Artwork by Sheila Dery
Mental Health Services Act DRAFT Innovation Proposal 2017
T
hank you for your interest in the San Bernardino County Department of Behavioral Health’s (DBH) Mental Health Services Act (MHSA) Innovation Plan. Since the passage of MHSA in 2004, the mental health system in the State of California has undergone a transformation in the services and treatment options available for individuals living with mental illness. Across San Bernardino County, an extensive network of services have been established through the guidance of the MHSA Components: Community Services and Supports, Prevention and Early Interventions, Innovation, Capital Facilities and Technological Needs, and Workforce Education and Training.
Message from the Director
The Innovation Component of MHSA provides counties with the opportunity and challenge to think outside the box and implement projects that encourage learning in the field of behavioral health. The purpose of Innovation projects is to enhance quality of services, improve outcomes, promote interagency collaboration, and increase access to services, especially for underserved groups. Innovation projects are time-limited and are an opportunity to creatively improve any aspect of the community mental health system. Innovation projects may introduce a mental health practice or approach that is new to the mental health system, make a change to an existing practice, or apply an existing non-mental health approach or promising community driven practice to mental health. This plan provides in depth information about the proposed project, Inland Empire PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services (IE PsychPartners) and is a dual county, regional approach to innovation. The proposed project is a collaborative effort to transform a part of our healthcare system in an innovative and efficient way by building on our relationships with our hospital partners and utilizing the dynamic communication technologies that are available today. In the Community Program Planning section you will find a description of the extensive and diverse stakeholder process that took place related to Innovation project planning. It is only after extensive conversation and careful consideration that the project is proposed to be funded under the Innovation Component of the MHSA. We find this project falls in line with the San Bernardino Countywide Vision by promoting wellness through improving collaboration and partnerships to better treat the whole person. I invite you to read the project plan and provide feedback at
[email protected]. Your time and feedback is greatly appreciated. If you would like additional translated items, including parts of this plan please contact Karen Cervantes, Program Manager I with the Office of Innovation at (909) 252-4068 or
[email protected]. Thank you.
Our job is to create a county in which those who reside and invest can prosper and achieve well-being. DRAFT MHSA Innovation Proposal 2017 1 of 140
G
Gracias.
Nuestra labor es crear un condado en el cual los que viven e invierten puedan prosperar y lograr el bienestar. DRAFT MHSA Innovation Proposal 2017 2 of 140
Message from the Director
racias por su interés en el Plan de Innovación de la Ley de Servicios de Salud Mental (MHSA por sus siglas en inglés) del Departamento de Salud Mental (DBH por sus siglas en inglés) del Condado de San Bernardino. Desde que la MHSA fue aprobada en el 2004, el sistema de salud mental en el estado de California ha experimentado una transformación en las opciones de servicios y tratamientos disponibles para individuos que viven con enfermedades de salud mental. A través del Condado de San Bernardino, se ha establecido una cadena extensiva de servicios bajo la orientación de los componentes de MHSA: Servicios y Apoyos Comunitarios, Prevención e Intervención Temprana, Innovación, Obras de Infraestructura y Necesidades Tecnológicas, y Educación y Capitación de la Fuerza Laboral. El componente de Innovación de la MHSA le proporciona a los condados la oportunidad y reto de pensar fuera de la caja e implementar proyectos que estimulan el aprendizaje en el campo de salud mental. El propósito de los proyectos de Innovación es de aumentar la calidad de servicios, mejorar resultados, promover colaboración interinstitucional, y aumentar el acceso a servicios, especialmente para los grupos desatendidos. Los proyectos de Innovación son por tiempo limitado, y ofrecen la oportunidad para mejorar con creatividad cualquier aspecto del sistema de salud mental comunitario. Proyectos de Innovación pueden introducir una práctica o estrategia nueva al sistema de salud mental, hacer un cambio a una práctica existente o aplicar una estrategia existente no relacionada con salud mental o practica prometedora de salud mental usada por la comunidad. Este plan proporciona información a fondo sobre el proyecto propuesto, Inland Empire Psych Partners: Public-Private Collaboration to Transform Emergency Pschiatric Services (I.E. Psych Partners) (por su nombre en inglés.) El proyecto propuesto es un esfuerzo colaborativo para transformar una parte de nuestro sistema de salud en una manera innovadora y eficiente aprovechando las relaciones con nuestros socios de hospitales y utilizando las tecnologías dinámicas de comunicación que tenemos disponible hoy. En la sección de Planificación de Programas Comunitarios (Community Program Planning por su nombre en inglés) encontrará una descripción sobre el extensivo y diverso proceso de reuniones de las partes interesadas que se llevó a cargo relacionadas a planificación de proyectos de Innovación. Es solamente después de conversaciones extensivas y consideración que el proyecto propuesto es considerado a ser fundado bajo el componente de Innovación de la MHSA. Encontramos también que este proyecto está en línea con la visión del Condado de San Bernardino a manera de promover salud a través de colaboración y asociaciones para tratar la persona entera. Los invito a leer el plan del proyecto y proporcionar sus sugerencias a
[email protected]. Se le agradece su tiempo y sugerencias. Si desea más elementos traducidos, incluyendo partes de este plan, comuníquese con Karen Cervantes, Gerente del Programa I con la Oficina de Innovación al (909) 252-4068 o
[email protected].
Title
Page
Message from the Director
1
Message from the Director (Spanish)
2
Innovation Plan
5
Innovation Project Description(s)
7
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services The Challenge
9
The Proposed Project
12
What lead to the development of this project?
16
Learning Goals
18
Previous Solutions
20
Getting Started
22
Community Program Planning
Table of Contents
8
23
Community Program Planning Overview
24
Community Program Planning Standards
25
Innovation Stakeholder Meeting Description
27
Project Development Process
32
Innovation Stakeholder Meeting Summary
33
Innovation Stakeholder Meeting Schedule
35
Innovation Stakeholder Demographics
40
Innovation Stakeholder Response
44
Stakeholder Comments
45
County Demographic Overview
46
Project Budget
51
Mental Health Services Oversight and Accountability Template
61
Glossary
100
DRAFT MHSA Innovation Proposal 2017 3 of 140
Title
Page
Attachments
101
Attachment A—County Compliance Certificate
102
Attachment B—County Fiscal Account Certificate
103
Attachments C—Press Release: Stakeholder Meeting Schedule
104
Attachment D—Flyer: Stakeholder Meeting Schedule
106
Attachment E—Web Blast: Community Planning Meeting Kick-Off Announcement
110
Attachment F—Web Blast: Online (Adobe Connect) Stakeholder Meeting Announcement
111
Attachment G—Press Release: October 2016 Community Policy Advisory Committee (CPAC) Meeting Invitation (Spanish & English)
112
Attachment H—Web Blast: October 2016 Community Policy Advisory 114 Committee (CPAC) Meeting Announcement Attachment I—October 2016 Community Policy Advisory Committee (CPAC) Presentation
115
Attachment J—October 2016 Community Policy Advisory Committee 121 (CPAC) Stakeholder Survey
123
Attachment L—Web Blast: December 2016 Community Policy Advisory Committee (CPAC) Meeting Invite
125
Attachment M—December 2016 Community Policy Advisory Committee (CPAC) Presentation
126
Attachment N—December 2016 Community Policy Advisory Committee (CPAC) Stakeholder Survey
131
Attachment O—Community Policy Advisory Committee (CPAC) Hand-out
134
Attachment P—Hospital Collaborative Meeting Hand-out
136
Attachment Q—Press Release Media Outlet List
138
DRAFT MHSA Innovation Proposal 2017 4 of 140
Innovation Plan
Attachment K—Flyer: December 2016 Community Policy Advisory Committee (CPAC) Meeting Announcement (Spanish & English)
T
he Mental Health Services Act (MHSA) is integral in assisting in the transformation of the public behavioral health system of care. Through the MHSA, county agencies ensure that community stakeholders have the opportunity to provide input into program development, implementation, evaluation, and policy formation of the MHSA funded programs. This approach assists San Bernardino County’s Department of Behavioral Health (DBH) in integrating the needs of diverse individuals, families, and communities into the program design.
Background In November 2004, California voters passed Proposition 63, known as the Mental Health Services Act (MHSA), which imposed a 1% tax on adjusted annual income over $1,000,000 (effective January 1, 2005). According to the MHSA, the intent of the funding is “to reduce the long-term adverse impact on individuals, families, and state and local budgets resulting from untreated serious mental illness.” In addition, local behavioral health delivery systems have been charged to “create a state-of-the-art, culturally competent system that promotes recovery/wellness for adults and older adults with serious mental illness and resilience for children and youth with serious emotional disorders and their families.” The MHSA identifies five (5) primary components for funding that are locally developed through a Community Program Planning process. Those five (5) components are:
Innovation Plan
Prevention and Early Intervention Community Services and Support Innovation Workforce Education and Training Capital Facilities and Technological Needs
Through the MHSA, counties have the responsibility and commitment to ensure the community has input and is actively involved in the development and implementation of MHSA programs at every step of the process. San Bernardino County has embraced the opportunities for collaborating with community stakeholders since the Community Program Planning process began in 2005 with program planning in the Community Services and Supports component. The Community Program Planning process provides the department the opportunity to reach populations identified as unserved, underserved, or inappropriately served on a regular basis. The County’s growing community of stakeholders has continuously viewed the various MHSA components as tools for system transformation and the individual components as building blocks for an integrated healthcare system.
Innovation The formal guidelines for Innovation are less prescriptive than the other MHSA components but do contain guidance that counties must follow. Innovation projects must contribute to learning and be developed within the community through a process that is inclusive and representative, especially of unserved, underserved, and inappropriately served populations. The intention of this component is to implement novel, creative, ingenious behavioral health approaches that are expected to contribute to learning, transformation, and integration of the behavioral health system. The Welfare and Institutions Code (WIC), section 5830, provides for the use of MHSA funds for DRAFT MHSA Innovation Proposal 2017 5 of 140
innovative programming and states all projects included in the Innovation Program must address at least one (1) of the following purposes:
Increase access to underserved groups Increase the quality of services, including better outcomes Promote interagency collaboration Increase access to services
The Innovation component of the MHSA allows counties the broadest possible scope to pilot new and adapted behavioral health approaches. WIC section 5830 states that an Innovation project may affect virtually any aspect of behavioral health practices or may assess a new or changed application of a promising approach to solving persistent, seemingly intractable behavioral health challenge, including, but not limited to, any of the following:
Administrative, governance, and organizational practices, processes, or procedures Advocacy Education and training for service providers, including nontraditional behavioral health practitioners Outreach, capacity building, and community development System development Public education efforts Research
Throughout the Community Program Planning process, our stakeholders share their experiences related to access, needs of cultural groups, and specialty population needs that have emerged and are considered in the design of this Innovation project. Additionally, county staff utilized stakeholder feedback in the analysis of current service needs, demographics, best practices, and health care services data to develop one (1) new Innovation project as described later in this plan. The project reflects many of the concerns, ideas, strategies and design suggestions discussed throughout the community planning process identified as relevant to our diverse communities. The County of San Bernardino is pleased to present the Mental Health Services Act (MHSA) DRAFT Innovation (INN) Plan 2017and encourages feedback on the plan either by phone at 800-722-9866 or by email at
[email protected].
DRAFT MHSA Innovation Proposal 2017 6 of 140
Innovation Plan
Innovation projects are similar to pilot or demonstration projects and subject to time limitations for assessment and evaluation of effectiveness and are required to secure ongoing, stable funding. In some cases, learning may occur that results in other entities outside DBH providing long-term funding for sustained Innovation projects, or portions of projects that are demonstrated to have substantial benefit. In other cases, Innovation projects may indicate that, due to outcomes, activities or projects do not need to occur and therefore can be discontinued. Because Innovation focuses on collaboration, partners and stakeholders may actually be the best resource for long term project sustainability, if the learning and outcomes demonstrate evidence that the programs should continue.
Innovation Project Description DRAFT MHSA Innovation Proposal 2017 7 of 140
Inland Empire (I.E.) PsychPartners:
Public-Private Collaboration to Transform Emergency Psychiatric Services
C
11.5
5.6
PROJECT PURPOSE The primary purpose of the I.E. PsychPartners project is to promote interagency collaboration related to a mental health practice, support, and outcomes by introducing a new application to the mental health system of a promising communitydriven practice or an approach that has been successful in a non-mental health context or setting.
First, part of the wait time disparity is related to a perceived lack of availability of psychiatric consultative services and/or psychiatrist. While large, urban hospitals have access to psychiatrists to provide consultation services to the emergency department, the same is not true for smaller, suburban or rural hospitals where the availability of psychiatrists or affordability of consultative services can be a barrier to providing emergency psychiatric
DRAFT MHSA Innovation Proposal 2017 8 of 140
Innovation Project Description
alifornians seeking emergency behavioral health care face one of the most complex care coordination, treatment, and management systems in the United States because of a care system comprised of primary care physicians, managed care plans, public behavioral health systems, and local hospitals. The nature of this service network leads to a level of complexity that causes individuals to default to known and trusted sources of emergency health care: the hospital emergency department. Emergency departments (EDs), by design, are created to address emergency health EMERGENCY DEPARTMENT WAIT TIMES services targeted for physical health conditions such as heart attacks, strokes, and physical trauma. Specialty behavioral health care and treatment consultations Hours Hours are not currently a mandated component in emergency care. Even without this Physical Psychiatric mandatory component, emergency departments always medically assess any individual that walks through their doors; but psychiatric patients on average spend twice as long waiting for treatment. According to a National Study by Harvard University, psychiatric patients spend an average of 11.5 hours in ED beds, prior to receiving appropriate behavioral health treatment and referral services. This is compared to the national average of 4.5 hours for ED wait time and a California average of 5.6 hour wait time for patients in ED beds waiting for treatment for a physical malady. Based on national, state, and regional trends, there are three reasons that the disparity in wait times exists.
services. This has resulted in longer wait times for psychiatric patients that can impact emergency department operations.
Innovation Project Description
Second, a standardized model for providing emergency psychiatric care in an emergency room setting does not exist. Each individual hospital, or hospital group, is left to create a model, usually without the assistance of the public behavioral health system or regional sister hospitals. This lack of a standardized treatment model leads to inconsistent outcomes concerning wait times in the ED for behavioral health consumers. The development of a standardized psychiatric work flow within in the emergency department, similar to other consultative services provided in an emergency department, would benefit individuals seeking physical or psychiatric emergency care and would result in reduced wait times for psychiatric patients. Third, emergency departments remain disconnected from the bulk of community-based treatment services and other options that are typically coordinated by public behavioral health departments. This separation results in the ED discharge plan that does not have natural access to all available behavioral health resources within the behavioral health system of care. Previously, the traditional option available for emergency psychiatric care had been inpatient hospitalization; but, as of 2006, inpatient beds have been reduced to less than 50,000 nationwide (Care of the Psychiatric Patient in the Emergency Department, October 2014). As hospitals are decreasing the number of inpatient beds, more work remains at the larger systemlevel to coordinate and align emergency psychiatric care with other crisis services offered by public county behavioral health departments. With EDs seeing increasing numbers of patients who need emergency behavioral health services, aligning ED needs with resources provided by the behavioral health sector is an important opportunity for collaboration to decrease hospital wait times but also to include the ED as another “door” that a behavioral health consumer can enter to be connected to larger systems of outpatient behavioral health care. San Bernardino County’s regional hospital administrators also recognize this problem.
The Challenge San Bernardino County is a region of collaborative public and private sector healthcare partners as inter-agency discussions occur on a routine basis to determine shared approaches to problem solving. However, without an opportunity like the one proposed in this Innovation plan, the ability to work to impact change and evaluate emergency-room specific outcomes data is limited. The conversation around emergency room wait times is a conversation that requires trust and partnership as hospital partners work to address the experience for emergency room patients. While baseline, hospital-specific wait times and other data with the intended hospital partners will not be available until the appropriate Memorandums of Understanding and agreements are inplace and a study period is initiated at the start of this Innovation plan, there are indicators, validated by regional and state-level data, that explain the problem of psychiatric patients waiting in San Bernardino County’s hospital emergency departments: 1. Even with Medi-Cal expansion, the volume of insured and uninsured people living on low-incomes is substantial in the region. According to the California Health Care Foundations’ “Regional Markets Brief” in March of 2016, San Bernardino and Riverside Counties, which make up the Inland Empire region, are still recovering from the 2008 recession and the “income level for this region’s population remains relatively low, and employment growth is characterized by lower-wage jobs with fewer health insurance benefits” (1). The report also noted that: “Many remain uninsured, even after large Medi-Cal expansion. The prevalence of low incomes across the Inland Empire contributed to an approximately 50% increase in Medi-Cal enrollees in this region since the state expanded the program in 2014. However, because of a DRAFT MHSA Innovation Proposal 2017 9 of 140
concurrent erosion of commercial coverage over the last few years and difficulties reaching people in more remote parts of this vast region, a relatively high proportion of Inland Empire residents still lacked coverage by the end of 2014, although Medi-Cal enrollment continued to climb throughout 2015. Moreover, despite some improvements, the community lacks a robust, extensive safety net to adequately serve low-income people’s primary care, specialty care, and behavioral health needs throughout the whole region” (1).
3. There are not enough psychiatric beds in the region. According to the California Health Care Almanac, “Psychiatric beds reportedly remain in short supply across the market” (6). 4. For psychiatric patients, new pathways are needed when they access EDs to ensure they have access to care and avoid wait times. A 2017 study titled “ The Acute Care Continuum in California” from a physician and associate professor at UC Irvine reported on California’s ED utilization trends. Dr. William Wesley Fields noted “Because of unmet needs in communities, multiple studies have shown that 10-12% of all ED visits are now because of mental health emergencies, often compounded by substance abuse issues. Waiting or boarding times for ED patients with psychiatric emergencies has been reported at 10-12 hours in California, and is often measured in days for patients without private health insurance” (pg. 182). While the study drew four conclusions about the acute care system, the last and most relevant to this proposed Innovation plan was: “frequent visitors to ED’s due to poorly controlled behavioral health [conditions] require their own urgent treatment pathways to preserve ED capacity” (178). The problem the I.E. Psych Partners Innovation project intends to solve is the creation of these improved pathways, or clinical workflows for psychiatric patients to navigate the EDs with the intention of treatment. To create these pathways, San Bernardino County’s hospital executives and emergency room staff, Hospital Association of Southern California (HASC) representatives, and county partners have been engaged in stakeholder conversation to identify the primary problems for psychiatric patients in Inland Empire emergency rooms validating the macroproblem and contextualizing it around three areas: 1. Long wait times for psychiatric patients 2. Lack of psychiatric consultation services 3. Increasing Ambulance Patient Offload Delay (APOD) HASC’s ad hoc committee, Ambulance Patient Offload Delay (APOD) taskforce, is reporting an increase in the numbers of patients requiring behavioral health treatment in the EDs throughout the region and the impact on APOD turnaround times. APOD measures the time between a patient arrival via emergency medical services (EMS) to the ED and the time that the patient is completely out of the care of the EMS crew. If the ED capacity is impacted, psychiatric patients will wait in the ambulance with the EMS crew, not only experiencing wait-times pre-admission to the ED, but delaying the EMS crew from returning to the field. Because the above issues involve both the regional hospital system, the public behavioral health DRAFT MHSA Innovation Proposal 2017 10 of 140
Innovation Project Description
2. Emergency room utilization is increasing as traditionally, emergency rooms are the primary healthcare destination for uninsured, and the newly insured. The same report noted that for the Inland Empire, “Some hospitals have faced a growing demand and capacity constraints in their emergency room departments (EDs), stemming particularly from newly insured people unable to access timely primary care or other outpatient services in the community. ED visits rose 11% in the market overall between 2011 and 2014” (11).
Innovation Project Description
system, commercial insurers, and Medi-Cal Managed Care plans, the solution must come from a collaborative effort to redesign the current system of emergency psychiatric care pathways collectively. Historically the behavioral health sector and EDs have not collaborated at the policy/ systems level to maximize and align behavioral health pathways at the operational level of EDs for shared patients and consumers. This project idea presents an opportunity that has been a topic of discussion with consumers, family members, ED physicians, Hospital Chief Executive Officers and the Regional Hospital Association, for over nine years: thus making this project a true regional, system-level innovation. While researching collaborative models to use as a template for our regional collaboration, it was discovered that interagency collaboration at the system-level produces its own set of challenges separate from the concerns of providing behavioral health services in the ED. Some common organizational barriers to interagency collaboration within healthcare that this project will seek to improve include, but are not limited to:
Lack of knowledge and appreciation of the roles of other healthcare professionals. Lack of outcomes research on system-wide collaborative efforts, to include a lack of data sharing between healthcare agencies. Financial constraints that prevent inventive thinking within existing healthcare organizations. Legal issues concerning scope-of-practice and liability between large healthcare agencies, to include unease with sharing in the clinical decision-making process. Lack of understanding of reimbursement structures for both physical and mental/ behavioral health procedures. Creating a collaborative service network out of the current system of “a la carte” services within Emergency Department settings. Difficulty in developing a commitment to the common goal of collaboration. Difficulty in achieving “buy-in” at the executive level of all partner agencies. Lack of shared vocabulary (i.e., shared terminology) that hinders effective crosssystem communication concerning problems and solutions. Lack of expertise on behalf of consulting physicians, if consulting from another region through telemedicine, on the outpatient system of care available to psychiatric patients. Lack of ability to influence the medical decision-making process of the emergency department physicians when patients present in the emergency department and their medications or psychiatric outpatient history is unknown to the treating physician.
This Innovation plan is poised to build the collaborations necessary to overcome the existing barriers and the EDs have noted that new approaches are needed. The major aim of this project is to create a set of treatment options within emergency room settings that enhance medical decision making, treatment interventions and improved outcomes for psychiatric patients. The regional impact of this effort cannot be understated as, not only will improved pathways benefit psychiatric patients, it will benefit all patients of EDs in order to reduce the impact on ED capacity. The Institute of Medicine (IOM) states that safety, effectiveness, patient-centeredness, efficiency timeliness, and equity are all compromised in overcrowded EDs due to long waits and diversion of the ambulance away from the hospital closest to the patients. As the potential impact on our region is significant, I. E. PsychPartners will work collaboratively with partnering hospitals to create improved pathways for psychiatric patients experiencing an emergency and improve care in the region’s emergency rooms.
_______________ ¹California Health Care Foundation. “California Health Care Almanac: Riverside/San Bernardino: Despite Large MediCal Expansion, Many Uninsured Remain.” March 2016. ²Fields, William Wesley. “The Acute Care Continuum in California.” Revista Medica Clinica Las Condes. 28(2). 2017 (178-185). DRAFT MHSA Innovation Proposal 2017 11 of 140
The Proposed Project
T
The proposed system transformation will be focused on removing the following identified barriers that currently exist between the public behavioral health system and the local hospitals: How is this project
innovative? 1. Partners: Interagency collaboration between two county behavioral health departments, a hospital association that represents more than 170 member hospitals, 36 emergency departments, and the existing network of community partners from both San Bernardino and Riverside Counties. 2. System Design: Creation of standardized regional model of emergency psychiatric care that aligns emergency departments, public behavioral health departments and commercial insurance providers. 3. Quality: Improves consistency and quality of care because there is improved information sharing and medical decision-making. 4. Training: Identify regional best practices and training needs focused at the reduction of stigma and discrimination associated with chronic behavioral health condition. 5. Linkage by Design: Provide linkages to community behavioral health resources with an embedded behavioral health nurse who can problem solve resources and coach consumers/ families on service navigation. 6. Regional Impact: Regional collaborative and oversight by HASC and potential sustainability by public, private sectors, and a professional association.
Lack of standardized psychiatric workflow based on best practices: By bringing consultative resources to the treating physician in the ED, this project is focused on the elimination of barriers that exist between the public and private healthcare systems. This collaboration will produce a new approach that empowers the ED physicians and staff to develop tools, such as standardized psychiatric workflow and pre-defined templates that contain sets of recommended treatment options called “Order Sets,” for enhanced consultation and expedited medical decisionmaking that improves the treatment options for behavioral health consumers. A clinical order set is a pre-defined template that provides support in making clinical decisions for a specific condition or medical procedure. It is a grouping of
DRAFT MHSA Innovation Proposal 2017 12 of 140
Innovation Project Description
he proposed project seeks to effect system-wide transformative change by modifying the ways in which the hospital system interacts with the public behavioral health system in the care of patients seeking psychiatric emergency services in hospital emergency departments. The focus of this project will be to construct a collaborative infrastructure to increase the quality of services, which includes better outcomes, by introducing a two county (regional) approach to the management and organization of behavioral health consultation services into a regional collaborative approach. The center piece of the collaborative infrastructure will be the coordination of the SBC-DBH Department of Behavioral Health (SBC-DBH), Riverside University Health System Behavioral Health (RUHS-BH), and the Hospital Association of Southern California (HASC).
orders that standardizes and expedites the ordering process for a common clinical scenario. Clinical order sets guide clinicians while treating patients to ensure that they do not miss any critical components of care
Innovation Project Description
Lack of regional training model between hospitals and the public behavioral health department that allows for shared learning: Part of this collaborative process will include the introduction of a regional training model that will allow the region to share best practices, increase awareness of behavioral health services within the region, and provide behavioral health trainings to decrease the stigma and discrimination associated with mental illness. Lack of ED access to patient behavioral health treatment and medication history: Without the appropriate medical history and knowledge of that patient’s connection to behavioral health systems of care, ED physicians and consulting telemedicine specialists are only able to make medical decisions based on single visits or the history of emergency department visits in their own electronic health records. The patient’s medical history is vital to informing the treating physician’s medical decisions and the care destination of that patient, and as this information is shareable under the Health Insurance Portability and Accountability Act (HIPAA) by entering into an Memorandum of Understanding (MOU) for the purpose of treatment and with appropriate consents, providing the outpatient medication and treatment plans with both the treating physician and specialist consulting on the patient’s behalf is an important problem that must be overcome. County size prevents the sharing of resources: The counties have identified that the use of interactive videoconferencing (telehealth technology) is the best place to begin to achieve the interconnectivity between the various disconnected, or fragmented, services that currently exist. Telehealth technology is an existing and established practice within the medical health field and has been in use since the early 2000s and the use of telehealth technology in the ED has been successfully Target Population used to provide real-time case 1. Population to be served includes all individuals consultation for other physical who access the ED for behavioral health crisis and health specialty fields, such as can be treated via consultation. cardiology and neurology. The 2. Due to the vast difference between emergency reasons for uses of telehealth departments in San Bernardino County an range from time and cost savings estimate that encompasses the different regions is not possible. Additionally, baseline data will be to a lack of resources in rural gathered in the first few months of the project to areas. According to determine the number of expected clients served Telepsychiatry in the Emergency annually. In general and for reference, based on Department (2009), a report hospital admission reports for San Bernardino prepared for the California County, in the 18 EDs approximately 762,000 Healthcare Foundation: “ED individuals were admitted to the ED in 2015; of those visits almost 50,000 had a behavioral health telepsychiatry programs appear to diagnosis. (OSHPD data) provide quick and specialized care to patients with the risk of psychiatric emergencies and have DRAFT MHSA Innovation Proposal 2017 13 of 140
COLLABORATIVE PARTNERS
These identified barriers will be eliminated and a new system of care created by using Innovation funding to create the following: Multi-disciplinary, team-based psychiatric consultations via telemedicine aimed at expediting emergency department physician medical decision making. The innovative component to the consultation is the addition of a Behavioral Health Nurse to join the psychiatric specialist and ED physician in order to overcome the lack of information, possibly available from the public behavioral health’s system of care, which may make it more difficult for the physicians during consultation. This includes information such as: 1. Medication History 2. Outpatient treatment history and management by a psychiatrist. 3. Previous discharge care plans 4. Family and social supports 5. Linkages to important program and outpatient services Construction of a standardized psychiatric workflow for the region’s emergency departments to use, to include policy, procedures, and pre-defined templates that provide support in making clinical decisions that standardize and expedite the ordering process for psychiatric treatment in the ED (i.e. Order Sets). Create and establish a regional training program that will continuously inform area hospitals of behavioral health resources available through San Bernardino and Riverside County’s behavioral health systems, provide in-services on de-escalation strategies and techniques, and general behavioral health trainings to reduce the stigma of psychiatric patients. Currently, there are no projects of this scope within the Inland Empire. The region’s hospitals DRAFT MHSA Innovation Proposal 2017 14 of 140
Innovation Project Description
the potential to assist in reducing crowding in EDs and lowering costs.” Even with the widespread acceptance of telepsychiatry and telemedicine as a means of delivering behavioral health services in the ED two issues have prevented widespread implementation: financial stability of telepsychiatry in the ED and the lack of published data and/ or metrics of the existing telepsychiatry programs. This project seeks to use telehealth technology to not only provide psychiatric consultative services, but also allow for a Behavioral Health Nurse to remotely participate in the consultation for medical-decision making with the treating emergency department physician, consulting psychiatrist, and as appropriate, the patient. While the region’s emergency departments that see a high volume of behavioral health emergencies will have a Behavioral Health Nurse physically present, the region’s smaller hospitals that see a lower behavioral health emergencies will benefit from a shared Behavioral Health Nurse available via telehealth technology. The sharing of behavioral health professionals is also anticipated to assist in alleviating the region’s psychiatric workforce shortage.
Innovation Project Description
continue to receive an increased number of individuals in crisis who are experiencing a behavioral health emergency and/or a substance use disorder issues to their EDs. These consumers usually require time intensive services that EDs are unable to provide. By creating a regional service network, regional hospitals and EDs would become part of a coordinated effort to find the best services available to address the needs of our shared consumers. This project would further expand on the integrated care model by developing a collaboration framework between primary care providers, hospital EDs, managed care plans, and county behavioral health departments in order to provide the most effective treatment plans for consumers with multiple ongoing healthcare needs. Using telehealth technology, the collaborative agencies will create an interagency treatment team that includes a psychiatrist and specialized behavioral health nurse available 24hours-a-day, 7-days-a-week within EDs in San Bernardino and Riverside Counties. Funding will be provided by SBC-DBH and RUHS-BH through the MHSA as part of the Act’s Innovation component. SBC-DBH, in partnership with HASC, will establish and evaluate performance metrics and based on the outcomes, provide a strategic approach for a sustainable I.E. PsychPartners program throughout San Bernardino County. Creation of a sustainable I.E. PsychPartners program will assist San Bernardino County residents who use the ED for psychiatric services by reducing wait time for services, reducing unnecessary psychiatric hospitalizations, and by linking these individuals into the larger network of client-centered behavioral health services offered by SBC-DBH. It is expected that this project will be contracted to HASC via a sole source agreement. SBC-DBH and RUHS-BH will work collaboratively with HASC, and HASC will contract with the hospitals to develop, gather, and evaluate the data collected. Hospitals are a major and valued partner in problem solving and decision making for issues in their own ED work flows. SBC-DBH is committed to ensuring consumer health information is handled according to privacy
Flow of Proposed Project Roles and Responsibilities
DRAFT MHSA Innovation Proposal 2017 15 of 140
standards. Although HASC will be contracting directly with the participating hospitals, DBH will establish memorandums of understanding and negotiate privacy and data sharing with each respective hospital. Telehealth is a critical component of this project. HASC is working with tele psychiatry vendors and local physician groups to establish the most meaningful and cost effective relationship in working with local hospitals. Due to vast difference in operating systems within the hospitals, there may be a combination of tele psychiatry vendors and local physicians participating in the project. HASC will finalize level of physician group involvement at the time of contract implementation with the hospitals.
S
BC-DBH began engaging stakeholders in 2005 concerning the emergency psychiatric care in San Bernardino County. This initial stakeholder feedback identified three stakeholder priorities that relate directly to the region’s emergency psychiatric services:
1. Need for programs that divert behavioral health consumers away from high-cost
hospital treatment to less restrictive forms of care. 2. Recognition that other options were needed for residential out-patient care. 3. Concern about long wait-times for behavioral health consumers seeking emergency psychiatric care in the local EDs. In consultation with law enforcement, hospitals, and community stakeholders it was determined that focus on the first two community identified priorities would positively impact outcomes associated with the third. The work that has gone into addressing the first two priorities include the SBC-DBH diversion programs (Triage, Engagement, and Support Teams (TEST), and the Community Crisis Response Teams (CCRT)), and the development of five crisis residential treatment centers (Transitional-Aged Youth crisis residential treatment center (The STAY) and four adult crisis residential treatment centers, placed strategically throughout the county, that are currently under construction). With work being done on the first two priorities, SBC-DBH completed an updated stakeholder feedback analysis concerning all feedback from 2005 – 2014. The result of this analysis were presented in the Three Year Integrated Pan for Fiscal Years 2014/15 through 2016/17. While the analysis indicated community satisfaction with the progress made toward the first two community identified priorities, community stakeholder feedback, also, identified a need to integrate emergency psychiatric care into the larger behavioral health system of care. Both consumers and family members shared stories of wait times and members of the hospital community voiced frustration with an ever growing network of community resources that they felt disconnected from. Initially, discussion centered on the creation of additional diversion programs or expansion of the current diversion programs. These programs have been highly successful in diverting individuals to lower levels of care, but no matter how successful, diversion programs will never divert 100% of those individuals seeking emergency psychiatric care from our community hospital’s emergency departments. With this in mind, SBC-DBH began to research ways to better connect the local emergency departments with community behavioral health resources, to include resources provided by SBC-DBH. This is where discussions with both hospitals and their association, HASC, concerning ED throughput of psychiatric consumers in both San Bernardino and Riverside Counties began and resulted in the project concept that became the innovation project I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Care. The original project concept also attracted the interest of the DRAFT MHSA Innovation Proposal 2017 16 of 140
Innovation Project Description
What lead to the development of this project?
managed care plans that operate in this county. These managed care plans have indicated their interest in joining this collaborative effort and have indicated that they have a continued commitment to obtaining and facilitating the care for their consumers that visit the ED seeking emergency behavioral health services.
Innovation Project Description
All the factors listed above, and the interest of our regional hospitals and managed care plans in partnering to redesign the emergency psychiatric workflow, is the reason why SBC-DBH decided it’s the right time for the I.E. PsychPartners project.
DRAFT MHSA Innovation Proposal 2017 17 of 140
Learning Goals
T
o qualify as an innovation project, the proposed project must contribute to learning. By providing the opportunity to “try out” new approaches that can inform current and future behavioral health practices, an innovation project contributes to the learning and adoption of new and better ways to provide behavioral health services. The I.E. Psych Partners project seeks to add to the existing body of behavioral health knowledge by learning the following:
Innovation Project Description
DRAFT MHSA Innovation Proposal 2017 18 of 140
Evaluation, Cultural Competence, & Stakeholder Participation
Innovation Project Description
SBC-DBH knows and acknowledges that those who engage in evaluation do so from perspectives that reflect their values, their ways of seeing the world, and their culture. This culture can shape the ways in which evaluation questions are conceptualized, which in turn influences what data is collected, and how data is analyzed and interpreted. To draw valid conclusions, the evaluation must consider important contributors to human behavior, including those related to culture, personal habit, situational limitations, assimilation and acculturation, or the effect that the knowledge of observation can have on the observed (American Evaluation Association, Cultural Competence in Evaluation, 2011). Without accounting for the ways in which cultural can affect behavior, evaluations can arrive at flawed findings with potentially devastating consequences. Because of these concerns the SBC-DBH Office of Cultural Competence and Ethnic Services (OCCES) is a key partner in all Innovation projects to ensure compliance with cultural competency standards and to ensure that the services provided address cultural and linguistic needs. OCCES remains available for consultation and to provide support to the Innovation Team regarding issues of diversity when necessary. Issues of cultural diversity and the social norms of a specific cultural group may present a barrier to a mentally ill individual participating in psychiatric treatment. These issues will be explored with the OCCES as they arise in order to provide services to the community in a culturally and linguistically meaningful and appropriate manner. In addition to working with the OCCES, SBCDBH Office of Innovation also partners with stakeholder sub-committees in an active way (beyond an advisory capacity) to further ensure effective, culturally-sensitive interactions. These subcommittees are presented with the evaluation questions and results to ensure that the evaluation framework and outcome results are inclusive and foster learning across cultural boundaries while respecting different worldviews. Every effort will be made to staff the Innovation project with individuals that are diverse and representative of the demographics of the Department’s consumers. Based on the continuous feedback from our community stakeholders, SBC-DBH has designed a meeting to address outcomes and evaluation in a setting that involves stakeholders, the Systemwide Performance Outcomes Committee (SPOC). This project would be subject to discussion at SPOC providing a balanced outcome-based focus regarding evaluation. Additionally, this Innovation project was presented at the monthly meetings for each of these cultural subcommittees to ensure that the community planning process included the voices of individuals who reflect the cultural, ethnic, and racial diversity that exists within San Bernardino County. The community planning process for this Innovation project started on August 23, 2016, and concluded December 19, 2016. Stakeholder engagement included a series of 24 community meetings, to include the cultural subcommittee meetings, held throughout the County with an evening online session for those community members who had other work commitments, transportation problems, or who otherwise were unable to attend one of the other 24 scheduled meetings. A total of 182 community members and stakeholders attended these sessions. From this planning process, 108 comments were received concerning the project. The comments received revealed overwhelming support for the collaborative interagency framework of this project and the systemwide approach to redesigning the way in which an ED would provide behavioral health services.
DRAFT MHSA Innovation Proposal 2017 19 of 140
Previous Solutions
S
Seven (7) regional Sheriff stations Three (3) Police Stations California State University, San Bernardino, Counseling Center & Police Station Public Defender’s Office (West Valley Region) County Probation Department Offices (High Desert and Morongo Regions) Embedded with three (3) Community Crisis Response Teams Two (2) Emergency Departments in Apple Valley and Loma Linda (In progress)
TEST staff are available at these locations Monday through Friday from 8:00am – 5:30pm. To date, the collaborative focus for the TEST program has been to assist law enforcement. TEST also provides two (2) months of intensive case management to activate the consumer into SBCDBH’s larger system of care after discharge from the hospital. The other SBC-DBH program with a similar goal of reducing unnecessary hospitalizations is the Community Crisis Response Teams (CCRT). CCRT provides crisis intervention to consumers in SBC-DBH in the least restrictive environment. CCRT utilizes specially trained mobile crisis response teams to provide crisis interventions, risk assessments, medication referrals, and trauma response to the community. CCRT also assists law enforcement with assessment and transportation of community members in crisis, as well as, providing crisis intervention training for law enforcement. A focus of CCRT is the reduction of involuntary hospitalizations (i.e. WIC §5150 Holds) by working with law enforcement to divert these consumers to appropriate behavioral health services in the community. Unlike TEST, CCRT is not co-located with another agency, but rather provides mobile crisis DRAFT MHSA Innovation Proposal 2017 20 of 140
Innovation Project Description
BC-DBH currently has two (2) programs that have similar goals to reduce hospital utilization and unnecessary psychiatric hospitalizations. There are opportunities for learning within each of the existing models that the I.E. PsychPartners project seeks to address. The first program is Triage, Engagement & Support Teams (TEST), which is a CA Senate Bill (SB) 82 grant-funded service that integrates engagement, assessment, and case management with crisis intervention and post-crisis discharge to reduce arrests, recidivism, and hospitalizations of those with unmet behavioral health needs. TEST staff are co-located at key points of access to emergency behavioral health services such as law enforcement and existing SBC-DBH crisis programs, as well as being co-located at key points of post-crisis discharge, such as county jails and the Public Defender’s Office. Co-location is an important component to the TEST program. The close working proximity of both the TEST staff and the staff of the collaborating agency allow for TEST staff members to accompany partner agency staff on crisis calls with the intention of diverting the consumers from hospitalization or incarceration in favor of integration in outpatient community-based services. When hospitalization cannot be avoided, TEST staff save law enforcement personnel time by providing transportation to the hospital for consumers and accompanying the consumer while waiting for hospital admission. Currently the TEST program is co-located in the following locations:
services countywide when called. CCRT is available 365 days a year, 7 days a week, 24 hours a day. CCRT does triage (i.e. prioritize) calls if the demand is high. Calls from law enforcement receive the highest priority since these calls tend to be the most serious and/or involve individuals presenting as a danger to themselves or others. CCRT responds to the immediate need for crisis intervention and does not provide ongoing case management.
Innovation Project Description
TEST and CCRT Outcomes
Source: Community Crisis Services: CCRT, TEST, RBEST Presentation on 5/8/2017
I.E. PsychPartners differs from both these programs by focusing on achieving system wide transformative change in the ways emergency departments interact with individuals presenting with behavioral health and substance use disorders. I.E. PsychPartners is not focused on diverting individuals seeking emergency behavioral healthcare away from the ED, rather I.E. PsychPartners seeks to understand how to improve the ED experience for those individuals who can benefit from psychiatric care in the ED. This project seeks to empower ED physicians and staff to redesign emergency healthcare so that individuals will have access to specialty care when visiting the ED for psychiatric health concerns. Because this project seeks system wide transformative change, the collaborative model includes the use of a regional association Hospital Association of Southern California, two county behavioral health agencies (SBC-DBH and RUHS-BH), and buy-in from the hospital management executive staff, and emergency department providers. This collaborative effort seeks to not just fill a service need, but seeks to understand how the shared emergency medical system can be changed for the betterment of the region’s shared consumers. Long term, this project seeks to also inform private and public commercial insurance plans, as their consumers will be served in the implementation of uniform order sets related to psychiatric consultation and expedited medical decision making as well. DRAFT MHSA Innovation Proposal 2017 21 of 140
Getting Started The I.E. Psych Partners project is expected to begin, beyond the initial planning phase, January 1, 2018, and continue through December 31, 2023. The total timeframe of this project will be five (5) years and will consist of four (4) phases.
I.E. PsychPartners Project Phases
DRAFT MHSA Innovation Proposal 2017 22 of 140
Innovation Project Description
It is anticipated that this timeline will provide an adequate opportunity to measure the project’s success. Data will be collected throughout the implementation of the project and analysis of progress towards the learning goals completed. This will allow for modification to the project as the learning occurs.
Artwork by David Pacheco
Community Program Planning DRAFT MHSA Innovation Proposal 2017 23 of 140
Community Program Planning Overview
T
DBH’s CPP protocol includes a participatory framework of regular, ongoing meetings with diverse stakeholders to discuss topics related to behavioral health policy, pending legislation, program planning, implementation and evaluation, and financial resources affiliated with behavioral health programs. This practice has allowed DBH to:
Be responsive to changes and concerns in the public behavioral health environment. Establish and maintain a two-way communication pathway for community-identified areas of improvement, which are introduced into DBH’s larger process improvement efforts and report results back to the larger community. Encourage community involvement in DBH’s Innovation project planning beyond the typical “advisory” role. Educate consumers and stakeholders about the MHSA, behavioral health resources and topics, to include the public behavioral health system as a whole.
DBH ensures diverse attendance by maintaining a published schedule of meetings and advertising these meetings using social media, press releases, other county departments, and an expansive network of known community partners and contracted vendors. To ensure participation from diverse stakeholders, meetings included interpreter services or, as the occasion dictates, meetings are held in languages other than English. Meeting locations are coordinated in every region of San Bernardino County, and web-conference style meetings are available for remote communities or for individuals who are unable to attend an in-person session or prefer the web format. These monthly meetings are documented through agendas, sign-in sheets, and detailed minutes. Currently the yearly roster of regularly scheduled meetings is as follows:
Behavioral Health Commission (BHC): twelve (12) monthly meetings District Advisory Committee meetings: five (5) monthly meetings, one (1) held in each of the five (5) supervisorial districts within the county and led by the Behavioral Health Commissioner(s) in each district Community Policy Advisory Committee (CPAC): six to twelve (6 -12) annually Cultural Competency Advisory Committee (CCAC), along with twelve (12) separate cultural subcommittees/coalitions: thirteen (13) monthly meetings Transitional Age Youth (TAY) Center Advisory Boards Consumer Clubhouse Advisory Boards. DRAFT MHSA Innovation Proposal 2017 24 of 140
Community Program Planning
he San Bernardino County Department of Behavioral Health (DBH) is dedicated to including diverse consumers, family members, stakeholders, and community members in the planning and implementation of Mental Health Services Act (MHSA) programs and services. DBH’s Community Program Planning (CPP) process encourages community engagement with the goal of empowering the community for the purpose of generating ideas, contributions to decision making, and to engender a county-community partnership to improve behavioral health outcomes for all San Bernardino County residents. These efforts include informing stakeholders of fiscal trends, evaluation, monitoring, and program improvement activities as well as obtaining feedback. DBH is committed to incorporating best practices in the planning processes that allow consumer and stakeholder partners to participate in meaningful discussions around critical behavioral health issues. DBH considers CPP an operations component and as a result, this MHSA component has become a robust year-round practice that has been incorporated into standard operations throughout the Department. Like the other MHSA components, the CPP process undergoes review and analysis that allows us to enhance and improve engagement strategies.
Community Program Planning Overview, cont.
Quality Management Action Committee (QMAC): Twelve (12) monthly meetings. MHSA Executive Committee: twelve (12) monthly meetings. Association of Community Based Organizations (ACBO): twelve (12) monthly meetings. Room and Board Advisory Coalition. Screening, Assessment, Referral and Treatment (SART) Collaborative. System-wide Program Outcomes Committee (SPOC).
Note: A regularly scheduled meetings may be rescheduled or cancelled by the collective agreement of the attendees.
Community Program Planning
Additional regular stakeholder engagement and education meetings include:
Bi-monthly Workforce Development Committee. Quarterly Prevention and Early Intervention (PEI) Provider Network Meeting. Ad hoc Juvenile Justice Program meetings. Clubhouse Consumer Peer Support Groups. Parent Partners Network. DBH Peer and Family Advocate employee meetings. Older Adult Peer Counselor Support and Outreach System. Transitional Age Youth (TAY) Network. Hospital Collaborative Meeting Law Enforcement Committee
Stakeholder attendance is recorded through meeting sign-in sheets and consumer feedback forms. These sign-in sheets also document the attendance of underserved, unserved, and inappropriately served populations as outlined in Welfare and Institutions Code (WIC) 5848.
Community Program Planning Standards 9 CCR § 3320 states that counties shall adopt the following standards in planning, implementing, and evaluating programs:
Community Collaboration Cultural Competence Client Driven Family Driven Wellness, Recovery, and Resilience Focused Integrated Service Experiences for Clients and Their Families
T
he Innovation component offers an opportunity to further transform and integrate the behavioral health system. The DBH Community Program Planning (CPP) process is consistent with the following general standards:
Community Collaboration – The Department has conducted an ongoing extensive CPP process that involved stakeholders within the community, as consistent with MHSA DRAFT MHSA Innovation Proposal 2017 25 of 140
Community Program Planning Standards, cont.
DRAFT MHSA Innovation Proposal 2017 26 of 140
Community Program Planning
regulations. The project will work in collaboration with all available psychiatric treatment modalities in the County and will promote access to the most appropriate level of care for the individual. These will include DBH operated programs and outpatient clinics, drug and alcohol programs, fee-for-service providers, faith-based organizations, social service organizations, veteran services, housing programs and alternatives, other County Departments such as the Department of Aging and Adult Services, Transitional Assistance Department, Department of Public Health, County Medical clinics and community based organizations. Educational organizations and vocational organizations will be utilized to assist consumers in meeting their personal goals as well as a means to more fully integrate the consumers into their surrounding community. Consumers and family members will be linked with regionally based providers to minimize any geographical obstacles to accessing services. Partnership with the Cultural Competency Advisory Sub-Committees and Community Health Workers program will assist in bridging the cultural and geographical diversity of the County in a community-driven manner. Cultural Competence – The DBH Office of Cultural Competency and Ethnic Services (OCCES) will be involved to ensure compliance with cultural competency standards and ensure that the services provided address cultural and linguistic needs. The OCCES remains available for consultation and to provide support to the teams regarding issues of diversity when necessary. Issues of cultural diversity and the social norms of a specific cultural group may present a barrier to a behaviorally ill individual participating in psychiatric treatment. These issues will be explored with the OCCES as they arise in order to provide services to the community in a culturally and linguistically meaningful and appropriate manner. Client Driven – Stakeholder feedback was received during the CPP process including clients, family and caregivers. The innovative concept of I.E. Psych Partners arose from the feedback received through these processes as well as the stakeholder workgroups. Family Driven – Stakeholder feedback was received during the CPP process. The innovative concept of I.E. Psych Partners arose from the feedback received through these processes as well as the stakeholder workgroups. Wellness, Recovery & Resilience Focus – This project promotes wellness, recovery, and resiliency by providing an increased level of access and linkage to a variety of services post emergency department visit. The project will work to link the individual and their families to the most appropriate service modalities in the community that will meet their unmet behavioral health and support needs. Outreach and engagement efforts will work towards involving the individual in the types of services and activities that will enable them to remain at the lowest level of care in the community thereby eliminating the need to use the ED as a primary source of behavioral health services. By helping the individual access the necessary and appropriate supportive services and therapeutic services in the community the I.E. Psych Partners project will assist the consumers on their journey towards greater wellness, recovery and resiliency. Integrated Service Experience – Referrals to resources will be coordinated and integrated to most appropriately meet the stated needs and discharge plan of the consumer. It is anticipated that referrals will be made to all venues and modalities of therapeutic and social programs. A holistic approach will be utilized in making referrals for services to the individual and their families in recognition of the need to address the psychiatric treatment needs of the individual but also their many educational, cultural, spiritual, social, and health needs. The project, as designed will provide educational and supportive services to the individual and their families to increase understanding and awareness of behavioral health disorders, outpatient services, knowledge of how to access services, as well as how to navigate the complicated system of care.
Innovation Stakeholder Meeting Description
S
Community Program Planning
BC-DBH began engaging stakeholders in 2005 concerning the emergency psychiatric care in San Bernardino County. This initial stakeholder feedback identified three stakeholder priorities that relate directly to the region’s emergency psychiatric services:
1. Need for programs that divert
WIC § 5848 states that counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on:
Mental health policy Program planning Implementation Monitoring Quality Improvement Evaluation Budget Allocations
behavioral health consumers away from high-cost hospital 9 CCR § 3300 states that involvement of clients and treatment to less restrictive their family members be in all aspects of the community forms of care. planning process and that training shall be offered, as 2. Recognition that other options needed, to stakeholders, clients, and client’s family who were needed for residential out are participating in the process. -patient care. 3. Concern about long wait-times for behavioral health consumers seeking emergency psychiatric care in the local EDs. In consultation with law enforcement, hospitals, and community stakeholders and consumers it was determined that focus on the first two community identified priorities would positively impact outcomes associated with the third. The work that has gone into addressing the first two priorities include the SBC-DBH diversion programs (Triage, Engagement, and Support Teams (TEST), and the Community Crisis Response Teams (CCRT)), and the development of five crisis residential treatment centers (Transitional-Aged Youth crisis residential treatment center (The STAY) and four adult crisis residential treatment centers, placed statistically throughout the county, that are currently under construction). With work being done on the first two priorities, SBC-DBH completed an updated stakeholder feedback analysis concerning all feedback from 2005 – 2014. The result of this analysis were presented in the Three Year Integrated Pan for Fiscal Years 2014/15 through 2016/17. While the analysis indicated community satisfaction with the progress made toward the first two community identified priorities, community stakeholder feedback, also, identified a need to integrate October 5, 2016 Facebook Post: www.facebook.com/sbdbh/posts/ emergency psychiatric care into the larger behavioral health system of care. Both consumers and family members shared stories of wait times and members of the hospital community voiced frustration with an ever growing network of DRAFT MHSA Innovation Proposal 2017 27 of 140
Innovation Stakeholder Meeting Description, cont.
October 2016 Community Policy Advisory Committee Meeting: I.E. PsychPartners
DRAFT MHSA Innovation Proposal 2017 28 of 140
Community Program Planning
community resources that they felt disconnected from. Initially, discussion centered on the creation of additional diversion programs or expansion of the current diversion programs. These programs have been highly successful in diverting individuals to lower levels of care, but no matter how successful, diversion programs will never divert 100% of those individuals seeking emergency psychiatric care from our October 14, 2016 Facebook Post: www.facebook.com/sbdbh/posts/ community hospital’s emergency departments. With this in mind, SBC-DBH began to research ways to better connect the local emergency departments with community behavioral health resources, to include resources provided by SBC-DBH.
Innovation Stakeholder Meeting Description, cont.
Community Program Planning
Targeted CPP Process Beginning in August 2016, the SBC-DBH Innovation Team began a targeted community planning process to develop the project outline that became the I.E. PsychPartners Project. A total of twenty-four (24) meetings were held between August 23, 2016, and December 19, 2016. SBC-DBH ensures diverse attendance by advertising these meetings using social media, press releases, other county departments, and an expansive network of known community partners and contracted vendors. SBC-DBH also has established 12 cultural subcommittees that meet monthly and this Innovation project was shared and feedback requested at the monthly meetings for each of these cultural subcommittees to ensure that the CPP included the voices of individuals who reflect the cultural, ethnic, and racial diversity that exists within San Bernardino County. Stakeholder meetings were held throughout the County with an evening online session for those community members who had other commitments, transportation problems, or who otherwise were unable to attend one of the other twenty-four (24) scheduled meetings. A total of 182 community members and stakeholders attended these sessions. From this planning process, 111 comments were received. The comments received revealed overwhelming support for the collaborative interagency framework of this project and the system-wide approach to redesigning the way in which an ED would provide behavioral health services. One (1) meeting was conducted in Spanish for monolingual stakeholders. Press releases, in both English and Spanish, with the stakeholder meeting schedule were sent to local newspapers and media contacts. Interpreter services are provided at all of the stakeholder events to ensure diverse community inclusion and these services were noted on all announcements prior to meetings. In addition to the stakeholder meeting scheduled for community members, consumers, and family members, SBC-DBH also scheduled four (4) planning meeting with HASC and representatives from the local hospitals. These meetings allowed for direct input from the hospital physicians, nurse managers, and hospital executive staff. These meetings were important during the planning phase because understanding the hospital perspective is critical to the Community Policy Advisory Committee (CPAC) meeting successful transformation of DRAFT MHSA Innovation Proposal 2017 29 of 140
Innovation Stakeholder Meeting Description, cont. the region’s emergency psychiatric care.
Targeted CPP Meeting Structure These meetings with stakeholders were intended to provide a platform for Community Policy Advisory Committee (CPAC) meeting community stakeholders to engage in learning, reflection, and interpretation of current and future Innovation projects with the goals of promoting: Obtain direct stakeholder feedback on the design of the I.E. PsychPartners project Diffusion of knowledge gained through implementation of those projects to date
Dissemination of innovative practices to stakeholders Enhanced sustainability of funded projects beyond conclusion of Innovation funding Generation of new ideas for future Innovation funded projects
The format used for the Innovation stakeholder meetings was standardized to ensure each group of participants went through the same process. Each meeting began with an introduction of MHSA and an overview of the Innovation component conducted by a member of the SBC-DBH Office of Innovation. The introduction included a description of MHSA, current funding context, the purpose of the planning process, and an explanation of the Innovation component. Handouts were provided to further explain this same information. Office of Innovation staff provided an overview of the project, detailing the purpose, population(s) served, and key activities. Throughout the meeting, participants were provided data in a consumer friendly, simple, straightforward manner with PowerPoint presentations, handouts, and question and answer periods. Participants had an opportunity to ask clarifying questions directly to the Innovation staff during and after the meeting. Contact information for the Innovation staff was also provided to meeting attendees, in case, the attendee had additional questions later. DRAFT MHSA Innovation Proposal 2017 30 of 140
Community Program Planning
Additionally, announcements were made available at community and regularly occurring Department meetings leading up to the twenty-four (24) scheduled stakeholder meetings conducted in the months of August through December 2016. Emails with stakeholder meeting information were sent to all SBC-DBH staff with instructions to disseminate to related interested parties.
Innovation Stakeholder Meeting Description, cont.
Community Program Planning
Throughout the stakeholder meetings, participants were asked to share their perspective on the evaluation of the projects and their effectiveness. They were encouraged to address the learned aspects from the previous projects and comment on the community needs from their own perspective as a community member. This data was compiled, along with other related stakeholder input received throughout the years, and contributed to the final Innovation project work plan. An additional opportunity to provide written feedback during the meeting was provided to participants in the form of individual stakeholder comment forms. This was intended to aid in the collection of demographic information and to enable individuals attending the meeting to submit additional input and program ideas they may not have had the opportunity to offer during the small or large group discussions. The form asked a series of questions designed to parallel those asked in the facilitated process in the community meetings. A Spanish-language interpreter was available at all community participation meetings, as well as American Sign Language (ASL) or any other language, upon request. This information, in addition to County and department demographics, treatment service data, as well as documented areas of gaps in service or ineffective service approaches were analyzed to complete the project proposed in this plan and serve as the basis for evaluation of current and future program planning activities for Innovation projects. This project development process represents the input and engagement of 4,158 stakeholders and began in 2005 when SBC-DBH began its first stakeholder engagement process.
DRAFT MHSA Innovation Proposal 2017 31 of 140
Project Development Process: 2005 - 2017
Community Program Planning
DRAFT MHSA Innovation Proposal 2017 32 of 140
Innovation Stakeholder Meeting Summary Highlighted squares indicate days where a community planning event was held. The number of sessions held that day is featured in the center of the square.
August 2016
Community Program Planning
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
24
25
26
27
28
29
1 30
31
September 2016 Sun
Mon
Tue
Wed
Thu
1
Fri
Sat
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
October 2016 Sun
2 9 16 23 30
Mon
1 10 17 2 31
Tue
4 11 18 1
Wed
5 12 19 1
Thu
6 13 1 1
DRAFT MHSA Innovation Proposal 2017 33 of 140
Fri
7 14 21 28
Sat
1 8 15 22 29
Innovation Stakeholder Meeting Summary, cont. November 2016 Sun
Mon
Tue
1 6
1
13 27
28
3
9
2
1
Thu
2 23
1 29
Fri
Sat
4
5
1
11
12
2
18
19
25
26
24
30
December 2016 Sun
Mon
Tue
Wed
Thu
1 4
5
6
11
12
13
14
18
19
20
21
25
26
27
28
1
8
Fri
2
Sat
3 1
10
16
17
22
23
24
29
30
31
1
Stakeholder Meetings: Online Adobe Connect Session
1
HASC & DBH Collaborative Meeting
4
Community Policy Advisory Committee
2
Cultural Competency Advisory Committee
1
District Advisory Committee
4
Cultural Subcommittees
12 TOTAL:
DRAFT MHSA Innovation Proposal 2017 34 of 140
24
Community Program Planning
20
2 1
14
Wed
Community Program Planning
Innovation Stakeholder Meeting Schedule
English Version: Announcement for Innovation Stakeholder Meetings DRAFT MHSA Innovation Proposal 2017 35 of 140
Innovation Stakeholder Meeting Schedule, cont.
DRAFT MHSA Innovation Proposal 2017 36 of 140
Community Program Planning
Spanish Version: Schedule of Stakeholder Meetings
Community Program Planning
Innovation Stakeholder Meeting Schedule, cont.
English and Spanish Version: Community Policy Advisory Committee (CPAC) Flyer, October 20, 2016 Meeting DRAFT MHSA Innovation Proposal 2017 37 of 140
Innovation Stakeholder Meeting Schedule, cont.
DRAFT MHSA Innovation Proposal 2017 38 of 140
Community Program Planning
English and Spanish Version: Community Policy Advisory Committee (CPAC) Flyer, December 15, 2016 Meeting
Community Program Planning
Innovation Stakeholder Meeting Schedule, cont.
Community Invitation to Adobe Connect Session Note: The project name during the planning phase was Telehealth Technology for Team Case Conferencing. Based on stakeholder feedback, the project name was changed to I.E. PsychPartners: PublicPrivate Collaboration to Transform Emergency Psychiatric Services. DRAFT MHSA Innovation Proposal 2017 39 of 140
Innovation Stakeholder Demographics WIC § 5848 states that each Plan shall be developed with local stakeholders, including: Adults and seniors with severe mental illness Families of children, adults, and seniors with severe mental illness Providers of services Law enforcement agencies Education Social services agencies Veterans Representatives from veterans organizations Providers of alcohol and drug services Health care organizations Other important interests
9 CCR § 3300 further includes:
Representatives of unserved and/or underserved populations and family members of unserved/underserved populations Stakeholders that represent the diversity of the demographics of the county, including but not limited to geographic location, age, gender, and race/ethnicity Clients with serious mental illness and/or serious emotional disturbance, and their family members
T
he Innovation (INN) Stakeholder Meetings attracted a diverse array of participants from throughout the County. Stakeholder comment forms were used to collect demographic information on the backgrounds and interests of the participants, their region of origin within the county, stakeholder representation or organizational affiliation, ethnicity, age group, and gender.
Stakeholder meeting participants came from a variety of regions of the county. The greatest number of participants, 27 percent, identified as part of the West Valley regions and a nearly equal proportion of 26 percent identified as part of the Central Valley and East Valley regions, with 21 percent coming from the Desert/Mountain region. Around one in six stakeholder meeting participants did not indicate their region, and a handful came from out of the county (see Demographic Information section for geographic definition of the County’s regions).
DRAFT MHSA Innovation Proposal 2017 40 of 140
Community Program Planning
Community Program Planning
Innovation Stakeholder Demographics, cont. The quality of the discussions which took place in the stakeholder meetings were a result of the diverse backgrounds of participants who attended. People with organizational affiliations were the largest group, with 62 percent of the responses indicating they were affiliated with either community or government/social service agencies. However, consumers were also well represented, with 20 percent of the responses indicating an association as a direct consumer and/or a family/caregiver of a consumer. DBH identified that there were no responses received that reflected representation from the active military or as a representative from a Veteran's Organization, despite reaching out to each of these populations with an invitation to attend. This is an area in which we will further develop outreach and engagement strategies for both ongoing and ad hoc meeting participation in the CPP processes. From the 182 attendees, 111 surveys were returned. Those 111 surveys contained 164 responses due to the participants’ ability to select more than one “area of representation.”
Stakeholder Representation
Source: 2017 Innovation Stakeholder Feedback Survey
Note: The Demographic Survey used to collect this information allows for a participant to select more than one (1) “area of representation.” For the purpose of this chart, each selection was counted as a one response; therefore, there were more responses to this question than there were participant surveys completed. DRAFT MHSA Innovation Proposal 2017 41 of 140
Innovation Stakeholder Demographics, cont. The ethnic breakdown of the CPP participants closely aligns with the ethnic breakdown of San Bernardino County for all reported groups. The group with the largest representation is the Latino/Hispanic population representing 46 percent of participants. This is in alignment with the Latino/Hispanic population that represents 40 percent of San Bernardino County’s total population. Participants who identified as Caucasian/White, the second largest group, represented 23 percent of the participants, compared to this group’s representation of 33 percent as the County’s population.
Stakeholder Ethnicity
DRAFT MHSA Innovation Proposal 2017 42 of 140
Community Program Planning
Source: 2017 Innovation Stakeholder Feedback Survey
Innovation Stakeholder Demographics, cont. Participants varied a fair amount in age. Although the largest portion fell in the age range of 2659 (75 percent), there was good representation of older adults over 60 years of age (10 percent), and transitional-aged youth 16-25 years (15 percent). The meeting held at the San Bernardino Transitional Age Youth (TAY) Center was very effective in securing participation by youth and young adults. See Figure 1 below.
Community Program Planning
The breakdown of participants from the Innovation stakeholder meetings by gender is as follows (see Figure 2): 70 percent of the participants are female, 29 percent of the participants are male, and 1 percent of the participants declined to state gender.
Stakeholder Age
Source: 2017 Innovation Stakeholder Feedback Survey
Stakeholder Gender
Source: 2017 Innovation Stakeholder Feedback Survey
DRAFT MHSA Innovation Proposal 2017 43 of 140
Innovation Stakeholder Response SBC-DBH's stakeholder engagement process is a continuous year long process where the overall satisfaction of participants is an important measurement to ensure that the diverse voices within our community are being engaged. Over the last year, 96 percent of meeting participants who completed a stakeholder comment form, were either very satisfied, somewhat satisfied, or satisfied with the meeting process and community program planning. Four percent (4%) of meeting participants were either unsatisfied or very unsatisfied with the stakeholder engagement process. As part of the continuous process improvement, unsatisfied stakeholders are contacted to initiate dialog on how to improve the engagement process on behalf of all community stakeholders.
96% Satisfied
4% Unsatisfied Source: 2016—2017 Mental Health Services Act (MHSA) Stakeholder Feedback Survey
DRAFT MHSA Innovation Proposal 2017 44 of 140
Community Program Planning
Stakeholder Satisfaction
Stakeholder Comments “This project does address community needs by providing greater access to [outpatient services]. This should help decrease the amount of emergency services utilized. Improves quality of service.”
Community Program Planning
“This would be very beneficial to increase access to services also reducing cost. Will increase convenience for consumers. This will allow consumers in remote areas to receive improved access to services.” “Educating first the hospital staff that a mental or psych patient [needs are] just as important as someone who comes in with a physical emergency vs a mental emergency. Put an assessment in place/triage to distinguish the difference and have another section to be routed to a separate area so wait is not so long and concerns can be addressed sooner.” “The [project] will help with efficiency in regards to how mental health issues are dealt with in the ED. Telehealth technology also seems like a way to increase access to mental health services and support to those most in need.” “I hope Telemed will be expanded to other treatment modalities sooner rather than later. It removes so many barriers to care and is more cost effective.” “Telehealth could increase success to the community, particularly those in more outlying and rural areas, or those without transportation or mobility. A live orientation or orientation [by] video might be helpful to acclimate consumers to this new technology.” “This project would be extremely helpful to be able to have access to a psychiatrist and to other medical personnel, along with a social worker or a therapist.”
DRAFT MHSA Innovation Proposal 2017 45 of 140
Artwork by Janet Barbagello
Demographic Information DRAFT MHSA Innovation Proposal 2017 46 of 140
San Bernardino County Demographic Overview
S
an Bernardino County is located in southeastern California, approximately 60 miles inland from the Pacific Ocean. The County is the largest, in terms of land mass, in the contiguous United States, covering over 20,104 square miles, the largest county in the United States by area. There are 24 cities in the County and multiple unincorporated and census designated places. Over 80% of the land is owned by federal agencies (Federal Bureau of Land Management and the Department of Defense). According to the California Department of Finance, the estimated population for 2014 is 2,085,669, making it the 5th most populous county in California. Approximately 75% of the County population resides in the West and East Valley region of the County, which accounts for only 2.5% of the land.
City of San Bernardino—Downtown
Demographic Information
San Bernardino County Ethnicity
The County has four (4) active military bases, utilizing 15% of the land, which include: Fort Irwin, Marine Corps Air Ground Combat Center Twenty-nine Palms, Marine Corps Logistics Base Barstow, and Twenty-nine Palms Strategic Expeditionary Landing Field. San Bernardino County is the fifth largest county in the State of California in terms of population and ethnic diversity. The largest population in the county is Latino, with 50%, followed by Caucasian, then African American, Asian/Pacific Islander, then Native American. The gender breakdown is even, with 50% male and 50% female. (Source: US Census Bureau, 2011— 2015 American Community Survey). County of San Bernardino’s four (4) geographic regions.
DRAFT MHSA Innovation Proposal 2017 47 of 140
Inland Empire Region Demographic Overview
T
Inland Empire—Wind Farm in San Bernardino/
The term "Inland Empire" is documented to have Riverside Desert Area been used by the Riverside Enterprise newspaper (now The Press-Enterprise) as early as April 1914. Developers in the area likely introduced the term to promote the region and to highlight the area's unique features. The "Inland" part of the name is derived from the region's location, about 60 miles (97 km) inland from Los Angeles and the Pacific Ocean. Originally, this area was called the Orange Empire due to the acres of citrus groves that once extended from Pasadena to Redlands during the first half of the twentieth century. The Inland Empire is defined as the cities of western Riverside County and the cities of southwestern San Bernardino County; adjacent to the Los Angeles metropolitan area. A generally broader definition will include the desert community of Palm Springs and its surrounding area, and a much larger definition will include all of San Bernardino and Riverside counties.
Inland Empire Ethnicity
DRAFT MHSA Innovation Proposal 2017 48 of 140
Demographic Information
he U.S. Census Bureau-defined Riverside-San Bernardino-Ontario metropolitan area as the Inland Empire. This area comprises Riverside County and San Bernardino County, California, and covers more than 27,000 square miles (70,000 km2) with a population of approximately 4 million. Most of the area's population is located in southwestern San Bernardino County and northwestern Riverside County. At the end of the nineteenth century, the Inland Empire was a major center of agriculture, including citrus, dairy, and wine-making. However, agriculture declined through the twentieth century, and since the 1970s a rapidly growing population, fed by families migrating in search of affordable housing, has led to more residential, industrial, and commercial development.
Demographic Overview of Community Members Served in MHSA Programs in San Bernardino
M
HSA services are far reaching and span the continuum of care by providing prevention, early intervention, outpatient, full service partnership, and recovery services. Consumers served in Community Services and Supports, Prevention and Early Intervention, and Innovation components in Fiscal Year 2016/17 totaled 179,074. This includes individuals who participated in outreach and education activities. The demographic breakdown related to age category, gender, and ethnicity are as follows:
Demographic Information
Age
Gender
Ethnicity
DRAFT MHSA Innovation Proposal 2017 49 of 140
Demographic Overview of Community Members Served in MHSA Programs in San Bernardino, cont. The demographic breakdown of individuals served across Community Services and Supports, Prevention and Early Intervention, and Innovation related to primary language categories are as follows:
Primary Language
DRAFT MHSA Innovation Proposal 2017 50 of 140
Demographic Information
The Diagnostic group category describes the primary diagnosis of individuals participating in therapeutic services in Community Services and Supports, Prevention and Early Intervention, and Innovation.
Artwork by Judy Whiting
Project Budget DRAFT MHSA Innovation Proposal 2017 51 of 140
I.E. PsychPartners Budget Narrative Budget Overview The total estimated budget for this project is approximately $24 million over the course of five years. Funding will be provided to HASC who will contract and administer the funding to each participating hospital. HASC will hire full-time staff including program manager, office assistant, data/business analyst, contract manager, who will oversee the implementation of the project in the region. Because the project will be implemented in both counties, funding for HASC staff and operating expenses will be split between RUHS-BH and SBC-DBH. Hospitals will hire behavioral health specialty nurses based on their volume classification. High volume hospitals will hire six, full-time behavioral health nurses and will be available 24-hours-aday, 7-days-a-week; medium volume hospitals will hire three full-time behavioral health nurses and will be available during the hospitals busiest times, for example 11:00am -11:00pm; low volume hospitals will hire an on-call behavioral health nurse. Additional staff such as a program manager and data analyst are existing hospital staff who are already on working in the hospitals and will dedicate portions of their time to project management and data collection on site. Telepsychiatry consults will be available 24 hours a day, 7-days-a-week and will be paid for by use per hospital. SBC-DBH will hire a project manager and business systems analyst to oversee the project as well as serve as liaisons to the hospital staff. A nurse educator/clinical therapist will be hired to provide the ongoing education to hospital staff.
DRAFT MHSA Innovation Proposal 2017 52 of 140
Project Budget
One caveat to the budget will be the final readiness of each of the prospective hospitals. Based on readiness and willingness to participate, there will be a limited number of hospitals that will take part in the I.E PsychPartners project. Interested hospitals have completed readiness assessments and have been participating in collaborative meetings with HASC and both counties with the understanding that this is a time limited project. The intention is to work with five (5) hospitals with a budget of approximately $24 million over five years. Due to regional interest in the project, the dialogue and collaboration is in place should additional hospitals need to join the project over five years, based on available funds.
New Innovative Project Budget by Fiscal Year Overview of “New Innovative Project Budget by Fiscal Year” Budget Sheet Please note that the proposed budget starts in FY17/18 which is currently in progress. If approved the plan is expected to start in contract with HASC on January 1, 2018, accounting for the last six months of FY17/18. Additionally, due to mid-year start in FY17/18 the project will go through December of FY 2022/2023. Both these fiscal years account for approximately six months’ worth of budgeted funds and are notably lower than the other fiscal years in the plan. Due to the nature and size of this project, participating hospitals will have staggered starting times. It is expected to start with three (3) hospitals in FY17/18 and add two additional hospitals in FY18/19, accounting for the increase in budget from the first fiscal year to the second. Fiscal years 18/19 – FY 21/22 show a steady budgeted amount of approximately $5 million each. Expenditures by line number:
Project Budget
1. Line item number one includes the personnel expenditures expected for the duration of the project for SBC-DBH, HASC and the participating hospitals. 2. Line item number two includes operating expenditures such as offices supplies, travel, communications and lease costs for SBC-DBH and HASC. 3. Line item number three includes non-recurring expenditures including facility build out and startup costs for HASC and SBC-DBH staff that will be hired to manage the project. 4. Line item number four is for consultant contracts which will include the psychiatric telehealth consults that the EDs will utilize to improve medical decision making. 5. Line item number five accounts for other projected expenditures including the administrative fees incurred by SBC-DBH and HASC. 6. Line item six is the total requested funding for the I.E. PsychPartners Project. The “New Innovative Project Budget by Fiscal Year” budget sheet demonstrates that most of the budget allocated for this project is going to personnel and consultant contracts. Emergency Departments work 24 hours a day, 7 days per week creating significant staffing costs. The plan includes hiring 18 full-time mental health nurses and two (2) on-call mental health nurses to work directly in the EDs. Additionally the plan allows for payment of existing ED staff that will serve as the project liaison or manager who will oversee the project and a data analyst who will provide the data collection and reporting respectively. Hospitals will utilize telehealth psychiatric consults noted in the consultant contracts, line four. HASC intends to hire a project manager to oversee the implementation of the project across both counties; a contract specialist who will manage the hospital contracts and billing; a data analyst to oversee the data collection from hospitals in both counties and an administrative assistant. SBC-DBH intends to also hire a project manager to oversee the implementation of the project for SBC-DBH, a data analyst to compile and analyze data and a Clinical Therapist II who will implement the education portion of the project with each of the EDs. Existing SBC-DBH staff will also be used to provide support for the project.
DRAFT MHSA Innovation Proposal 2017 53 of 140
New Innovative Project Budget by Fiscal Year
Project Budget
DRAFT MHSA Innovation Proposal 2017 54 of 140
Expenditures by Fiscal Year Expenditures for Administration, Evaluation and Total by Funding Source and FY Expenditures are broken out by administration, evaluation and total expenditures. Administration funds include the projected staffing by HASC, SBC-DBH and the Hospitals to oversee the implementation and operations of the project. Administrative hospital staff are all existing staff that will serve as project managers at each location and be partially funded to oversee the project. HASC administrative funds include the project manager, contract specialist and the administrative assistant. SBC-DBH administrative costs include the project manager and office assistant time to oversee the project. Evaluation funds include the staffing by HASC, SBC-DBH and Hospitals to collect, compile and analyze data for the project. This includes existing staff that will be partially funded at each hospital that will compile and provide data to HASC and SBC-DBH. Funds will include HASC’s and SBCDBH’s data analysts.
Project Budget
The total mental health expenditures are the total funds requested per fiscal year for the duration of the project. This encompasses all staffing, operations, evaluation, and implementation costs for the project.
DRAFT MHSA Innovation Proposal 2017 55 of 140
Expenditures by Fiscal Year
Project Budget
DRAFT MHSA Innovation Proposal 2017 56 of 140
I.E. PsychPartners Budget I.E. PsychPartners Budget The I.E. PsychPartners Budget sheet shows the overall budget of the project including Personnel costs, Operating costs, One-time costs, Consultant costs and Other costs. The budget is broken out by the participating partners including the High Volume Hospitals (3 total), Low Volume Hospitals (2 total), HASC and SBC-DBH. Total Personnel costs over the five years includes salaries and benefits for a total of $13,597,988. This includes staffing for five EDs of 18 FTE behavioral health nurses, two part-time behavioral health nurses, and partial FTEs for administration and data collection at each of the five hospitals. HASC staffing will include a project manager, contract specialist, data analyst and administrative assistant. HASC staff will oversee the project in both counties therefore the staffing is funded at 50 percent due to cost sharing with RUHS-BH. SBC-DBH staff includes FTE contract project manager, contract business systems analyst II, contracted clinical therapist II, and partial pay for existing staff including an office assistant, business systems analyst II and staff analyst II. Operating costs are broken down for HASC and SBC-DBH and total $156,576. These costs include expenditures for office supplies, travel, ongoing communications, and rent and lease costs for HASC and DBH for the duration of the project. One-time funds total $46,611 and include startup costs for HASC and facility and space build out for contracted SBC-DBH staff, including the purchase of computer equipment.
Project Budget
Consultant costs include the telehealth psychiatry consults for each of the participating hospitals. These costs are estimated based on the volume of the hospitals and expected psychiatric consult need. The budgeted amount for the five participating hospitals is $9,667,938 for five years. Other costs total $183,621 include HASC and DBH standard administrative fees. This budget sheet provides and overview of the expected budget costs per collaborative agency taking part in the I.E. PsychPartners Project.
DRAFT MHSA Innovation Proposal 2017 57 of 140
I.E. PsychPartners Budget
Project Budget
DRAFT MHSA Innovation Proposal 2017 58 of 140
I.E. PsychPartners Budget, cont. I.E. PsychPartners Budget One-time funds total $46,611 and include startup costs for HASC and facility and space build out for contracted SBC-DBH staff, including the purchase of computer equipment. Consultant costs include the telehealth psychiatry consults for each of the participating hospitals. These costs are estimated based on the volume of the hospitals and expected psychiatric consult need. The budgeted amount for the five participating hospitals is $9,667,938 for five years. Other costs total $183,621 include HASC and DBH standard administrative fees.
Project Budget
This budget sheet provides and overview of the expected budget costs per collaborative agency taking part in the I.E. PsychPartners Project.
DRAFT MHSA Innovation Proposal 2017 59 of 140
I.E. PsychPartners Budget, cont.
Project Budget
DRAFT MHSA Innovation Proposal 2017 60 of 140
Artwork by David Pacheco
Mental Health Services Oversight and Accountability Commission Optional Innovation Project Plan Template DRAFT MHSA Innovation Proposal 2017 61 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Primary Problem a) What primary problem or challenge are you trying to address? Californians seeking emergency behavioral health care face one of the most complex care coordination, treatment, and management systems in the United States because of a care system comprised of primary care physicians, managed care plans, public behavioral health systems, and local hospitals. The nature of this service network leads to a level of complexity that causes individuals to default to known and trusted sources of emergency health care: the hospital emergency department. Emergency departments (EDs), by design, are created to address emergency health services targeted for physical health conditions such as heart attacks, strokes, and physical trauma. Specialty behavioral health care and treatment consultations are not currently a mandated component in emergency care. Even without this mandatory component, emergency departments always medically assess any individual that walks through their doors; but psychiatric patients on average spend twice as long waiting for treatment. According to a National Study by Harvard University, psychiatric patients spend an average of 11.5 hours in ED beds, prior to receiving appropriate behavioral health treatment and referral services. This is compared to the national average of 4.5 hours for ED wait time and a California average of 5.6 hour wait time for patients in ED beds waiting for treatment for a physical malady. Based on national, state, and regional trends, there are three reasons that the disparity in wait times exists. First, part of the wait time disparity is related to a perceived lack of availability of psychiatric consultative services and/or psychiatrist. While large, urban hospitals have access to psychiatrists to provide consultation services to the emergency department, the same is not true for smaller, suburban or rural hospitals where the availability of psychiatrists or affordability of consultative services can be a barrier to providing emergency psychiatric services. This has resulted in longer wait times for psychiatric patients that can impact emergency department operations. Second, a standardized model for providing emergency psychiatric care in an emergency room setting does not exist. Each individual hospital, or hospital group, is left to create a model, usually without the assistance of the public behavioral health system or regional sister hospitals. This lack of a standardized treatment model leads to inconsistent outcomes concerning wait times in the ED for behavioral health consumers. The development of a standardized psychiatric workflow within in the emergency department, similar to other consultative services provided in an emergency department, would benefit individuals seeking physical or psychiatric emergency care and would result in reduced wait times for psychiatric patients. Third, emergency departments remain disconnected from the bulk of community-based treatment services and other options that are typically coordinated by public behavioral health departments. This separation results in the ED discharge plan that does not have natural access to all available behavioral health resources within the behavioral health system of care. Previously, the traditional option available for emergency psychiatric care had been inpatient hospitalization; but, as of 2006, inpatient beds have been reduced to less than 50,000 nationwide (Care of the Psychiatric Patient in the Emergency Department, October 2014). As hospitals are decreasing the number of inpatient beds, more work remains at the larger system-level to coordinate and align emergency psychiatric care with other crisis services offered by public county behavioral health departments. With EDs seeing increasing numbers of
DRAFT MHSA Innovation Proposal 2017 62 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
patients who need emergency behavioral health services, aligning ED needs with resources provided by the behavioral health sector is an important opportunity for collaboration to decrease hospital wait times but also to include the ED as another “door” that a behavioral health consumer can enter to be connected to larger systems of outpatient behavioral health care. San Bernardino County’s regional hospital administrators also recognize this problem. San Bernardino County is a region of collaborative public and private sector healthcare partners as interagency discussions occur on a routine basis to determine shared approaches to problem solving. However, without an opportunity like the one proposed in this Innovation plan, the ability to work to impact change and evaluate emergency-room specific outcomes data is limited. The conversation around emergency room wait times is a conversation that requires trust and partnership as hospital partners work to address the experience for emergency room patients. While baseline, hospital-specific wait times and other data with the intended hospital partners will not be available until the appropriate Memorandums of Understanding and agreements are in-place and a study period is initiated at the start of this Innovation plan, there are indicators, validated by regional and state-level data, that explain the problem of psychiatric patients waiting in San Bernardino County’s hospital emergency departments: 1. Even with Medi-Cal expansion, the volume of insured and uninsured people living on lowincomes is substantial in the region. According to the California Health Care Foundations’ “Regional Markets Brief” in March of 2016,1 San Bernardino and Riverside Counties, which make up the Inland Empire region, are still recovering from the 2008 recession and the “income level for this region’s population remains relatively low, and employment growth is characterized by lower-wage jobs with fewer health insurance benefits” (1). The report also noted that: “Many remain uninsured, even after large Medi-Cal expansion. The prevalence of low incomes across the Inland Empire contributed to an approximately 50% increase in Medi-Cal enrollees in this region since the state expanded the program in 2014. However, because of a concurrent erosion of commercial coverage over the last few years and difficulties reaching people in more remote parts of this vast region, a relatively high proportion of Inland Empire residents still lacked coverage by the end of 2014, although Medi-Cal enrollment continued to climb throughout 2015. Moreover, despite some improvements, the community lacks a robust, extensive safety net to adequately serve low-income people’s primary care, specialty care, and behavioral health needs throughout the whole region” (1). 2. Emergency room utilization is increasing as traditionally, emergency rooms are the primary healthcare destination for uninsured, and the newly insured. The same report noted that for the Inland Empire, “Some hospitals have faced a growing demand and capacity constraints in their emergency room departments (EDs), stemming particularly from newly insured people unable to access timely primary care or other outpatient services in the community. ED visits rose 11% in the market overall between 2011 and 2014” (11).
1
California Health Care Foundation. “California Health Care Almanac: Riverside/San Bernardino: Despite Large Medi-Cal Expansion, Many Uninsured Remain.” March 2016.
DRAFT MHSA Innovation Proposal 2017 63 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
3. There are not enough psychiatric beds in the region. According to the California Health Care Almanac, “Psychiatric beds reportedly remain in short supply across the market” (6). 4. For psychiatric patients, new pathways are needed when they access EDs to ensure they have access to care and avoid wait times. A 2017 study titled “The Acute Care Continuum in California” from a physician and associate professor at UC Irvine reported on California’s ED utilization trends.2 Dr. William Wesley Fields noted “Because of unmet needs in communities, multiple studies have shown that 10-12% of all ED visits are now because of mental health emergencies, often compounded by substance abuse issues. Waiting or boarding times for ED patients with psychiatric emergencies has been reported at 10-12 hours in California, and is often measured in days for patients without private health insurance” (182). While the study drew four conclusions about the acute care system, the last and most relevant to this proposed Innovation plan was: “frequent visitors to ED’s due to poorly controlled behavioral health [conditions] require their own urgent treatment pathways to preserve ED capacity” (178). The problem the I.E. Psych Partners Innovation project intends to solve is the creation of these improved pathways, or clinical workflows for psychiatric patients to navigate the EDs with the intention of treatment. To create these pathways, San Bernardino County’s hospital executives and emergency room staff, Hospital Association of Southern California (HASC) representatives, and county partners have been engaged in stakeholder conversation to identify the primary problems for psychiatric patients in Inland Empire emergency rooms validating the macro-problem and contextualizing it around three areas: 1. Long wait times for psychiatric patients 2. Lack of psychiatric consultation services 3. Increasing Ambulance Patient Offload Delay (APOD) HASC’s ad hoc committee, Ambulance Patient Offload Delay (APOD) taskforce, is reporting an increase in the numbers of patients requiring behavioral health treatment in the EDs throughout the region and the impact on APOD turnaround times. APOD measures the time between a patient arrival via emergency medical services (EMS) to the ED and the time that the patient is completely out of the care of the EMS crew. If the ED capacity is impacted, psychiatric patients will wait in the ambulance with the EMS crew, not only experiencing wait-times pre-admission to the ED, but delaying the EMS crew from returning to the field. Because the above issues involve both the regional hospital system, the public behavioral health system, commercial insurers, and Medi-Cal Managed Care plans, the solution must come from a collaborative effort to redesign the current system of emergency psychiatric care pathways collectively. Historically the behavioral health sector and EDs have not collaborated at the policy/systems level to maximize and align behavioral health pathways at the operational level of EDs for shared patients and consumers. This project idea presents an opportunity that has been a topic of discussion with consumers, family members, ED physicians, Hospital Chief Executive Officers and the Regional Hospital Association, for 2
Fields, William Wesley. “The Acute Care Continuum in California.” Revista Medica Clinica Las Condes. 28(2). 2017 (178-185).
DRAFT MHSA Innovation Proposal 2017 64 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
over nine years: thus making this project a true regional, system-level innovation. While researching collaborative models to use as a template for our regional collaboration, it was discovered that interagency collaboration at the system-level produces its own set of challenges separate from the concerns of providing behavioral health services in the ED. Some common organizational barriers to interagency collaboration within healthcare that this project will seek to improve include, but are not limited to:
Lack of knowledge and appreciation of the roles of other healthcare professionals. Lack of outcomes research on system-wide collaborative efforts, to include a lack of data sharing between healthcare agencies. Financial constraints that prevent inventive thinking within existing healthcare organizations. Legal issues concerning scope-of-practice and liability between large healthcare agencies, to include unease with sharing in the clinical decision-making process. Lack of understanding of reimbursement structures for both physical and mental/behavioral health procedures. Creating a collaborative service network out of the current system of “a la carte” services within Emergency Department settings. Difficulty in developing a commitment to the common goal of collaboration. Difficulty in achieving “buy-in” at the executive level of all partner agencies. Lack of shared vocabulary (i.e., shared terminology) that hinders effective cross-system communication concerning problems and solutions. Lack of expertise on behalf of consulting physicians, if consulting from another region through telemedicine, on the outpatient system of care available to psychiatric patients. Lack of ability to influence the medical decision-making process of the emergency department physicians when patients present in the emergency department and their medications or psychiatric outpatient history is unknown to the treating physician.
This Innovation plan is poised to build the collaborations necessary to overcome the existing barriers and the EDs have noted that new approaches are needed. The major aim of this project is to create a set of treatment options within emergency room settings that enhance medical decision making, treatment interventions and improved outcomes for psychiatric patients. The regional impact of this effort cannot be understated as, not only will improved pathways benefit psychiatric patients, it will benefit all patients of EDs in order to reduce the impact on ED capacity. The Institute of Medicine (IOM) states that safety, effectiveness, patient-centeredness, efficiency timeliness, and equity are all compromised in overcrowded EDs due to long waits and diversion of the ambulance away from the hospital closest to the patients. As the potential impact on our region is significant, I. E. PsychPartners will work collaboratively with partnering hospitals to create improved pathways for psychiatric patients experiencing an emergency and improve care in the region’s emergency rooms.
DRAFT MHSA Innovation Proposal 2017 65 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
b) Describe what led to the development of the idea for your INN project and the reasons that your project is a priority for your county. San Bernardino County Department of Behavioral Health (SBC-DBH) began engaging stakeholders in 2005 concerning the emergency psychiatric care in San Bernardino County. This initial stakeholder feedback identified three stakeholder priorities that relate directly to the region’s emergency psychiatric services: 1. Need for programs that divert behavioral health consumers away from high-cost hospital treatment to less restrictive forms of care. 2. Recognition that other options were needed for residential out-patient care. 3. Concern about long wait-times for behavioral health consumers seeking emergency psychiatric care in the local EDs. In consultation with law enforcement, hospitals, and community stakeholders it was determined that focus on the first two community identified priorities would positively impact outcomes associated with the third. The work that has gone into addressing the first two priorities include the SBC-DBH diversion programs (Triage, Engagement, and Support Teams (TEST), and the Community Crisis Response Teams (CCRT)), and the development of five crisis residential treatment centers (Transitional-Aged Youth crisis residential treatment center (The STAY) and four adult crisis residential treatment centers, placed strategically throughout the county, that are currently under construction). With work being done on the first two priorities, SBC-DBH completed an updated stakeholder feedback analysis concerning all feedback from 2005 – 2014. The result of this analysis were presented in the Three Year Integrated Pan for Fiscal Years 2014/15 through 2016/17. While the analysis indicated community satisfaction with the progress made toward the first two community identified priorities, community stakeholder feedback, also, identified a need to integrate emergency psychiatric care into the larger behavioral health system of care. Both consumers and family members shared stories of wait times and members of the hospital community voiced frustration with an ever growing network of community resources that they felt disconnected from. Initially, discussion centered on the creation of additional diversion programs or expansion of the current diversion programs. These programs have been highly successful in diverting individuals to lower levels of care, but no matter how successful, diversion programs will never divert 100% of those individuals seeking emergency psychiatric care from our community hospital’s emergency departments. With this in mind, SBC-DBH began to research ways to better connect the local emergency departments with community behavioral health resources, to include resources provided by SBC-DBH. This is where discussions with both hospitals and their association, HASC, concerning ED throughput of psychiatric consumers in both San Bernardino and Riverside Counties began and resulted in the project concept that became the innovation project I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Care. The original project concept also attracted the interest of the managed care plans that operate in this county. These managed care plans have indicated their interest in joining this collaborative effort and have indicated that they have a continued commitment to obtaining and facilitating the care for their consumers that visit the ED seeking emergency behavioral health services.
DRAFT MHSA Innovation Proposal 2017 66 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
All the factors listed above, and the interest of our regional hospitals and managed care plans in partnering to redesign the emergency psychiatric workflow, is the reason why SBC-DBH decided it’s the right time for the I.E. PsychPartners project. What Has Been Done Elsewhere To Address Your Primary Problem? “A mental health practice or approach that has already demonstrated its effectiveness is not eligible for funding as an Innovative Project unless the County provides documentation about how and why the County is adapting the practice or approach… (CCR, Title 9, Sect. 3910(b)). Describe the efforts have you made to investigate existing models or approaches close to what you’re proposing (e.g., literature reviews, internet searches, or direct inquiries to/with other counties). Have you identified gaps in the literature or existing practice that your project would seek to address? SBC-DBH currently has two (2) programs that have similar goals to reduce hospital utilization and unnecessary psychiatric hospitalizations. There are opportunities for learning within each of the existing models that the I.E. PsychPartners project seeks to address. The first program is Triage, Engagement & Support Teams (TEST), which is a CA Senate Bill (SB) 82 grant-funded service that integrates engagement, assessment, and case management with crisis intervention and post-crisis discharge to reduce arrests, recidivism, and hospitalizations of those with unmet behavioral health needs. TEST staff are co-located at key points of access to emergency behavioral health services such as law enforcement and existing SBC-DBH crisis programs, as well as being co-located at key points of post-crisis discharge, such as county jails and the Public Defender’s Office. Co-location is an important component to the TEST program. The close working proximity of both the TEST staff and the staff of the collaborating agency allow for TEST staff members to accompany partner agency staff on crisis calls with the intention of diverting the consumers from hospitalization or incarceration in favor of integration in outpatient community-based services. When hospitalization cannot be avoided, TEST staff save law enforcement personnel time by providing transportation to the hospital for consumers and accompanying the consumer while waiting for hospital admission. Currently the TEST program is co-located in the following locations: Seven (7) regional Sheriff stations Three (3) Police Stations California State University, San Bernardino, Counseling Center & Police Station Public Defender’s Office (West Valley Region) County Probation Department Offices (High Desert and Morongo Regions) Embedded with three (3) Community Crisis Response Teams Two (2) Emergency Departments in Apple Valley and Loma Linda (In progress)
TEST staff are available at these locations Monday through Friday from 8:00am – 5:30pm. To date, the collaborative focus for the TEST program has been to assist law enforcement. TEST also provides two (2) months of intensive case management to activate the consumer into SBC-DBH’s larger system of care after discharge from the hospital.
DRAFT MHSA Innovation Proposal 2017 67 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
The other SBC-DBH program with a similar goal of reducing unnecessary hospitalizations is the Community Crisis Response Teams (CCRT). CCRT provides crisis intervention to consumers in SBC-DBH in the least restrictive environment. CCRT utilizes specially trained mobile crisis response teams to provide crisis interventions, risk assessments, medication referrals, and trauma response to the community. CCRT also assists law enforcement with assessment and transportation of community members in crisis, as well as, providing crisis intervention training for law enforcement. A focus of CCRT is the reduction of involuntary hospitalizations (i.e. WIC §5150 Holds) by working with law enforcement to divert these consumers to appropriate behavioral health services in the community. Unlike TEST, CCRT is not co-located with another agency, but rather provides mobile crisis services countywide when called. CCRT is available 365 days a year, 7 days a week, 24 hours a day. CCRT does triage (i.e. prioritize) calls if the demand is high. Calls from law enforcement receive the highest priority since these calls tend to be the most serious and/or involve individuals presenting as a danger to themselves or others. CCRT responds to the immediate need for crisis intervention and does not provide ongoing case management.
Figure 1: TEST & CCRT Outcomes
DRAFT MHSA Innovation Proposal 2017 68 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
I.E. PsychPartners differs from both these programs by focusing on achieving system wide transformative change in the ways emergency departments interact with individuals presenting with behavioral health and substance use disorders. I.E. PsychPartners is not focused on diverting individuals seeking emergency behavioral healthcare away from the ED, rather I.E. PsychPartners seeks to understand how to improve the ED experience for those individuals who can benefit from psychiatric care in the ED. This project seeks to empower ED physicians and staff to redesign emergency healthcare so that individuals will have access to specialty care when visiting the ED for psychiatric health concerns. Because this project seeks system wide transformative change, the collaborative model includes the use of a regional association Hospital Association of Southern California, two county behavioral health agencies (SBC-DBH and RUHS-BH), and buy-in from the hospital management executive staff, and emergency department providers. This collaborative effort seeks to not just fill a service need, but seeks to understand how the shared emergency medical system can be changed for the betterment of the region’s shared consumers. Long term, this project seeks to also inform private and public commercial insurance plans, as their consumers will be served in the implementation of uniform order sets related to psychiatric consultation and expedited medical decision making as well. The Proposed Project Describe the Innovative Project you are proposing. Note that the “project” might consist of a process (e.g. figuring out how to bring stakeholders together; or adaptation of an administrative/management strategy from outside of the Mental Health field), the development of a new or adapted intervention or approach, or the implementation and/or outcomes evaluation of a new or adapted intervention. See CCR, Title 9, Sect. 3910(d). Include sufficient details so that a reader without prior knowledge of the model or approach you are proposing can understand the relationship between the primary problem you identified and the potential solution you seek to test. You may wish to identify how you plan to implement the project, the relevant participants/roles, what participants will typically experience, and any other key activities associated with development and implementation. The proposed project seeks to effect system-wide transformative change by modifying the ways in which the hospital system interacts with the public behavioral health system in the care of patients seeking psychiatric emergency services in hospital emergency departments. The focus of this project will be to construct a collaborative infrastructure to increase the quality of services, which includes better outcomes, by introducing a two county (regional) approach to the management and organization of behavioral health consultation services into a regional collaborative approach. The center piece of the collaborative infrastructure will be the coordination of the San Bernardino County Department of Behavioral Health (SBC-DBH), Riverside University Health System Behavioral Health (RUHS-BH), and the Hospital Association of Southern California (HASC).
DRAFT MHSA Innovation Proposal 2017 69 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
The proposed system transformation will be focused on removing the following identified barriers that currently exist between the public behavioral health system and the local hospitals: Lack of standardized psychiatric workflow based on best practices: By bringing consultative resources to the treating physician in the ED, this project is focused on the elimination of barriers that exist between the public and private healthcare systems. This collaboration will produce a new approach that empowers the ED physicians and staff to develop tools, such as standardized psychiatric workflow and pre-defined templates that contain sets of recommended treatment options called “Order Sets¹,” for enhanced consultation and expedited medical decision-making that improves the treatment options for behavioral health consumers. Lack of regional training model between hospitals and the public behavioral health department that allows for shared learning: Part of this collaborative process will include the introduction of a regional training model that will allow the region to share best practices, increase awareness of behavioral health services within the region, and provide behavioral health trainings to decrease the stigma and discrimination associated with mental illness. Lack of ED access to patient behavioral health treatment and medication history: Without the appropriate medical history and knowledge of that patient’s connection to behavioral health systems of care, ED physicians and consulting telemedicine specialists are only able to make medical decisions based on single visits or the history of emergency department visits in their own electronic health records. The patient’s medical history is vital to informing the treating physician’s medical decisions and the care destination of that patient, and as this information is shareable under the Health Insurance Portability and Accountability Act (HIPAA) by entering into an Memorandum of Understanding (MOU) for the purpose of treatment and with appropriate consents, providing the outpatient medication and treatment plans with both the treating physician and specialist consulting on the patient’s behalf is an important problem that must be overcome. County size prevents the sharing of resources: The counties have identified that the use of interactive videoconferencing (telehealth technology) is the best place to begin to achieve the interconnectivity between the various disconnected, or fragmented, services that currently exist. Telehealth technology is an existing and established practice within the medical health field and has been in use since the early 2000s and the use of telehealth technology in the ED has been successfully used to provide real-time case consultation for other physical health specialty fields, such as cardiology and neurology. The reasons for uses of telehealth range from time and cost savings to a lack of resources in rural areas. According to Telepsychiatry in the Emergency Department (2009), a report prepared for the California Healthcare Foundation: “ED telepsychiatry programs appear to provide quick and specialized care to patients with the risk of psychiatric emergencies and have the potential to assist in reducing crowding in
DRAFT MHSA Innovation Proposal 2017 70 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
EDs and lowering costs.” Even with the widespread acceptance of telepsychiatry and telemedicine as a means of delivering behavioral health services in the ED two issues have prevented widespread implementation: financial stability of telepsychiatry in the ED and the lack of published data and/or metrics of the existing telepsychiatry programs. This project seeks to use telehealth technology to not only provide psychiatric consultative services, but also allow for a Behavioral Health Nurse to remotely participate in the consultation for medical-decision making with the treating emergency department physician, consulting psychiatrist, and as appropriate, the patient. While the region’s emergency departments that see a high volume of behavioral health emergencies will have a Behavioral Health Nurse physically present, the region’s smaller hospitals that see a lower behavioral health emergencies will benefit from a shared Behavioral Health Nurse available via telehealth technology. The sharing of behavioral health professionals is also anticipated to assist in alleviating the region’s psychiatric workforce shortage. These identified barriers will be eliminated and a new system of care created by using Innovation funding to create the following: Multi-disciplinary, team-based psychiatric consultations via telemedicine aimed at expediting emergency department physician medical decision making. The innovative component to the consultation is the addition of a Behavioral Health Nurse to join the psychiatric specialist and ED physician in order to overcome the lack of information, possibly available from the public behavioral health’s system of care, which may make it more difficult for the physicians during consultation. This includes information such as: 1. Medication History 2. Outpatient treatment history and management by a psychiatrist. 3. Previous discharge care plans 4. Family and social supports 5. Linkages to important program and outpatient services Construction of a standardized psychiatric workflow for the region’s emergency departments to use, to include policy, procedures, and pre-defined templates that provide support in making clinical decisions that standardize and expedite the ordering process for psychiatric treatment in the ED (i.e. Order Sets). Create and establish a regional training program that will continuously inform area hospitals of behavioral health resources available through San Bernardino and Riverside County’s behavioral health systems, provide in-services on de-escalation strategies and techniques, and general behavioral health trainings to reduce the stigma of psychiatric patients. Currently, there are no projects of this scope within the Inland Empire. The region’s hospitals continue to receive an increased number of individuals in crisis who are experiencing a behavioral health
DRAFT MHSA Innovation Proposal 2017 71 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
emergency and/or a substance use disorder issues to their EDs. These consumers usually require time intensive services that EDs are unable to provide. By creating a regional service network, regional hospitals and EDs would become part of a coordinated effort to find the best services available to address the needs of our shared consumers. This project would further expand on the integrated care model by developing a collaboration framework between primary care providers, hospital EDs, managed care plans, and county behavioral health departments in order to provide the most effective treatment plans for consumers with multiple ongoing healthcare needs. Using telehealth technology, the collaborative agencies will create an interagency treatment team that includes a psychiatrist and specialized behavioral health nurse available 24-hours-a-day, 7-days-a-week within EDs in San Bernardino and Riverside Counties. Funding will be provided by SBC-DBH and RUHS-BH through the MHSA as part of the Act’s Innovation component. SBC-DBH, in partnership with HASC, will establish and evaluate performance metrics and based on the outcomes, provide a strategic approach for a sustainable I.E. PsychPartners program throughout San Bernardino County. Creation of a sustainable I.E. PsychPartners program will assist San Bernardino County residents who use the ED for psychiatric services by reducing wait time for services, reducing unnecessary psychiatric hospitalizations, and by linking these individuals into the larger network of client-centered behavioral health services offered by SBC-DBH. It is expected that this project will be contracted to HASC via a sole source agreement. SBC-DBH and RUHS-BH will work collaboratively with HASC, and HASC will contract with the hospitals to develop, gather, and evaluate the data collected. Hospitals are a major and valued partner in problem solving and decision making for issues in their own ED work flows.
Figure 2: Flow of Proposed Roles and Responsibilities
DRAFT MHSA Innovation Proposal 2017 72 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
SBC-DBH is committed to ensuring consumer health information is handled according to privacy standards. Although HASC will be contracting directly with the participating hospitals, DBH will establish memorandums of understanding and negotiate privacy and data sharing with each respective hospital. Telehealth is a critical component of this project. HASC is working with tele psychiatry vendors and local physician groups to establish the most meaningful and cost effective relationship in working with local hospitals. Due to vast difference in operating systems within the hospitals, there may be a combination of tele psychiatry vendors and local physicians participating in the project. HASC will finalize level of physician group involvement at the time of contract implementation with the hospitals. _________________________ ¹ Clinical Order Set: A clinical order set is a pre-defined template that provides support in making clinical decisions for a specific condition or medical procedure. It is a grouping of orders that standardizes and expedites the ordering process for a common clinical scenario. Clinical order sets guide clinicians while treating patients to ensure that they do not miss any critical components of care.
Innovative Component Describe the key elements or approach(es) that will be new, changed, or adapted in your project (potentially including project development, implementation or evaluation). What are you doing that distinguishes your project from similar projects that other counties and/or providers have already tested or implemented? The key elements that distinguish this project are: 1.
2.
3. 4. 5.
6.
Partners: Interagency collaboration between SBC-DBH, RUHS-BH, HASC that represents more than 170 member hospitals, 36 emergency departments, and the existing network of community partners from both San Bernardino and Riverside Counties. System Design: Creation of standardized regional model of emergency psychiatric care that aligns emergency departments, public behavioral health departments and commercial insurance providers. Quality: Improves consistency and quality of care because there is improved information sharing and medical decision-making. Training: Identify regional best practices and training needs focused on the reduction of stigma and discrimination associated with mental illness. Linkage by Design: Provide linkages to community behavioral health resources with an embedded behavioral health nurse who can problem solve resources and coach consumers/families on service navigation. Regional Impact: Regional collaborative and oversight by HASC and potential sustainability by public, private sectors, and a professional association.
DRAFT MHSA Innovation Proposal 2017 73 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Learning Goals / Project Aims Describe your learning goals/specific aims. What is it that you want to learn or better understand over the course of the INN Project? How do your learning goals relate to the key elements/approaches that are new, changed or adapted in your project? There is no maximum number of learning goals required, but we suggest at least two. Goals might revolve around understanding processes, testing hypotheses, or achieving specific outcomes. Learning Goal 1: To determine which communication and feedback mechanisms are effective for establishing a collaborative care process between County MHPs and local hospitals at the systems level. It is expected that collaborating agencies will develop implementation plans and meet regularly to discuss, troubleshoot, and support new practices. The transformed system will be expected to have developed joint ownership and a commitment to processes and practices that best support mental well-being in emergency departments. In addition, it is expected that establishing collaborative processes at the institutional level is mutually reinforcing with improved collaborative processes at the individual level by creating an environment in which support for both providers and consumers has been enhanced. Learning Goal 2: To determine if utilizing tele health technology in the collaborative care process in the ED expedites psychiatric treatment interventions in the ED, decreases ED wait times, increases psychiatric services provided by the ED, and decreases recidivism to the ED. It is expected that more readily available psychiatric consultants and behavioral health case consultation will decrease the unnecessary “boarding” of psychiatric clients in the ED. Learning Goal 3: To determine if regional training in de-escalation techniques and quality crisis interventions within an ED setting improves ED staff capacity to respond to psychiatric crisis in the emergency room. Learning Goal 4: To determine if access to outpatient care can be increased through multiple interagency collaboration, by co-locating Behavioral Health staff in the emergency department. Behavioral Health staff are responsible for promoting access, linkage, and care for consumers within the behavioral health system in order to positively impact utilization of behavioral health outpatient services and decrease psychiatric hospitalizations.
DRAFT MHSA Innovation Proposal 2017 74 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Evaluation or Learning Plan For each of your learning goals or specific aims, describe the approach you will take to determine whether the goal or objective was met. What observable consequences do you expect to follow from your project’s implementation? How do they relate to the project’s objectives? What else could cause these observables to change, and how will you distinguish between the impact of your project and these potential alternative explanations? The greater the number of specific learning goals you seek to assess, generally, the larger the number of measurements (e.g., your “sample size”) required to be able to distinguish between alternative explanations for the pattern of outcomes you obtain. In formulating your data collection and analysis plan, we suggest that you consider the following categories, where applicable: a) Who are the target participants and/or data sources (e.g., who you plan to survey to or interview, from whom are you collecting data); How will they be recruited or acquired? b) What is the data to be collected? Describe specific measures, performance indicators, or type of qualitative data. This can include information or measures related to project implementation, process, outcomes, broader impact, and/or effective dissemination. Please provide examples. c) What is the method for collecting data (e.g. interviews with clinicians, focus groups with family members, ethnographic observation by two evaluators, surveys completed by clients, analysis of encounter or assessment data)? d) How is the method administered (e.g., during an encounter, for an intervention group and a comparison group, for the same individuals pre and post intervention)? e) What is the preliminary plan for how the data will be entered and analyzed?
The target participants for this innovation project are adults presenting with a psychiatric crisis in local hospital EDs. Project measurement will include both quantitative and qualitative data collection. Proposed project measurement for each learning goal is as follows: Learning Goal 1: Survey data and qualitative data from collaborative care meetings will be utilized to measure staff perceptions, active participation, and buy-in to collaborative care; qualitative data will be examined through rigorous multi-reviewer thematic analysis. Participation and commitment to the collaboration will be measured with a Net Promoter Score Study. In addition a survey tool and focus groups will be used to measure the extent to which hospital EDs have incorporated the jointly developed care collaboration practices which will include the measurement of the consultation impact on the time and quality of medical decision-making in the ED. The option for interagency dashboards is also being explored. Learning Goal 2: Data on time of admission, time of crisis service ED contact, and time of discharge from the ED will be recorded in the ED system to examine wait time to care and overall length of stay in the ED. Data on time and type of services provided through the collaborative care process and disposition at discharge will also be collected. Baseline data on average ED wait times for clients in
DRAFT MHSA Innovation Proposal 2017 75 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
need of psychiatric care prior to program implementation will need to be collected prior to program implementation to provide the appropriate comparison data. Recidivism to the ED will be evaluated by and analysis of ED admissions during a baseline period as reported by each ED and/or individual level admissions data. Learning Goal 3: Survey results from regional trainings will be used to measure gains in EDs staff understanding of de-escalation techniques, crisis intervention, and any reduction in stigma towards those with behavioral health needs. Learning Goal 4: Data from the initial ED encounter will be collected and will be used to match clients to outpatient service (for crisis and routine services) and psychiatric hospitalization data extracted from electronic health records. The ED will provide the data necessary to understand aspects of the ED encounter (encounter disposition), collect consumer demographics and provide enough identifying information to match clients to determine outpatient service usage both before and after their encounter within the ED.
DRAFT MHSA Innovation Proposal 2017 76 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
DRAFT MHSA Innovation Proposal 2017 77 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Contracting If you expect to contract out the INN project and/or project evaluation, what project resources will be applied to managing the County’s relationship to the contractor(s)? How will the County ensure quality as well as regulatory compliance in these contracted relationships? Funding will be provided by SBC-DBH and RUHS-BH through the MHSA as part of the Act’s Innovation component. SBC-DBH, in partnership with HASC, will establish and evaluate performance metrics and based on the outcomes, provide funding for a sustainable I.E. PsychPartners program throughout San Bernardino County. Creation of a sustainable I.E. PsychPartners program will assist San Bernardino County residents who use the ED for psychiatric services by reducing wait time for services, reducing unnecessary psychiatric hospitalizations, and by linking these individuals into the larger network of client-centered behavioral health services offered by SBC-DBH. It is expected that this project will be contracted to HASC via a sole source agreement. SBC-DBH and RUHS-BH will work collaboratively with HASC, and HASC will contract with the hospitals to hire staff, develop, gather, and evaluate the data collected. Hospitals are a major and valued partner in problem solving and decision making for issues in their own ED work flows. Certifications Innovative Project proposals submitted for approval by the MHSOAC must include documentation of all of the following: a) Adoption by County Board of Supervisors. b) Certification by the County mental health director that the County has complied with all pertinent regulations, laws, and statutes of the Mental Health Services Act (MHSA). c) Certification by the County mental health director and by the County auditor-controller that the County has complied with any fiscal accountability requirements, and that all expenditures are consistent with the requirements of the MHSA. d) Documentation that the source of INN funds is 5% of the County’s PEI allocation and 5% of the CSS allocation.
Community Program Planning Please describe the County’s Community Program Planning process for the Innovative Project, encompassing inclusion of stakeholders, representatives of unserved or under-served populations, and individuals who reflect the cultural, ethnic and racial diversity of the County’s community. Include a brief description of the training the county provided to community planning participants regarding the specific purposes and MHSA requirements for INN Projects.
DRAFT MHSA Innovation Proposal 2017 78 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
SBC-DBH began engaging stakeholders in 2005 concerning the emergency psychiatric care in San Bernardino County. This initial stakeholder feedback identified three stakeholder priorities that relate directly to the region’s emergency psychiatric services: 1. Need for programs that divert behavioral health consumers away from high-cost hospital treatment to less restrictive forms of care. 2. Recognition that other options were needed for residential out-patient care. 3. Concern about long wait-times for behavioral health consumers seeking emergency psychiatric care in the local EDs. In consultation with law enforcement, hospitals, and community stakeholders and consumers it was determined that focus on the first two community identified priorities would positively impact outcomes associated with the third. The work that has gone into addressing the first two priorities include the SBC-DBH diversion programs (Triage, Engagement, and Support Teams (TEST), and the Community Crisis Response Teams (CCRT)), and the development of five crisis residential treatment centers (Transitional-Aged Youth crisis residential treatment center (The STAY) and four adult crisis residential treatment centers, placed statistically throughout the county, that are currently under construction). With work being done on the first two priorities, SBC-DBH completed an updated stakeholder feedback analysis concerning all feedback from 2005 – 2014. The result of this analysis were presented in the Three Year Integrated Pan for Fiscal Years 2014/15 through 2016/17. While the analysis indicated community satisfaction with the progress made toward the first two community identified priorities, community stakeholder feedback, also, identified a need to integrate emergency psychiatric care into the larger behavioral health system of care. Both consumers and family members shared stories of wait times and members of the hospital community voiced frustration with an ever growing network of community resources that they felt disconnected from. Initially, discussion centered on the creation of additional diversion programs or expansion of the current diversion programs. These programs have been highly successful in diverting individuals to lower levels of care, but no matter how successful, diversion programs will never divert 100% of those individuals seeking emergency psychiatric care from our community hospital’s emergency departments. With this in mind, SBC-DBH began to research ways to better connect the local emergency departments with community behavioral health resources, to include resources provided by SBC-DBH. Beginning in August 2016, the SBC-DBH Innovation Team began a targeted community planning process to develop the project outline that became the I.E. PsychPartners Project. A total of twenty-four (24) meetings were held between August 23, 2016, and December 19, 2016. SBC-DBH ensures diverse attendance by advertising these meetings using social media, press releases, other county departments, and an expansive network of known community partners and contracted vendors. SBC-DBH also has established 12 cultural subcommittees that meet monthly and this Innovation project was shared and feedback requested at the monthly meetings for each of these cultural subcommittees to ensure that the CPP included the voices of individuals who reflect the cultural, ethnic, and racial diversity that exists
DRAFT MHSA Innovation Proposal 2017 79 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
within San Bernardino County. Stakeholder meetings were held throughout the County with an evening online session for those community members who had other commitments, transportation problems, or who otherwise were unable to attend one of the other twenty-four (24) scheduled meetings. A total of 182 community members and stakeholders attended these sessions. From this planning process, 111 comments were received. The comments received revealed overwhelming support for the collaborative interagency framework of this project and the system-wide approach to redesigning the way in which an ED would provide behavioral health services. One (1) meeting was conducted in Spanish for monolingual stakeholders. Press releases, in both English and Spanish, with the stakeholder meeting schedule were sent to local newspapers and media contacts. Interpreter services are provided at all of the stakeholder events to ensure diverse community inclusion and these services were noted on all announcements prior to meetings.
In addition to the stakeholder meeting scheduled for community members, consumers, and family members, SBC-DBH also scheduled four (4) planning meeting with HASC and representatives from the local hospitals. These meetings allowed for direct input from the hospital physicians, nurse managers, and hospital executive staff. These meetings were important during the planning phase because understanding the hospital perspective is critical to the successful transformation of the region’s emergency psychiatric care. Additionally, announcements were made available at community and regularly occurring Department meetings leading up to the twenty-four (24) scheduled stakeholder meetings conducted in the months of August through December 2016. Emails with stakeholder meeting information were sent to all SBCDBH staff with instructions to disseminate to related interested parties.
Targeted CPP Stakeholder Demographics The Innovation (INN) Stakeholder Meetings attracted a diverse array of participants from throughout the County. Stakeholder comment forms were used to collect demographic information on the backgrounds and interests of the participants, their region of origin within the county, stakeholder representation or organizational affiliation, ethnicity, age group, and gender. Stakeholder meeting participants came from a variety of regions of the county. The greatest number of participants, 27 percent, identified as part of the West Valley regions and a nearly equal proportion of 26 percent identified as part of the Central Valley and East Valley regions, with 21 percent coming from the Desert/Mountain region. Around one in six stakeholder meeting participants did not indicate their region, and a handful came from out of the county (see Demographic Information section for geographic definition of the County’s regions).
DRAFT MHSA Innovation Proposal 2017 80 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
The quality of the discussions which took place in the stakeholder meetings were a result of the diverse backgrounds of participants who attended. People with organizational affiliations were the largest group, with 62 percent of the responses indicating they were affiliated with either community or government/social service agencies. However, consumers were also well represented, with 20 percent of the responses indicating an association as a direct consumer and/or a family/caregiver of a consumer. SBC-DBH identified that there were no responses received that reflected representation from the active military or as a representative from a Veteran's Organization, despite reaching out to each of these populations with an invitation to attend. This is an area in which we will further develop outreach and engagement strategies for both ongoing and ad hoc meeting participation in the CPP processes. From the 182 attendees, 111 surveys were returned. Those 111 surveys contained 164 responses due to the participants’ ability to select more than one “area of representation.”
Stakeholder Representation
Note: The Demographic Survey used to collect this information allows for a participant to select more than one (1) “area of representation.” For the purpose of this chart, each selection was counted as a one response; therefore, there were more responses to this question than there were participant surveys completed.
The ethnic breakdown of the CPP participants closely aligns with the ethnic breakdown of San Bernardino County for all reported groups. The group with the largest representation is the Latino/Hispanic population representing 46 percent of participants. This is in alignment with the Latino/Hispanic population that represents 40 percent of San Bernardino County’s total population. Participants who identified as Caucasian/White, the second largest group, represented 23 percent of the participants, compared to this group’s representation of 33 percent as the County’s population.
DRAFT MHSA Innovation Proposal 2017 81 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino Stakeholder Ethnicity
Stakeholder Gender
Stakeholder Satisfaction
Date Posted: 09/01/2017 Stakeholder Age
Participants varied a fair amount in age. Although the largest portion fell in the age range of 26-59 (75 percent), there was good representation of older adults over 60 years of age (10 percent), and transitional-aged youth 1625 years (15 percent). The meeting held at the San Bernardino Transitional Age Youth (TAY) Center was very effective in securing participation by youth and young adults. The breakdown of participants from the Innovation stakeholder meetings by gender is as follows 70 percent of the participants are female, 29 percent of the participants are male, and 1 percent of the participants declined to state gender. SBC-DBH’s stakeholder engagement process is a continuous year long process where the overall satisfaction of participants is an important measurement to ensure that the diverse voices within our community are being engaged. Over the last year, 96 percent of meeting participants who completed a stakeholder comment form, were either very satisfied, somewhat satisfied, or satisfied with the meeting process and community program planning. Four percent (4%) of meeting participants were either unsatisfied or very unsatisfied with the stakeholder engagement process. As
DRAFT MHSA Innovation Proposal 2017 82 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
part of the continuous process improvement, unsatisfied stakeholders are contacted to initiate dialog on how to improve the engagement process on behalf of all community stakeholders.
Targeted CPP Meeting Structure These meetings with stakeholders were intended to provide a platform for community stakeholders to engage in learning, reflection, and interpretation of current and future Innovation projects with the goals of promoting: Obtain direct stakeholder feedback on the design of the I.E. PsychPartners project Diffusion of knowledge gained through implementation of those projects to date Dissemination of innovative practices to stakeholders Enhanced sustainability of funded projects beyond conclusion of Innovation funding Generation of new ideas for future Innovation funded projects The format used for the Innovation stakeholder meetings was standardized to ensure each group of participants went through the same process. Each meeting began with an introduction of MHSA and an overview of the Innovation component conducted by a member of the SBC-DBH Office of Innovation. The introduction included a description of MHSA, current funding context, the purpose of the planning process, and an explanation of the Innovation component. Handouts were provided to further explain this same information. Office of Innovation staff provided an overview of the project, detailing the purpose, population(s) served, and key activities. Throughout the meeting, participants were provided data in a consumer friendly, simple, straightforward manner with PowerPoint presentations, handouts, and question and answer periods. Participants had an opportunity to ask clarifying questions directly to the Innovation staff during and after the meeting. Contact information for the Innovation staff was also provided to meeting attendees, in case, the attendee had additional questions later. Throughout the stakeholder meetings, participants were asked to share their perspective on the evaluation of the projects and their effectiveness. They were encouraged to address the learned aspects from the previous projects and comment on the community needs from their own perspective as a community member. This data was compiled, along with other related stakeholder input received throughout the years, and contributed to the final Innovation project work plan. An additional opportunity to provide written feedback during the meeting was provided to participants in the form of individual stakeholder comment forms. This was intended to aid in the collection of demographic information and to enable individuals attending the meeting to submit additional input and program ideas they may not have had the opportunity to offer during the small or large group discussions. The form asked a series of questions designed to parallel those asked in the facilitated
DRAFT MHSA Innovation Proposal 2017 83 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
process in the community meetings. A Spanish-language interpreter was available at all community participation meetings, as well as American Sign Language (ASL) or any other language, upon request. This information, in addition to County and department demographics, treatment service data, as well as documented areas of gaps in service or ineffective service approaches were analyzed to complete the project proposed in this plan and serve as the basis for evaluation of current and future program planning activities for Innovation projects. This project development process represents the input and engagement of 4,158 stakeholders and began in 2005 when SBC-DBH began its first stakeholder engagement process.
DRAFT MHSA Innovation Proposal 2017 84 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Project Development Process: 2005 - 2017
DRAFT MHSA Innovation Proposal 2017 85 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Primary Purpose Select one of the following as the primary purpose of your project. (I.e. the overarching purpose that most closely aligns with the need or challenge described in Item 1 (The Service Need). ☐ Increase access to mental health services to underserved groups ☐ Increase the quality of mental health services, including measurable outcomes ☒ Promote interagency collaboration related to mental health services, supports, or outcomes ☐ Increase access to mental health services
MHSA Innovative Project Category Which MHSA Innovation definition best applies to your new INN Project (select one): ☐ Introduces a new mental health practice or approach ☐ Makes a change to an existing mental health practice that has not yet been demonstrated to be effective, including, but not limited to, adaptation for a new setting, population or community ☒ Introduces a new application to the mental health system of a promising community-driven practice or an approach that has been successful in a non-mental health context or setting.
Population (if applicable) a. If your project includes direct services to mental health consumers, family members, or individuals at risk of serious mental illness/serious emotional disturbance, please estimate number of individuals expected to be served annually. How are you estimating this number? b. Describe the population to be served, including relevant demographic information such as age, gender identity, race, ethnicity, sexual orientation, and/or language used to communicate. In some circumstances, demographic information for individuals served is a reporting requirement for the Annual Innovative Project Report and Final Innovative Project Report. c. Does the project plan to serve a focal population, e.g., providing specialized services for a target group, or having eligibility criteria that must be met? If so, please explain.
DRAFT MHSA Innovation Proposal 2017 86 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Population to be served includes all individuals who access the ED for behavioral health crisis and can be treated via consultation. Due to the vast difference between emergency departments in San Bernardino County an estimate that encompasses the different regions is not possible. Additionally, baseline data will be gathered in the first few months of the project to determine the number of expected clients served annually. In general and for reference, based on hospital admission reports for San Bernardino County, in the 18 EDs approximately 762,000 individuals were admitted to the ED in 2015; of those visits almost 50,000 had a behavioral health diagnosis. (OSHPD data)
MHSA General Standards Using specific examples, briefly describe how your INN Project reflects and is consistent with all potentially applicable MHSA General Standards set forth in Title 9 California Code of Regulations, Section 3320. (Please refer to the MHSOAC Innovation Review Tool for definitions of and references for each of the General Standards.) If one or more general standard could not apply to your INN Project, please explain why. a) Community Collaboration b) Cultural Competency c) Client-Driven d) Family-Driven e) Wellness, Recovery, and Resilience-Focused f)
Integrated Service Experience for Clients and Families
This project as designed fully adopts, supports, and is in alignment with the applicable general, acceptable standards as specifically set for in CCR Title 9, Section 3320 as evidence as follows: a) Community Collaboration – SBC-DBH has conducted an ongoing extensive Community Program Planning (CPP) process that involved stakeholders within the community, as consistent with MHSA regulations. The project will work in collaboration with all available psychiatric treatment modalities in the County and will promote access to the most appropriate level of care for the individual. These will include SBC-DBH operated programs and outpatient clinics, drug and alcohol programs, fee-forservice providers, faith-based organizations, social service organizations, veteran services, housing programs and alternatives, other County Departments such as the Department of Aging and Adult Services, Transitional Assistance Department, Public Health, County Medical clinics and community based organizations. Educational organizations and vocational organizations will be utilized to assist consumers in meeting their personal goals as well as a means to more fully integrate the consumers into their surrounding community. Consumers and family members will be linked with regionally based providers to minimize any geographical obstacles to accessing services. Our partnership with the Cultural Competency Advisory Sub-Committees and Community Health Workers program will
DRAFT MHSA Innovation Proposal 2017 87 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
assist us in bridging the cultural and geographical diversity of our County in a community-driven manner. b) Cultural Competence - The SBC-DBH Office of Cultural Competency and Ethnic Services (OCCES) will be involved to ensure compliance with cultural competency standards and ensure that the services provided address cultural and linguistic needs. OCCES remains available for consultation and to provide support to the teams regarding issues of diversity when necessary. Issues of cultural diversity and the social norms of a specific cultural group may present a barrier to a behaviorally ill individual participating in psychiatric treatment. These issues will be explored with the OCCES and Ethnic Services as they arise in order to provide services to the community in a culturally and linguistically meaningful and appropriate manner. Partnering with the Sub-Committees in a more active way (beyond an advisory capacity) will further ensure effective, culturally-sensitive interactions. Every effort will be made to staff the teams so that they are diverse and representative of the demographics of the Department’s consumers. Efforts will be made to include bi-lingual staff members, especially in Spanish, which is the threshold language for San Bernardino County. Additionally, materials will be available in threshold languages and interpreter services will be provided as needed. c) Client Driven - Stakeholder feedback was received during the Community Program Planning process including clients, family and caregivers. The innovative concept of I.E. PsychPartners arose from the feedback received through these processes as well as the stakeholder workgroups. d) Family Driven - Stakeholder feedback was received during the Community Program Planning process including clients, family and caregivers. The innovative concept of I.E. PsychPartners arose from the feedback received through these processes as well as the stakeholder workgroups. e) Wellness, Recovery and Resilience - Starting where the individual “is at in their recovery” is a central component of the MHSA. This project promotes wellness, recovery, and resiliency by providing an increased level of access and linkage to a variety of services post emergency department visit. The project will work to link the individual and their families to the most appropriate service modalities in their community that will meet their unmet behavioral health and support needs. Outreach and engagement efforts will work towards involving the individual in the types of services and activities that will enable them to remain at the lowest level of care in the community thereby eliminating the need to use the emergency department as a primary source of behavioral health services. By helping the individual access the necessary and appropriate supportive services and therapeutic services in the community the I.E. PsychPartners project will assist the consumers on their journey towards greater wellness, recovery and resiliency. f)
Integrated Service Experiences for Clients and their Families – One focus of this project will focus on linkage for the individual with culturally appropriate services in the local community post emergency department visit. These referrals to resources will be coordinated and integrated to most
DRAFT MHSA Innovation Proposal 2017 88 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
appropriately meet the stated needs and discharge plan of the consumer. It is anticipated that referrals will be made to all venues and modalities of therapeutic and social programs. A holistic approach will be utilized in making referrals for services to the individual and their families in recognition of the need to address the psychiatric treatment needs of the individual but also their many educational, cultural, spiritual, social, and health needs. The project, as designed will provide educational and supportive services to the individual and their families to increase understanding and awareness of behavioral health disorders, outpatient services, knowledge of how to access services, as well as how to navigate the complicated system of care. Continuity of Care for Individuals with Serious Mental Illness Will individuals with serious mental illness receive services from the proposed project? If yes, describe how you plan to protect and provide continuity of care for these individuals when the project ends. Yes, clients with serious mental illness will receive services from this proposed innovative project. Clients who receive care through this project will continue to receive care when the project ends via the emergency departments. Upon completion of the proposed project participating EDs would continue to provide service they provide.
INN Project Evaluation Cultural Competence and Meaningful Stakeholder Involvement. a) Explain how you plan to ensure that the Project evaluation is culturally competent. Note: this is not a required element of the initial INN Project Plan description but is a mandatory component of the INN Final Report. We therefore advise considering a strategy for cultural competence early in the planning process. An example of cultural competence in an evaluation framework would be vetting evaluation methods and/or outcomes with any targeted ethnic/racial/linguistic minority groups. SBC-DBH knows and acknowledges that those who engage in evaluation do so from perspectives that reflect their values, their ways of seeing the world, and their culture. This culture can shape the ways in which evaluation questions are conceptualized, which in turn influences what data is collected, and how data is analyzed and interpreted. To draw valid conclusions, the evaluation must consider important contributors to human behavior, including those related to culture, personal habit, situational limitations, assimilation and acculturation, or the effect that the knowledge of observation can have on the observed (American Evaluation Association, Cultural Competence in Evaluation, 2011). Without accounting for the ways in which cultural can affect behavior, evaluations can arrive at flawed findings with potentially devastating consequences. Because of these concerns the SBC-DBH OCCES is a key partner in all Innovation projects to ensure
DRAFT MHSA Innovation Proposal 2017 89 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
compliance with cultural competency standards and to ensure that the services provided address cultural and linguistic needs. OCCES remains available for consultation and to provide support to the Innovation Team regarding issues of diversity when necessary. Issues of cultural diversity and the social norms of a specific cultural group may present a barrier to a mentally ill individual participating in psychiatric treatment. These issues will be explored with the OCCES as they arise in order to provide services to the community in a culturally and linguistically meaningful and appropriate manner. In addition to working with the OCCES, SBC-DBH Office of Innovation also partners with stakeholder sub-committees in an active way (beyond an advisory capacity) to further ensure effective, culturally-sensitive interactions. These sub-committees are presented with the evaluation questions and results to ensure that the evaluation framework and outcome results are inclusive and foster learning across cultural boundaries while respecting different worldviews. Every effort will be made to staff the Innovation project with individuals that are diverse and representative of the demographics of the Department’s consumers. b) Explain how you plan to ensure meaningful stakeholder participation in the evaluation. Note that the mere involvement of participants and/or stakeholders as participants (e.g. participants of the interview, focus group, or survey component of an evaluation) is not sufficient. Participants and/or stakeholders must contribute in some meaningful way to project evaluation, such as evaluation planning, implementation and analysis. Examples of stakeholder involvement include hiring peer/client evaluation support staff, or convening an evaluation advisory group composed of diverse community members that weighs in at different stages of the evaluation. Based on the continuous feedback from our community stakeholders, SBC-DBH has designed a meeting to address outcomes and evaluation in a setting that involves stakeholders, the System-wide Performance Outcomes Committee (SPOC). This project would be subject to discussion at SPOC providing a balanced outcome-based focus regarding evaluation. Additionally, this Innovation project was presented at the monthly meetings for each of these cultural subcommittees to ensure that the community planning process included the voices of individuals who reflect the cultural, ethnic, and racial diversity that exists within San Bernardino County. The community planning process for this Innovation project started on August 23, 2016, and concluded December 19, 2016. Stakeholder engagement included a series of 24 community meetings, to include the cultural subcommittee meetings, held throughout the County with an evening online session for those community members who had other work commitments, transportation problems, or who otherwise were unable to attend one of the other 24 scheduled meetings. A total of 182 community members and stakeholders attended these sessions. From this planning process, 108 comments were received concerning the project. The comments received revealed overwhelming support for the collaborative interagency framework of this project and the system-wide approach to redesigning the way in which an ED would provide behavioral health services.
DRAFT MHSA Innovation Proposal 2017 90 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Deciding Whether and How to Continue the Project without INN Funds Briefly describe how the County will decide whether and how to continue the INN Project, or elements of the Project, without INN Funds following project completion. For example, if the evaluation does (or does not) indicate that the service or approach is effective, what are the next steps? The decision to continue this project will depend on the project outcomes, funding and stakeholder feedback. If the project is deemed successful, funding could come from MHSA program expansion in order to deliver services to all EDs with blended funding in partnership with HASC serving as the financial intermediary for hospitals sustaining interagency collaboration, potential cost savings, and return-on-investment for hospitals. Continued funding may only require minimal Behavioral Health staff to provide supportive services. This could also include linking funding through the SBC-DBH Community Crisis Response Team (CCRT) for ongoing funding and provision of 24-hour tele-case management services. Additionally, this project presents the option to explore partnership with the local health plans for applicable clients. Communication and Dissemination Plan Describe how you plan to communicate results, newly demonstrated successful practices, and lessons learned from your INN Project. a) How do you plan to disseminate information to stakeholders within your county and (if applicable) to other counties? Project outcomes related to this innovative project will be disseminated to stakeholders in San Bernardino County via the continuous community program planning that currently occurs. Project updates will include participation from project participants. Community invites to these ongoing events are shared via various social media platforms targeting the community at large and stakeholders. Additionally a final report will be provided to the Mental Health Services and Accountability Commission for distribution with other counties. b) How will program participants or other stakeholders be involved in communication efforts? A list of interested participants and stakeholders will be developed and included in the any communication efforts made. Additionally, regular program updates will be pre-provided during the robust stakeholder process already in place allowing for stakeholders to provide input and feedback on the program while it is in progress. c) KEYWORDS for search: Please list up to 5 keywords or phrases for this project that someone interested in your project might use to find it in a search. Care coordination; tele-psych; behavioral health care in the emergency department; regional collaboration; two county innovation/partnership; professional association and county partnership; public-private collaboration Timeline
DRAFT MHSA Innovation Proposal 2017 91 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
A) Specify the total timeframe (duration) of the INN Project: ____ Years ____ Months B) Specify the expected start date and end date of your INN Project: ____ Start Date ____ End Date Note: Please allow processing time for approval following official submission of the INN Project Description. C) Include a timeline that specifies key activities and milestones and a brief explanation of how the project’s timeframe will allow sufficient time for a. Development and refinement of the new or changed approach; b. Evaluation of the INN Project; c. Decision-making, including meaningful involvement of stakeholders, about whether and how to continue the Project; d. Communication of results and lessons learned. A. Total time frame (duration) of the innovative project is five (5) years B. The expected Start Date: 1/1/2018; Expected End Date: 12/31/2023 C. This project is expected to consist of four (4) phases. The phases are
Figure 3: I.E. PsychPartners Project Phases
It is anticipated that this timeline will provide an adequate opportunity to measure the project’s success. Data will be collected throughout the implementation of the project and analysis of progress towards the learning goals completed. This will allow for modification to the project as the learning occurs.
DRAFT MHSA Innovation Proposal 2017 92 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Provide a brief budget narrative to explain how the total budget is appropriate for the described INN project. The goal of the narrative should be to provide the interested reader with both an overview of the total project and enough detail to understand the proposed project structure. Ideally, the narrative would include an explanation of amounts budgeted to ensure/support stakeholder involvement (For example, “$5000 for annual involvement stipends for stakeholder representatives, for 3 years: Total $15,000,”) and identify the key personnel and contracted roles and responsibilities that will be involved in the project (For example, “Project coordinator, full-time; Statistical consultant, part-time; 2 Research assistants, part-time…”). Please include a discussion of administration expenses (direct and indirect) and evaluation expenses associated with this project. Budget Overview: The total estimated budget for this project is approximately $24 million over the course of five years. Funding will be provided to HASC who will contract and administer the funding to each participating hospital. HASC will hire full-time staff including program manager, office assistant, data/business analyst, contract manager, who will oversee the implementation of the project in the region. Because the project will be implemented in both counties, funding for HASC staff and operating expenses will be split between RUHS-BH and SBC-DBH. Hospitals will hire behavioral health specialty nurses based on their volume classification. High volume hospitals will hire six, full-time behavioral health nurses and will be available 24-hours-a-day, 7-days-aweek; medium volume hospitals will hire three full-time behavioral health nurses and will be available during the hospitals busiest times, for example 11:00am -11:00pm; low volume hospitals will hire an oncall behavioral health nurse. Additional staff such as a program manager and data analyst are existing hospital staff who are already on working in the hospitals and will dedicate portions of their time to project management and data collection on site. Telepsychiatry consults will be available 24 hours a day, 7-days-a-week and will be paid for by use per hospital. SBC-DBH will hire a project manager and business systems analyst to oversee the project as well as serve as liaisons to the hospital staff. A nurse educator/clinical therapist will be hired to provide the ongoing education to hospital staff. One caveat to the budget will be the final readiness of each of the prospective hospitals. Based on readiness and willingness to participate, there will be a limited number of hospitals that will take part in the I.E PsychPartners project. Interested hospitals have completed readiness assessments and have been participating in collaborative meetings with HASC and both counties with the understanding that this is a time limited project. The intention is to work with five (5) hospitals with a budget of approximately $24 million over five years. Due to regional interest in the project, the dialogue and collaboration is in place should additional hospitals need to join the project over five years, based on available funds.
DRAFT MHSA Innovation Proposal 2017 93 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Overview of “New Innovative Project Budget by Fiscal Year” Budget Sheet Please note that the proposed budget starts in FY17/18 which is currently in progress. If approved the plan is expected to start in contract with HASC on January 1, 2018, accounting for the last six months of FY17/18. Additionally, due to mid-year start in FY17/18 the project will go through December of FY 2022/2023. Both these fiscal years account for approximately six months’ worth of budgeted funds and are notably lower than the other fiscal years in the plan. Due to the nature and size of this project, participating hospitals will have staggered starting times. It is expected to start with three (3) hospitals in FY17/18 and add two additional hospitals in FY18/19, accounting for the increase in budget from the first fiscal year to the second. Fiscal years 18/19 – FY 21/22 show a steady budgeted amount of approximately $5 million each. Expenditures by line number: 1. Line item number one includes the personnel expenditures expected for the duration of the project for SBC-DBH, HASC and the participating hospitals. 2. Line item number two includes operating expenditures such as offices supplies, travel, communications and lease costs for SBC-DBH and HASC. 3. Line item number three includes non-recurring expenditures including facility build out and startup costs for HASC and SBC-DBH staff that will be hired to manage the project. 4. Line item number four is for consultant contracts which will include the psychiatric telehealth consults that the EDs will utilize to improve medical decision making. 5. Line item number five accounts for other projected expenditures including the administrative fees incurred by SBC-DBH and HASC. 6. Line item six is the total requested funding for the I.E. PsychPartners Project. The “New Innovative Project Budget by Fiscal Year” budget sheet demonstrates that most of the budget allocated for this project is going to personnel and consultant contracts. Emergency Departments work 24 hours a day, 7 days per week creating significant staffing costs. The plan includes hiring 18 full-time mental health nurses and two (2) on-call mental health nurses to work directly in the EDs. Additionally the plan allows for payment of existing ED staff that will serve as the project liaison or manager who will oversee the project and a data analyst who will provide the data collection and reporting respectively. Hospitals will utilize telehealth psychiatric consults noted in the consultant contracts, line four. HASC intends to hire a project manager to oversee the implementation of the project across both counties; a contract specialist who will manage the hospital contracts and billing; a data analyst to oversee the data collection from hospitals in both counties and an administrative assistant. SBC-DBH intends to also hire a project manager to oversee the implementation of the project for SBCDBH, a data analyst to compile and analyze data and a Clinical Therapist II who will implement the education portion of the project with each of the EDs. Existing SBC-DBH staff will also be used to provide support for the project. “Expenditures for Administration, Evaluation and Total by Funding Source and FY” Budget Sheet Expenditures are broken out by administration, evaluation and total expenditures.
DRAFT MHSA Innovation Proposal 2017 94 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Administration funds include the projected staffing by HASC, SBC-DBH and the Hospitals to oversee the implementation and operations of the project. Administrative hospital staff are all existing staff that will serve as project managers at each location and be partially funded to oversee the project. HASC administrative funds include the project manager, contract specialist and the administrative assistant. SBC-DBH administrative costs include the project manager and office assistant time to oversee the project. Evaluation funds include the staffing by HASC, SBC-DBH and Hospitals to collect, compile and analyze data for the project. This includes existing staff that will be partially funded at each hospital that will compile and provide data to HASC and SBC-DBH. Funds will include HASC’s and SBC-DBH’s data analysts. The total mental health expenditures are the total funds requested per fiscal year for the duration of the project. This encompasses all staffing, operations, evaluation, and implementation costs for the project. “I.E. PsychPartners Budget” Sheet The I.E. PsychPartners Budget sheet shows the overall budget of the project including Personnel costs, Operating costs, One-time costs, Consultant costs and Other costs. The budget is broken out by the participating partners including the High Volume Hospitals (3 total), Low Volume Hospitals (2 total), HASC and SBC-DBH. Total Personnel costs over the five years includes salaries and benefits for a total of $13,597,988. This includes staffing for five EDs of 18 FTE behavioral health nurses, two part-time behavioral health nurses, and partial FTEs for administration and data collection at each of the five hospitals. HASC staffing will include a project manager, contract specialist, data analyst and administrative assistant. HASC staff will oversee the project in both counties therefore the staffing is funded at 50 percent due to cost sharing with RUHS-BH. SBC-DBH staff includes FTE contract project manager, contract business systems analyst II, contracted clinical therapist II, and partial pay for existing staff including an office assistant, business systems analyst II and staff analyst II. Operating costs are broken down for HASC and SBC-DBH and total $156,576. These costs include expenditures for office supplies, travel, ongoing communications, and rent and lease costs for HASC and DBH for the duration of the project. One-time funds total $46,611 and include startup costs for HASC and facility and space build out for contracted SBC-DBH staff, including the purchase of computer equipment. Consultant costs include the telehealth psychiatry consults for each of the participating hospitals. These costs are estimated based on the volume of the hospitals and expected psychiatric consult need. The budgeted amount for the five participating hospitals is $9,667,938 for five years. Other costs total $183,621 include HASC and DBH standard administrative fees. This budget sheet provides and overview of the expected budget costs per collaborative agency taking part in the I.E. PsychPartners Project. The total cost for the project is $23,655,735 over five years.
DRAFT MHSA Innovation Proposal 2017 95 of 140
NEW INNOVATIVE PROJECT BUDGET BY FISCAL YEAR
$12,773
10.57%
$583,412
0.00%
$32,845
9.56%
$2,870,245
$0
0.00%
$32,045
9.66%
$2,884,175
0.00%
$0
0.00%
$32,045
9.76%
$2,898,485
$2,016,625
0.00%
$0
0.00%
$32,045
9.85%
$2,913,184
0.00%
$1,008,313
0.00%
$0
0.00%
$17,823
9.82%
$1,448,488
$183,622
$0.00
$9,667,938
0.00%
$46,611
0.00%
$159,576
9.76%
$13,597,988
TOTAL
0.00%
$36,611
0.00%
$2,016,625
0.00%
$17,863
0.00%
FY 22/23
$10,000 0.00%
$2,016,625
0.00%
$39,274
0.00%
$23,655,735
FY 21/22
Projected expenditure of INN Funds for this INN Project, by fiscal year, for: a. Personnel expenditure, including salaries, wages & benefits
0.00%
$2,016,625
0.00%
$38,159
0.00%
$2,492,487
FY 20/21
b. Estimate the percentage (%) of this expenditure that is for EVALUATION
$593,125 0.00%
$37,076
0.00%
$5,001,128
FY 19/20
a. Operating expenditure
0.00%
$36,023
0.00%
$4,985,314
FY 18/19
b. Estimate the percentage (%) of this expenditure that is for EVALUATION a. Non-recurring expenditures, e.g., cost of equipping new employees with technology necessary to perform MHSA duties to conduct the INN Project b. Estimate the percentage (%) of this expenditure that is for EVALUATION a. Consultant contracts (add additional line items for specific contracts, e.g. clinical training contract(s), facilitator contract(s), evaluation contract(s)) b. Estimate the percentage (%) of this expenditure that is for EVALUATION
$15,227
0.00%
$4,969,921
FY 17/18
a. Other expenditures projected to be incurred on items not listed above (please explain below in the budget narrative)
0.00%
$4,992,349
EXPENDITURES
1
2
3
4
5
6
$1,214,537
b. Estimate the percentage (%) of this expenditure that is for EVALUATION a. TOTAL FUNDING REQUESTED (Total amount of MHSA INN funds you are requesting that the MHSOAC approve)
DRAFT MHSA Innovation Proposal 2017 96 of 140
A.
1 2 3 4 5 6 B.
1 2 3 4 5 6 C.
1 2 3 4 5 6
Estimated total mental health expenditures for administration for the entire duration of this INN Project by FY & the following funding sources: Innovative MHSA Funds Federal Financial Participation 1991 Realignment Behavioral Health Subaccount Other funding* Total Proposed Administration Estimated total mental health expenditures for EVALUATION for the entire duration of this INN Project by FY & the following funding sources: Innovative MHSA Funds Federal Financial Participation 1991 Realignment Behavioral Health Subaccount Other funding* Total Proposed Evaluation Estimated TOTAL mental health expenditures (this sum to total funding requested) for the entire duration of this INN Project by FY & the following funding sources: Innovative MHSA Funds Federal Financial Participation 1991 Realignment Behavioral Health Subaccount Other funding* Total Proposed Expenditures
* If "Other funding" is included, please explain.
FY 18/19
$496,768 $0 $0 $0 $0 $496,768 FY 18/19
$274,487 $0 $0 $0 $0 $274,487 FY 18/19
$4,992,349 $0 $0 $0 $0 $4,992,349
FY 19/20
$505,058 $0 $0 $0 $0 $505,058 FY 19/20
$278,578 $0 $0 $0 $0 $278,578 FY 19/20
$4,969,921 $0 $0 $0 $0 $4,969,921
FY 20/21
FY 20/21
$282,779 $0 $0 $0 $0 $282,779
$4,985,314 $0 $0 $0 $0 $4,985,314
FY 20/21
$513,580 $0 $0 $0 $0 $513,580
FY 21/22
FY 21/22
FY 21/22
$5,001,128 $0 $0 $0 $0 $5,001,128
$287,091 $0 $0 $0 $0 $287,091
$522,338 $0 $0 $0 $0 $522,338
Expenditures for A. Administration, B. Evaluation & C. TOTAL By Funding Source and FY FY 17/18
$61,674 $0 $0 $0 $0 $61,674
$141,994 $0 $0 $0 $0 $141,994 FY 17/18
FY 17/18
$1,214,537 $0 $0 $0 $0 $1,214,537
FY 22/23
FY 22/23
FY 22/23
$253,513 $0 $0 $0 $0 $253,513
$142,264 $0 $0 $0 $0 $142,264
$2,492,487 $0 $0 $0 $0 $2,492,487
TOTAL
$2,433,251 $0 $0 $0 $0 $2,433,251
TOTAL
$1,326,872 $0 $0 $0 $0 $1,326,872
TOTAL
$23,655,735 $0 $0 $0 $0 $23,655,735
DRAFT MHSA Innovation Proposal 2017 97 of 140
I.E Psych Partners Budget
$46,811 $643,269 $28,543 $718,623
$23,406 $321,635 $14,270 $359,311
$23,406 $321,635 $14,270 $359,311
$210,650 $2,894,711 $128,442 $3,233,803
$234,056 $3,216,346 $142,712 $3,593,114
5 Year Total
$46,811 $643,269 $28,543 $718,623
$46,811 $643,269 $28,543 $718,623
FY 22/23 (Half FY)
$46,811 $643,269 $28,543 $718,623
$46,811 $643,269 $28,543 $718,623
FY 21/22
$46,811 $643,269 $28,543 $718,623 $46,811 $643,269 $28,543 $718,623
FY 20/21
$23,406 $321,635 $14,270 $359,311 $46,811 $643,269 $28,543 $718,623
FY 19/20
$187,245 $107,212 $114,170 $408,627
$0
FY 18/19
Location 0.25 6.00 0.25 6.50 $187,245 $107,212 $114,170 408,627
FY 17/18
PERSONNEL COSTS Salaries & Benefits High Volume Hosptial 1 High Volume Hosptial 1 High Volume Hosptial 1 High Volume Hosptial 1 0.25 6.00 0.25 6.50
Estimated Cost
HIGH VOLUME 24/7 Coverage Nurse Manager Behavioral RN Business Analyst Total High Volume Hospital 2 High Volume Hospital 2 High Volume Hospital 2 High Volume Hospital 2
$210,650 $2,894,711 $128,442 $3,233,803
FTE
Nurse Manager Behavioral RN Business Analyst Total
$23,406 $321,635 $14,270 $359,311
$10,060,720
$46,811 $643,269 $28,543 $718,623
$1,077,933
$140,434 $268,030 $85,626 $494,090
$46,811 $643,269 $28,543 $718,623
$2,155,869
$14,043 $26,803 $8,563 $49,409
$46,811 $643,269 $28,543 $718,623
$2,155,869
$28,087 $53,606 $17,125 $98,818
$46,811 $643,269 $28,543 $718,623
$2,155,869
$28,087 $53,606 $17,125 $98,818
$0 $2,155,869
$28,087 $53,606 $17,125 $98,818
$187,245 $107,212 $114,170 $408,627 $359,311
$28,087 $53,606 $17,125 $98,818
0.25 6.00 0.25 6.50 $1,225,881
$14,043 $26,803 $8,563 $49,409
High Volume Hospital 3 High Volume Hospital 3 High Volume Hospital 3 High Volume Hospital 3 19.50
$187,245 $107,212 $114,170 $408,627
Nurse Manager Behavioral RN Business Analyst Total
0.15 0.50 0.15 0.80
Total High Volume
Low Volume Hospital 1 Low Volume Hospital 1 Low Volume Hospital 1 Low Volume Hospital 1
$988,180
LOW VOLUME Nurse Manager Behavioral RN Business Analyst Total
$98,818
$339,463 $311,779 $232,939 $159,294 $1,043,475
$140,434 $268,030 $85,626 $494,090 $197,636
$31,970 $29,363 $21,938 $15,002 $98,272
$14,043 $26,803 $8,563 $49,409 $197,636
$71,965 $66,095 $49,382 $33,770 $221,212
$28,087 $53,606 $17,125 $98,818 $197,636
$69,868 $64,170 $47,944 $32,786 $214,768
$28,087 $53,606 $17,125 $98,818 $197,636
$67,833 $62,301 $46,547 $31,831 $208,513
$28,087 $53,606 $17,125 $98,818 $98,818
$65,858 $60,487 $45,191 $30,904 $202,439
$28,087 $53,606 $17,125 $98,818
$817,254
$31,970 $29,363 $21,938 $15,002 $98,272
$14,043 $26,803 $8,563 $49,409
1.60
$127,879 $117,450 $87,750 $60,008 $393,086
$187,245 $107,212 $114,170 $408,627
0.50 0.50 0.50 0.50 2.00
0.15 0.50 0.15 0.80
HASC HASC HASC HASC HASC
$535,687 $150,804 $47,935 $434,316 $88,766 $248,105 $1,505,613 $13,597,988
Low Volume Hosptial 2 Low Volume Hosptial 2 Low Volume Hosptial 2 Low Volume Hosptial 2
SBC-DBH SBC-DBH SBC-DBH SBC-DBH SBC-DBH SBC-DBH SBC-DBH
$0 $0 $6,300 $7,245 $2,100 $9,000 $24,645
$1,800 $100 $3,600 $5,500 $17,823
$0 $0 $3,150 $3,623 $1,050 $4,500 $12,323
$18,000 $1,700 $19,800 $39,500 $159,576
$0 $0 $28,350 $36,226 $10,500 $45,000 $120,076
5 Year Total
$62,845 $16,030 $5,095 $50,952 $9,435 $29,107 $173,464 $1,448,487
$0 $0 $6,300 $7,245 $2,100 $9,000 $24,645
$3,600 $200 $3,600 $7,400 $32,045
FY 22/23
$122,624 $31,277 $9,942 $99,419 $18,410 $56,794 $338,467 $2,913,184
$0 $0 $6,300 $7,245 $2,100 $9,000 $24,645
$3,600 $200 $3,600 $7,400 $32,045
FY 21/22
$119,634 $30,515 $9,699 $96,994 $17,961 $55,408 $330,212 $2,898,485
$0 $0 $6,300 $7,245 $2,100 $9,000 $24,645
$3,600 $200 $3,600 $7,400 $32,045
FY 20/21
$116,716 $29,770 $9,463 $94,629 $17,523 $54,057 $322,158 $2,884,176
$0 $0 $0 $3,623 $1,050 $4,500 $9,173
$3,600 $1,000 $3,600 $8,200 $32,845
FY 19/20
$113,869 $29,044 $9,232 $92,321 $17,096 $52,739 $314,300 $2,870,245
High Volume Low Volume HASC HASC HASC HASC HASC
$1,800 $0 $1,800 $3,600 $12,773
FY 18/19
$0 $14,168 $4,503 $0 $8,340 $0 $27,011 $583,411
DBH DBH DBH DBH
FY 17/18
1.00 $111,092 0.50 $56,672 0.10 $90,069 1.00 $90,069 0.25 $66,716 0.50 $102,905 3.35 $517,522 26.45 $2,953,743
Nurse Manager Behavioral RN Business Analyst Total Total Low Volume Hospital Association of Southern California (HASC) Contract Specialist Project Manager Data Analyst Administrative Assistant Total San Bernardino County Department of Behavioral Health (SBC-DBH) Contract Project Manager Office Assistant III Business Systems Analyst II Contract Business Systems Analyst II Staff Analyst II Contract Clinical Therapist II Total Total Personnel Costs OPERATING COSTS
Services and Supplies Travel Communications Lease/Rent HASC Total Operating Costs Services and Supplies Communications Travel Expense DBH Total Operating Costs Total Operating Costs
DRAFT MHSA Innovation Proposal 2017 98 of 140
ONE TIME COSTS
Recruitment, Equipment, Furniture, Software, & Office Supplies HASC Total One Time Costs Facilities Fee Computer Equipment & Software DBH Toal One Time Costs Total One Time Costs CONSULTANT COSTS Consultants/Professional Services Training Consultants/Professional Services Training
Total Consultant Costs
$0 $0 $10,000 $10,000
5 Year Total
$0 $0 $0 $0
FY 22/23 $0 $0 $0 $0
FY 21/22 $0 $0 $0 $0
FY 20/21 $0 $0 $0 $0
FY 19/20 $0 $0 $0 $0
FY 18/19 $0 $0 $10,000 $10,000
FY 17/18 High Volume Low Volume HASC HASC
$26,210 $10,401 $36,611 $46,611
$8,481,688 $1,186,250 $0 $0 $9,667,938
5 Year Total
$0 $0 $0 $0
FY 22/23
$0 $0 $0 $0 FY 21/22
$889,688 $118,625 $0 $0 $1,008,313
$0 $0 $0 $0 FY 20/21
$1,779,375 $237,250 $0 $0 $2,016,625
$0 $0 $0 $0 FY 19/20
$1,779,375 $237,250 $0 $0 $2,016,625
$26,210 $10,401 $36,611 $36,611 FY 18/19 $1,779,375 $237,250 $0 $0 $2,016,625
$1,779,375 $237,250 $0 $0 $2,016,625
$0 $0 $0 $10,000 FY 17/18 $474,500 $118,625 $0 $0 $593,125
DBH DBH DBH
High Volume Low Volume HASC DBH
5 Year Total
$0 $0 $156,521 $27,101 $183,622
FY 22/23
$0 $0 $14,741 $3,122 $17,863
$10,057,747
FY 21/22 $0 $0 $33,182 $6,092 $39,274
$1,043,999
$23,655,735
FY 20/21 $0 $0 $32,215 $5,944 $38,159
$2,087,944
$2,492,486
FY 19/20 $0 $0 $31,277 $5,799 $37,076
$2,086,829
$5,001,128
FY 18/19 $0 $0 $30,366 $5,657 $36,023
$2,085,746
$4,985,314
FY 17/18 $0 $0 $14,741 $486 $15,227
$2,122,104
$4,969,921
OTHER COSTS
$631,125
$4,992,349
High Volume Low Volume HASC DBH
Total Proposed Expenditures
$1,214,536
DBH Admin Fee DBH Admin Fee Total Other Costs
Total INN Funding Requested
DRAFT MHSA Innovation Proposal 2017 99 of 140
I.E. PsychPartners: Public-Private Collaboration to Transform Emergency Psychiatric Services INNOVATIVE PROJECT PLAN DESCRIPTION Optional Template County: San Bernardino
Date Posted: 09/01/2017
Glossary Clinical Order Set: A clinical order set is a pre-defined template that provides support in making clinical decisions for a specific condition or medical procedure. It is a grouping of orders that standardizes and expedites the ordering process for a common clinical scenario. Clinical order sets guide clinicians while treating patients to ensure that they do not miss any critical components of care.i Throughput: In hospital management, the sum of the services provided by a health care institution per unit of time. It includes the number of patients treated, admitted, and discharged; the total number of procedures performed; and the quantity of laboratory or radiological services rendered. It is a measure of institutional volume or capacity and a determinant of productivity.ii Hospital Volume: The number of cases of specific conditions (such as stroke, acute myocardial infarction, or organ transplantation) treated at an inpatient facility. Morbidity and mortality are typically lowest in treatment centers where professional staff has the greatest clinical experience.iii In this document High Volume hospitals are refer to ED hospitals who see 40,000 – 60,000 patients per year. Very High Volume ED hospitals see 60,000+ patients per year and Low Volume ED hospitals see less than 20,000 patients per year. Inland Empire: Region made up of Riverside and San Bernardino Counties. i
https://www.policymedical.com/best-practices-clinical-order-set-management-hospitals/ http://medical-dictionary.thefreedictionary.com/throughput iii http://medical-dictionary.thefreedictionary.com/hospital+volume ii
DRAFT MHSA Innovation Proposal 2017 100 of 140
Attachments DRAFT MHSA Innovation Proposal 2017 101 of 140
Attachment A
MHSA COUNTY COMPLIANCE CERTIFICATION San Bernardino County: _____________________________ Local Mental Health Director Name:
Veronica Kelley, LCSW
Telephone Number: E-mail:
Program Lead Name:
(909) 388-0801
Telephone Number:
[email protected]
County Mental Health Mailing Address:
Michelle Dusick
E-mail:
(909) 252-4046
[email protected]
Department of Behavioral Health 303 East Vanderbilt Way San Bernardino, CA 92415
I hereby certify that I am the official responsible for the administration of county mental health services in and for said county and that the County has complied with all pertinent regulations and guidelines, laws and statutes of the Mental Health Services Act in preparing and submitting this annual update, including stakeholder participation and nonsupplantation requirements. This annual update has been developed with the participation of stakeholders, in accordance with Welfare and Institutions Code Section 5848 and Title 9 of the California Code of Regulations section 3300, Community Planning Process. The draft annual update was circulated to representatives of stakeholder interests and any interested party for 30 days for review and comment and a public hearing was held by the local mental health board. All input has been considered with adjustments made, as appropriate. The annual update and expenditure plan, attached hereto, was adopted by the County Board of Supervisors on __________ Mental Health Services Act funds are and will be used in compliance with Welfare and Institutions Code section 5891 and Title 9 of the California Code of Regulations section 3410, Non-Supplant. All documents in the attached annual update are true and correct.
Veronica Kelley, LCSW ______________________________________ Local Mental Health Director/Designee (PRINT)
To be signed after 30-day posting
________________________________ Signature Date
DRAFT MHSA Innovation Proposal 2017 102 of 140
Attachment B
MHSA COUNTY FISCAL ACCOUNTABILITY CERTIFICATION1 San Bernardino County/City: ___________________________
ڙThree-Year Program and Expenditure Plan ڙAnnual Update ڙAnnual Revenue and Expenditure Report
Local Mental Health Director
County Auditor-Controller / City Financial Officer
Name: Veronica Kelley, LCSW
Name:
Telephone Number: (909) 388-0801
Telephone Number:
E-mail:
[email protected]
E-mail:
Local Mental Health Mailing Address:
Department of Behavioral Health 303 East Vanderbilt Way San Bernardino, CA 92415-0026
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 counties in future years. I declare under penalty of perjury under the laws of this state that the foregoing and the attached update/revenue and expenditure report is true and correct to the best of my knowledge.
Veronica Kelley, LCSW _______________________________________ Local Mental Health Director (PRINT)
To be signed after 30-day posting period
_________________________________ Signature Date
, the County/City has maintained an interest-bearing I hereby certify that for the fiscal year ended June 30, 2017 local Mental Health Services (MHS) Fund (WIC 5892(f)); and that the County’s/City’s financial statements are audited for the fiscal year ended June annually by an independent auditor and the most recent audit report is dated . I further certify that for the fiscal year ended June 30,_______, the State MHSA distributions were 30, 2017 2017 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 if there is a revenue and expenditure report attached, is true and correct to the best of my knowledge. ______________________________________________ County Auditor Controller / City Financial Officer (PRINT)
1
Welfare and Institutions Code Sections 5847(b)(9) and 5899(a)
To be signed after 30-day posting period
________________________________ Signature Date
Three-Year Program and Expenditure Plan, Annual Update, and RER Certification (07/22/2013) DRAFT MHSA Innovation Proposal 2017 103 of 140
Attachment C
Behavioral Health Aimara Freeman Media Specialist/Public Information Officer (909) 383-3952
[email protected]
October 27, 2016
More community meetings for behavioral health projects The Department of Behavioral Health (DBH) invites community members to engage in an interactive public discussion on how new innovation projects, designed to test new practices and/or approaches in the field of behavioral health, can best meet local behavioral health needs. Discussion topics will include a DBH mobile resource app and expanding behavioral health services through the use of virtual technology, known as tele-health. This series of meetings are being held in various locations throughout the county throughout the month of October, November and December. A complete meeting schedule follows and posted to DBH’s website, www.sbcounty.gov/dbh/news. “The feedback we receive from the public is valued and assists DBH and our community partners in designing behavioral health services that best meet the needs of San Bernardino County residents,” said DBH Director Veronica Kelley. Innovation projects are time-limited, must contribute to learning, and are developed through an inclusive process that is representative of the community, especially for those populations that are unserved, underserved, and inappropriately served. Innovation projects are funded by the Mental Health Services Act (MHSA), which is funded by a 1 percent tax surcharge on personal income over $1 million per year, passed by California voters in November 2004. For more information on this public meeting, please call (800) 722-9866 or 7-1-1 for TTY users. For interpretation services or requests for disability-related accommodations, please contact the number above at least seven days prior to the meeting. DBH, through the MHSA, is supporting the Countywide Vision by providing behavioral health services and ensuring residents have the resources they need to promote wellness, recovery and resilience in the community. Information on the Countywide Vision and on DBH can be found at www.sbcounty.gov.
DRAFT MHSA Innovation Proposal 2017 104 of 140
Consumer and Family Member Awareness Subcommittee October 24, 2016
District Advisory Committee (DAC) 5th District October 24, 2016
LGBTQ Awareness Subcommittee October 25, 2016
Pathways to Recovery Clubhouse 850 E. Foothill Blvd. Rialto, CA 92376
New Hope Family Life CenterAuditorium 1505 W. Highland Ave. San Bernardino, CA 92411
DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
2:00—3:00 p.m. Women Awareness Subcommittee October 26, 2016 DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415 1:00—2:00 p.m.
5:30—7:30 p.m. Latino Awareness Subcommittee October 27, 2016 Consulate of Mexico in San Bernardino293 North D St. San Bernardino, CA 92401
12:30—1:30 p.m. Veterans Awareness Subcommittee November 7, 2016 DBH Administration-Room 109A 303East Vanderbilt Way San Bernardino, CA 92415 3:00—4:30 p.m.
Spirituality Awareness Subcommittee November 8, 2016
10:00—11:30 a.m. District Advisory Committee (DAC) 2nd/4th Districts November 10, 2016
Transitional Age Youth (TAY) Subcommittee November 15, 2016
DBH Administration-Room 109 B 303 East Vanderbilt Way San Bernardino, CA 92415
Mariposa Community Counseling 2940 Inland Empire Blvd. Room 164 Ontario, CA 91764
One Stop TAY Center 780 E. Gilbert St. San Bernardino, CA 92404
12:30—1:30 p.m.
10:00—11:00 a.m.
Disabilities Awareness Subcommittee November 16, 2016
District Advisory Committee (DAC) 1st District November 16, 2016
1:00—2:00 p.m. Native American Awareness Subcommittee November 15, 2016 Native American Resource Center 11980 Mt. Vernon Ave. Grand Terrace, CA 92313 2:00—3:30 p.m.
DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
Victor Community Counseling 15400 Cholame Rd. Victorville, CA 92392 11:00 a.m.—12:00 p.m.
Cultural Competency Advisory Committee (CCAC) November 17, 2016
10:00—11:30 a.m. Co-Occurring and Substance Abuse Subcommittee November 17, 2016
African American Awareness Subcommittee November 21, 2016
CSBHS-Auditorium 850 E. Foothill Blvd. Rialto, CA 92376
Uplift Family Services 572 N. Arrowhead Ave. #200 San Bernardino, CA 92401
Young Visionaries 696 S. Tippecanoe Ave. San Bernardino, CA 92408
1:00—2:30 p.m. District Advisory Committee (DAC) 3rd District November 22, 2016
3:00—4:30 p.m. Asian Pacific Islander Awareness Subcommittee December 9, 2016
2:00—3:00 p.m. Adobe Connect Session
Phoenix Community Counseling Center 920 E. Gilbert St. San Bernardino, CA 92415
AARC Asian-American Resource Center 1115 South “E” St. San Bernardino, CA 92408
11:00 a.m. - 2:00 p.m.
1:00—2:30 p.m.
-30-
DRAFT MHSA Innovation Proposal 2017 105 of 140
Online
Date to Be Determined
Attachment D
Join us for a special series of community presentations on the New Innovation Project Concepts funded by the Mental Health Services Act (MHSA). Please join us as we engage in an interactive discussion to obtain input from partners and community members on how upcoming Innovation (INN) projects concepts can meet local mental health needs through the Department of Behavioral Health, Mental Health Services Act Innovation Component. Objectives include:
Presentation of new Innovation project concepts.
Receive community input to assist in project concept development.
Discuss the next steps for these projects.
Don’t miss this opportunity to provide your input on these exciting innovation concepts!
See reverse side for details. For additional information, language services or to request disability-related accommodations, please contact Cheryl McAdam at (800) 722-9866,
[email protected] or 7-1-1 for TTY users.
DRAFT MHSA Innovation Proposal 2017 106 of 140
This series of community meetings will kickoff the Innovation Community Planning Process that will take place throughout October, November, and December. The purpose of these meetings will be to promote community conversation and participation regarding current MHSA Innovation project concepts. Everyone with an interest in providing input to shape the development of the proposed Innovation project concepts is highly encouraged to attend. Consumer and Family Member Awareness Subcommittee October 24, 2016
District Advisory Committee (DAC) 5th District October 24, 2016
LGBTQ Awareness Subcommittee October 25, 2016
Pathways to Recovery Clubhouse 850 E. Foothill Blvd. Rialto, CA 92376
New Hope Family Life Center-Auditorium 1505 W. Highland Ave. San Bernardino, CA 92411
DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
2:00—3:00 p.m. Women Awareness Subcommittee October 26, 2016
5:30—7:30 p.m. Latino Awareness Subcommittee October 27, 2016
12:30—1:30 p.m. Veterans Awareness Subcommittee November 7, 2016
DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
Consulate of Mexico in San Bernardino293 North D St. San Bernardino, CA 92401
DBH Administration-Room 109A 303East Vanderbilt Way San Bernardino, CA 92415
1:00—2:00 p.m. Spirituality Awareness Subcommittee November 8, 2016
10:00—11:30 a.m. District Advisory Committee (DAC) 2nd/4th Districts November 10, 2016
3:00—4:30 p.m. Transitional Age Youth (TAY) Subcommittee November 15, 2016
Mariposa Community Counseling 2940 Inland Empire Blvd. Room 164 Ontario, CA 91764
One Stop TAY Center 780 E. Gilbert St. San Bernardino, CA 92404
1:00—2:00 p.m. Native American Awareness Subcommittee November 15, 2016
12:30—1:30 p.m. Disabilities Awareness Subcommittee November 16, 2016
10:00—11:00 a.m. District Advisory Committee (DAC) 1st District November 16, 2016
Native American Resource Center 11980 Mt. Vernon Ave. Grand Terrace, CA 92313
DBH Administration-Room 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
Victor Community Counseling 15400 Cholame Rd. Victorville, CA 92392
2:00—3:30 p.m. Cultural Competency Advisory Committee (CCAC) November 17, 2016
10:00—11:30 a.m. Co-Occurring and Substance Abuse Subcommittee November 17, 2016
11:00 a.m.—12:00 p.m. African American Awareness Subcommittee November 21, 2016
CSBHS-Auditorium 850 E. Foothill Blvd. Rialto, CA 92376
Uplift Family Services 572 N. Arrowhead Ave. #200 San Bernardino, CA 92401
Young Visionaries 696 S. Tippecanoe Ave. San Bernardino, CA 92408
1:00—2:30 p.m. District Advisory Committee (DAC) 3rd District November 22, 2016
3:00—4:30 p.m. Asian Pacific Islander Awareness Subcommittee December 9, 2016
2:00—3:00 p.m. Adobe Connect Session
Phoenix Community Counseling Center 920 E. Gilbert St. San Bernardino
AARC Asian-American Resource Center 1115 South “E” St. San Bernardino, CA 92408
11:00 a.m. - 2:00 p.m.
1:00—2:30 p.m.
DBH Administration-Room 109 B 303 East Vanderbilt Way San Bernardino, CA 92415
Online
Date to Be Determined
For additional information, language services or to request disability-related accommodations, please contact Cheryl McAdam at (800) 722-9866,
[email protected] or 7-1-1 for TTY users.
DRAFT MHSA Innovation Proposal 2017 107 of 140
Acompáñenos para una serie de presentaciones especiales de los Nuevos Conceptos para Proyectos de Innovación fundado por la Ley de Servicios de Salud Mental (MHSA, por sus siglas en inglés). Por favor acompáñenos, en una discusión interactiva para obtener sugerencias de nuestros socios y miembros de la comunidad sobre cómo los conceptos de los próximos proyectos de Innovación (INN) pueden satisfacer las necesidades locales de salud mental a través del Departamento de Salud Mental y el Componente de Innovación de la Ley de Servicios de Salud Mental. Los objetivos incluyen:
Presentación de nuevos conceptos de proyectos de Innovación.
Recibir sugerencias de la comunidad para ayudar en el desarrollo de conceptos de los proyectos.
Discutir los próximos pasos para estos proyectos.
¡No se pierda la oportunidad de aportar sus sugerencias sobre estos emocionantes conceptos de innovación!
Vea el reverso para más detalles. Para obtener información adicional, servicios de idiomas o adaptaciones por discapacidad, por favor, comuníquese con Cheryl McAdam al (800) 722-9866,
[email protected] o 7-1-1 para los usuarios de TTY.
DRAFT MHSA Innovation Proposal 2017 108 of 140
Esta serie de reuniones comunitarias darán inicio al Proceso de Planificación Comunitaria que se llevará a cabo durante los meses de octubre, noviembre y diciembre. El propósito de estas reuniones, será promover la conversación y participación de la comunidad sobre los conceptos de los proyectos de Innovación actuales de MHSA. Toda persona con un interés en brindar sugerencias para dar forma al desarrollo de la propuesta de los proyectos de Innovación están invitados a asistir. Subcomité de Concientización de Consumidores y Miembros de Familias 24 de octubre de 2016
Comité Consultivo del Distrito (DAC) Quinto Distrito 24 de octubre de 2016
Subcomité de Concientización de LGBTQ 25 de octubre de 2016
Pathways to Recovery Clubhouse 850 E. Foothill Blvd. Rialto, CA 92376
New Hope Family Life Center-Auditorio 1505 W. Highland Ave. San Bernardino, CA 92411
2:00 a 3:00 p.m. Subcomité de Concientización de Mujeres 26 de octubre de 2016
5:30 a 7:30 p.m. Subcomité de Concientización Latino 27 de octubre de 2016
12:30 a 1:30 p.m. Subcomité de Concientización de Veteranos 7 de noviembre de 2016
Administración de DBH-Sala 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
Consulado de México en San Bernardino 293 North D St. San Bernardino, CA 92401
Administración de DBH-Sala 109A 303East Vanderbilt Way San Bernardino, CA 92415
1:00 a 2:00 p.m. Subcomité de Concientización de Espiritualidad 8 de noviembre de 2016
10:00 a 11:30 a.m. Comité Consultivo del Distrito (DAC) Segundo y Cuarto Distrito 10 de noviembre de 2016
3:00 a 4:30 p.m. Subcomité de Concientización de Jóvenes en Edad de Transición (TAY) 15 de noviembre de 2016
Administración de DBH-Sala 109B 303 East Vanderbilt Way San Bernardino, CA 92415
Mariposa Community Counseling 2940 Inland Empire Blvd. Sala 164 Ontario, CA 91764
One Stop TAY Center 780 E. Gilbert St. San Bernardino, CA 92404
1:00 a 2:00 p.m. Subcomité de Concientización de Nativos Americanos 15 de noviembre de 2016
12:30 a 1:30 p.m. Subcomité de Concientización de Discapacidades 16 de noviembre de 2016
10:00 a 11:00 a.m. Comité Consultivo del Distrito (DAC) Primer Distrito 16 de noviembre de 2016
Native American Resource Center 11980 Mt. Vernon Ave. Grand Terrace, CA 92313
Administración de DBH-Sala 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
Victor Community Counseling 15400 Cholame Rd. Victorville, CA 92392
2:00 a 3:30 p.m. Comité Consultivo de Competencia Cultural (CCAC) 17 de noviembre de 2016
10:00 a 11:30 a.m. Subcomité de Concientización de Diagnostico Dual y Drogadicción 17 de noviembre de 2016
11:00 a.m. a 12:00 p.m. Subcomité de Concientización de Afroamericanos 21 de noviembre de 2016
CSBHS-Auditorio 850 E. Foothill Blvd. Rialto, CA 92376
Uplift Family Services 572 N. Arrowhead Ave. Nro. 200 San Bernardino, CA 92401
Young Visionaries 696 S. Tippecanoe Ave. San Bernardino, CA 92408
1:00 a 2:30 p.m. Comité Consultivo del Distrito (DAC) Tercer Distrito 22 de noviembre de 2016
3:00 a 4:30 p.m. Subcomité de Concientización de Asiáticos/Isleños del Pacífico 9 de diciembre de 2016
2:00 a 3:00 p.m. Sesión de Adobe Connect
Phoenix Community Counseling Center 920 E. Gilbert St. San Bernardino
AARC Asian-American Resource Center 1115 South “E” St. San Bernardino, CA 92408
11:00 a.m. a 12:00 p.m.
1:00 a 2:30 p.m.
Administración de DBH-Sala 109A 303 E. Vanderbilt Way San Bernardino, CA 92415
En línea
La fecha será determinada próximamente
Para obtener información adicional, servicios de idiomas o adaptaciones por discapacidad, por favor, comuníquese con Cheryl McAdam al (800) 722-9866,
[email protected] o 7-1-1 para los usuarios de TTY.
DRAFT MHSA Innovation Proposal 2017 109 of 140
Attachment E
DRAFT MHSA Innovation Proposal 2017 110 of 140
Attachment F
DRAFT MHSA Innovation Proposal 2017 111 of 140
Attachment G
DRAFT MHSA Innovation Proposal 2017 112 of 140
DRAFT MHSA Innovation Proposal 2017 113 of 140
Attachment H
DRAFT MHSA Innovation Proposal 2017 114 of 140
Attachment I 8/22/2017
Mental Health Services Act
Page 2
Behavioral Health
The Mental Health Services Act (MHSA), Prop 63, was passed by California voters in November 2004 and went into effect in January 2005.
Office of Program Planning and Development (OPPD)
Community Policy Advisory Committee (CPAC)
The MHSA provides increased funding for mental health programs across the state.
Mental Health Services Act (MHSA), Innovation Component
The MHSA is funded by a 1% tax surcharge on personal income over $1 million per year.
Sarah Eberhardt-Rios, Assistant Director Michelle Dusick, MHSA Coordinator Karen Cervantes, Innovation Program Manager I
As these taxes are paid, fluctuations impact fiscal projections and available funding.
October 20, 2016 www.SBCounty.gov
Purpose of MHSA
Page 3
To create a culturally competent system that promotes recovery/wellness for adults and older adults with severe mental illness and resiliency for children with serious emotional disorders and their families.
www.SBCounty.gov
Community Program Planning
Components of MHSA
Per the California Department of Mental Health Vision Statement and Guiding Principles (2005):
Behavioral Health
Behavioral Health
Page 5
www.SBCounty.gov
Page 4
Community Services and Supports (CSS). Prevention and Early Intervention (PEI). Innovation (INN). Workforce Education and Training (WET). Capital Facilities and Technological Needs (CFTN). Community Program Planning (CPP).
Behavioral Health
What is Innovation?
www.SBCounty.gov
Page 6
WIC § 5848 states that counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on:
Mental Health Policy. Program Planning. Implementation. Monitoring. Quality Improvement. Evaluation. Budget Allocations.
Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
1 DRAFT MHSA Innovation Proposal 2017 115 of 140
8/22/2017
Merriam Webster’s Definition
Page 7
Innovate: [in-uh veyt] verb • to do something in a new way. • to have new ideas about how something can be done.
Purpose of the Innovation Component
Page 8
Address one of the following learning purposes as its primary purpose: To increase access to underserved groups. To increase the quality of services, including better outcomes. To promote interagency collaboration. To increase access to services.
Behavioral Health
www.SBCounty.gov
Innovative Project Requirements
Page 9
Support innovative approaches by doing at least one (1) of the following:
www.SBCounty.gov
Behavioral Health
Innovation Legislative Requirements WIC § 5830, Part 3.2
Page 10
An Innovation project is defined as one that contributes to learning rather than a primary focus on providing a service.
Introduce a new mental health practice or approach that is new to the overall mental health system, including, but not limited to, prevention and early intervention.
County mental health programs shall expend funds for their innovation projects upon approval by the Mental Health Services Oversight and Accountability Commission (MHSOAC).
Make a change to an existing mental health practice or approach, including, but not limited to, adaptation for a new setting or community. Apply to the mental health system a promising community-driven practice or an approach that has been successful in non-mental health contexts or settings. www.SBCounty.gov
Innovation Legislative Requirements CCR § 3910.010
Page 11
Time-limited Pilot Project
www.SBCounty.gov
Behavioral Health
INN Project Learning and Application
Page 12
LEARNING This project has lead to the creation of the Media Specialist position within DBH and the integration of social media into department business practices.
2010-2014 OVERVIEW A model for use by diverse ethnicities, communities and unserved populations to address personal and community traumatic events though the provision of training to cultural brokers. LEARNING The Department continued training for one year after project conclusion. The Trauma Resiliency Model (TRM) was the primary model used to design CRM training and is ongoing.
INN- 03 Coalition Against Sexual Exploitation (CASE)
2010-2014 OVERVIEW Was the launching point for DBH using social media for dissemination of information, advertising community program planning, trainings and special events.
INN-02 Community Resiliency Model (CRM)
INN Project Learning and Application
Maximum of five (5) years of INN funding from the start date of the project. Successful parts of the project may continue under a different funding source or be incorporated into existing services. Projects may be terminated prior to planned end date.
INN-01 Online Diverse Community Experience (ODCE)
Behavioral Health
2010-2014 OVERVIEW CASE developed and tested a collaborative model of interventions and services for diverse children to reduce the number drawn into child sex trafficking and exploitation. LEARNING There was value found in the CASE projects collaborative model. The Department of Behavioral Health (DBH) and stakeholders recommended maintaining the successful activities of the project under PEI through a leveraged funding model.
NACo Award (2011): Coalition Against Sexual Exploitation
Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
2 DRAFT MHSA Innovation Proposal 2017 116 of 140
8/22/2017
INN Project Learning and Application
Page 13
Updated scope of work for Family Resource Center (FRC) to include support and relapse groups for those living with mental illness and includes cultural specific outreach models.
LEARNING Mentoring system has proven to be successful and has been integrated into an array of programs serving (Transitional Age Youth (TAY), ages 16-25, including programs within Children Family Services and the Probation Department. NACo Award (2013): Interagency Youth Resiliency Team (IYRT)
2013-2017 OVERVIEW A short-term crisis residential treatment program for the Transitional Aged Youth (TAY) who are experiencing an acute psychiatric episode or crisis, and are in need of a higher level of care than board and care residential. LEARNING Having TAY specific programing has been effective in engaging this population.
2014-2018 OVERVIEW Project “activates” individuals into appropriate mental health services through field-based outreach, engagement, case management, family education, support and therapy services for the most challenging, diverse adult clients in the community who suffer from untreated mental illness.
INN-New Project Planning
Peer Counseling model to be incorporated with the Community Health Workers PEI program.
INN-07 Recovery Based Engagement Support Teams (RBEST)
LEARNING
2012-2015 OVERVIEW An intensive trauma informed, culturally appropriate mentoring project.
Page 14
INN Project Learning and Application INN- 06 Transitional Age Youth Behavioral Health Hostel (STAY)
2012-2015 OVERVIEW Brought together all of the County’s diverse cultures and communities in one location to provide culture specific healing techniques.
INN-05 Interagency Youth Resiliency Team (IYRT)
INN-04 Holistic Campus
INN Project Learning and Application
INN Project Learning and Application
LEARNING Project is still in progress. Preliminary data shows that this approach works.
NACo Award (2014): Transitional Age Youth Behavioral Health Hostel (STAY)
Stakeholder informed Innovation project planning is from October 20, 2016 through December 9, 2016 for proposed future projects. Community program planning will be held throughout the community and at Community Policy Advisory Committee (CPAC) and Cultural Competency Subcommittees.
Center for Civic Policy & Leadership – Health Innovation Prize (2016): Transitional Age Youth Behavioral Health Hostel (STAY)
www.SBCounty.gov
Behavioral Health
The STAY – Finding His Path
Page 15
www.SBCounty.gov
Behavioral Health
Overview of Lessons Learned
Page 16
Create and develop partnerships that span the entire continuum of care. Substantial time is needed in both internal and external stakeholder meetings discussing the rigor, requirements, and purpose of INN. The central purpose of INN is learning, not just providing services. It is important to set clear expectations for consumers, community partners, and staff that INN projects are time-limited.
www.SBCounty.gov
Behavioral Health
Overview of Lessons Learned Continued
Page 17
In most cases, portions or all of the programming may be continued in other parts of the system of care based on learning. In some cases, the limited capacity to ramp up implementation projects in a short period of time affected project outcomes. INN evaluation requires organizational capacity to collect required data for continuous evaluation, improvement, and learning purposes.
INN Project Timeline
June: ODCE Projects Completed
2010 Sept: ODCE Project Implemented
2011
2012
Oct: Holistic Jan: IYRT Project Campus Implemented Project Implemented July: STAY Project Implemented
Dec: CRM Project Implemented
www.SBCounty.gov
Page 18
June: CASE Project Completed
Dec: CRM Projects Completed
Sept: CASE Project Implemented
Behavioral Health
www.SBCounty.gov
Behavioral Health
Behavioral Health
2013
2014 Mar: RBEST Project Implemented
Mar: STAY Project Completed
June: Holistic Campus and IYRT Project Completed
2015
Oct: RBEST Project Completed
Mar: BH Commission Approval
2016
2017
Oct – Dec: CPP Planning
Apr: County BOS Approval
Dec: CPAC to present final project proposals
May: MHSOAC Approval
2018
www.SBCounty.gov
3 DRAFT MHSA Innovation Proposal 2017 117 of 140
8/22/2017
Local Stakeholder Responses
Page 19
The Department of Behavioral Health (DBH) has been successful in the ongoing engagement of stakeholders during the design, implementation, and evaluation of Innovation projects over the past ten (10) years. Stakeholder feedback has been captured and the following themes have been identified.
Behavioral Health
www.SBCounty.gov
What is Telemedicine/Telehealth?
Page 21
Themes of Local Stakeholder Responses
Page 20
The community voiced… Use technology to support and reinforce behavioral health treatment. Develop a mobile app for interventions and information sharing. Extend the use of mobile technology to behavioral health. Develop cutting edge ideas to improve access to behavioral health. Improve collaboration between medical providers and mental health services. Integrate technology (e.g. tele-health) into service provision. Integrate lessons and interventions from the latest research. Behavioral Health
www.SBCounty.gov
What did the Community Say?
Page 22
Collaborate with community partners to reduce unnecessary involuntary holds and unnecessary psychiatric visits in Emergency Departments (EDs). Better communication and collaboration between medical and behavioral health care providers. Implement the use of technology to support and reinforce behavioral health treatment. Develop cutting edge ideas to improve access to behavioral health services.
Behavioral Health
www.SBCounty.gov
Telehealth Technology for Team Case Conferencing Page 23
Concept: Extend the behavioral health workforce by utilizing telehealth technology in Emergency Departments (EDs) to provide consultation, referrals and resources to hospital patients experiencing a behavioral health crisis. Add a case manager to the ED and provide a clinical consultation pathway. The primary learning purpose of the project is to promote interagency collaboration leading to an increase of quality and awareness of services.
Behavioral Health
www.SBCounty.gov
Behavioral Health
What Does the Research Say?
www.SBCounty.gov
Page 24
San Bernardino County has a total of 18 Emergency Departments (EDs), all of which have experienced increases in individuals experiencing psychiatric crisis (2011-2014). According to a National Study by Harvard University, California had an average wait time of 5.6 hours in the ED, in comparison psychiatric patients spend an average of 11.5 hours in the ED prior to receiving appropriate behavioral health care treatment and referral services. Telepsychiatry has the ability to use technology in order to extend the workforce, provide convenience of services, increase access, improve consumer adherence with therapy, and improve the overall quality and continuity of care for mental health patients (NC Medical Journal, 2011). Behavioral Health
www.SBCounty.gov
4 DRAFT MHSA Innovation Proposal 2017 118 of 140
8/22/2017
Learning Goals – Telehealth Technology for Team Page 25 Case Conferencing
How is this Project Innovative?
Page 26
DBH and the community will be able to learn if the use of telehealth technology connects ED patients experiencing a behavioral health crisis to appropriate outpatient behavioral health services:
Currently, there are no research outcomes on the effectiveness of using telehealth technology to connect ED patients with the outpatient behavioral health continuum of care.
Does the use of telehealth technology for consultation reduce the amount of time individuals spend in the ED?
Interagency collaboration between health system partners include, but are not limited to the following:
Does the use of telehealth technology for care coordination improve access and linkage to DBH services or other behavioral health services?
Behavioral Health
Page 27
Does this project address community needs and priorities for mental health services? If so, how? If not, is there any specific area where we can further expand on in order for this project to meet additional community needs?
Behavioral Health
www.SBCounty.gov
Next Steps
Page 28
We need community feedback! Update of community feedback results will be provided at the December 15, 2016, CPAC meeting. Proposed Innovation Plan will be posted for public review and comment by April 2017. County Behavioral Health Commission, County Board of Supervisors, and Mental Health Services Oversight and Accountability Commission approval is required.
Are there any areas where we can improve the innovative component in order to meet the needs of the community?
Project development/implementation is anticipated to begin July 2017.
www.SBCounty.gov
Closing
Page 29
Thank you for your thoughtful participation! Your feedback is important to us. Please ensure that you have submitted your completed comment forms. Behavioral Health
Department of Behavioral Health (DBH). Hospital Association of Southern California (HASC). Health Plans. Local Emergency Departments (EDs).
www.SBCounty.gov
Table Discussion
Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
Contact
Page 30
For help in accessing Behavioral Health Services please call the DBH Access Unit at:
(909) 386-8256 Toll Free 1 (800) 743-1478 or 7-1-1 for TTY users.
Behavioral Health
www.SBCounty.gov
5 DRAFT MHSA Innovation Proposal 2017 119 of 140
8/22/2017
Concerns
Page 31
To report any concerns related to MHSA Community Program Planning, please refer to the MHSA Issue Resolution Process located at: http://wp.sbcounty.gov/dbh/wpcontent/uploads/2016/06/COM0947_IssueResolution.pdf
Behavioral Health
www.SBCounty.gov
Questions
Page 32
For questions or comments, please contact: Michelle Dusick MHSA Administrative Manager
[email protected] (909) 252-4017
Behavioral Health
www.SBCounty.gov
6 DRAFT MHSA Innovation Proposal 2017 120 of 140
Attachment J
Demographic Information: What is your age? ☐ 0-15 yrs ☐ 16-25 yrs
What is your gender? ☐ Female ☐ Male
☐ 26-59 yrs ☐ 60 + yrs
☐ Other: _______________
What region do you live in? ☐ Central Valley Region ☐ Desert/Mountain Region ☐ East Valley Region ☐ West Valley Region What group(s) do you represent? ☐ Family member of consumer
☐ Social Services Agency
☐ Consumer of Mental Health Services
☐ Health Care Provider
☐ Consumer of Alcohol and Drug Services
☐ Community Member
☐ Law Enforcement
☐ Active Military
☐ Education
☐ Veteran
☐ Community Agency
☐ Representative from Veterans Organization
☐ Faith Community
☐ Provider of Mental Health Services
☐ County Staff
☐ Provider of Alcohol and Drug Services
What is your Ethnicity? ☐ African American/Black
☐ Caucasian/White
☐ American Indian/Native American
☐ Latino/Hispanic
☐ Asian/Pacific Islander
☐ Other:______________
What is your primary language? ☐ English
☐ Spanish
☐ Vietnamese
☐ Other:_____________
How did you hear about this meeting? ☐ Web Blast ☐ E-mail ☐ Co-worker ☐ Other __________________________
☐ Community Partner
Who is one person that you will share what you learned at this meeting? ☐ Family ☐ Friend
☐ Co-worker ☐ Other ___________________________________
DRAFT MHSA Innovation Proposal 2017 121 of 140
Telehealth Technology for Team Case Conferencing 1. Does this project address community needs and priorities for behavioral health services? If so, how? If not, is there any specific area where we can further expand on in order for this project to meet additional community needs?
2. Are there any areas where we can improve the innovative component in order to meet the needs of the community?
DRAFT MHSA Innovation Proposal 2017 122 of 140
Attachment K
Join us this Thursday at the Community Policy Advisory CommiƩee (CPAC) A special presentaƟon on the new InnovaƟon Project Concepts funded by the Mental Health Services Act (MHSA). Please join us as we engage in an interac ve discussion to share feedback and obtain input from partners and community members on how upcoming Innova on (INN) projects concepts can meet local mental health needs. ObjecƟves include: Presenta on of feedback obtained from Community Program Planning. Opportunity for partners and community members to provide addi onal
input to assist in project concept development. Discuss the next steps for these projects.
December 15, 2016 9:00 a.m. ‐ 11:00 a.m. County of San Bernardino Health Services Building, Auditorium 850 East Foothill Blvd. Rialto, CA 92376 Don’t miss this opportunity to provide your input on these exciƟng InnovaƟon Concepts! For addi onal informa on, language services or to request disability‐related accommoda ons, please contact Cheryl McAdam at (800) 722‐9866,
[email protected] or 7‐1‐1 for TTY users.
DRAFT MHSA Innovation Proposal 2017 123 of 140
Acompáñenos este jueves en el Comité Asesor de PolíƟca Comunitaria Una presentación especial de los nuevos Conceptos para Proyectos de Innovación fundado por la Ley de Servicios de Salud Mental (MHSA, por sus siglas en inglés). Por favor acompáñenos, en una discusión interac va para compar r comentarios y obtener sugerencias de nuestros socios y miembros de la comunidad sobre cómo los conceptos de los próximos proyectos de Innovación (INN) pueden sa sfacer las necesidades locales de salud mental. Los objeƟvos incluyen: Presentación de comentarios recibidos durante el Proceso de Planificación Comunitaria. Oportunidad para recibir sugerencias adicionales de nuestros socios y miembros de la comunidad para ayudar en el desarrollo de conceptos de los proyectos. Discu r los próximos pasos para estos proyectos.
15 de diciembre de 2016 9:00 a.m. ‐ 11:00 a.m. Edificio de Servicios de Salud del Condado de San Bernardino, Auditorio 850 East Foothill Blvd. Rialto, CA 92376 ¡No se pierda la oportunidad de aportar sus sugerencias sobre estos emocionantes conceptos de Innovación! Para obtener información adicional, servicios de idiomas o adaptaciones por discapacidad, por favor, comuníquese con Cheryl McAdam al (800) 722‐9866,
[email protected] o 7‐1‐1 para los usuarios de TTY .
DRAFT MHSA Innovation Proposal 2017 124 of 140
Attachment L
DRAFT MHSA Innovation Proposal 2017 125 of 140
Attachment M 8/23/2017
Mental Health Services Act
Page 2
Behavioral Health
The Mental Health Services Act (MHSA), Prop 63, was passed by California voters in November 2004 and went into effect in January 2005.
Office Innovation
Community Policy Advisory Committee (CPAC)
The MHSA provides increased funding for mental health programs across the state.
Mental Health Services Act (MHSA), Innovation Component
The MHSA is funded by a 1% tax surcharge on personal income over $1 million per year.
Michelle Dusick, MHSA Coordinator Karen Cervantes, Innovation Program Manager I
As these taxes are paid, fluctuations impact fiscal projections and available funding.
December 15, 2016
www.SBCounty.gov
Purpose of MHSA
Page 3
To create a culturally competent system that promotes recovery/wellness for adults and older adults with severe mental illness and resiliency for children with serious emotional disorders and their families.
www.SBCounty.gov
Purpose of the Innovation Component
Page 5
Address one of the following learning purposes as its primary purpose: To increase access to underserved groups. To increase the quality of services, including better outcomes. To promote interagency collaboration.
www.SBCounty.gov
Components of MHSA
Per the California Department of Mental Health Vision Statement and Guiding Principles (2005):
Behavioral Health
Behavioral Health
Page 4
Community Services and Supports (CSS). Prevention and Early Intervention (PEI). Innovation (INN). Workforce Education and Training (WET). Capital Facilities and Technological Needs (CFTN). Community Program Planning (CPP).
Behavioral Health
www.SBCounty.gov
Innovative Project Requirements
Page 6
Support innovative approaches by doing at least one (1) of the following: Introduce a new mental health practice or approach that is new to the overall mental health system, including, but not limited to, prevention and early intervention. Make a change to an existing mental health practice or approach, including, but not limited to, adaptation for a new setting or community.
To increase access to services. Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
1 DRAFT MHSA Innovation Proposal 2017 126 of 140
8/23/2017
Innovation Legislative Requirements WIC § 5830, Part 3.2
Page 7
Apply to the mental health system a promising community-driven practice or an approach that has been successful in non-mental health contexts or settings.
Innovation Legislative Requirements CCR § 3910.010
Page 8
Time-limited Pilot Project Maximum of five (5) years of INN funding from the start date of the project. Successful parts of the project may continue under a different funding source or be incorporated into existing services. Projects may be terminated prior to planned end date.
An Innovation project is defined as one that contributes to learning rather than a primary focus on providing a service. County mental health programs shall expend funds for their innovation projects upon approval by the Mental Health Services Oversight and Accountability Commission (MHSOAC). www.SBCounty.gov
Behavioral Health
INN Project Timeline
June: ODCE Projects Completed
Page 9
June: CASE Project Completed
Dec: CRM Projects Completed
2010 Sept: ODCE Project Implemented Sept: CASE Project Implemented
2011
2012
Oct: Holistic Jan: IYRT Project Campus Implemented Project Implemented July: STAY Project Implemented
2013
2014
Mar: STAY Project Completed
June: Holistic Campus and IYRT Project Completed
2015
Mar: RBEST Project Implemented
Dec: CRM Project Implemented
Behavioral Health
2017
Oct – Dec: CPP Planning
Apr: County BOS Approval
Dec: CPAC to present final project proposals
May: MHSOAC Approval
Oct: RBEST Project Completed
2018
www.SBCounty.gov
Community Program Planning
Community Program Planning Legislative Requirements
www.SBCounty.gov
Page 10
WIC § 5848 states that counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on:
Mar: BH Commission Approval
2016
Behavioral Health
Page 11
Mental Health Policy. Program Planning. Implementation. Monitoring. Quality Improvement. Evaluation. Budget Allocations.
Behavioral Health
What is Community Engagement?
www.SBCounty.gov
Page 12
The Department of Behavioral Health (DBH) initiated the Innovation Community Program Planning process from October 24 through December 9. This stakeholder engagement included a series of 19 community meetings held throughout the county, as well as, an after hours online session. A total of 182 community members and stakeholders were engaged,108 responses were collected covering all 5 regions of San Bernardino County. These community meetings were held in order to promote conversation, participation and the collection of input to shape the development of the proposed innovation project concepts. Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
2 DRAFT MHSA Innovation Proposal 2017 127 of 140
8/23/2017
Community Program Planning Demographics: Groups Represented
Page 13
Community Program Planning Demographics: Age
Page 14
Age
Groups Represented Provider of Alcohol and Drug Services (1%)
Veteran (2%) Law Enforcement (1%)
Family Member of Consumer (7%) Provider of Mental Health Services (13%)
60+ y (9%)
Consumer of Mental Health Services (11%)
Community Member (8%)
16-25 y (15%)
Education (6%)
Health Care Provider (3%)
Community Agency (19%)
Social Services Agency (9%) County Staff (18%)
26-59 y (76%)
Faith Community (2%)
www.SBCounty.gov
Behavioral Health
Community Program Planning Demographics: Region
Page 15
www.SBCounty.gov
Behavioral Health
Community Program Planning Demographics: Gender
Page 16
Gender
Region Other (4%)
West Valley (26%)
Male (23%)
Central Valley (25%)
Desert/Mountain (17%)
East Valley (32%)
Female (73%)
www.SBCounty.gov
Behavioral Health
Community Program Planning Demographics: Ethnicity
Page 17
Latino/Hispanic (47%)
DBH Resource Mobile App
www.SBCounty.gov
Page 18
Project Concept:
Ethnicity
Other (4%)
Behavioral Health
African American/Black (13%)
Mobile app for smart phones and mobile devices to assist partners and the community in accessing real time behavioral health resources:
American Indian/Native American (3%)
Location finder for DBH services and treatment options. Locate the nearest connection to Community Crisis Response Team (CCRT). Linkage to National Suicide Prevention Hotline. Enhance and build on current services, not replace services.
Asian/Pacific Islander (10%)
Caucasian/White (23%)
The primary learning purpose of the DBH Resource App is to increase access to services via real time information. Behavioral Health
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
3 DRAFT MHSA Innovation Proposal 2017 128 of 140
8/23/2017
DBH Resource App Learning Goals
Page 19
DBH and the community will be able to learn if promoting the use of technology will improve access to services: Does the increase of real time information via mobile technology improve access to DBH services? Does the use of technology create better linkages between consumers, family members, partners, and community members to services?
Behavioral Health
Table Discussion
Ensure there is ample marketing and education regarding mobile app. Inclusion of established community networks (e.g., contracted agencies, faith based organizations and local community providers). Include additional services and resources (e.g., shelters, food banks, domestic violence groups). Ability to access San Bernardino County threshold languages. Other development factors (e.g., texting, voice command, and other user friendly options). Behavioral Health
www.SBCounty.gov
Telehealth Technology for Team Case Conferencing Page 21
Page 22
Concept: Extend the behavioral health workforce by utilizing telehealth technology in Emergency Departments (EDs) to provide consultation, referrals and resources to hospital patients experiencing a behavioral health crisis.
What factors should be considered in the evaluation of this project? What would successful outcomes look like for this project?
Add a specialized behavioral health case manager to the ED and provide a clinical consultation pathway. The primary learning purpose of the project is to promote interagency collaboration leading to an increase of quality and awareness of services.
www.SBCounty.gov
Learning Goals – Telehealth Technology for Team Page 23 Case Conferencing DBH and the community will learn if the use of telehealth technology connects ED patients experiencing a behavioral health crisis to appropriate outpatient behavioral health services across an entire region of the state. Does the collaboration between two counties and the hospital result in improved care for consumers while in the EDs? Does the use of telehealth technology for team case conferencing reduce the amount of time individuals spend in the ED? Does the use of telehealth technology for team case conferencing improve access and linkage to DBH services or other behavioral health services? Behavioral Health
Page 20
The community voiced…
www.SBCounty.gov
Based on the information provided, does the project feedback meet the needs of the community, or do you have additional ideas/suggestions that can assist in developing this project?
Behavioral Health
Themes of Local Stakeholder Responses
www.SBCounty.gov
Behavioral Health
Themes of Local Stakeholder Responses
www.SBCounty.gov
Page 24
The community voiced… Educate the community about telehealth to increase awareness. Provide the ability to access telehealth services in language of preference. Telehealth will help individuals who need assistance and will reduce ED visits for individuals experiencing psychiatric episodes. Telehealth will enhance our ability to increase capacity and to serve. Hold post consult evaluations to determine effectiveness of telehealth. Behavioral Health
www.SBCounty.gov
4 DRAFT MHSA Innovation Proposal 2017 129 of 140
8/23/2017
Table Discussion
Page 25
Based on the information provided, does the project feedback meet the needs of the community, or do you have additional ideas/suggestions that can assist in developing this project?
County Behavioral Health Commission, County Board of Supervisors, and Mental Health Services Oversight and Accountability Commission approval is required. Project development/implementation is anticipated to begin July 2017.
www.SBCounty.gov
Closing
Page 27
Thank you for your thoughtful participation!
www.SBCounty.gov
Page 29
To report any concerns related to MHSA Community Program Planning, please refer to the MHSA Issue Resolution Process located at: http://wp.sbcounty.gov/dbh/wpcontent/uploads/2016/06/COM0947_IssueResolution.pdf
Behavioral Health
www.SBCounty.gov
Contact
Page 28
(909) 386-8256 Toll Free 1 (800) 743-1478 or 7-1-1 for TTY users.
Please ensure that you have submitted your completed comment forms.
Concerns
Behavioral Health
For help in accessing Behavioral Health Services please call the DBH Access Unit at:
Your feedback is important to us.
Behavioral Health
Page 26
Proposed Innovation Plan will be posted for public review and comment by April 2017.
What factors should be considered in the evaluation of this project? What would successful outcomes look like for this project?
Behavioral Health
Next Steps
www.SBCounty.gov
Behavioral Health
www.SBCounty.gov
Questions
Page 30
For questions or comments, please contact: Michelle Dusick MHSA Administrative Manager
[email protected] (909) 252-4017
Behavioral Health
www.SBCounty.gov
5 DRAFT MHSA Innovation Proposal 2017 130 of 140
Attachment N
Demographic Information: What is your age? ☐ 0-15 yrs ☐ 16-25 yrs
☐ 26-59 yrs ☐ 60 + yrs
What is your current gender identity? ☐ Female ☐ Male ☐ Female to Male (FTM) / Transgender Male / Trans Man ☐ Male-to-Female (MTF) / Transgender Female / Trans Woman ☐ Genderqueer, neither exclusively male nor female ☐ Questioning or unsure of gender identity ☐ Other (please specify): ____________________________ ☐ I do not wish to answer this question
What region/city do you live in? ☐ Central Valley Region Bloomington, Colton, Fontana, Grand Terrace, Rialto ☐ Desert/Mountain Region Adelanto, Amboy, Angelus Oaks, Apple Valley, Baker, Barstow, Big Bear City, Cima, Daggett, Earp, Essex, Fawnskin, Fort Irwin, Helendale, Hesperia, Hinkley, Joshua Tree, Landers, Lucerne Valley, Ludlow, Morongo Valley, Mountain Pass, Needles, Newberry Springs, Nipton, Oro Grande, Parker Dam, Phelan, Pinion Hills, Pioneertown, Skyforest, Sugarloaf, Trona, Twentynine Palms, Victorville, Vidal, Wrightwood, Yermo, Yucca Valley ☐ East Valley Region Green Valley Lake, Highland, Lake Arrowhead, Loma Linda, Lytle Creek, Mentone, Patton, Redlands, Rimforest, Running Springs, San Bernardino, Twin Peaks, Yucaipa ☐ West Valley Region Chino, Chino Hills, Guasti, Mt. Baldy, Montclair, Ontario, Rancho Cucamonga, Upland What group(s) do you represent? ☐ Family member of consumer
☐ Social Services Agency
☐ Consumer of Mental Health Services
☐ Health Care Provider
☐ Consumer of Alcohol and Drug Services
☐ Community Member
☐ Law Enforcement
☐ Active Military
☐ Education
☐ Veteran
☐ Community Agency
☐ Representative from Veterans Organization
☐ Faith Community
☐ Provider of Mental Health Services
☐ County Staff
☐ Provider of Alcohol and Drug Services
DRAFT MHSA Innovation Proposal 2017 131 of 140
What is your Ethnicity? ☐ African American/Black
☐ Caucasian/White
☐ American Indian/Native American
☐ Latino/Hispanic
☐ Asian/Pacific Islander
☐ Other:______________
What is your primary language? ☐ English
☐ Spanish
☐ Vietnamese
☐ Other:_____________
How did you hear about this meeting? ☐ Web Blast ☐ E-mail ☐ Co-worker ☐ Other __________________________
☐ Community Partner
Who is one person that you will share what you learned at this meeting? ☐ Family ☐ Friend
☐ Co-worker ☐ Other ___________________________________
DRAFT MHSA Innovation Proposal 2017 132 of 140
Telehealth Technology for Team Case Conferencing 1. Based on the information provided, does the project feedback meet the needs of the community, or do you have additional ideas/suggestions that can assist in developing this project?
2. What factors should be considered in the evaluation of this project? What would successful outcomes look like for this project?
DRAFT MHSA Innovation Proposal 2017 133 of 140
Attachment O
Telehealth Technology for Team Case Conferencing (Proposed Project Concept) Use telehealth technology in Emergency Departments (EDs) to provide referrals and resources to hospital patients experiencing a mental health crisis.
What is the project concept?
Why is this project innovative? • Currently, there are no data outcomes for the effectiveness of using telehealth technology to connect ED patients with the outpatient behavioral health continuum of care.
Extend the Behavioral Health workforce by utilizing telehealth technology in EDs by providing referrals and resources to hospital patients experiencing a mental health crisis.
• Interagency collaboration between health system partners including, but not limited to the following: • Department of Behavioral Health (DBH), • Hospital Association of Southern California (HASC), • Health Plans, and • Local Emergency Departments (EDs).
What does the research say?
What did the community say?5
• San Bernardino County has a total of 18 EDs experiencing increases in individuals suffering from a severe mental health crisis (2011-2014).1 • According to a National Study by Harvard University, psychiatric patients spend an average of 11.5 hours in ED beds, prior to receiving appropriate mental health treatment and referral services.2 Compared to the national average of 4.5 hours for ED wait times and the California average of 5.6 hours.3 • Telepsychiatry has the ability to use technology in order to extend workforce, provide convenience of services, increase access, improve patient compliance with therapy, and improve the overall quality and continuity of care for mental health patients.4 http://www.oshpd.ca.gov/HID/ED-AS-Data.html#Frequencies http://www.aha.org/content/15/150604webinarpresentation.pdf. 3 American College of Emergency Physicians, America’s Emergency Care Environment: A State by State Report Card (2014). 1 2
• Collaborate with community partners to reduce unnecessary psychiatric holds and measure reduction in Emergency Departments; • Improve communication and collaboration between medical & behavioral health care providers; • Integrate technology; • Implement the use of technology to support and reinforce mental health; and • Develop cutting edge ideas to improve access to behavioral health services.
4
Sy Atezaz Saeed, John Diamond, Richard M. Bloch, North Carolina Medical Journal Vol.72, No.3 (July 2011). 5 DBH Community Program Planning (2010-Present).
DRAFT MHSA Innovation Proposal 2017 134 of 140
9/22/16
Tecnología de Telesalud para Conferencias de Equipos Sobre Casos (Propuesta Conceptual del Proyecto) Usar tecnología de telesalud en los Departamentos de Emergencia para proveer referencias y recursos a pacientes de hospitales pasando por una crisis de salud mental.
¿Cuál es el concepto del proyecto? Extender la fuerza laboral de Salud Mental por medio de tecnología de telesalud en los Departamentos de Emergencia (ED, por sus siglas en inglés) proveyendo referencias y recursos a los pacientes de hospitales pasando por una crisis de salud mental.
¿Por qué es este proyecto innovador? • Actualmente no hay resultados de datos a fin de conocer la eficacia del uso de tecnología de telesalud para conectar a los pacientes de ED con la atención continua ambulatoria de salud mental. • Colaboración interinstitucional entre asociados del sistema de salud incluyendo pero no limitado a las siguientes: • Departamento de Salud Mental (DBH, por sus siglas en inglés), • Asociación de Hospitales del Sur de California (HASC, por sus siglas en inglés), • Planes de salud, y • Departamentos de Emergencia (ED, por sus siglas en inglés) locales.
¿Qué señalo la comunidad?5
¿Qué indica la investigación? • El Condado de San Bernardino tiene un total de 18 Departamentos de Emergencias que están experimentando un aumento de individuos pasando por una crisis de salud mental (2011-2014).1 • De acuerdo a un Estudio Nacional de la Universidad de Harvard, los pacientes psiquiátricos pasan en promedio 11.5 horas en camas de ED antes de recibir un tratamiento y servicios de remisiones para el cuidado de salud mental apropiados.2 En comparación con el promedio nacional de 4.5 horas en los tiempos de espera de ED, y el promedio de 5.6 horas de California.3 • La telepsiquiatría tiene la capacidad de usar tecnología para ampliar el personal, brindar comodidad en los servicios, aumentar el acceso, mejorar el cumplimiento de los pacientes respecto a la terapia, y mejorar la calidad y continuidad general del cuidado de los pacientes de salud mental.4 http://www.oshpd.ca.gov/HID/ED-AS-Data.html#Frequencies http://www.aha.org/content/15/150604webinarpresentation.pdf. 3 American College of Emergency Physicians, America’s Emergency Care Environment: A State by State Report Card (2014). 1 2
• • • •
• Colaborar con los socios comunitarios para reducir esperas psiquiátricas innecesarias y medir su reducción en los Departamentos de Emergencia. Mejorar la comunicación y colaboración entre los proveedores de atención médica y de salud mental. Integrar la tecnología. Implementar el uso de la tecnología para apoyar y reforzar la salud mental. Desarrollar ideas innovadoras para mejorar el acceso a los servicios de salud mental.
4
Sy Atezaz Saeed, John Diamond, Richard M. Bloch, North Carolina Medical Journal Vol.72, No.3 (July 2011). 5Planificación del programa comunitario del DBH (2010 a la actualidad).
DRAFT MHSA Innovation Proposal 2017 135 of 140
9/22/16
HASC & DBH Collaboration Meeting Telehealth Technology for Care Coordination Innovation Development
Telehealth Technology for Team Case Conferencing (Project Abstract)
The use of interactive videoconferencing to provide psychiatric (Telepsychiatry) consultation services within an Emergency Department (ED) has been in use since the early 2000s. The reasons for uses of telepsychiatry range from time and cost saving to a lack of psychiatric resources in rural areas. According to Telepsychiatry in the Emergency Department (2009), a report prepared for the California Healthcare Foundation: “ED telepsychiatry programs appear to provide quick and specialized care to patients with the risk of psychiatric emergencies and have the potential to assist in reducing crowding in EDs and lowering costs.” Even with the widespread acceptance of telepsychiatry and telemedicine as a means of delivering behavioral health services in the ED two issues have prevented widespread implementation: financial stability of telepsychiatry in the ED and the lack of published data and/or metrics of the existing telepsychiatry programs. The purpose of using Telehealth Technology for Team Case Conferencing is for San Bernardino’s Department of Behavioral Health (DBH) to partner with the Hospital Association of Southern California (HASC) to begin using telehealth technology to form an interagency treatment team that includes specialized Behavioral Health case managers available 24 hours a day 7 days a week within San Bernardino County’s EDs. The distinguishing innovative element is the integration of a live or virtual case manager, knowledgeable in the DBH continuum of care, into the case conferencing process that starts in the ED. The conceptual focus of this project will be to extend the consultation capabilities by utilizing telehealth technology to create an interagency treatment team to begin the case conferencing process while the patient is still in the ED. The specialized Behavioral Health case manager will assist by providing referrals and resources to the treatment team that will facilitate a warm hand-off for hospital patients experiencing a mental health crisis in effectively accessing the DBH continuum of care. Currently, the same or similar technology and consultation practices are used for other specialties, such as cardiology and neurology. Funding will be provided by DBH through the Mental Health Services Act (MHSA) as part of the Act’s Innovation component. DBH, in partnership with HASC, will establish and evaluate performance metrics and based on these outcomes provide funding for a sustainable Telehealth Technology for Team Case Conferencing program throughout San Bernardino County. Creation of a sustainable ED Telehealth Technology for Team Case Conferencing program will assist San Bernardino County residents who use the ED for psychiatric services by reducing wait time for services, reducing unnecessary psychiatric hospitalizations, and by linking these individuals into the larger network of clientcentered behavioral health services offered by DBH.
Figure 1: Telehealth Technology for Team Care Conferencing Project Concept
DRAFT MHSA Innovation Proposal 2017 136 of 140
Attachment P
HASC & DBH Collaboration Meeting Telehealth Technology for Care Coordination Innovation Development
What is the proposed project concept? Extend the consultation capabilities by utilizing telehealth technology in EDs for providing referrals and resources to hospital patients experiencing a mental health crisis. Figure 1: Flow of proposed project roles and responsibilities
• •
PLAN APPROVAL OVERSIGHT
Mental Health Services Oversight and Accountability Commission (MHSOAC)
• • •
FUNDER OVERSIGHT EVALUATION
San Bernardino County Department of Behavioral Health (DBH) Office of Innovation
•
RESEARCH & DEVELOPMENT
1
2
3
Behavioral Health Providers
4
• Provide: o Psychiatric Consult o Referrals & Services
•
7 Hospital Association of California (HASC)
REPORT OUTCOMES & LEARNING
Hospitals COLLECTIVE GOAL: INTERAGENCY COLLABORATION FOR OUTPATIENT BEHAVIORAL HEALTH COORDINATED
Target Population
6
•
MEASURE & VALIDATE
DBH Research & Evaluation
5
•
ACHIEVE KEY OUTCOMES
Figure 2: System Continuous Improvement
•Evaluate •Apply lessons learned •Modify as necessary
•Establish a baseline •Identify priorities •Set improvement goals and standards
ACT
PLAN
Continual Improvement •Monitor and Measure •Find and Fix •Document Results
CHECK
DO
•Implement Actions •Plans to Achieve Goals
DRAFT MHSA Innovation Proposal 2017 137 of 140
Attachment Q
Behavioral Health
Press Release Media Outlet List ABC News Albert Morrissette Apple Valley News Associated Press Barb Stanton Big Bear Grizzly Black Voice News Bloomberg BNA CBS News CBS Radio Chino Champion City News Group City News Service Daily Journal Desert Dispatch Desert Trail News ET News Fontana Herald Fox 11 News Hi-Desert Star High Desert Daily Highland Community News Highland News Homeless Times Inland Empire Business Journal Inland Empire Community Newspaper Inland Empire Hispanic News Inland Empire Magazine Inland Newspaper Inland Empire News Radio Inland News Today KBHR 93.3 FM KCAL9 News KCDZ 107.7 FM KESQ News KFI News KFRG 95.1FM and 92.9 FM KNX News Radio KPCC 89.3 AM KTIE/KRLA KTLA News KVVBTV High Desert
La Prensa Los Ángeles News Group Los Angeles Times Lucerne Valley Leader Mountain News NBC News NBC Universal/Telemundo Needles Desert Star News Line News Mirror News Radio Precinct Reporter Press Enterprise San Bernardino American News San Bernardino City News San Bernardino Sun Senior News/Desert News Post SoCal News The Alpenhorn News Tri-Community NewsPlus Phelan/Wrightwood/Pinon Hills Univision KMEX 34 Victorville Daily Press Westside Story Newspaper Yucaipa/Calimesa News Mirror
DRAFT MHSA Innovation Proposal 2017 137 of 139
Page Intentionally Left Blank
Department of Behavioral Health, Office of Innovation September 1, 2017
