SAN MATEO COUNTY MENTAL HEALTH SERVICES ACT

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					SAN MATEO COUNTY                            MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS              THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                       JANUARY 1 - DECEMBER 31, 2007




                    SAN MATEO COUNTY
                        HEALTH DEPARTMENT
 BEHAVIORAL HEALTH AND RECOVERY SERVICES DIVISION




        Mental Health Services Act (MHSA)
       IMPLEMENTATION PROGRESS REPORT OF THE
 COMMUNITY SERVICES AND SUPPORTS (CSS) COMPONENT
  OF THE THREE-YEAR PROGRAM AND EXPENDITURE PLAN
               FOR CALENDAR YEAR 2007




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SAN MATEO COUNTY                                    MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                       THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007


A. PROGRAM/SERVICES IMPLEMENTATION

1. Briefly report by Work Plan on how implementation of the approved program
   or services is proceeding. Suggested length is no more than half a page per
   Work Plan. Report whether the implementation activities are generally
   proceeding as described in the County’s Plan. If not, identify key differences.
   Describe the major implementation challenges.


FULL SERVICE PARTNERSHIPS

“TURNING POINT” FOR CHILD/YOUTH/TRANSITION AGE YOUTH (TAY) FSP - As reported
last year, Edgewood was contracted to provide the 40-enrollee child/youth and 40-
enrollee transition age youth Full Service Partnerships (FSPs), Turning Point. The
program has reached full enrollment and will be able to enhance its responsiveness to
enrollees and their families through increased staffing including: crisis workers; behavior
coaches; family conferencing coordinator; and peer partners. The State approved the
increased cost for FY 07-08 ($35,845 instead of $28,676 including housing) as part of
the Expansion plan, bringing it more in line with comparable wrap-around programs.

The enrollees have a high level of acuity, a high incidence of co-occurring substance
abuse problems (53% of TAY) and developmental delays (18%). They have been older
on average (67% of TAY are over 18 years old, and Child/Youth average 14.5 years old)
and have high intensity needs, many stepping down from group homes, coming out of
juvenile justice (21%), and emancipating from foster care.

The cultural diversity of the program is strong with African American representation and
Spanish and Tagalog language capacity, and there is a diverse group of family partners.
The enrollees have been diverse: 38% Caucasian, 18% African American, 30% Latino,
7.5% Filipino or Chinese and1% Native American. There are four peer partners and
three family partners on staff.

Establishing appropriate program space was an initial challenge identified in the
previous report. Edgewood has kept the primary site in San Carlos and has rented a
space for the TAY Drop-In Center component in San Bruno near major thoroughfares
and public transportation. The Drop-In Center opened in San Bruno in May 2007. This
addition has been an enormous success, serving not only Turning Point enrollees but
other Transition Age Youth in the County (about 1/3rd are non-Turning Point youth).
Staffed by Peer Partners, the Turning Point Drop-In Center offers a multitude of services
including: support groups; independent living skills; educational support; social skills
building; and a healthy meal. On September 14th, 2007 the Turning Point Program
invited community members to tour the Drop-In Center.

Edgewood has been working with Caminar and the Community Colleges to establish the
supported education component. There is also a need to develop an educational
component more targeted to youth who are working toward obtaining a GED and are not




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SAN MATEO COUNTY                                     MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                        THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                  JANUARY 1 - DECEMBER 31, 2007


yet ready for the community college program. Turning Point TAY FSP enrollees are
engaged in a variety of supported education activities including GED prep activities, high
school completion, education readiness groups at the Drop-In Center and attending
College of San Mateo.

Collaboration with the Mental Health Association (MHA), the contractor for supported
housing for FSPs, continues to address challenges unique to housing the TAY
population. Scattered site options have not proven to be as feasible for providing the
kinds of supports (including crisis response, in-home support and transportation) that are
necessary for enrollees who have no experience living independently. There is a
Quarterly Housing Meeting with MHA, Turning Point and San Mateo County Behavioral
Health and Recovery Services (BHRS) leadership to provide oversight to the housing
project. In collaboration with MHA, Turning Point opened two transitional age youth
―houses‖, a male house and a female house of three young adults each. In addition
there currently exists a spectrum of housing options for TAY.

Start-up implementation meetings with Edgewood Turning Point management have
evolved from a weekly to a monthly frequency. In addition, a collaborative meeting with
supervisory level system of care partners meets twice a month to review treatment
planning, case management problem-solving, and clinical risk.

BHRS meets quarterly with Human Services Agency management to review Senate Bill
(SB) 163 eligibility, enrollment and funding implementation; SB 163 capacity of 30
enrollees met.

On December 31st, there were 38 children/youth and 40 transition age youth enrolled.

“TRANSITIONS” FOR ADULT AND OLDER ADULT FSP – As previously reported Telecare,
Inc. was contracted to provide the 60 slot adult and 50 slot older adult Full Service
Partnerships.

The program was approved for a 20 slot expansion for FY 07-08. Implementation
activities are proceeding as expected although it has been a challenge to maintain the
pace of enrollment that was targeted in the approved Plan. The program has worked to
actively engage potential enrollees over many months prior to formal program
enrollment. Many of these potential enrollees are being transitioned from long-term
restrictive locked institutional environments.

It has been a challenge to fully staff and maintain this focus on engagement while also
providing intensive services to enrolled members, including after-hour response for calls
and community visits. Restructuring to provide more field based support for the
engagement of potential enrollees is a focus of the approved expansion for FY07-08.

After initial challenges for both programs in recruiting qualified staff they are now fully
staffed and have Chinese, Spanish, Tagalog, and Russian language capacity and peer
partners.




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SAN MATEO COUNTY                                   MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                      THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007


As of December 31st, there were 51 adults and 41 older adults enrolled. The Adult
enrollees are 59% Caucasian, 18% Hispanic, 14% African American, and 10% Asian
(6% Filipino, 2% Japanese, 2% Korean). The Older Adult enrollees are 73% Caucasian,
10% Hispanic, 15% African American, and 1% Asian (Filipino). There are 2 employees
who identify themselves as consumers.


HOUSING (ALL AGES) - Mental Health Association (MHA) was contracted to provide the
housing for all Full Service Partnerships. MHA contracted with a property management
firm and established a memorandum of understanding with Telecare, Inc. and
Edgewood.

After the initial start-up period, MHA and Telecare determined to move the housing
responsibility for adults and older adults to Telecare. This commenced on December
2nd, 2007.

MHA continues to work with Edgewood to identify housing options most appropriate for
the TAY FSP enrollees, and has obtained consultation from a housing consultant who
has worked with similar populations to identify best practices. The Mental Health
Association continues to participate with San Mateo County’s Department of Housing
and Human Services Agency and others in planning and implementing the County’s Ten
Year Plan to End Homelessness (HOPE) that has a significant ―special needs/supported
housing‖ component.

Finding apartments, even in clusters, has not been a problem. However, the modified
scattered site apartments model does not seem to be the level of housing needed. We
are now exploring all opportunities to find community housing locations in which we can
locate onsite support services.

A significant challenge faced during this period was supporting people in the type of
community settings contracted to house the FSP members. The level of support
available at the apartments has not always been sufficient to meet the intensive level of
support needed by the members.

Another major challenge has been engaging and enrolling new members who have been
living in institutional settings for a long time. The unfamiliarity with community-based
living as well as apprehension about making such a big change has made the
engagement/ enrollment process a very prolonged one for potential members.

Although both programs are fully staffed, there has been some staff turnover. A staffing
challenge for both programs has been the significant training needs of the staff.


COMMUNITY OUTREACH AND ENGAGEMENT

Navigator/Outreach Program (All Ages) - The Request for Proposals (RFP) for the
southern region (East Palo Alto) was developed through a collaborative community



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SAN MATEO COUNTY                                   MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                      THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007


process in which members of the community identified parameters and priorities for the
effort over a period of several months.

The RFP was released in November 2006 and the contract was awarded to One East
Palo Alto, representing a collaboration of Free At Last, For Youth By Youth, and El
Concilio, among other community-based organizations with strong ties to the community.
This partnership has experience providing similar services in the community to the
African American, Latino, Pacific Islander and other populations. The member agencies
of the partnership provide other services within the community and are integrating the
mental health outreach component with other services. For Youth By Youth has youth
leadership and strong ties to the schools and youth serving agencies. The contract was
established in June 2007 and training and implementation tasks occurred over the
summer. Numerous trainings (i.e. Mental Health 101, Safety Planning and Intake) of
outreach workers were facilitated by BHRS staff. The first services were provided in late
September, and by the end of December, 252 people had received outreach and
education services through this initiative. During this same period, referrals to the East
Palo Alto based Community Counseling Clinic increased, through collaboration between
that clinic and the outreach workers, who meet weekly. The Community Counseling
Clinic received the County’s Board of Supervisors STARS award for excellent customer
service in December as a result of their responsiveness to community needs.

The feedback from the MHSA outreach process has been important in developing the
RFP parameters and has also elicited additional input from stakeholders in the various
cultural disparity grant processes. The RFP for the North County that focuses on Daly
City, South San Francisco and Pacifica was planned for release in 2008, hence outside
of the scope of the present report.


PRIMARY CARE INTERFACE FOR CHILD/YOUTH - The program was approved for expansion
for FY07-08. The expansion of the Primary Care Interface team to include one adult
psychiatrist, one youth/child trained psychiatrist, two Spanish speaking and one
Cantonese speaking clinicians has proceeded rapidly.

The original youth psychiatrist resigned in July 2007. Our second child psychiatrist
started in November 2007 and has proven to be a real asset to the team. Although he is
not bi-lingual, he is bi-cultural and sensitive to cultural issues.

The first Spanish speaking youth clinician took maternity leave and we were unable to
find a temporary backfill for the position. Experienced Spanish speaking clinicians are
seldom available to work extra help. Additionally, the clinician decided to work part time
with another team after returning to work (she left on Maternity Leave in December
2007). The second Spanish speaking youth clinician moved to Texas after working with
us for 5 months, since August 2007 until February 2008. We are in the final stages of
interviews for both positions.

The adult psychiatrist resigned suddenly in November 2007 to take a position with much
higher pay in the prison system –this is an increasing systemic issue faced by many




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SAN MATEO COUNTY                                    MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                       THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007


counties. In April 2008 we recruited and hired a bi-lingual bi-cultural Spanish speaking
adult psychiatrist.


PRIMARY CARE INTERFACE FOR OLDER ADULTS - Behavioral Health and Recovery
Services has hired all staff including the Community Mental Health nurse, Spanish and
Chinese speaking clinicians and the gero-focused psychiatrist for this program.

These nurse and clinician positions, which were originally half time, were brought to full-
time through the expansion for FY07-08. We have 20 hours of psychiatry time for this
program covered by two different people. One of the psychiatrists covering 10 hours left
in the last quarter of 2007 and we are still recruiting for the position.

This mental health team will be collaborating with primary care to treat depression in
older adults in primary care settings using the IMPACT model, an evidence-based
treatment model. While the model is developing, these clinicians also provide services
to the Older Adult System of Care Development program. We are currently in the
process of identifying the primary care settings where we will implement this program. A
contractor has been identified with extensive experience with this model to provide
training and implementation assistance. Training is targeted to begin in fall 2008.


LICENSED MENTAL HEALTH CLINICIAN TO YOUTH AND FAMILY ENRICHMENT SERVICES CRISIS
HOTLINE - Youth and Family Enrichment Services (YFES) works with Behavioral Health
and Recovery Services to improve crisis response linkages to mental health.

A licensed mental health clinician provides case management and consultation follow-up
as a result of calls to the hotline; outreach evaluations and follow-up at school sites
where crises occur; response to hotline calls; and outreach/information to community
groups.

YFES hired a new clinician on August 22nd, 2007, and the services rendered are as
follows: Case management/phone consultation for youth and adults: 19. Youth
outreach interventions (which are evaluations at school sites): 10; outreach
presentations (youth and adults groups in the community) reached a total of 184 persons
by December 31st, 2007.


EAST PALO ALTO OPEN ACCESS PROJECT - Since the implementation of the Open
Access Project in May 2006, EPA:

   Has seen a 30% increase in caseload compared to the previous year;
   Clients were seen more quickly and the initiation and engagement rates have
    increased dramatically;
   Clients are reporting more satisfaction because they are being seen quicker and they
    are also feeling more welcomed and respected by the staff.




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SAN MATEO COUNTY                                   MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                     THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                JANUARY 1 - DECEMBER 31, 2007


In 2007, 252 individuals were served. At the December 18, 2007 Board of Supervisors
meeting, the East Palo Alto Open Access Project was awarded the San Mateo County
STARS Award for Customer Service. The STARS awards enable the County to publicly
recognize and highlight programs that meet program goals, demonstrate innovation and
collaboration, and achieve outstanding results.


SYSTEM DEVELOPMENT

OLDER ADULT SYSTEM OF CARE DEVELOPMENT - The Older Adult Clinical Services
Manager and Nurse Case Manager were hired. These positions were expanded from
part to full-time in FY07-08.

The Request for Proposals for expanded peer counseling was released in May and
Family Service Agency (FSA) was selected as the provider. The transition of the
program to FSA is targeted to begin in February 2008 with program expansion targeted
at the Chinese, Filipino and LGBT older adults and incorporation of the existing program.

On July 18th, approximately 90 people attended the 20th anniversary lunch celebration of
the Senior Peer Counseling program.

The Older Adult Manager is involved with older adult system of care planning with the
Health Services Department’s Aging and Adult Services Division in addition to the Ron
Robinson Senior Care Center operated by the San Mateo Medical Center. This initiative
has already substantially strengthened the public mental health program for older adults.


SCHOOL-BASED SERVICES CHILD/YOUTH - The RFP for the service was released in early
September 2006 targeting evidence based services to be provided to four middle
schools that have no mental health resources: Thomas R. Pollicita Middle School (6-8)
in Daly City, Parkway Heights Middle School (6-8) in South San Francisco, and two to be
identified in underserved communities. There was a challenge identifying the schools
among the many schools in San Mateo County that were most appropriate to target the
additional resources available through this initiative. This was done through
collaboration with the school districts.

Asian American Recovery Services began providing mental health services using a
trauma focused cognitive behavioral evidence-based practice in April 2007 at the
northern schools.

The original approved plan assumed a higher proportion of non-MHSA revenue. Post
start-up analysis reveals that some of the services rendered are not reimbursable under
insurers provisions, and/or more youth than expected are turning out to be
under/uninsured. We plan on using CSS Growth dollars to sustain this program, with no
change in total cost per client.




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SAN MATEO COUNTY                                     MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                        THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                   JANUARY 1 - DECEMBER 31, 2007


Measures are being taken to ensure that youth who are eligible for some form of
insurance are properly linked.


PATHWAYS, COURT MENTAL HEALTH PROGRAM (ADULTS) - As reported last year, The
Superior Court, Mental Health, Probation, the District Attorney, Private (Public)
Defender, Sheriff’s Office, and Correctional Health conducted a series of planning
meetings that were chaired by the Presiding Judge and the Assistant Presiding Judge
(and the Judge who accepted the MH Court calendar) of the Superior Court. These led
to the development of specific plans and protocols for this program. The mental health
clinician, consumer liaison, and family partner were hired, and the first cases were heard
in October 2006. By March 2007, 18 people were enrolled. The Sheriff’s Office was
also awarded a MIOCR grant to expand this collaborative effort to provide trauma
focused services for 35 mentally ill offender women.

There have been some challenges with enrollment. These have included a variety of
reasons including prisoners not wanting to self identify as being seriously mentally ill or
choosing to just serve their time rather than being closely monitored in a program.
These issues are being addressed in a number of ways. We now have group
presentations and individual meetings with prisoners in the jail to clarify services offered
and help them understand how they might benefit. One of our presenters is a peer
partner who has been through a similar program. She is able to use her story to
encourage enrollment through providing hope and support.

We are also planning ―Seeking Safety‖ type groups for the women’s jail population and
for women on probation in the community to attempt to interest others in participation.

Also, the program was originally designed to just accept people ―post plea.‖ In order to
increase participation, the Court has approved enrollment of people with modifiable
sentences.

Both the staff and the enrollees are a diverse ethnic and cultural mix. The staff is strong
with African American and Latino representation and with Spanish speaking capacity.
The enrollees are diverse: 52% Caucasian, 18% African American, 16% Latino, 8%
Filipino, 2% other Asian, 2% Pacific Islander, and 2% Indian. There are also staff who
identify themselves as consumers in recovery and family members.

Overall, the Pathways Program is a very well received collaborative program throughout
the County. It continues to develop and enroll new people each week. Pathways taps
into a host of other services and resources in the community to assist the enrollees.
Some of these include Alcohol and Other Drug services and Full Service Partnership
slots.




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SAN MATEO COUNTY                                    MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                       THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007

SYSTEM TRANSFORMATION AND EFFECTIVENESS STRATEGIES
The following initiatives substantially support capacity development within the existing
county-operated and contracted public mental health system.

SYSTEM-WIDE TRAINING - The Behavioral Health and Recovery Services Division (BHRS)
continues to work on a comprehensive, phased three-year workforce development plan
to identify long range needs and strategies and to integrate numerous MHSA funded
trainings with existing training resources within BHRS and the County. This initiative has
benefited the County’s entire public behavioral health system.

The youth system has identified Teaching Prosocial Skills (TPS) (formerly known as
Aggression Replacement Therapy, ART) as a preferred evidence based practice.
Twelve BHRS employees, including supervisors, clinicians and family partners, were
sent to the California Institute for Mental Health (CiMH)-sponsored training in January
07. Staff implemented ART groups in school-based day treatment and outpatient
settings starting in February 07. Five groups have been held in outpatient clinics where
there were no groups before. Clinicians also received a one-day booster training in April
07. The training has also included weekly on-going consultation phone calls with master
trainers to expand learning and move providers toward certification. A second round of
training in December expanded participation to 18 clinicians, five AOD, probation and
group home workers, two family partners and five supervisors."

Our Wellness and Recovery-focused training initiative has been led by ―Paving the
Way,‖ a multi-disciplinary provider/consumer/family member committee developed to
guide the integration of mental health consumers and family members into the workforce
and the development of a welcoming environment for the new consumer and family
member employees (including appropriate training). The Paving the Way Committee
continues to meet monthly.

Training and support guided by Paving The Way include:

1) Training and Support for New Community Workers and Family Partners: A variety of
training programs, resources, supports and consultation networks have been
implemented for the new employees. Paving The Way and Inspired At Work jointly plan
trainings for the new Community Workers and Family Partners, and monitor their on-
going training and consultation/support needs.

2) Three Day Orientation and 20 Hour Intensive Training: Newly hired and existing
Community Workers and Family Partners have all completed the 3 Day Orientation and
the 20 Hour Intensive Training through Inspired at Work.

3) On-Going Consultation: On-going consultation is provided to all new community
workers and family partners through weekly 1.5 hour meetings. Topics for these
meetings are suggested by the group members, unit chiefs, and the group facilitators.
Consultation meetings are held separately for family partners, and also for community
workers. In addition, joint family partner/community worker consultation trainings are
held. These joint consultation trainings are led by Inspired At Work.




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SAN MATEO COUNTY                                     MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                       THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                  JANUARY 1 - DECEMBER 31, 2007


4) Continuing Education and Training: Inspired at Work has been able to bring the
College of San Mateo course, Introduction to Case Management, (with college credit
being awarded) on-site to San Mateo County Mental Health. Courses in Psycho-Social
Rehabilitation may also be made available through this format.

5) Training and Support for Supervisors: To ensure supervisors questions are answered
in a timely fashion, and to assure supervisors that support is available for them as they
work to integrate the new employees into their teams, specific training and support
programs have been developed.

6) ADA Training: Three hour training was provided by Protection & Advocacy on
psychiatric disabilities and ADA. This training provided an opportunity for all Unit Chiefs
and the EPS ADA Coordinator to understand the intricacies of ADA as they relate to
psychiatric disabilities. 7) Regional Team Dialogues: Each region has an identified
Regional Dialogue Team comprised of a unit chief, medical chief, manager and
consumer/family member representative. The members of the Regional Dialogue Teams
provide a consistent sounding board and consultative support attending service/regional
team meetings to discuss the integration of consumer and family member employees in
the workplace. 8) Ensuring Successful Integration of CW/FP in Regional Teams:
Deputy’s, Managers, and Supervisors met over a period of 4-6 months to ensure
successful integration of the new employees.

Perhaps the most significant change to occur in 2007 and that is having great impact in
our system was the creation of the new Behavioral Health and Recovery Services
Division of the Health Department, combining the Mental Health Services (MH) and
Alcohol and Other Drug Services (AOD) Divisions. This organizational shift occurred
after several years of collaboration between the two organizations, led by the Mental
Health and AOD directors. They co-led a multi-year integrated services program
development and training initiative for co-occurring alcohol, other drug, and psychiatric
disorders for providers serving all ages funded through the Mental Health Services Act.
The integration effort is far reaching and includes assessment of system-wide training
needs and styles. We have distributed training needs surveys to all staff and the rich
information collected is also informing our MHSA WET proposal development.

Lastly, our BHRS has increased the availability of system wide training in motivational
interviewing, a core skill in successfully working with clients suffering from co-occurring
problems. After large scale trainings in Nov 2007, we are currently providing team-
based training opportunities up to 3 times a week that focus on the application of skills in
the context of actual cases.


CONSUMER AND FAMILY PARTNER (ALL AGES) - Extensive outreach and recruitment led to
a tremendous response of applicants for the new consumer and family partner
community worker positions.

Positions were primarily focused on bi-lingual capability (Spanish, Tagalog,
Mandarin/Cantonese.) Initial interviews of 60 family partner applicants and 86 consumer



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SAN MATEO COUNTY                                      MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                        THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                   JANUARY 1 - DECEMBER 31, 2007


candidates over the summer resulted in hiring of a diverse group of bilingual and
bicultural family partners (8) and consumer partners (9).

In the expansion plan we added positions and the recruitment for those is now
underway.

San Mateo’s consumer and family member initiative has been identified as a best
practice by the Bay Area Mental Health Workforce Collaborative. Family and Peer
Partners served 160 people by December 31st.


CONSUMER AND FAMILY PARTNERS ACADEMY (ALL AGES) - The Behavioral Health and
Recovery Services Division contracted with Inspired At Work (a private consulting
partnership) to assist in recruitment and outreach for the new consumer and family
partner positions. Training and orientation has been carried out as described above.


NEIGHBORHOOD-BASED MULTI-CULTURAL PEER RUN SELF-HELP CENTER (ADULT) - The
Multi-cultural Wellness Center will be located in East Palo Alto (EPA), a diverse and high
need area. A multi-ethnic consumer work group led by Linford Gayle, the Director of our
Office of Consumer and Family Affairs, is meeting with local consumers and community
leaders and organizations (including the faith-based community) to design
consumer/family member outreach, conceptualize the range of services that will be
provided and identify potential locations for the Wellness Center.

It is anticipated that the center will involve family members as well as consumers to more
appropriately reflect the family focused cultural norms of the ethnically diverse
populations of EPA and to reduce potential stigma associated with self-identifying as
having a psychiatric disability and using self-help services.

In November 07, Linford Gayle and Irma Prothrow held educational sessions about
mental illness and stigma with leaders of the faith community in EPA as part of this
ongoing project.

The RFP has already been released.


EVIDENCE BASED PRACTICE EXPANSION (ALL AGES) - The Behavioral Health and
Recovery Services Division has filled all bilingual positions through this initiative, and
has embarked on several ambitious evidence based practices training initiatives as
described above and below under Wellness and Recovery.

Funding has been awarded to the Mental Health Contractors Association to support
participation in the system-wide Co-occurring Initiative.

In addition, BHRS created three administrative support positions and funded community
based organizations to provide core and specialized integrated services to individuals



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SAN MATEO COUNTY                                     MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                       THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                  JANUARY 1 - DECEMBER 31, 2007


with co-occurring MH/AOD disorders.


TRAINEES (ALL AGES) - MHSA funds supported cultural competence stipends for 10
mental health clinical trainees (MFT & MSW) representing bilingual and bicultural
Spanish and African American populations. This effort has been successful since
inception, with no difficulties finding culturally diverse clinical trainees.


EXPANDED ACCESS TO JOB DEVELOPER AND JOB COACH THROUGH DEPARTMENT OF
REHABILITATION/DEPARTMENT OF MENTAL HEALTH COOPERATIVE AGREEMENT (ADULTS) -
BHRS initiated the expansion in this program with the local Department of Human
Services Vocational Rehabilitation Services (VRS), which provides supported
employment services as a Department of Rehabilitation Co-op and through an MOU with
Mental Health.

This expansion has increased access to the Job Developer in the mental health clinics
and increased effort by the job developer to ―sculpt‖ employment opportunities for mental
health consumers.

This also provided an additional support in the recruitment and job application process
for consumer focused ―Community Worker‖ positions. In 2007, VRS placed 14
individuals in jobs as a result of this effort, and provided a total of 2,783 hours of job
coaching services.



2. For each of the six general standards below, very briefly describe one example
   of a successful activity, strategy or program implemented through CSS
   funding and why you think it is an example of success, e.g. what was the result
   of your activity. Please be specific. Suggested length is three pages total.

a. Community collaboration between the mental health system and other
   community agencies, services, ethnic communities, etc.

   Our innovative project, Open Access East Palo Alto (EPA), integrates the
   involvement of public mental health and community-based providers in a
   collaborative initiative advised by community residents and stakeholders. These
   residents and stakeholders include OneEPA -the convening nonprofit organization,
   among other faith and community-based organizations with ties with and outside the
   Mental Health and Alcohol and Other Drug spheres. So me of those organizations
   include Free at Last, El Concilio of San Mateo, For Youth By Youth as well as the
   EPA Community Counseling Clinic, and a faith-based organization. The project grew
   out of the commitment by the San Mateo County Behavioral Health and Recovery
   Services Division to promote wellness and recovery and create public/private
   partnerships to provide outreach and support to people who have complex problems
   that include mental health, substance abuse, re-entry from the criminal justice
   system, health disparities, lack of jobs and housing, community violence.


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SAN MATEO COUNTY                                     MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                        THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                   JANUARY 1 - DECEMBER 31, 2007


   Initial goals included providing same day access to mental health services, creating a
   welcoming environment and increasing collaboration with these key community
   partners.

   The project began in May 2006 when the East Palo Alto clinic began serving clients
   on a same-day basis. During the first year of operation, Open Access East Palo Alto
   served 363 clients, a 30% increase in the East Palo Alto caseload. Between October
   2006 and May 2007, new clients were seen on average within 3.8 days of their first
   appointment, and many clients were seen on the same day they contacted the
   system by phone or drop-in. Among the many numbers that reflect the program’s
   success, a few stand out. Between October 2006 and May 2007, the average rate of
   Latino clients seen for a third or fourth appointment within 30 days of their second
   appointment was 56 percent, which is 22 percent higher than the system average in
   2005-06. Research shows that seeing clients repeatedly contributes greatly to
   treatment effectiveness. Clients also register high levels of satisfaction. More than
   85 percent of clients in a survey said they were satisfied with the speed with which
   they received their first service. Client satisfaction regarding how welcome and
   respected they felt by the staff was more than 85 percent.

   San Mateo County’s Board of Supervisors awarded the STARS Customer Service
   Award to The Open Access East Palo Alto Project in December 2007. Created in
   2006, STARS Awards recognize County programs that demonstrate exceptional
   customer service and/or program performance. The partnership was present in full at
   the awards ceremony.

b. Cultural competence - As is self evident in item II. B. below, our efforts to address
   disparities are a success on all fronts, and continue to grow strong. For the purpose
   of b. here we will focus on the Filipino Mental Health Initiative.

   The MHSA outreach process targeting the Filipino population included a series of
   focused meetings with Filipino stakeholders to develop recommendations for
   targeted training, outreach and education, development of an updated resource
   directory, and outreach. These desired outcomes were formalized in a Request for
   Proposals and in September 2006 Asian American Recovery Services was awarded
   the contract for these services. The first event, a day-long training aimed at
   increasing cultural competence in serving the Filipino population targeted at more
   than 80 providers and others was held on March 16th. In July, the Filipino Mental
   Health Initiative, a partnership between community based organizations and BHRS,
   performed outreach at the 13th Annual Fil-Am Sister-to-Sister City event at Serra
   Bowl in Daly City. The second day long training, ―Looking Through a Different Lens:
   Cultural Considerations When Working with Filipinos‖, was held on September 28th.
   Drs. Jei Africa (BHRS Health Disparities Manager) and Melen McBride (Stanford
   Geriatric Center) were the presenters. Over 120 providers, community members and
   staff attended.

   We believe that the success of this initiative is reflected in the fact that all goals have
   been reached, and that participants and attendees who have engaged in the




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IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007


   activities have expressed a high degree of satisfaction, and the will to continue
   working together in the future.

c. Client/family driven mental health system – As explained elsewhere in this
   progress report, our County has gone to great lengths to outreach to and recruit
   consumers and family members in community worker positions.

   We believe that the inclusion of consumers and family members in the workforce is
   key to spearhead the shift towards a consumer and family driven mental health
   delivery systems. This inclusion is damping the system with this unique perspective,
   as well as enriching the quality of our work with life experiences that make an
   invaluable contribution to our system.

   Much more work remains to be done and we are constantly looking at the way to
   help this shift we all agree needs to deepen. As we continue our work, we also do so
   through a cultural competence lens, which is reflected in the diverse group of
   bilingual and bicultural family and consumer partners we have been able to hire.

d. Wellness/recovery/resilience focus

   We have talked in this report about our Wellness and Recovery focused training
   initiative, and its ongoing efforts towards providing training and support for
   consumers and family partners led by ―Paving the Way‖.

   As the newly created Behavioral Health and Recovery Services Division continues its
   work around integrating Mental Health and Alcohol and Other Drug, our co-occurring
   initiative is looking at how both once separate systems understand and conceive
   wellness and recovery, and how to come up with a stable definition or set of criteria
   around these notions that will foster a seamless focus.

   By the same token, as we work on developing our training plan and draft our MHSA
   WET proposal, wellness and recovery are at the center of the training philosophy
   that’s emerging from this work.

   We are also focused on incorporating this lens through multifaceted approaches
   such as having panels of consumers and family members share their stories and
   what has helped or would have helped them in their process to wellness recovery. A
   recent BHRS Leadership meeting heard compelling stories from consumers and
   family members and brainstormed on ways to further impregnate these notions in
   everything we do, everywhere we do it.

   We encourage the reviewers of this report to visit our Consumers Hall of Fame
   website, through which we honor clients in the path to wellness and recovery.

   http://sanmateo.networkofcare.org/mh/home/hall_convos.cfm




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IMPLEMENTATION PROGRESS REPORT                                JANUARY 1 - DECEMBER 31, 2007

e. Integrated services experience for clients and families: changes in services
   that result in services being seamless or coordinated so that all necessary
   services are easily accessible to clients and families

   An essential piece of a successful new Behavioral Health and Recovery Services
   Division is the work around creating an integrated system of care for individuals with
   complex co-occuring MH/AOD disorders, key to fostering an integrated service
   experience for our clients. The Steering Committee established (including AOD/MH
   representatives, Mental Health and AOD Board members, provider agencies,
   consumers and family members) has met regularly and has completed a ―Consensus
   Document‖ that includes principles and action steps to guide the process.

   Additionally, the Steering Committee prioritized change activities for the coming year
   including addressing co-occurring quality improvement programs, developing a
   ―welcoming policy‖ to better engage consumers, and examining how to best integrate
   AOD and MH services. Well over 100 clinical leaders have been identified to
   represent MH/substance use programs and continue to meet quarterly with
   consultants to improve program co-occurring service delivery. These change agents
   have assisted their programs in completing program-level self-assessments
   (COMPASS), and have developed action plans to initiate program policy changes
   based on the COMPASS results. Change Agents are also active in reviewing
   housing options, and are considering ways COD individuals and families can better
   obtain and maintain safe, quality housing in the county.

   Site visits have also been completed by Drs. Minkoff and Cline (from Zia Partners,
   the consultants assisting us in this project) for about 35 programs with more to be
   scheduled over the course of the consultation.

   The Steering Committee is also initiating discussions with the goal of developing
   policies around creating an integrated crisis safety net for those clients at greatest
   risk of harm as the result of COD. Youth leadership from MH and AOD are also
   meeting to best determine how to improve integrated co-occurring capability and
   treatment services for youth and their families. Training on Motivational Interviewing,
   an evidence based treatment recommended for co-occurring disorders, is being
   provided throughout the system to AOD and MH clinical teams. AOD and MH
   clinicians are working to build partnerships between agencies, which has improved
   greatly fostered coordination and integration.


3. For the FSP category only:

a. If the County has not implemented the SB 163 Wraparound and has agreed to
   work with their county department of social services and the California Dept of
   Social Services toward the implementation of the SB 163 Wraparound, please
   describe the progress that has been made, identify any barriers encountered,
   and outline the next steps anticipated.

   San Mateo County has implemented the SB 163 Wraparound program.




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IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007



b. Please provide the total amount of MHSA funding approved as FSP
   partnership funds that was used for short-term acute inpatient care.

   San Mateo County does not use MHSA dollars for short-term acute inpatient care.


4. For the General System Development category only, briefly describe how the
   implementation of the General System Development programs have
   strengthened or changed the County’s overall public mental health system.
   (Suggested length one page). If applicable, please provide an update on any
   progress made towards addressing and conditions that may have been
   specified in your DMH approval letter.


B. EFFORTS TO ADDRESS DISPARITIES

   Below we describe our progress in implementing our initiatives that address
   disparities, including successes and challenges as requested in B. 1) and B. 2).

   Of note is the fact that our Health Disparities Initiatives Manager coordinates these
   culturally focused initiatives and is also involved with the Divisions’ cultural
   competence mission. She performs outreach and information dissemination to
   community partners and other providers about these initiatives (presentations to
   community based organizations, classrooms, support groups, etc.), and invites
   participation in the planning and development of projects related to these initiatives.
   There has been a significant addition of community partners and clients in the
   Cultural Competence Committee, which helps support and guide these initiatives.

      The MHSA outreach process in East Palo Alto has evolved into a series of
       continuing needs assessment and planning meetings between community
       representatives and the Mental Health Services Division to identify barriers to
       access for EPA African American, Latino, and Pacific Islander populations,
       opportunities for collaboration and to advise on program implementation issues in
       EPA including the development of the Multi-cultural Consumer Self-help Center.
       Mental Health has entered into a contract with One East Palo Alto—a community
       convening and advocacy organization (O-EPA) to provide support to this effort to
       include the development of and ongoing Mental Health Advisory Committee
       representing key underserved populations and a range of community agencies.
       There were several meetings with the Advisory Committee and training and
       orientation group throughout spring 2007. On September 28th, 2007, the East
       Palo Alto Partnership for Mental Health Outreach was launched with a
       celebration/kick-off for the community and stakeholders. This collaboration
       includes One East Palo Alto, Free at Last, El Concilio of San Mateo, For Youth
       By Youth as well as the EPA Community Counseling Clinic and BHRS
       administration.
      The MHSA outreach process targeting the Filipino population included a series of
       focused meetings with Filipino stakeholders to develop recommendations for


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SAN MATEO COUNTY                                    MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                      THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007

       targeted training, outreach and education, development of an updated resource
       directory, and outreach which were formalized in a Request for Proposals. Asian
       American Recovery Services was awarded the contract for these services in
       September 2006. The first event, a day-long training aimed at increasing cultural
       competence in serving the Filipino population targeted at more than 80 providers
       and others was held on March 16th. In July, the Filipino Mental Health Initiative, a
       partnership between community based organizations and BHRS, performed
       outreach at the 13th Annual Fil-Am Sister-to-Sister City event at Serra Bowl in
       Daly City. The second day long training, ―Looking Through a Different Lens:
       Cultural Considerations When Working with Filipinos‖, was held on September
       28th. Drs. Jei Africa (BHRS Health Disparities Manager) and Melen McBride
       (Stanford Geriatric Center) were the presenters. Over 120 providers, community
       members and staff attended.
      The East Palo Alto (EPA) outreach process (above) has also included
       representatives of the area’s long established AA community including local
       churches. On October 25th, more than 110 people gathered at the Senior Center
       in East Palo Alto for EPA Family Awareness Night to discuss mental health and
       wellness and to hear stories from consumers and family members who live with
       mental illness. Participants agreed that the stigma around mental illness remains
       a major obstacle in seeking help. Education and increasing awareness about
       mental illness and substance abuse is a critical step in addressing this barrier.
       The event was organized by the EPA Mental Health Advisory Group comprised
       of community and faith based organizations, EPA residents and other
       stakeholders. There was an African American Roundtable on November 15,
       2007, a two hour event facilitated by Dr. Cecil Reeves, a longtime EPA resident
       and activist. was tasked to answer 2 questions: (1) What do you perceive are the
       physical and mental health/Alcohol and Other Drug (AOD) needs of African
       Americans in San Mateo County? and (2) Is recruitment, retention, promotion of
       African Americans a problem in San Mateo County-- If so, begin to identify y
       strategies to address these concerns?
      Mental Health hosted a monthly lunch facilitated speaker/discussion series from
       January-June 2007 to support workforce development for Chinese staff from
       Mental Health, Health and other agencies serving the Chinese population to
       follow-up on recommendations from the MHSA outreach process. Topics
       included Face and Shame, Pathological Gambling and Other Addictions,
       Domestic Violence, The Role of Interpreters, and Inter-Generational Challenges.
      Mental Health and Pacific Islander representatives met in September to follow-up
       on recommendations out of a November 2005 summit. A Pacific Islander staff
       (Tongan) resource has initiated outreach and education with these highly under-
       served/high need communities. Outreach efforts will include Pacific Islander
       faith-based organizations, schools and youth focused groups as well as re-
       instituting a Pacific Islander radio show (previously discontinued due to loss of
       grant funding) that focuses on health—incorporating mental health in a
       framework that is less stigmatizing for Pacific Islander communities. We created
       a work plan for outreach and education that includes training and translation of
       materials. Public service announcements were created in Tongan and Samoan
       for the On October 25th EPA Family Awareness Night (see above).
      About 22 staff and interns from Behavioral Health, Public Health, Probation and
       Health Policy and Planning gathered for a potluck lunch at the Youth Services


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IMPLEMENTATION PROGRESS REPORT                                 JANUARY 1 - DECEMBER 31, 2007

       Campus on October 25, 2007 to talk about gay, lesbian, bisexual, transgender,
       queer and questioning (GLBTQQ)- related issues. This initiated a dialogue on
       supporting GLBTQQ clients as well as recognizing the presence of staff and
       interns who are employed within the County, and resulted in the creation of the
       PRIDE Initiative.

       Engagement of persons from all ethnic groups and cultures is always a
       challenge, although as evidenced above we continue to make great progress.


3. Number of Native American organizations or tribal communities that have been
   funded to provide services under the MHSA

   Although there are no San Mateo-based Native American organizations, Native
   Americans are served within San Mateo’s network of mental health services and
   were represented in San Mateo’s MHSA planning process (our various planning
   processes have counted on the participation of persons who identify as Native
   Americans).

   San Mateo is in the service area covered by Oakland and San Francisco based
   federal Native American Health organizations and San Mateo has participated in
   regional forums to learn more about the needs for this population in San Mateo
   County. San Mateo will continue to explore possibilities for future collaborations with
   these regional organizations.



4. Policy/system improvements specific to reducing disparities, such as
   inclusion of language/cultural competency criteria to procurement documents
   and/or contracts:

      San Mateo requests for proposals and contracts request contractors to provide
       language/cultural capacity appropriate for the target population of the program.

      The Health Department, including Mental Health, has established linguistic
       access as a priority following a needs assessment that identified areas of needed
       improvement. Mental Health has identified priorities for improving linguistic
       access in the next fiscal year and has planned for a training initiative to focus on
       improvements in this area.


C. Stakeholder Involvement

   San Mateo has continued the planning structure outlined in the CSS Plan to obtain
   input for activities related to the Mental Health Services Act. The Mental Health
   Board (MHB) is involved as is the 55-member MHSA Steering Committee created in
   2005. All MHB, MHSA Steering Committee and Work Group Meetings of all planning




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SAN MATEO COUNTY                                   MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS                      THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                                JANUARY 1 - DECEMBER 31, 2007



   process are open to the public, and advertised through numerous networks including
   provider agencies, consumer and advocacy organizations, internal meeting structure,
   flyers and word of mouth.
   The Mental Health Board and MHSA Steering Committee met October 16, 2006 to
   review progress in implementation and to adopt an approach to prevention/early
   intervention planning. The MHSA Work Groups met March 19-22 2007 to review
   progress in implementation and offer input to the draft Expansion Plan.
   Subsequently, on April 2, 2007, the MHB and MHSA Steering Committee met to
   review the draft Implementation Progress Report and Expansion Plan. In addition to
   these groups, the Implementation Progress Report and Expansion Plan was
   discussed at a Family Focus Group (4/14/07), Older Adult Lunch Club (4/24/07), and
   Consumer Speaks Forum (4/25/07). The Consumer Speaks event was developed
   and led by consumers and was attended by almost 80 consumers.

   Current planning emphasis has been on the Prevention and Early Intervention and
   Workforce Education and Training components of the MHSA. Since the additional
   resources for the CSS growth did not allow us to focus on new programs, we’ve
   concentrated our energy and efforts on the components mentioned at the beginning
   of this paragraph.

   Notes from the meetings are maintained on the County’s Network of Care website
   http://sanmateo.networkofcare.org.


D. Public Review and Hearing

   The Mental Health Board released the Implementation Progress Report and
   Expansion Plan for 30 days of public comment on May 7, 2008 ending June 9, 2008.
   The Implementation Progress Report is posted on the County website and the
   Network of Care. A notice has been published in the local newspaper.

   The Mental Health Board will hold a public hearing on June 4, 2008. Announcements
   about the public hearing will be posted in local newspapers, and flyers will be sent by
   mail and email to all our networks.

   All the public comment received during the public comment period including the
   public hearing will be contained in a ―Summary of Comments Provided During the
   Public Comment Period May 7, 2008 – June 9, 2008” and attached with the
   submission of the report to the State Department of Mental Health.




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SAN MATEO COUNTY                             MENTAL HEALTH SERVICES ACT
COMMUNITY SERVICES AND SUPPORTS               THREE-YEAR PROGRAM AND EXPENDITURE
IMPLEMENTATION PROGRESS REPORT                        JANUARY 1 - DECEMBER 31, 2007




        Kindly send any input or comments about this
             document via email or regular mail
                    until June 9, 2008 to:


                     Sandra Santana-Mora
                       MHSA Coordinator
            Behavioral Health and Recovery Services
                        225 37th Avenue
                     San Mateo, CA 94403
                         (650) 573-2889
              ssantana-mora@co.sanmateo.ca.us


      Regardless of the 30-day public comment period
          deadline, San Mateo County welcomes
                    your input anytime.



            Please, let us know what’s on your mind!




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