1. health and fitness

ADMHS Director’s Report
Prepared for the Mental Health Commission, February 20, 2015 BUDGET UPDATE Project Summary: Strategies for Improvement: Challenges: Dr. Gleghorn appeared before the Board of Supervisors on February 17th to provide a budget update. The ADMHS deficit is projected to be $4.6 million by the end of fiscal year 2014‐15. The large number of individuals found to be incompetent to stand trial (IST) court‐ordered to the Psychiatric Health Facility (PHF) is a major factor contributing to the deficit. When beds are not available at the PHF, many clients are placed in out‐of‐county facilities such as Vista del Mar in Ventura. Additional factors contributing to the deficit are increased costs of placements in Institutions for Mental Disease (IMDs) and a flat level of documentation of services. The Board of Supervisors will consider the final ADMHS FY 2015‐16 budget in March.  ADMHS is actively engaging with a number of agencies to find alternatives to PHF placements for IST designees when appropriate.  The ADMHS forensic team is being expanded to offer outpatient restoration for suitable individuals found to be incompetent to stand trial.  Several new crisis services – residential respite, triage teams and Crisis Stabilization Units – will provide preventive services that will help some individuals prior to the stage at which hospitalization is required. A great deal of inter‐agency collaboration and program implementation will be necessary to reduce out‐of‐county hospital placements. ALLOCATION FOR SANTA MARIA CRISIS STABILIZATION UNIT (CSU) Project Summary: Funding from Senate Bill 82 is allowing ADMHS to expand crisis response services. Included for funding is a Crisis Stabilization Unit (CSU) to be based in Santa Barbara. Thanks to unanticipated savings from the SB 82 allocation, the Department is able to plan for a second Crisis Stabilization Treatment Program in Santa Maria. Like its Santa Barbara counterpart, the Santa Maria facility will be designed to provide a safe, nurturing, short‐term emergency treatment alternative to hospitalization for individuals experiencing a mental 1 | P a g e Achievements: health emergency for stays up to 23 hours.  On January 29, 2015, the California Health Facilities Financing Authority approved establishing a Santa Maria CSU. Identifying a site and recruiting and training staff will be the next steps toward full implementation. Challenges: SUBMISSION OF MHSA PLAN UPDATE TO BOARD OF SUPERVISORS Project Summary: On March 10 in Santa Maria, the Board of Supervisors will consider approving the Mental Health Services Act Plan Update for Fiscal Year 13/14 and the 14/15. The plan provides an update of funded programs and services, as required by the California Department of Health Care Services. The Fiscal Year 13/14 Update contains no significant changes. The Three Year Plan Update for Fiscal Year 14/15 contains significant changes that establish the foundation upon which system change can occur for the department. Approval of the recommended action is a State requirement per Assembly Bill 1467 and will ensure ADMHS continues to receive Mental Health Services Act funding in a timely manner. An exceptionally lengthy stakeholder process was completed. Achievements: The Plan was modified to incorporate stakeholder feedback. The Mental Health Commission approved the FY 14‐15 MHSA Plan Update on January 16. ADMHS will work to improve the stakeholder process to increase the Challenges: engagement of the Mental Health Commission and community‐based providers in the creation of future MHSA Plan Updates. 
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STAFF SAFETY TRAINING Project Summary: Achievements: The ADMHS Safety Committee has recognized a need for ADMHS staff to be trained in key safety topics including crisis prevention, de‐
escalation, disaster response, etc.  Mark Lawler, LPT, Team Supervisor with the Psychiatric Health Facility, is developing the outline for a “blended” safety curriculum that incorporates highlights from Crisis Prevention and Intervention, Mental Health First Aid and Safety at the Front Desk.  In January, ADMHS Safety Officer Tina Wooton and eight other ADMHS staff persons attended a one‐day Safety at the Front Desk Training in Anaheim to evaluate its potential for ADMHS. Topics included: Violence and Safety in the Workplace; No‐Nonsense 2 | P a g e Challenges: Management of the Front Desk and Lobby Area; Critical Communication Skills; When Worst Case Scenarios Become Real; and Security Measures to Increase Workplace Safety.  Yaneris Muñiz is facilitating a workgroup that is revising a policy addressing the management of disruptive/threatening client behaviors. The policy will address emergency response procedures, the application of universal codes, documentation of incidents, etc. The workgroup will have first draft ready by early March. We need to develop a safety training budget that addresses longstanding unmet training needs in the department and complete work on an integrated staff safety training by May 2015. SAMHSA MENTAL HEALTH BLOCK GRANT FIRST‐EPISODE PSYCHOSIS FUNDING The primary age of onset of psychosis falls within the transition‐age youth group, 16‐25. Community outreach and education is a critical component in the effort to improve the lives of transition‐age youth facing mental illness. A solid body of evidence supports the importance of the early detection of psychosis. Of equal importance is the reduction in the duration of untreated psychosis, which can substantially ameliorate distress and disability. ADMHS countywide Prevention and Early Intervention (PEI) programs for TAY are primarily funded by the Mental Health Services Act (MHSA). However, they are eligible for additional funding through the Substance Abuse and Mental Health Services Administration, which currently funds other ADMHS programs for children and adults. ADMHS applied for additional SAMHSA funding to support the TAY component. Achievements: Our proposed use of SAMHSA TAY‐FEP funding was awarded through the end of FY 2015 and will provide the following: training for county‐operated PEI TAY lead clinicians on cognitive behavioral therapy for psychosis; community outreach and education campaign for first‐episode psychosis; training for colleges (UCSB, SBCC and Allan Hancock) on the Transition to Independence model, unique to first‐episode psychosis; and the development of peer teams on each campus. Project Summary: Challenges: 
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Combating community stigma toward mental illness. Educating college students about FEP and supporting and motivating them to continue campus outreach and education. Providing adequate resources for referrals stemming from this outreach and education initiative. 3 | P a g e GRANT SUBMITTED TO FUND TRAININGS FOR STAFF WITH LIVED EXPERIENCES
On January 13 ADMHS submitted a funding proposal to the California Office of Statewide Health Planning and Development (OSHPD). $150,000 was requested for a one‐year project. Funds would be used to provide trainings to consumers, family members and caregivers working in the Santa Barbara County behavioral health system. The grant would also provide trainings and stipends for individuals with lived experiences to facilitate support groups in under‐served communities. Achievements:  Jennifer Langenheim, ADMHS Systems Training Coordinator, and Alka Sudduth, a member of the Peer Expert Pool, conducted a telephone survey about training needs. Thirty‐two consumers, family advocates/parent partners and caregivers responded.  Obtained 16 participation letters from community‐based organizations in Santa Barbara County. Challenges: If the grant is awarded, we will 1) develop and present four or five core trainings; 2) provide customized training support to participating individuals and 3) implement the support group outreach component. Project Summary: FUNDING
UPDATING ADMHS POLICY & PROCEDURE 73, “ WHO WE SERVE” Yaneris Muñiz, ADMHS Behavioral Health Policy Coordinator, Project Summary: conducted research to understand the issues associated with the policy and gave a presentation to the Leadership Team in January 2015. Preliminary discussions called for its repeal, but the February 2015 Compliance Committee made the decision not to formally withdraw the policy until a new document was in place. Dr. Gleghorn suggested that a “system identity” policy be created. This policy would replace P&P 73 and broaden the focus even further by explaining the Department’s position (who we are), what services we provide and to whom we provide services, with an emphasis on whom we serve (everyone) vs. whom we treat (those who are clinically indicated). In addition, the policy will also address other components (ways of welcoming, co‐occurring competence, etc). The policy will be based on a consensus agreement generated by the Steering Committee/Office of Strategy Management (OSM). Challenges: Implementing a collaboration among the Systems Change Steering Committee, the Mental Health Commission, the Drug and Alcohol Advisory Board, the Latino Advisory Committee, the Consumer and Family Member Advisory Committee, change agents and other stakeholders to ensure the creation of a comprehensive system identity policy. 4 | P a g e ADMHS Saanta Barbara C
County of Alccohol, Drug and Menttal Health Serrvices www.coun
ntyofsb.org/aadmhs (805) 681‐5220 Alice Glegh
horn, Ph.D., D
Director 5 | P
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