marin behavioral health and recovery ... and human services 20 north san pedro road, ste 2028 san...
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Health and Human Services
20 North San Pedro Road, Ste 2028
San Rafael, CA 94903
415 473 3696 T / 415 473 3344 F
marinhhs.org
October 25, 2016
MARIN BEHAVIORAL HEALTH AND RECOVERY SERVICES – Department Update
P R E S E N T E D B Y :
S U Z A N N E T A V A N O , P H D
B E H A V I O R A L H E A L T H A N D R E C O V E R Y S E R V I C E S D I R E C T O R
M A R I N C O U N T Y H E A L T H A N D H U M A N S E R V I C E S
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 2
Update on Key Services and Initiatives
• Homeless Outreach Team Pilot
• Community Crisis Response Teams
• Crisis Stabilization Unit
• Drug Medi-Cal Waiver Implementation
• Road to Recovery
• Chronic Inebriate Project
• Access Team
• AB1421 Update
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 3
Homeless Outreach Team (HOT) Pilot
I N I T I A T E D F E B R U A R Y , 2 0 1 6
• Focused on homeless individuals in downtown San Rafael
• Based on evidence-based practices of:
o individualizing solutions to homelessness
o Providing wrap-around services
• Outcomes:
• 13 clients engaged
o Those clients were “housed” 64% of the time in a variety of settings
Two are permanently housed,
Six in temporary residential services
• Decreased police contacts and medical transports for the highest utilizer of each of these services
• Initiating use of structured screening tool to prioritize outreach efforts
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 4
BHRS Consumer Voices
C O N S U M E R S A T I S F A C T I O N S U R V E Y : M A Y 2 0 1 6
“No available housing in Marin Co. Very difficult for my social worker and myself.”
“I wish I can find housing sooner. A low income housing. I wish I can afford this housing. Thank you very much.”
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 5
Residential Services Update
• Adult Transitional Housing:
o Contracting with Progress Foundation for a 10-12 bed therapeutic transitional housing for adults: length of stay up to one year
• California Housing Finance Agency (CalHFA):
o BHRS submitted forms to the State requesting return of housing funds; working to identify a project for permanent housing
• No Place Like Home:
o Work groups are forming
o Supervisor Connolly sits on the Technical work group
o California Behavioral Health Directors' Association (CBHDA) will have one seat on the Advisory group
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 6
Transition Team Mobile Crisis
Response Team
Outreach &
Engagement Team
Short-term (60 day) case management to stabilize and connect individuals
with ongoing services
Responds to mental health/substance use
crises in the community seven days/week
Supportive outreach to individuals not engaged in services and to their
families/friends
Community Crisis Response Teams
R E S P O N D I N G T O T H E C O M M U N I T Y
MCR O&E T
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 7
Community Crisis Response Teams
• O & E: Launched February, 2015: served 158 clients with 599 encounters
• Transitions: Since March, 2015: served 312 clients with 2,171 encounters
• MCR: Since July, 2015: served 543 clients with 1,186 encounters
• 82% of the contacts initiated by community members or community entities
• Since the June BOS update, the teams have served 259 new individuals with 937 encounters
MCR O&E T 1,013
Individuals Served
3,596
Services Provided
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 8
Crisis Stabilization Unit Admissions
I N C R E A S I N G A D M I S S I O N S
335 315
295 309 310
334 314
297
335
404
374
0
50
100
150
200
250
300
350
400
450
Q1 Q2 Q3 Q4
2014
2015
2016
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 9
Crisis Stabilization Unit
R E V I E W O F 3 7 6 A D M I S S I O N S : A P R I L – J U N E 2 0 1 6
32%
37%
22%
6% 1% 2%
Marijuana
Benzodiazapines
Amphetamines
Opiates
Barbituates
Cocaine
77% Consented to
drug/alcohol screening 53% Tested positive for alcohol or drugs Most frequent drugs: 32% marijuana 37% benzodiazepines 22% amphetamines
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 10
Psychiatric Hospitalization
C R I T I C A L S T A T E W I D E S H O R T F A L L O F P S Y C H I A T R I C B E D S
o Demand for inpatient beds projected to increase 17% over FY14/15
o Use of out-of-county hospitals has increased 60% in the past two years
42
81
65 65 64 63
90
68
78
67
84
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4
2014
2015
2016
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 11
Drug/Medi-Cal Organized Delivery System (DMC-ODS) Waiver
• The DMC-ODS improves access to and quality of care for Marin Medi-Cal beneficiaries by:
o Enhancing Continuum of Services
o Expanding access to—and federal Medicaid reimbursement for—substance use services not currently covered by the Drug/Medi-Cal program.
o Promoting integration and coordination of care with mental and physical health providers
o Expanding eligible service providers to include Licensed Practitioners of the Healing Arts (e.g. Licensed Clinical Social Workers, Licensed Marriage and Family Therapists)
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 12
DMC-ODS Waiver: Key Elements
• Coordination with Managed Care to Ensure Integrated Care
o Memoranda of Understanding (MOUs) among Medi-Cal managed care plans
• Access and Authorization
o 24/7 Toll free Access number and authorization for residential services
• Services Utilize Evidence Based Practices (EBPs)
o Implement at least two of the identified EBPs and monitor fidelity
• County Oversight, Monitoring and Reporting
o Provide quality improvement , utilization management and outcomes reporting
• Selective Provider Contracting
o Procedures for selecting and retaining providers
o Ensure availability and accessibility of required services
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 13
Drug/Medi-Cal Organized Delivery System (DMC-ODS) Waiver
o Enhanced Continuum of Services includes:
Outpatient Treatment (General and Intensive)
Case Management
Medication Assisted Treatment
Recovery Services
Withdrawal management (at least one level)
Residential Treatment (any size)
Physician Consultation
• In September, 2016 BHRS hired a board-certified psychiatrist specializing in Addiction Services to guide development of the new treatment delivery system.
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 14
State Plan DMC (Current) vs DMC-ODS Waiver
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 15
Preparation for the DMC-ODS – Expansion and Integration
• In CY 2015 and CY 2016, eight agencies submitted applications to the State to provide D/MC services as part of the DMC-ODS Waiver
New Programs Launching in FY 2016-17 Status
Intervention Services for Older Adults Implemented in September 2016
Additional Medication Assisted Treatment Hired Addiction Psychiatrist in October 2016
Outpatient Treatment for Adults with Co-Occurring Substance Use Disorders and Serious Mental Illness
Opening November 2017
Adolescent Partial Hospitalization and Residential Substance Use Treatment Services
Opening pending State licensure/certification
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 16
BHRS Road to Recovery
• Drug/Medi-Cal certified county-operated outpatient clinic to provide services for individuals with co-occurring Serious Mental Illness and substance use disorders: Planned Opening: November 7, 2016
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 17
Chronic Inebriate Project
• Consultant-facilitated public policy/problem-solving process
o Goals:
Bring together key stakeholders
Design a system focused on helping those with a pattern of chronic alcohol use and repeated criminal justice system contacts
Implement a system featuring:
Alternative sentencing
Harm reduction-based treatment models
Medication Assisted Treatment (Vivitrol)
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 18
BHRS Access Team
• Relocated to 250 Bon Air to increase collaboration with the Crisis Stabilization Unit and Community Crisis Response Teams to promote voluntary service entry
• Initiating Walk-In Access Pilot:
o Walk In assessments start November 1, 2016 on:
Wednesdays 9:00 am to 2:00 pm
Fridays 9:00 am to 12:00 pm
Monthly:
750-1,000 Calls
150
Screenings
60 Assessments
(capacity)
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 19
If you or a loved one is in need… Help is Available 24/7 O U R 3 C R I S I S T E A M S H A V E R E S P O N D E D T O C A L L S F R O M 2 5 0 + F A M I L Y A N D F R I E N D S
Marin Behavioral Health and Recovery Services Access Line
(888) 818-1115
Psychiatric Emergency Services
(415) 473-6666
Mobile Crisis Response Team (1 pm - 9 pm/7 days a week)
(415) 473-6392
www.marinhhs.org/mhsus
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 20
BHRS Consumer Voices
C O N S U M E R P E R C E P T I O N S U R V E Y , M A Y 2 0 1 6
“Odyssey is a good company … caring. Thank you.”
“The STAR Program in Marin should be adopted everywhere in the State. The “one-stop” service hotel and peer groups are really good.”
“Thank you for All the Help. Marin County agencies Rock!”
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 21
AB1421 Update
• Monitor outcomes of implementations around the State
• Monitor emerging evidence in the scientific literature
• Continue to expand evidence-based programs
• Provide full update in February, 2017 as requested by the Board
Health and Human Services
Marin Behavioral Health and Recovery
Services
October 25, 2016
marinhhs.org
Slide 22
Recommendations
• Provide responsive, high quality care to our most vulnerable consumers:
o Ensure access to timely hospital care
o Provide access to permanent housing
o Increase hours of operation of Community Crisis Response Teams
o Expand capacity of Full Service Partnerships
Health and Human Services
20 North San Pedro Road, Ste 2028
San Rafael, CA 94903
415 473 3696 T / 415 473 3344 F
marinhhs.org
Thank You