.2%

0.2%

1%

0%

Examples of Notable Community Impact: This program is a vital necessity to unserved and underserved clients in Imperial County. The MHSA-RCP assists clients that would otherwise not be able to attend community college. This program assists consumers by paying for tuition, books, and transportation, if needed. The majority of these clients are on a very limited income and these costs are astronomical to someone on a limited income. This program also offers GED and math classes (and a variety of other educational classes) to consumers. This program has successfully assisted consumers in obtaining their diplomas and/or degrees during FY 2011-2012. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: The population served by this program is at a higher risk due to the clients’ past lifestyle choices, which is one of the main barriers to providing psychiatric treatment to this population. Data supports that individuals diagnosed with a mental illness have a higher rate of diabetes and cardiovascular disease and that the average life expectancy is twenty five (25) years less than the average person. Additionally, many of the MHSA-RCP consumers have health conditions that are not addressed, which makes it necessary to collaborate with their primary care physicians or rural health clinics, such as Clinicas de Salud del Pueblo, for referral of clients needing medical services. ICBHS has also partnered with Fitness Oasis to offer consumers the opportunity to participate in zumba and weight resistance classes, which are held on site. These classes are taught by certified fitness instructors from Fitness Oasis. A notable challenge that has been experienced is the financial cost for consumers to acquire physicals so that they may participate in the exercise classes. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: In order to promote the recovery of consumers, the MHSA-RCP has a wellness and recovery approach to treatment modalities, which include medication support, weekly individual therapy, monthly family sessions, and case management services, if needed. The therapy process uses evidence-based Cognitive Behavioral Therapy and Cognitive Processing Therapy. The therapy process focuses on the wellness of each individual; psychoeducation for the individual and his or her family; medication management; sleep, hygiene, diet, and nutrition; and illness management. As a result, the MHSA-RCP has added additional support groups that are held

31

one time per week. The topics covered are psychoeducation, wellness and recovery, and medication. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: One new change to the MHSA-RCP is the is addition of a Nutrition Group to the services that are currently offered. This new nutrition group will be facilitated by a certified nutritionist and is expected to be implemented during FY 2013-2014. In FY 2013-2014, ICBHS will be reorganizing the current clinical divisions to focus each division’s efforts by specific age groups and to tailor services by considering the unique needs and challenges of each particular stage of development. The clinical divisions will be reorganized as follows: Children and Adolescent Services, Youth and Young Adult Services, and Adult and Older Adult Services. Due to the reorganization, only clients age 26 and older will be served at the Adult and Older Adult Services Division. In addition, the Full Service Partnership Programs (JSTS, SASS, and Adult DDx-ISTS) will be merged into one Full Partnership Program, which will be renamed the Adult and Older Adult Full Service Partnership. In order to improve services in FY 2013-2014, there will be a creation of a new MHSA-RCP satellite clinic in the outlying area of Brawley. To enhance services at this satellite clinic and ensure accessibility the services available for MHSA eligible individuals, the Adult and Older Adult Full Partnership Programs will be housed in the new location. It is anticipated that by locating the Recovery Center Program in this area, individuals living in this region will find it easier to access services. Along with the anticipated positive results from this merge, concerns have been identified by clients as possible consequences of combining the various populations at one clinic. For instance, the more vulnerable individuals based on past experience, diagnosis, and triggers, may in fact be negatively impacted by being grouped with the higher-risk populations. To avoid such issues, the Adult and Older Adult Services clinic in each city will be separating the populations by having “clinic days” assigned to specific groups. Individuals with trauma, anxiety, and depression may come in on specified days for appointments while individuals with psychotic disorders on another day. Supportive services will also be set up accordingly depending on the “clinic day”. It is believed that by distinguishing the populations in this manner, each will experience a higher level of support from individuals with whom they can identify and will receive the highest therapeutic level of treatment possible.

Outreach and Engagement Outreach and Engagement Program The Outreach and Engagement Program provides outreach and engagement activities to unserved and underserved seriously emotionally disturbed and seriously mentally ill individuals in the communities where they reside, including the homeless population. The program’s focus is to reduce the stigma associated with receiving mental health treatment by providing educational information and to promote access to services. The program provides education to the community, schools, and various agencies regarding early identification of mental health illness, resources to improve access to care, and stigma reduction.

32

Notable Performance Measures: The Outreach and Engagement Program provided outreach to 4,441 individuals during FY 2011-2012. The demographic breakdown includes: 

Age:

274 821 47 1,999 1,208 92



Gender:

1,497 male 2,944 female



Race/Ethnicity:

3,823 211 52 27 8 96 12 212

age 0-5 age 6-17 age 16-25 age 26-59 age 60+ age not reported

Hispanic White Black Alaskan/Native American Asian Multi-ethnic Other not reported Gender

Age 2% 6%

34% 18%

27%

1% 66%

45%

0-5

6-17

16-25

26-59

60+

Male

Not Reported

Female

Race/Ethnicity 100%

86%

80% 60% 40% 20%

5%

1%

1%

0.2%

2%

0.3%

5%

0%

The Outreach and Engagement Program successfully linked 32 individuals to ICBHS services. 33

Examples of Notable Community Impact: The Outreach and Engagement Program worked in collaboration with 48 Community-Based Organizations throughout Imperial County. This includes the outlying cities of Bombay Beach, Niland, and Winterhaven. The goal and purpose of working together is to serve the unserved and underserved populations and to develop awareness of services available through Imperial County Behavioral Health Services. The community has been educated about ICBHS through presentations, collaboration, and information dissemination at different agencies including, but not limited to, Clinicas de Salud del Pueblo, the WIC program, community hospitals, Mexico Consulate, the Department of Social Services, One-Stop Employment Centers, community centers, the United States Postal Office, police departments, and community faith-based organizations. The population currently being served consists of children, adolescents, transition-age youth, adults, and older adults. The Outreach and Engagement Program has been working in collaboration with different coalitions, committees, and task forces, with the purpose of developing strategies to motivate individuals within the community to participate during public events, thus increasing individuals’ awareness of the various services available in Imperial County. Each agency member provides ideas with the intention to create reachable outcomes to better serve targeted populations. Furthermore, the Outreach and Engagement Program participates in the following collaborative meetings: Tobacco Coalition, World AIDS Day (WAD) Planning Committee, Physical Activity and Healthy Eating (PAHE) Coalition, Initiative of the Americas/Binational Health Week Task Force, Child Obesity Physical Activity (COPA) Coalition, Veterans Employment Committee, and Employment Development Department. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: A challenge this program has encountered is providing outreach to faith-based organizations. Outreach and Engagement staff have implemented education strategies to improve access to faith-based organizations. Outreach and Engagement staff have worked with local faith-based organization staff by teaching them the importance of educating the public regarding available mental health services, especially if the faith-based organization at-hand is serving the homeless; individuals who are in the action stage and rehabilitating from a chemical dependency; and females and children who hold a history of domestic violence and are in need of housing. When Outreach and Engagement staff have requested to educate individuals, who are in a group home and/or in the action stage of rehabilitating from a chemical dependency, regarding 34

MHSA programs that provide substance abuse and co-occurring disorder treatment, faith-based organization staff have often affirmed that policy does not allow psychotropic medication to be present on their premises due to the potential for sharing, selling, and/or abusing medication; therefore, faith-based organization staff recommend that individuals access mental health services once they have completed their faith-based rehabilitation program. After educating faith-based organization staff on the available resources for children, adolescents, transition-age youth, adults, and older adults, the department has been allowed to disseminate educational materials regarding mental health services and community resources to help the unserved and underserved population that access faith-based organizations. Imperial County Behavioral Health Services has also been permitted to educate all individuals who attend faith-based organizations’ during food commodities activities therefore providing a venue to reach individuals that are low income and/or homeless. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: There were no significant changes to the Outreach and Engagement Program for FY 20112012. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: No significant changes to the Outreach and Engagement Program are planned for FY 20132014.

Transitional Engagement Supportive Services (TESS) Program The Transitional Engagement Supportive Services (TESS) Program provides supportive network services for unserved and underserved seriously emotionally disturbed and seriously mentally ill individuals, ages of 18 and older, residing in racially and ethnically diverse communities. The TESS Program offers services to conservatees who have just been released from LPS Conservatorship by the courts and are in need of supportive services, to assist them with reintegrating back into the community, and a supportive environment, including gaining entry into the mental health system. Services are also offered to clients that have been discharged from the Crisis Referral Desk and are not actively receiving services from ICBHS. Additionally, inactive clients that have been hospitalized and are being discharged from the hospitalization are assigned to the TESS Program to assist the client with linkage to community agencies/services and continued mental health treatment. The TESS Program provides culturally competent services to consumers. This program serves unserved and underserved populations regardless of gender, religion, or sexual preference. The outcome goals of the program are to reduce disparities in services provided to individuals residing in racially and ethnically and diverse communities, reduce homelessness, incarcerations, and the stigma associated with mental illness. Additional goals are to increase collaboration and the level of engagement in racially, and ethnically diverse communities, strengthen the local communities’ capacity to identify target populations, and promote outside agencies inclusion in the mental health service delivery system. The TESS Program provides a wide range of supportive services to assist consumers in transitioning between various levels of treatment. This includes temporary housing (Imperial Valley Housing Authority, Neighborhood House, The Redeemer, Woman Haven, House of Hope, and other faith based organizations), assistance with SSI/SSA applications, emergency

35

food stamps, referral to other community services (Food Bank, Salvation Army, and other faithbased programs), and linkage to ICBHS’ outpatient mental health services. Notable Performance Measures: The TESS Program served a total of 194 clients during FY 2011-2012. The demographic breakdown includes: 

Age Group:

33 Tranisition-Age Youth 161 Adults



Gender:

101 male 93 female 1 unknown



Race/Ethnicity:

110 63 14 3 1 1 2

Hispanic White Black Alaskan/Native American Asian Native Other Asian Other

Age Group

Gender 0.5%

17% 48%

52%

83%

TAY

Adults

Male

Female

Race/Ethnicity 100% 80% 60% 40% 20%

57% 32% 7%

2%

0.5%

0.5%

1%

0%

The TESS Program also provided services to 25 transient individuals residing outside of Imperial County. 36

Examples of Notable Community Impact: The TESS Program provided services to Imperial County residents as well as to transient individuals who resided outside of Imperial County during FY 2011-2012. A total of 25 transient individuals were provided with services as they presented either in a crisis situation or were hospitalized in a psychiatric setting due to danger to self/others or grave disability. The TESS Program staff provided the necessary linkage to assist clients to return to their home environment whenever possible. In addition, a total of 35 Conservatees were provided with services and necessary support needed upon being released from LPS Conservatorship by the courts. The services provided assisted these clients in reintegrating back into the community and into a supportive environment, including the mental health system. Without the much needed follow up and linkage to services provided by TESS Program, these individuals could end up decompensating and require hospitalization. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: One of the major challenges the TESS Program encountered during FY 2011-2012 was a high number of individuals that declined services being offered. Although the number of individuals that declined services offered by ICBHS has decreased, the TESS Program continues to make attempts to effectively engage clients and assist them with the referral process. Additionally, the lack of effective engagement with clients is another challenge faced by this program. TESS Program staff have been provided with trainings to ensure delivery of services meet program standards. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: During FY 2011-2012, TESS Program staff were trained on Motivational Interviewing, Client Centered Techniques, and Documentation Training. In addition, the TESS Program forms being utilized were updated to ensure clarity. A new Mental Health Rehabilitation Technician was assigned to the TESS Program to assist in providing the necessary services to clients. Additionally, the TESS Program staff took a more proactive role in providing outreach services to the community. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: The TESS Program staff will now be expected to take an active approach in client plan development in order to ensure clients receive the much needed services. It is expected that this will assist clients with the referral process to the outpatient clinic. TESS Program staff will also ensure clients identified as being at high risk of not following through with their initial scheduled mental health appointments receive the attention needed. Adult clients will be evaluated upon arrival at the Assessment Center and those not meeting criteria to be placed on a 5150 hold will be assigned to the TESS Program to ensure linkage to mental health services. Client diagnosed with co-occurring mental health and substance abuse disorders coming into the Crisis Unit shall be referred to the McAlister Institute, if medical necessity is met. TESS Program staff will provide follow-up care to clients referred to the McAlister Institute. It is anticipated that the TESS Program will be working collaboratively with local Imperial County hospitals to ensure mental health services are offered to clients in need. TESS Program staff will educate hospital staff regarding the TESS Program and how to refer potential clients to the TESS Program.

37

Prevention and Early Intervention The intent of Prevention and Early Intervention (PEI) programs is to move to a “help first” system in order to engage individuals before the development of serious mental illness or serious emotional disturbance or to alleviate the need for additional or extended mental health treatment by facilitating access to supports at the earliest signs of mental health problems. To facilitate accessing services and supports at the earliest signs of mental health problems and concerns, PEI builds capacity for providing mental health early intervention services at sites where people go for other routine activities (e.g., health providers, education facilities, community organizations). Mental health becomes part of the wellness for individuals and the community, reducing the potential for stigma and discrimination against individuals with mental illness.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Program and Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) On June 19, 2009, ICBHS submitted the Prevention and Early Intervention Plan recommending the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Program and the Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) as the two activities to address the needs of the priority population of trauma exposed individuals. Activity No. 1: TF- CBT The TF-CBT Program serves children and adolescents, ages 4-18, who have been exposed to trauma. The components in the TF-CBT model are designed to help children, youth, and their parents overcome the negative effects of traumatic life events such as child sexual or physical abuse; traumatic loss of a loved one; domestic, school, or community violence; or exposure to natural disasters, terrorist attacks, or war trauma. The interventions also address issues commonly experienced by traumatized children, such as poor self-esteem, difficulty trusting others, mood instability, and self-injurious behaviors, including substance abuse. TF-CBT incorporates cognitive and behavioral interventions with traditional child abuse therapies that focus on enhancement of interpersonal trust and empowerment. Additionally, it targets symptoms related to Post-Traumatic Stress Disorder (PTSD), which often occurs with depression and behavior problems. TF-CBT is being implemented as an early intervention aiming to prevent some of the long- term negative effects such as increased risk of substance abuse, suicide attempts, and social and relationship difficulties. TF-CBT clinicians provide these services in non-traditional settings such as schools, community centers, family resource centers, and the client’s home, if appropriate. TF-CBT includes the following components:  Psychoeducation to children and their families regarding the impact of trauma and common childhood reactions.  Parenting skills are provided to optimize children’s emotional and behavioral adjustment.  Individualized relaxation and stress management skills are introduced to the child and parent. 38

    

Affective expression and modulation are presented to help children and parents identify and cope with various emotions. Cognitive coping and processing are enhanced by demonstrating the relationships between thoughts, feelings, and behaviors. Trauma narration, where the child describes their traumatic experiences. Conjoint child-parent sessions which help the child and parent talk to each other about the child’s trauma. Enhancing future safety and development.

Additional elements of the TF-CBT Program are outreach and prevention activities that are conducted by the clinicians and the mental health rehabilitation technician. The focus of these activities includes providing presentations to the community on trauma and the impact of traumatic experiences on children. The presentations incorporate topics such as bullying, depressed youth, respectful behavior, and empathy. Activity No. 2: PEARLS The PEARLS Program is designed to provide services to older adults, age 60 and older, with minor depression or dysthymia. It has been established that problem solving training helps individuals exert control over their problems, thus individuals with solid problem solving skills experience less depression. Since depression often leads to withdrawal from activities; with behavioral activation, individuals can learn to reestablish healthy routines and activities. The PEARLS Program provides early intervention to prevent the onset of mental illness and decrease the risk for a higher level of care including crisis intervention and/or hospitalization. The PEARLS clinician will conduct services in the individual’s home for eight (8) sessions over a nineteen (19) week period. The desired outcome is to reduce the symptoms of depression, increase socialization, and prevent the progression of signs and symptoms resulting in the deterioration of mental health, loss of independence, and/or substance abuse. Notable Performance Measures: Activity No. 1: TF- CBT TF-CBT program staff has built collaborative relationships with school districts and community agencies to assure children exhibiting early symptoms of trauma are identified and referred to the program. Additionally the clinicians and Mental Health Rehabilitation Technician regularly meet with school personnel to provide information on the criteria for the program and referral process. The relationships have proven to be highly effective in view of 236 referrals received in FY 2011-2012. Referrals were generated by the following agencies: Department of Social Services, Imperial County Office of Education, Imperial County Public Health, and School Districts from Brawley Elementary, Brawley High School, Calexico, El Centro Elementary, Heber Elementary, Imperial, Meadows, San Pasqual, and Westmorland. The TF-CBT Program served a total of 143 children during FY 2011-2012. The demographic breakdown includes: 

Gender:

72 male 71 female



Primary Language:

69 English 74 Spanish



Race/Ethnicity:

137 Hispanic 6 White 39

Gender

Primary Language

50%

Male

48%

52%

50%

Female

English

Spanish

Race/Ethnicity 100%

96%

80% 60% 40% 20%

4%

0% Hispanic

White

Activity No. 2: PEARLS During this fiscal year a total of 18 referrals were received for this program; However, 15 referrals were screened out due to the following reasons: 1) unable to locate the individuals, 2) individuals referred did not meet service criteria, 3) individuals declined services. The PEARLS Program served a total of 3 older adults during FY 2011-2012. The demographic breakdown includes: 

Gender:

1 male 2 female



Primary Language:

1 English 2 Spanish



Race/Ethnicity:

2 Hispanic 1 White

Examples of Notable Community Impact: Activity No. 1: TF- CBT The desired outcomes of TF-CBT is children receiving services will demonstrate a reduction in PTSD, anxiety and depression symptoms, decrease in behavioral problems, sexualized behaviors and trauma-related shame, and improvement in interpersonal trust and social competence.

40

During FY 2011-2012, of the 143 children who received services, 90 children and their families successfully completed the program. By the end of the fiscal year, 38 were still receiving services, 24 were referred to ICBHS’ Regional Clinics, and 29 dropped out of services prematurely. It is important to note that not all children referred to this program required the full course of TF-CBT because, in many cases, problems resolved early in the intervention. Of the 90 that completed the treatment model, parents and/or caregivers reported a reduction in somatic symptoms, intrapersonal distress, problems with interpersonal relations, social problems, and behavioral dysfunction in 71% of the cases. Improvements were reported in the reduction of PTSD symptoms such as intrusive and upsetting memories, thoughts or dreams about the trauma; avoidance of things or situations; emotional numbing; and physical reactions of hyperarousal, trouble concentrating, or irritability. The TF-CBT program has also been effective in helping parents overcome general feelings of depression, reduce PTSD symptoms, reduce emotional distress about the child’s trauma, improve parenting practices, and enhance their ability to support their children. TF-CBT has generated highly observable results as demonstrated in the following case: Robert was a 9 year old boy who was referred to the TF-CBT program due to struggling with the death of his mother, moving to a new home, and adjusting to a newly blended family. Robert had been living with his mother and grandparents in Las Vegas. One morning he awoke to find his mother dead in her bed. She had a history of substance abuse and reportedly her cause of death was an overdose. Robert’s grandparents were unable to care for him, therefore he was sent to live with his biological father whom he hardly knew. Robert encountered having to adjust to his father getting married and welcoming a new baby and two step-brothers. Though Robert was doing well academically, he began to exhibit emotional outbursts. Robert’s parents were concerned and sought assistance from the TF-CBT Program. With the use of TF-CBT interventions, Robert received education on grieving and loss, stress management, cognitive coping and processing, and affective expression and modulation to help Robert cope with a range of emotions. The goal was to help Robert remember his mother without feeling so much pain and relieving any guilt associated with her death. With the interventions provided, Robert was able to accomplish this. At the end of Robert’s 4th grade year, he successfully completed the program and earned Student of the Year of his entire school. Robert was able to cope with the death of his mother and his parents received the skills to assist Robert in dealing with his loss. Another significant impact the TF-CBT Program has made to the community is that it has served as a vehicle for the early detection of children whose impairments and symptoms meet the criteria for a mental health disorder. Through the comprehensive intake assessments conducted by the program’s clinicians, they have been able to identify when a child presents with a mental health disorder and requires mental health treatment. Such cases have been promptly referred to ICBHS’ Children’s Regional Clinics. These children might have otherwise gone undetected if not for being referred to the TF-CBT Program. Activity No. 2: PEARLS Although a low number of individuals were served, those that were serviced were provided with interventions that increased their awareness and importance of increased physical activities to 41

reduce signs and symptoms of depression. Individuals also increased their understanding of effective problem solving skills which assisted them in decreasing their depressive symptoms and in reengaging into the community. Outreach presentations were provided to continue to educate the community on mental illness prevention for the older adult population. Local community agencies such as Imperial Valley Home Health, Adult Day Out Program, Diabetes Education and Self-Management Center (El Centro Regional Medical Clinic), and their consumers continued to be provided with presentations to become aware of the early intervention services available to this population. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: Activity No. 1: TF- CBT The TF-CBT Program continues to be well received by the community as it has proven to be an effective early intervention for children and adolescents with an array of trauma-related difficulties. Consequently, the program continues to receive a high volume of referrals. Presently the program operates with two full- time clinicians and continues to utilize the assistance of a part-time master’s level intern; however, due to the continuous flow of referrals, the program maintains a waiting list of up to 30 clients. In an effort to serve the children being referred to the program, the intent is to add another full time clinician to assure timeliness of services and continue to meet the needs of the community. Activity No. 2: PEARLS A challenge for the PEARLS Program was related to the lack of sufficient and appropriate referrals. Out of the 18 referrals received during FY 2011-2012, a high number of individuals referred declined services, were unable to be located, or did not meet the program criteria. This occurred even though outreach was provided in various locations which were identified as being in need of these types of services. Unfortunately, the anticipated positive impact this program was expected to have on the community continued to be unsuccessful. A strategy utilized to mitigate the aforementioned challenge was to continue to provide more consistent and proactive outreach services to various community agencies. This included follow up to enhance relationships with these various agencies, and thus to increase the communities knowledge regarding the PEARLS criteria and target population. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: Activity No. 1: TF- CBT No significant changes have occurred for FY 2011-2012. Activity No. 2: PEARLS No significant changes have occurred for FY 2011-2012. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: Activity No. 1: TF- CBT In order to meet the needs of the community and ensure timeliness of services, the program will add an additional full time clinician. Activity No. 2: PEARLS Effective FY 2013-2014, ICBHS will be closing the PEI PEARLS Program. The unfortunate closure of this program is due to insufficient referrals being received from various community agencies throughout Imperial County, regardless of the efforts made to get appropriate referrals

42

and getting the clients involved. Additionally, many of the new referrals that were received from various community agencies located throughout Imperial County did not meet the required services necessity criteria. Due to the aforementioned circumstances, this program is not being utilized to its full capacity by the residents of this community.

43

Workforce Education and Training The MHSA Workforce Education and Training (WET) Plan component provides education and training for all individuals who provide or support services in the Public Mental Health System. The mission of WET is developing and maintaining a sufficient workforce capable of providing client and family driven, culturally competent services that promote wellness, recovery and resiliency, and lead to evidenced-based, value driven outcomes. WET has five separate funding categories, which include Workforce Staffing Support, Training and Technical Assistance, Mental Health Career Pathway Programs, Residency and Internship Programs, and Financial Incentive Programs. Imperial County’s WET plan was approved in May of 2011. Within the plan, four separate actions were proposed that fall under three of the major funding categories, which are Training and Technical Assistance, Mental Health Career Pathway Programs, and Financial Incentive Programs.

1. Training and Technical Assistance: Action 1: Evidence-Based and Promising Practices Trainings The CSS stakeholder process identified the need to further utilize evidence-based and promising practices. In evaluating evidence-based practices and promising practices that meet the needs of the targeted youth populations served, the following programs were identified: 

Aggression Replacement Training (ART) – Designed to alter the behavior of aggressive and violent youth ages 12 to 17 who were incarcerated in juvenile institutions to reduce aggressive and antisocial and high-risk behavior and promote anger management and social competence. It is expected that implementing this practice will reduce the number of seriously emotionally disturbed youth and transition-age youth in juvenile halls, reincarceration, inability to work, inability to manage independence, isolation, as well as improve safety and permanence at home, school and in the community.



Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – Designed to reduce PostTraumatic Stress Disorder (PTSD) symptoms by exploring inaccurate or unhelpful cognitions about the trauma and the feelings that accompany them. The expected outcomes are decreasing PTSD symptoms, decreasing externalizing problem behaviors, improve parent-child relationships, improve parenting, and decrease parental depression. It is expected that implementing this practice will improve safety and permanence at home, school and in the community of seriously emotionally disturbed youth/transition-age youth.



Early Detection and Intervention for the Prevention of Psychosis (EDIPP) – Designed as an intervention for young people exhibiting early symptoms of psychotic illnesses, but also seeks to build community support for changing the way severe mental illness is approached. EDIPP focuses on the early emergence of symptoms that might indicate the likelihood of a future mental illness without intervention. The success of EDIPP is predicated on connecting with, engaging, and educating social workers, doctors, nurses, students, teachers, parents, clergy, police officers, youth workers, and other groups that have regular interactions with adolescents and young adults. Families and patients are educated on psychobiology of psychosis and trained in coping skills to avoid psychosis by reducing stress and optimizing social environment at home, school, and work.

44

Moreover, participants are provided direct assistance, guidance and ongoing support to gain employment and succeed in their educational goals. Action 2: Interpreter Training Program The Interpreter Training Program has two components: (1) Mental Health Interpreter Training for Interpreters and (2) Mental Health Interpreter Training for Providers Who Use Interpreters. The Mental Health Interpreter Training for Interpreters is designed to immerse bilingual staff who currently serve as interpreters in a mental health setting in the principles and practices of interpreter communication skills. Topics for the training included a discussion on federal and state regulations, communication in high and low context cultures verbal and non-verbal communication, the interpreting process, roles of the interpreter, interpreter techniques, and mental health terminology. Mental Health Interpreter Training for Providers Who Use Interpreter Services is designed for monolingual English speaking clinicians and other providers to learn to work more effectively with consumers through the use of trained interpreters. Topics for the training included a discussion in federal and state regulation, interpreter’s legal and ethical responsibilities, terminology, of interpretation, therapeutic triad, role of the interpreter, and cross-cultural communication.

2. Mental Health Career Pathway Programs Action 3: Clinical Practicum Supervision This action is a collaborative effort between a local university, a federally qualified health center (FQHC), and Imperial County to assist MFT students moving forward in their careers by providing opportunities to obtain practicum hours on a volunteer basis. Imperial County will facilitate the placement MFT practicum students at the FQHC as well as dedicate licensed clinical professionals to provide clinical supervision to undergraduates as an early engagement strategy to develop licensed clinical staff and encourage students to consider a career in the public mental health field.

3. Financial Incentive Programs Action 4: Stipends for Graduate Students This action provides for ten stipends to individuals interested in pursuing a graduate level degree in social work from San Diego State University (SDSU) to expand the diversity and cultural competence of our workforce. The stipend program offers a fixed amount to students in the second and third year of their Master of Social Work (MSW) Program to assist in covering their expenses in exchange for a commitment to work in the public mental health system for a specific time period. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: Action 1. Evidenced –Based Trainings: During FY 2011-2012 Imperial County experienced workforce shortages in most clinical and support positions, including Mental Health Rehabilitation Technicians. The staff shortage prevented the department from implementing two new evidence-based programs, ART and TF-CBT, and one promising practice, EDIPP.

45

Action 2: Interpreter Training Program There were no challenges or barriers to implementing the Interpreter Trainings during FY 20112012. Action 3: Clinical Practicum Supervision There were no challenges or barriers to implementing the Clinical Practicum Supervision action during FY 2011-2012. Action 4. Stipends for Graduate Students Our challenge or barrier to awarding 10 stipends was the limited pool of applicants to choose from. Only eight MSW students from SDSU-Imperial Valley Campus applied for the ten available stipends. Notable Performance Measures in FY 2011-2012: Action 1: Evidenced-based Trainings: Due to the staffing shortage experienced during FY 2011-2012, Imperial County was unable to provide the ART, TF-CBT, and EDIPP. Therefore, the funding for these staff development opportunities will roll over into FY 2012-2013. Action 2: Interpreter Training: The Mental Health Interpreter Training for Interpreters three-day workshop was offered December 5-7, 2012. Twenty–four (24) staff attended the training. Mental Health Interpreter Training for Providers Who Use Interpreter Services one-day training was offered on December 8, 2012. Fifteen (15) clinicians attended the training. Action 3: Clinical Practicum Supervision During FY 2011-2012 licensed clinical professionals provided clinical supervision to ten MFT practicum students. Action 4. Stipends for Graduate Students On September 11, 2012, ICBHS entered into a multi-year Memorandum of Understanding (MOU) with the SDSU School of Social Work and Research Foundation. According to the terms of the MOU, ICBHS grants funding for eight educational stipends not to exceed $9,000.00 per year, plus the sum of the cost of staff time, operating cost, and administrative overhead needed to manage the program. The SDSU School of Social Work and Research Foundation agreed to distribute the eight stipends during FY 2012-2013 and FY 2013-2014. During FY 2012-2013, 2013-2014, 2014-2015, and 2015, the SDSU School of Social Work and Research Foundation will track and report on the number of students that complete the program and manage contract responsibilities that include offering specific courses that focus on mental health. In March 2012, eight MSW students from SDSU-Imperial Valley Campus applied for the stipends and all of the students were awarded the stipends after completing an application, writing an essay, and completing an interview. The eight stipend recipients are all Hispanic females. Seven of the stipend recipients are bilingual Spanish. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: Action 1: Evidenced-based Trainings In line with Imperial County’s commitment to a well-educated and well-prepared workforce, the following evidence-based training opportunities have been identified for FY 2013-2014.

46

1. Cognitive Processing Therapy (CPT) – This training will introduce staff to one of the most effective treatments for individuals who have Post-Traumatic Stress Disorder (PTSD). CPT is an evidence-based, short-term treatment for PTSD, developed by Dr. Patricia Resick and her colleagues. CPT is based on a social cognitive theory of PTSD that focuses on how the traumatic event is construed and coped with by a person who is trying to regain a sense of mastery and control over his or her life. Understanding and competence in treating PTSD is an important skill for mental health providers to have. This training is a two-day workshop for 15 staff followed by 26 weekly consultation consultation calls for two teams of therapist. 2. Depression Treatment Quality Improvement (DTQI) – The California Institute of Mental Health (CiMH) will train staff on the evidence-based practice DTQI. DTQI is a manualized 12-16 session Cognitive Behavioral Therapy (CBT) program for depression in teens and young adults, ages 12-21. DTQI includes training and consultation delivered by the developers of the model, Joan Asarow Ph.D., and /or Margaret Mason-Rea. The DTQI provides three one-day trainings for 20 staff followed by ten one-hour consultation calls per team of therapist. Budget Justification: The budgeted amount includes the cost of training modules, travel expenses to attend trainings, and administrative overhead. These costs were based on our experience with similar trainings, and on research on pricing conducted for the purposes of this plan, and comparable existing contracts. 1.

CPT: Two-day workshop= $6,952 Consultation calls= $7,800 Travel = $1,048 Total Item A = $15,800 Budget Breakdown:  



Initial two-day workshop for 15 staff Travel for Trainer o Airfare o Meals o Car expense o Lodging 26 consultation calls per team (2) of therapists @ $150 per call

$ 6,952 $ $ $ $

150 138 150 610

$ 7,800 Total: $ 15,800

2.

DTQI: Three one-day workshops = $30,000 Consultation Calls = $7,500 CiMH Fee = $3,000 Total Item B = $15,800 Budget Breakdown:   

Three one-day workshops for 20 staff (includes DTQI manuals and workbooks) CiMH Fee (10%) 30 consultation calls @ $250 per call

47

$30,000 $ 3,000

(ten one-hour consultation calls per team (3) of therapists)

$ 7,500 Total: $40,500

FY 2013-2014 Total: $56,300 Action 2: Interpreter Training: The Mental Health Interpreter Training for Interpreters and the Mental Health Interpreter Training for Providers Who Use Interpreter Services were provided in FY 2011-2012. There are no proposed changes for this action for FY 2013-2014. Action 3: Clinical Supervision: The WET Plan adopted in May 2011 provided funding for this action during FY 2011-2012 and FY 2012-2013. There continues to be a need for additional licensed clinicians in the local labor force. Continuing this collaborative in FY 2013-2014 will serve both the county and the community in developing trained professionals to provide mental health services. Imperial County will facilitate the placement MFT practicum students at the FQHC and county-operated clinics as well as dedicate licensed clinical professionals to provide clinical supervision to undergraduates as an early engagement strategy to develop licensed clinical staff and encourage students to consider a career in the public mental health field. Budget Justification:   

Supervision of MFT practicum students ($75.00 per hour for 144 hours of two licensed supervising clinicians) Operating expenses for supplies, communication, & travel Administrative cost for WET coordination

$10,800 $ 583 $ 1,620

Total: $13,003 FY 2012-2013 Total: $13,003 Action 4. Stipends for Graduate Students Imperial County was unable to award two stipends in FY 2011-2012 due to the limited applicant pool. Funding for the stipends will be rolled over to the next cohort of MSW students at SDSUImperial Valley Campus, which will commence in the summer of 2014. It is anticipated that the stipends will be distributed in September 2015.

48

Capital Facilities and Technological Needs As one of five components of MHSA, the Capital Facilities and Technological Needs (CFTN) component provides resources to promote the efficient implementation of the MHSA. the planned use of Capital Facilities and Technological Needs funds should produce long-term impacts with lasting benefits that move the mental health system towards the goals of wellness, recovery, resiliency, cultural competence, prevention/early intervention and expansion of opportunities for accessible community-based services for clients and their families which promote the reduction of disparities to underserved groups. The Imperial County Capital Facilities and Technological Needs Plan was submitted to the Department of Mental Health in May 2011. The plan identifies the technological needs which meet the goals set by the state to: 1) modernize and transform clinical and administrative information systems to ensure quality of care, parity, operational efficiency and cost effectiveness; 2) to increase client and family empowerment and engagement by providing tools for secure client and family access to health information that is culturally and linguistically competent within a wide range of public and private settings, as the county moves towards and integrated Information Systems Infrastructure. Project 1: Electronic Health Record System Project CareConnect and OrderConnect CareConnect will provide a secure way to exchange clinical and administrative information between and among providers involved in the case of the consumer. OrderConnect is a secure web-based electronic lab and radiology ordering management system. These clinically innovative solutions help providers improve quality of care, reduce errors and meet criteria to receive Medicaid and Medicare funds for Meaningful Use of an Electronic Health Record (EHR). These products are fully integrated with Avatar, which is Imperial County Behavioral Health Services information system. Project 2: Client and Family Empowerment ConsumerConnect ConsumerConnect is a service that will increase client and family member empowerment and engagement by providing tools for secure client and family member access to electronic health record and wellness information that is culturally competent. ConsumerConnect offers a unique way to furnish consumer access to a host of information related to their care, 24 hours a day. It also allows for interactive involvement from consumers around their treatment plans and medications. ConsumerConnect is a secure, Web-based portal designed to work with Avatar accessible via a Web browser from home or a public access Internet. Project 3: Other Technological Needs Projects that Support MHSA Operations Document imaging and Signature Capture Document Imaging facilitates the electronic collection, transformation, management, delivery, storage and ongoing access to information. This information can include images, insurance forms, orders, lab results, referrals and releases, system-created legal documents, and other information vital to electronic health records. The signature capture allows for electronically capturing the consumer’s signature into any document in Avatar.

49

Project 4: Other Technological Needs Projects that Support MHSA Operations ITEMS (Information Technology Enhancement Management System) Project ITEMS includes the installation of workgroup servers for the centralization and management of key Imperial County Behavioral Health Services data at all remote offices, replacement of desktop computers and the standardization of PC operating systems, updating all PCs to same latest version of business applications, installation of data back-up repositories, automation of data back-ups using the latest enterprise back-up software. The ITEMS project will ensure that staff have adequate computer technology hardware/software to operate in a modernized, transformed and integrated information systems environment. Notable Performance Measures: Imperial County Behavioral Health Services contracted with Netsmart, the vendor for Avatar, for the acquisition of the OrderConnect, CareConnect, ConsumerConnect and Document Imaging products on August 2011. On September 2011, to support the installation of the abovementioned products, five servers were purchased from NetSmart. The fiver servers arrived on October 2011 and work began on configuring them. It is expected that switching from a single server information system to a five-server system will improve performance of the current application and pave the way for these additional modules. Describe any Examples of Notable Community Impact During FY 2011-2012: The addition of the Systems Analyst greatly enhanced the capacity of department to assist users. It impacted the ability to successfully rollout out the new machines and software to users. Also through his knowledge of servers, network protocols and back-up software, we expanded our ability to efficiently handle day to day helpdesk work orders that might otherwise be handled by County Information System’s department which would have taken longer with a possibility of interruption of service to the users. The upgrade of the new machines and the software enhanced the continuity between users by allowing them to work with new faster machines that could sustain the new Radplus 2010 and amount of data needed to do their daily work. It also greatly enhanced the ability to work within the same platforms both within the Windows operating system and the upgraded versions of MS Excel and MS Word. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: The purchased hardware that would allow the implementation of OrderConnect, CareConnect, ConsumerConnect and Document Imaging modules is pending configuration. There have been delays in implementing the five-server solution due to configuration issues between the operating system and the application Avatar. A designated team including staff from ICBHS and NetSmart continue to address the issue by meeting and discussing possible solutions to this configuration challenge. This group also worked on the plan for data migration from current server to new servers as well as strategizing to deploy links connecting users to the new platform. For CF/TN and Housing, Describe if the County is Meeting Benchmarks or if there are Significant Delays and Reasons for those Delays to Implementation: The majority of milestones did not proceed as plan due to unresolved issues with hardware and software installation. The original benchmarks adopted were not met due to hardware/software

50

installation issues on five machines and delays in the hiring process for the administrative analyst assigned to work on these projects List any Significant Changes, Including New or Discontinued Programs, for FY 20132014: Imperial County Behavioral Health Services is adopting the following projects consistent with the original goal set by the state to modernize and transform information systems towards an integrated infrastructure: Project 5: ITEMS – Catastrophic Contingency Disaster Backup Plan A change from the existing plan is to implement a complete catastrophic contingency disaster backup plan. This would include:  An assessment of the electrical configuration of the server room to sustain the number of UPS’s to be used as back-up power.  A state of the art fire suppressant system to replace the current water sprinklers  A enterprise back-up solution/server  A redundant backup repository to include three locations; on-site on a local server, county server and an offsite vendor proportioned server Also upgrade Helpdesk and inventory program to an enterprise version to include:  70’ inch HD monitor in the computer to monitor ICBHS network configuration  Manage all Helpdesk tickets more efficiently without an interruption in service to the users Using a LAN state console monitoring software program Project 6: Crystal Reporting Skills Crystal Report Consultant A change from the existing plan is the need for crystal reporting skills that would allow to extract the additional data that will be stored in the new modules. Crystal reporting skills was a need identified by the External Quality Review Organization during their review on January 2013. The additional modules present a challenge to manage properly without the information needed to manage the software as well as to provide client information to service providers, which will now exist in the system. One way to acquire the crystal reporting skills is to contract with a consultant for crystal reports support who can provide existing staff with the support needed to develop reports in-house. The crystal report support will provide:  assistance with planning on report format  report optimization  assistance with writing formulas It is estimated that a proposed 100 hours of support will suffice to provide two staff with the instruction and support. The additional cost will be around $15,000 as the consultant’s rate is $150 per hour. Project 7: Organization Performance Measurement Tool Enlightened Analytics NetSmart, vendor for Avatar (ICBHS Information System), has a new product available that allows an organization to access information about services provided, client information, quality

51

outcomes, cost of services through a drill down process that views real time detailed information by population, service provider, program, division or the entire organization. ICBHS plans to acquire this product in FY 13/14 to improve the ability to make decisions resulting in improved operations and enhance patient care. The manner in which information is display allows for coordinators, case managers, therapists, psychiatrists, nurses, and peer specialists up-to-date, actionable information that helps them improve patient access and transform care. This product also allows for identifying and tracking service utilization rates thus promoting data-driven decision making and improving the quality of services. Budget Justification: Fire Suppressant System New Server to be used as part Catastrophic Contingency Backup Solution Plan Server room electrical assessment As part of proposed Catastrophic Contingency Backup Solution Plan Enterprise Help Desk Program Enterprise Inventory Program 70” HD TV Monitor LAN state Console Monitor Program Crystal Report Consultant Offsite Backup (NetSmart) Enlightened Analytics Total FY 2013-2014:

52

$ 19,386 $ 29,793 $

5,000

$ 3,500 $ 2,700 $ 51,650 $ 500 $ 15,000 $ 51,000 $115,000 $243,519

Housing Executive Order S-07-06, signed by Governor Schwarzenegger on May 12, 2006, mandated the establishment of the MHSA Housing Program. This program makes permanent financing and capitalizes operating subsidies available for the purpose of developing permanent supportive housing, including both rental housing and shared housing, to serve persons with serious mental illness who are homeless or at risk of homelessness.

MHSA Housing for the Mentally Ill or at Risk of Homelessness The MHSA Housing Program for the homeless or at-risk-of homelessness mentally ill, which is now known as the “Las Brisas” Apartments, was completed in September 2012 and consists of a 72 unit affordable housing apartment complex of which 18 units have been set aside for MHSA eligible tenants. On October 1, 2012, all 18 units were occupied by MHSA eligible tenants. All tenants represent the target population of MHSA eligible seriously mentally ill adults, older adults, transition-age youth, and seriously emotionally disturbed children that meet the criteria of homeless or at-risk of homelessness. The total project consists of five two-story residential structures with a total of eight onebedroom units, 36 two-bedroom units, and 28 three-bedroom units, a community center, and private office space for ICBHS staff to provide services for MHSA tenants. MHSA set-aside units consist of eight one-bedroom units, six two-bedroom units, and four three-bedroom units. ICBHS serves as the provider of services for MHSA tenants. Chelsea Investment Corporation, Inc., is the qualified developer of the project, and CIC Management Inc. is the property management company that manages Las Brisas. In addition to the MHSA funds committed, Las Brisas was financed with a combination of Federal, State, and Municipal affordable housing resources. Rents on MHSA funded units are based on 30% of Area Median Income. Notable Performance Measures: During the period of time that Las Brisas was undergoing construction, ICBHS staff engaged consumers with information and presentations regarding the availability of affordable housing. An interest list was established to be able to assist ICBHS staff in providing linkage for consumers to this resource. A preliminary list of 92 interested individuals was developed. This list consisted of 48 adults, 35 children and nine transition-age youth consumers. On June 21, 2012, training was provided to Mental Health Rehabilitation Technicians regarding the screening and certification process for consumers who wanted to apply for MHSA funded housing. Lease up of the units began in September and by October 1, 2012, 78 MHSA qualified consumers had been certified for the application process. Additionally, MHSA Flex funding assisted nine MHSA tenants with rent deposits, which facilitated their ability to occupy these

53

units. MHSA funded units are occupied by eight adult consumers/families, eight children/families and two transition-age youth. On February 12, 2013, training was provided to all ICBHS Mental Health Rehabilitation Technicians regarding their new role in providing supportive services to the MHSA tenants at Las Brisas. Mental Health Rehabilitation Technicians were provided information on the rules of the property, amenities, establishing client plan goals to assist the clients in maintaining their new home, and living successfully in an affordable housing community. Examples of Notable Community Impact: On December 13, 2012, Chelsea Investment Corporation sponsored a Grand Opening Ceremony at Las Brisas. Representatives from the various investors, City, and, County dignitaries led the celebration of Las Brisas’ presence in the Community. Some of the housing units were made available for tours by the attendees. A tenant art project was unveiled at the event. Each tenant created a painted tile which is now hung in the Community Room. The highlight of the Grand Opening was a personal testimony by one of the tenants who is also a MHSA tenant. She spoke of how this housing has been a tremendous assistance to her and her family achieving stability and hope in their lives. Challenges or Barriers and Strategies to Mitigate Those Challenges or Barriers in FY 2011-2012: Infrastructure development consisting of road improvements in front of the Las Brisas Apartments is still under construction. Sidewalks, curbs and gutters, road widening, and paving is expected to be completed in April 2013. The City of El Centro, which is doing the construction, has established temporary road access to Las Brisas during the construction. This measure has mitigated any difficulty accessing the property. Additionally, the bus stop is located approximately two city blocks away from the property. In an effort to assist clients with their transportation needs, CIC Management, Inc., has established a shuttle service that provides daily transportation for Las Brisas residents to wherever they need to go within the City of El Centro. Significant Changes, Including New or Discontinued Programs, for FY 2011-2012: There were no new, significantly changed, or discontinued programs for FY 2011-2012. Benchmarks or Significant Delays and Reasons for those Delays to Implementation: The project is on schedule and no delays have been encountered to date. Significant Changes, Including New or Discontinued Programs, for FY 2013-2014: There are no new, significantly changed, or discontinued programs for FY 2013-2014.

54

MHSA Funding Summary FY 2013/14 County:

Imperial

Date:

04/11/2013

MHSA Funding

A.

CSS

WET

CFTN

PEI

INN

$579,237

$1,548,755

$1,124,489

$578,577

$1,161,972

$336,357

Local Prudent Reserve

Estimated FY 2013/14 Funding 1.

Estimated Unspent Funds from Prior Fiscal Years

$2,205,487

2.

Estimated New FY 2013/14 Funding

$5,233,386

3.

Transfer in FY 2013-14

4.

Access Local Prudent Reserve in FY 2013-14

5.

Estimated Available Funding for FY 2013-14

a/

B.

Estimated FY 2013/14 Expenditures

C.

Estimated FY 2013/14 Contingency Funding

$7,438,873

$579,237

$1,548,755

$2,286,461

$914,934

$7,340,559

$579,237

$1,548,755

$1,139,959

$340,859

$98,314

$0

$0

$1,146,502

$574,075

a/

Per Welfare and Institutions Code Section 5892(b), Counties may use a portion of their CSS funds for WET, CFTN, and the Local Prudent Reserve. The total amount of CSS funding used for this purpose shall not exceed 20% of the total average amount of funds allocated to that County for the previous five years.

D.

Estimated Local Prudent Reserve Balance 1.

Estimated Local Prudent Reserve Balance on June 30, 2013

2.

Contributions to the Local Prudent Reserve in FY 2013/14

$0

3.

Distributions from Local Prudent Reserve in FY 2013/14

$0

4.

Estimated Local Prudent Reserve Balance on June 30, 2014

55

$2,752

$2,752