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Approve a 4 year contract with the Regents of the University of California, University of California, Davis for $122,812 to provide infrastructure development for a statewide early psychosis learning health care network beginning January 1, 2019 through December 31, 2023; and Authorize the County Administrator to execute the contract and any subsequent amendments that remain within budgeted appropriations
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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 a 4 year contract with the Regents of the University of California, University of California, Davis for $122,812 to provide infrastructure development for a statewide early psychosis (EP) learning health care network (LHCN) beginning January 1, 2019 through December 31, 2023; and authorize the County Administrator to execute the contract and any subsequent amendments that remain within budgeted appropriations.
SUMMARY:
Solano County, along with several other California counties, serves as a partner agency for the sustainable LHCN for EP treatment programs. EP programs serve mental health consumers who have experienced their first episode of psychosis within 24 months of referral. This project is intended to support quality improvements, consumer engagement and provider use of measurement-based care in EP programs. Part of the infrastructure provided by University of California, Davis includes the development of self-reporting assessment tools and the associated app; the equipment needed to implement the LHCN; ongoing program and statewide evaluation to improve the efficacy of EP programs; and support to implement measurement-based care in EP treatment programs to improve consumer mental health outcomes.
FISCAL IMPACT:
Funding for the EP LHCN Innovation project has been approved by the Mental Health Services Act (MHSA) Steering Committee, stakeholders, and the Board of Supervisors as part of the MHSA Reversion Plan approved on October 23, 2018. MHSA funding under the Innovations component, provides the funding for this agreement. The MHSA Innovation funds required for the Reversion Plan have already been received from the State and are unspent funds from previous years. Non-reversion Innovation funds will be used to fund the project from July 1, 2020 through December 31, 2023. There is no impact to County General Fund. Appropriation is available in the Department’s FY2018/19 Adopted Budget.
DISCUSSION:
MHSA programs address a broad continuum of prevention, early intervention and direct services along with the necessary infrastructure, technology and training elements to effectively support the mental health system. With the passage of Assembly Bill (AB) 114, counties received notification that previously unspent MHSA funds that were subject to reversion 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. The Innovation funds, as part of the MHSA technology component, were at risk of reversion locally in Solano County. Innovation funds are unique in that funds may not be used to support existing programs or even program models existing in other counties that are not in place locally in Solano County. Innovation 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. Furthermore, Innovation projects must be approved by the Mental Health Services Oversight and Accountability Commission (MHSOAC) Innovation Committee before projects can commence locally.
An Influx of state dollars has led to rapid development of EP programs across California. As of 2017 there were 30 EP programs in 24 counties, with more starting each year. The primary purpose of EP LHCN 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. The EP LHCN project, which includes a collaboration between five counties (early adopters), UC Davis Behavioral Health Center of Excellence, UC San Francisco, and UC San Diego, was approved by the MHSOAC Innovation Committee on December 17, 2018. Finalization of the proposed agreement was delayed due to the state’s approval timing and coordination efforts between the five counties, however the project work began in January 2019. Solano County currently administers an EP program under the current MHSA Three-Year Integrated Plan, which is delivered by a local community-based agency in partnership with a training and consultation team from UC Davis Behavioral Health Center of Excellence. Per data provided by External Quality Review Organization during an annual site review, Solano County showed a higher proportion of individuals with psychotic disorders in the population served compared to the state. Therefore, leveraging the training and consultation from the EP LHCN will assist Solano County in address the needs of mental health consumers with diagnoses of psychosis. Consumers will utilize technology, such as tablets, to complete questionnaires and monitor progress throughout the course treatment.
With the support of this innovative LHCN, 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 treatment planning. UC Davis, UCSF, and UCSD will provide evaluation of EP program efficacy for participating programs and counties. With the rapid development of EP programs across the State there have been challenges including: no uniformity in implementation of EP services or models being used; no standard measurement of outcomes using valid and appropriate measures for EP populations, and no method for implementing measurement-based care in community practice. Additionally, California EP programs are currently isolated from each other and struggle to find training and support for the staff providing services, often resulting in high staff turnover, as well as difficulty finding appropriate resources for the consumers and families being served. This project will allow EP programs to learn from each other through a training and technical assistance collaborative and will 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
ALTERNATIVES:
The Board may choose not to approve this contract with the University of California, Davis for implement EP LHCN. This is not recommended as this project will improve service delivery for mental health consumers who, without early intervention, are at risk of involvement with the criminal justice system, hospitalization, homelessness and suicide. Furthermore, this project will position Solano County to be better equipped to respond to State and federal grants that require measurement-based care, data sharing, and regional collaborations.
OTHER AGENCY INVOLEMENT:
Community stakeholders, the MHSA Steering Committee and the MHSOAC Innovations Committee have approved the use of MHSA Innovation funds to support the implementation of the EP LHCN which includes the following counties: Los Angeles, San Diego, Solano and Orange as early adopters. Napa County is expected to join the EP LHCN once it has completed its local MHSA stakeholder process. Additionally, a local community-based organization is currently providing the direct services in the local EP program and they will be participate in the EP LHCN.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION