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Approve the Mental Health Services Act (MHSA) Reversion Expenditure Plan FY2018/19 through FY2019/20 for a total amount of $1,429,797 to fund enhancements to current mental health projects which aim to increase access to services for the unserved and underserved communities, and to improve consumer mental health outcomes
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board approve the Mental Health Services Act (MHSA) Reversion Expenditure Plan FY2018/19 through FY2019/20 for a total amount of $1,429,797 to fund enhancements to current mental health projects which aim to increase access to services for the unserved and underserved communities, and to improve consumer mental health outcomes.
SUMMARY:
With the passage of Assembly Bill 114 (AB 114), counties received notification that previously unspent MHSA funds that were subject to reversion to the State could be retained within the originally intended funding category upon timely development of a new plan for expenditure of the funds by June 30, 2020.
Department of Health Care Services (DHCS) notified Solano County that the following funds have been identified as unspent MHSA funds and are subject to reversion if not spent down by June 30, 2020:
- $370,701 Prevention and Early Intervention (PEI) funding category
- $547,223 Workforce and Education Training (WET) funding category
- $338,660 Capital Facilities and Technology Needs (CFTN) funding category
- $1,429,797 Innovation (INN) funding category
While PEI, WET, and CFTN funds are expected to be expended per the current initiatives outlined in the Board approved Solano County Mental Health Services Act Three-Year Integrated Program and Expenditure Plan for Fiscal Years 2017/18 through 2019/20. Therefore, those funds are not actually at risk of reversion and are not subject to the MHSA Reversion Plan.
The INN funds are the only funds at risk of reversion and require a Reversion Plan. INN funds are unique in that programs may not support existing programs or even programs existing in other counties that are not in place locally in Solano County. INN funds require the mental health system to implement innovative “demonstration projects” that will support system improvements, increase access to services for the unserved and unserved communities, and improve consumer outcomes.
The MHSA Steering Committee endorsed the use of INN reversion funds to support two initiatives that are also supported by community stakeholders:
• A Statewide Early Psychosis Learning Health Care Network, which has an anticipated annual cost of $90,000 per year, for a total of $180,000.
• Implementation of the “Mental Health Interdisciplinary Collaboration and Cultural Transformation Model (ICCTM)” activities associated with the implementation of quality improvement (QI) Action Plans, approximately $1,249,797, or the balance of funds based upon the actual costs of the program listed above.
FISCAL IMPACT:
The $1,429,797 in MHSA INN funds required for the Reversion Plan have already been received from the State and are unspent funds from previous years. The programs/projects that the reversion INN funds will augment are funded through the Solano County Mental Health Services Act Three-Year Integrated Program and Expenditure Plan for Fiscal Years 2017/18 through 2019/20. The Approved Budget for FY2018/19 includes $1.4M in appropriation for Innovation expenditures. Staff will assess at Midyear if appropriations need to be increased to implement these additional initiatives. There is no impact to County General Fund.
DISCUSSION:
Currently 23 counties have established Early Psychosis (EP) services using State or federal dollars. EP programs serve mental health consumers who have experienced their first episode of psychosis within 24 months of referral. Solano County currently funds an EP program under the current MHSA three-year plan. H&SS, in collaboration with UC Davis Behavioral Health Center of Excellence, is seeking approval to use INN reversion funds to develop the infrastructure for a sustainable statewide Early Psychosis Learning Health Care Network. The proposed project seeks to demonstrate the utility of the 23 county network via a collaborative statewide evaluation to evaluate agreed upon outcomes measures. The project will be led by UC Davis in partnership with UC San Francisco, UC San Diego, University of Calgary and multiple California counties, and will give clinicians easy access to client level data for the purposes of real-time data sharing with clients; allow programs to learn from each other through a training and technical assistance collaborative; and position the State to participate in the development of a national network to inform and improve care for individuals with early psychosis across the United States.
The primary purpose of proposed project is to increase the quality of mental health services, including measurable outcomes, for consumers with a diagnosis of psychosis and/or consumers with high risk of psychosis. Consumers will utilize technology, such as tablets, to complete questionnaires measuring their symptomatology and progress throughout the course treatment. With the support of this innovative learning health care network, the EP program and its associated counties will have access to patient-level and service-level clinical data available to providers and their clients in real-time that can be used as part of consultation.
The second proposed INN project involves implementation of the County’s Mental Health Interdisciplinary Collaboration and Cultural Transformation Model (ICCTM). The County has partnered with the University of California, Davis - Center for Reducing Health Disparities (CRHD) to implement the ICCTM project which aims to increase culturally competent and linguistically appropriate services for Solano County-specific unserved and underserved populations with low mental health services utilization rates: the Latino, Filipino, and LGBTQ communities. The 5-year project, which was initiated in January of 2016, included the creation of a region-specific curriculum based on the national Culturally and Linguistically Appropriate Services (CLAS) standards and the local community’s perspective on culturally competent practices that should be integrated into the current local mental health system to increase access to the targeted populations.
The ICCTM is a 3-phase project: Phase 1 involved a comprehensive cultural health assessment of the local community including the collection of qualitative data captured through key informant interviews, focus groups, community forums, organizational surveys and quantitative service data pulled from the County electronic health record (EHR); Phase 2 which is currently underway, focuses on facilitating three CLAS training cohorts specific to the mental health needs of Solano County. Each CLAS cohort is comprised of up to 30 stakeholders who are tasked with developing quality improvement (QI) action plans geared to address barriers in the system of care including stigma resulting in poor access to services, need for more bilingual and diverse staff, poor retention rates, and other factors. Phase 3 will involve the coordination and implementation of the QI action plans, all potentially in different phases of implementation, and coaching from the UCD CRHD staff. Additionally, over the course of the project the UCD team will engage in evaluation aimed to measure the impact of the project and quadruple aim of increased consumer satisfaction, improved health outcomes, increased provider satisfaction, and reduced per-capita costs.
The proposed INN reversion fund project will be used to support the implementation of the QI action plans which may include: developing outreach materials and signage to combat stigma, stigma reduction public service announcements or campaigns, translating mental health materials into Tagalog, the sub-threshold language in Solano County; creating mental health career pipeline projects with local high schools and community colleges; providing internship stipends for trainees/interns who represent the 3 target communities; purchasing equipment needed for surveying the community; redesigning both county and contractor clinic lobbies to promote welcoming environments; trainings and education for providers; enhancements to the Netsmart EHR by that would support the overall project including data dashboards to track progress and outcomes of the QI action plans. As QI action plans are implemented and initial results reviewed, the CLAS cohorts leading the QI action plans will adjust strategies according to findings in order to achieve intended goals. The intention is to allow for the flexibility of funding so that the QI action plans can be implemented successfully in support of improved service delivery and reducing health disparities.
ALTERNATIVES:
The Board may choose not to approve the MHSA Reversion Expenditure Plan for FY2018/2019 through FY/2019-2020. This is not recommended as these funds will help improve service delivery and will otherwise revert to the State.
OTHER AGENCY INVOLEMENT:
The Solano County Behavioral Health MHSA Reversion Expenditure Plan FY2018/2019 through FY2019/2020 was developed through a countywide stakeholder process which gathered input from a variety of stakeholders through community meetings, a 30-day public comment period, and a public hearing at the local Mental Health Advisory Board.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION